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A Day in the Life of a Cardiothoracic Nurse Manager Her desk is a chocoholic's dream. Heather Veltre, R.N., keeps a glass plate next to her calendar that is filled with a miniature Hershey bars and Reese's Pieces. It is a favorite stop for many nurses and physicians on the Cardiothoracic Stepdown Unit at Saint Barnabas Medical Center. Gary Rogal, M.D., Chief of Cardiology Services for the Saint Barnabas Health Care System, sees Ms. Veltre in the hall and admits to taking a few treats in her absence. "That's why they are there," she says with a smile. The candy is a fitting centerpiece on the desk of an individual whose sweet personality is enjoyed by patients and staff alike. That personality, combined with energy, enthusiasm and experience, assists her in a role that is demanding and ever changing. As nurse manager of the 24-bed Cardiothoracic Stepdown Unit, Ms. Veltre oversees the care of patients in one of the most sophisticated and specialized areas in the Medical Center. It is quite literally a huge responsibility. A Full Census
In addition to functioning as an inpatient area, the Unit has added a new Same Day Cardiothoracic area where patients are prepped for catheterization and where they recover after the procedure before returning home. Previously, patients went to a Same Day Unit that monitored anyone who had undergone a general outpatient surgical procedure. "The staff in our Same Day area consists of cardiac-trained nurses, so physicians and heart patients have a certain comfort level," says Ms. Veltre. While the typical open-heart patient on the unit is in his or her 70s, those recovering from angioplasty are frequently a decade or two younger. It is this age group that Ms. Veltre sometimes finds to be resistant to rest and recovery. "We have people who come in and open their laptops after the procedure," she relates. "Or they tell me that they have to leave for a meeting. Often they don't eat right and have stressful jobs. I try to relate to them that heart problems are not just a nuisance. You need time to recover." In the morning, she reviews the status of all the patients with herstaff. In a conversation with one nurse, the two agree that a particular patient needs extra motivation to get him up and moving. Another nurse relates that even though a finger test of a patient showed the oxygen levels to be low, the nurse felt the reading was "off" since the patient seemed fine otherwise. Ms. Veltre praises the nurse for taking the situation a step further and confirming that the reading was not a true value. Sometimes, if an otherwise healthy individual has poor circulation in the extremities, oxygen levels appear low. "Always look at the big picture and use your instincts," she says. "Technology is wonderful but it is only as good as the person using it. Trust your inner voice." Ms. Veltre finds that the best way to monitor a patient is through a combination of instrumentation and assessment. Each day she personally visits at least half the patients on her Unit, meeting the other half the following day. These meetings provide tactile information. The half eaten breakfast on the tray might indicate a patient who does not feel well, but who is afraid to say something that might jeopardize a return home. Making the Rounds
The patient says that the sound of a medicine door slamming outside "When you are sick, everything is magnified and your senses are on overload," she relates. "Comfort issues are important." The spacious Unit was designed with this is mind. Dedicated in 2000, the state-of-the-art HEART HOSPITAL of New Jersey features a comfortable, hotel-like setting, dark mahogany wood and Tuscany scenes on the walls. Patient rooms are large and medical equipment is hidden behind pull-close mahogany panels that can be quickly opened. Each patient receives a large blue, heart-shaped pillow in addition to the standard hospital issues. The next patient, also an elderly female, has come all the way from Toms River, N.J. for heart bypass surgery. She feels comfortable with Ms. Veltre and they discuss everything from her broken hip, which has since healed, to gardening. Throughout the day, patients share many things with Ms. Veltre, from fears about surgery to memories of a child that died. She fusses over them, fixing a gown, lowering a food tray, ordering a special menuof soft food for a patient with problems chewing. "I truly like that part of the job," she says. "People are smart, and they know when you care and when you do not. I always try to listen and make them feel they are important." On each patient's wall is a bulletin board with a personal plan of care. It might mention the importance of activities such as walking, breathing exercises or taking pain control medication. The board has the date and the name of the attending nurse, which helps patients who might feel confused after surgery. "We treat our patients as we would our own family members," says Ms. Veltre. "I always ask myself what kind of care I would want my mother to receive." A Nursing Career Nine years ago, Ms. Veltre began working in the Telemetry Unit at Saint Barnabas. When The HEART HOSPTIAL opened at Saint Barnabas two years ago, she transferred to the brand new Unit with great expectations. After eight months, she was promoted to nurse manager. In the early months of the Unit's opening, a patient came to the Stepdown Unit after undergoing a 10-vessel bypass surgery. As she spoke with him, Ms. Veltre became concerned that he "did not seem right," though all of his assessments seemed normal. As she prepared to do a check of his blood/gas level, he went into cardiac arrest. "I was on his bed doing chest compressions as they wheeled us straight into the operating room," she recalls. "I think back to that day and know that I was hooked from that moment on. I knew this Unit was the place for me. Each day here takes on a life of its own." She follows in the footsteps of her grandmother and mother who both were nurses. Her sister, Tana Menafro, is also a nurse at Saint Barnabas who works on a general surgical unit. In her role as nurse manager, Ms. Veltre has the added dimension of administrative responsibility in addition to patient care. "I try to be the kind of manager that I wanted to have as a nurse," she says. "It helps that I have excellent nurses here. These nurses are very skilled and very marketable, and it is important for them to be happy at their jobs because we do not want to lose them. We truly work as a team with everything from scheduling conflicts to flexible Heart to Heart The day is a whirlwind. From patient visits, to evaluations given for staff members, to arranging for a new nurse to observe the Catheterization Laboratory, Ms. Veltre has a scant 20 minutes for lunch. She constantly reviews the caseload of patients leaving and arriving, assuring that beds are available. Nursing coverage is also an important concern and schedules are repeatedly reviewed. During the day she works with many physicians on the Unit to maintain a continuum of patient care and finds these interactions to be very positive. She mentions one physician who provides lunch for the nurses on extra busy days, another who throws a holiday party for the entire staff. "There is a mutual respect between the physicians and nurses here," says Ms. Veltre. "They know and trust us. We are their eyes and ears on the Unit and it is a wonderful relationship. When physicians are called by our Unit, their response time is very quick because they know that if we call, it is significant. The skill of our nurses is on the mark." In an era that is increasingly plagued by a nursing shortage both here and abroad, good nurses are more in demand than ever. Despite the need, Ms. Veltre relates, it is sometimes difficult to attract young people to a profession with hard work and long hours. She smiles as she thinks about her 22-year-old relative who wants to make a great deal of money while spending most of the day e-mailing friends at her job. "The people going into nursing have it in their souls," says Ms. Veltre at the close of a long day. "They are the caregivers. You earn an honest living, but you work for it. I have found it to be a very rewarding profession. There is nothing else that I would rather do." [ top ] |
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On this day, as on most days, the Unit is just about filled to capacity. It is a predictably busy place, with patients arriving daily from the Cardiothoracic Intensive Care Unit just as recovered patients are leaving for home. Those who have undergone openheart surgery come to the Stepdown Unit 12 to 24 hours after the operation and generally stay five days. For angioplasty, the stay is 24 hours. About 60 percent of the patients on the Unit are here for interventions, such as angioplasty or electrophysiology, and 40 percent are here for surgery.
At the first patient's room, Ms. Veltre introduces herself and speaks in a warm and friendly manner. The elderly female patient discusses her recovery and Ms. Veltre encourages her, saying, "This has been a marathon for you, but you are doing so well now. It won't be long before you can go home."
