I started working in the catheterisation laboratory (cath lab) at Buckinghamshire Healthcare NHS Trust 17 years ago. When I joined this team, it was my first experience of cardiology. I enjoyed working in the cath lab from my first day. What I found most exciting was that everything seemed quite straightforward, but changes could happen in an instant and the patient's condition deteriorate within a very short time span. This required the cath lab staff to be focused and alert to any possibility. When necessary, as a nurse in the cath lab, you have to think and act quickly to support your team and your patients. Our patients were mostly elective, and the nature of the procedure involves investigating the coronary arteries.
The outcomes for patients attending are largely positive and the work that is performed in the cath lab is life saving and performed non-invasively.
I loved being the scrub nurse and handling the equipment. After a few years I could predict what equipment was required for the cases and I could support the consultants. I began to gain an understanding of all the techniques. One of the biggest advantages of being a scrub nurse is that you have the experience of working with many different consultants and you can learn tips and tricks from watching each of them.
I worked as a scrub nurse in the cath lab for a few years and then I became the cath lab manager. I then undertook an MSc in Advanced Nursing Practice. After completing my MSc I wanted to continue working in the cath lab as an advanced practitioner. I knew there are many advanced practice roles for nurses in health care and I saw an opportunity in the cath lab to develop this role.
I thought it would be advantageous to the lab to train a nurse to perform angiograms. This was because there was often a delay waiting for a consultant to start the procedure. They have several other tasks to perform, such as completing the previous patient's report, seeing unwell patients in the ward, advising junior doctors about patients and many other tasks while they are working in the cath lab. This results in patients' procedures having to be cancelled or patients being kept waiting for long periods of time for their procedures. This affects the patient experience negatively and reduces cath lab productivity.
‘My idea was to train to perform angiograms. This would help the cath lab's efficiency, reduce waiting times, increase capacity, and improve nurse development and retention and patient satisfaction’
My idea was to train to perform angiograms. This would help the cath lab's efficiency, reduce waiting times, increase capacity, and improve nurse development and retention and patient satisfaction. I had previously heard of nurses performing angiograms; however, there was no available governance information or clear pathways to support training and establish this nursing role in my Trust.
I asked our lead consultant if he would be willing to train me to perform angiograms for all the reasons mentioned. He agreed to support my training. I then asked all the consultants in the department if they were willing to support my training in performing angiograms and they all agreed. After obtaining their approval, I went to the service delivery meeting and presented my idea and gained approval there.
I created a job description, personal specification, training programme, audit tool, competencies document and patient satisfaction tool and I then presented my case to the nursing and midwifery board in the organisation, and this was again given approval. Finally, I went to the new clinical procedure committee in the organisation, and they gave me permission to begin my training and audit, which involved performing 250 cases. I was told that, depending on the training and successful audit of the 250 cases, I would need to return for a final decision.
It took over 1 year to complete the training and audit of 250 cases. For every angiogram I performed I was assessed on arterial access site success, obtaining right and left coronaries success, observing haemodynamics, arterial closure, contrast given and radiation exposure. I also retrospectively searched all the patients to ensure there were no post-procedure vascular or cerebral complications. There were none. The audit result showed a positive progressive trajectory for training and success of the overall training. The medical director and the new clinical procedure committee alongside the chief nurse then approved the role and I began practising in 2014.
I did all my training cases with a consultant cardiologist by my side. After the first 250 cases, the consultant observed me from the viewing room for approximately another 100 cases. After this, as long as there was a consultant cardiologist on site, I could perform the angiograms alone.
I continued to practise for a year and my lead cardiologist submitted my work to the European Society of Cardiology Conference, which was held in Rome in 2016. From thousands of applications, I was one of four selected for the Nurse and Allied Health Professionals Recognition Award. I went to the conference and presented my work. While I was in Rome, there was a great deal of interest on Twitter and the role gained a lot of recognition. People from all over the world began contacting me to find out how I had set up this practice. I realised there was a lot of interest from nurses who wanted to set up this role within their own organisations. I was contacted by people almost every week.
As I had done all the governance work and set up the role successfully within my organisation, I was very willing to share my work. In 2018 our chief nurse nominated me for the Windrush Awards on the NHS's 70th anniversary. I won the Rising Star and Innovation Award at the Awards event. It was so rewarding to be recognised for my work and the opportunities I had been given. Following this, I wrote an article that was accepted by the British Journal of Cardiology. This was also something I was thrilled about. This published article would also be readily available for nurses to support setting up the role within their organisations.
I set up an annual study day as I felt there was a need to share my work and I could present to 40 people at a time. I started the Advanced Cath Lab Skills study day in my Trust with the support of Medtronic in 2018. Due to COVID-19 restrictions, I did not run the course for a few years but the course recommenced in October 2022. The course is always fully booked and fully attended with outstanding feedback. The presentations on the day are also supported by the cardiology consultants within the department.
Following the set up of this course, I began teaching at our local university on the Coronary Care course, which was a great way to teach nurses beginning their careers in cardiology.
Recently, one of our cardiology consultants went on sabbatical and I was asked to cover his angiogram list while he was away. At this time the benefits of my training and skills became even more evident as I was able to continue the service and perform the procedures so that patients' procedures didn't need to be cancelled and continuity was ensured.
I was also pleased to achieve a Gold Award in the Cardiovascular Nurse of the Year category of the BJN Awards 2023.
I feel very honoured to have been provided the opportunities to develop my skills and experience and I am grateful to the cardiologists who believed in me and supported me to achieve this.