|Author: Jeneane Brown|
|Giving Patients Better Access to Cardiac Care|
|Janel Trovato-Vass, RN, MSN, FNP-C, works in the private cardiology practice of Dr. Robert J. Fanning Jr. in Wheeling, WV. "I am happy to wake up and spend my day at the office or in the hospital. I actually can't wait to go to work," she says of her current position.
"I work in a small office," Travato-Vass explains. The hospital that we use is approximately a 250-bed facility with a cardiac program that includes cardiac catheterization, angioplasty, and open-heart surgery. Our office does testing. We have equipment to perform nuclear stress tests, echocardiograms, pacemaker and implanted defibrillator checks, and EKGs." Travato-Vass's job allows her to add new programs to Dr. Fanning's practice. "I am in the process of designing a lipid clinic where we will draw blood and perform lab work in the office and manage patients with hyperlipidemia," she says. "We are also looking into doing our own protimes [protimes with International Normalization Ratio, or PT/INR] in the office as well. The program was awaiting my arrival post-graduation."
Although her current position -- which she started in August of 2002 -- is a good fit for her, Trovato-Vass needed to do some campaigning to secure it. "I first met Dr. Fanning through my job as a nurse in the CCU at Wheeling Hospital," she recalls. "He impressed me with his knowledge, aggressive and determined practice of medicine and compassion toward patients. He is always up-to-date on the newest studies and standards of practice. I discussed school and the nurse practitioner role with him when I began the program. As I completed classes and got closer to graduation, I marketed the position to Dr. Fanning with multiple articles and web sites explaining the reasons he needed me in his practice. I continued to prove myself to him, and pretty much created the job!"
Trovato-Vass says her efforts to get a job on the cardiology practice staff has more than paid off: "I feel so very fortunate and continue to pinch myself daily. This is a dream job come true," she enthuses. She is glad to be working in a challenging specialty so soon after graduation. "For the area I reside in, it is a great achievement for me to start as a nurse practitioner in cardiology."
Trovato-Vass' drive to become a nurse practitioner was fueled by several important people and events. "First, my mother and father always taught me to set my goals high and to fulfill my dreams. My dad died suddenly of a heart attack at a young age. My mom and I found papers from a conference he attended that asked what his goals/dreams were, and he wished for me to be successful and attend graduate school," she recalls.
In addition to her father's hopes, her mother's strength helped point Trovato-Vass towards excellence in nursing. "She has been a pillar and nothing but supportive and encouraging throughout my life." She also credits her husband -- who also works in the medical field -- for his support as she pursued an advanced nursing education. "It wasn't easy for him to have so little of my time while I worked a full-time job and attended graduate school two to three days a week for two years," she says. "He has always believed in me, and tells me I am the smartest person he knows.
Travato-Vass also acknowledges Dr. Fanning's faith in her. "When I began the nurse practitioner program, I would ask him various questions and voice concerns about cardiac topics. His responses educated me and prompted me to want to learn more. He asked me many times, 'Why aren't you in medical school?' That always made me feel good," she recalls, "and gave me more confidence in my clinical abilities and practice."
Even before that, however, Travato-Vass had amassed an impressive amount of nursing education and experience. "I obtained my undergraduate degree at West Liberty State College in West Liberty, West Virginia. I was in the first class to graduate from the new BSN program." For the next six years, she worked as an intensive care and emergency department nurse, earning her CCRN (Critical Care Registered Nurse) certification -- a credential she maintains today. "I also became an ACLS [Advanced Cardiac Life Support] instructor, and continue to teach classes two times a year at a local hospital," she says. Some of her unique work experiences include caring for a ventilator-dependent child with Congenital Central Hypoventilation Syndrome. She is also experienced with patients who use diaphragmatic pacers (Jukka), which electronically stimulate breathing without total ventilator support.
"I then transferred to work in a coronary care unit for the next four years, and spent one year in an open-heart surgery unit [CVICU, or cardiovascular intensive care unit]," continues Trovato-Vass. In May 2002, she graduated from Wheeling Jesuit University in Wheeling, WV, with a Master of Science in Nursing, specializing as a family nurse practitioner. During her academic career, she was inducted into Sigma Theta Tau International Honor Society of Nursing, and is currently active in her local chapter.
Today, working with patients gives Trovato-Vass her greatest fulfillment. "My patients have been great," she says. "They make my job rewarding." Every week, she gets phone calls from patients thanking her for taking time to explain their medical conditions to them. But Trovato-Vass feels as though she should be thanking them for helping to make her job so gratifying. Her daily schedule varies. "I have office hours when I see patients, do stress testing at the office using cardiolyte sestimibi and adenosine preparations." She also must take into account times when the doctor is unavailable, as well as the needs of acute or emergent patients. "I have been designated the HIPAA (Health Insurance Portability and Accountability Act) officer to educate the office staff on the changes and monitor office compliance," she adds. "I make rounds with Dr. Fanning at the hospital, and am waiting for approval of privileges at the hospital to make patient rounds on my own, which will involve doing admission and discharge summaries, history and physical exams and patient education. I am involved with a great deal of patient education on a daily basis, which is one of the components of practice as a nurse practitioner."
In addition to providing education to patients, Trovato-Vass also likes to acquire new skills that will enhance her clinical work. "I am assisting in the cardiac cath lab. I am doing the history and physical exams and dictation to the hospital. I may also learn to use the Vasoseal and Angioseal devices which are used to 'plug' the artery post-procedure so that the patients are ambulatory within two hours. This also minimizes hospital stay and nursing time doing groin checks and maintaining sandbags to the femoral site. It is also more comfortable for the patient. I will also be participating in the development of CHF (Congestive Heart Failure) 'routine orders' with Dr. Fanning at the hospital. This is to aid the family practice physicians in recognizing the treatments and medications that are recommended by the AHA [American Heart Association] and ACC [American College of Cardiology]. The goal is to prevent readmission, exacerbations of heart failure and to promote better quality of life for the patient. We are hoping to devise some sort of cardiac rehab program for the CHF patient that will be covered by and meet requirements for payment from Medicare and other health plans."
Health insurance paper trails comprise the only part of Trovato-Vass' job that she dislikes. "It seems like when you feel every form possible has been completed and mailed, they come up with another request," she laments. In addition to insurance woes, Trovato-Vass sometimes feels as if she is swimming against a tide of stereotypes about the role of NPs. "Currently, my biggest challenge is overcoming the barriers that lie in the physician population mindset that the nurse practitioner is 'just a helper.' I am trying to educate the doctors that nurse practitioners have a place in the medical field and that we are by no means trying to take over their job. I tell all of the patients that I am not here to replace the doctor; I am here to enhance their care and to teach them, to give them better access to cardiac care and troubleshoot some of the problems."
Perhaps Trovato-Vass' greatest challenge of all, however, is coping with her own perfectionism at times. "I strive for perfection and want to help every patient. When I am faced with a situation where I cannot make things right, I question myself if I am missing something or if I don't know enough," she explains. "I am continually reading and I try to learn something new every day. There is so much information and so many things change with new studies every day, I sometimes find it difficult to keep up. I am challenged on a daily basis to learn something or to teach someone else."
It is this kind of drive to learn and grow professionally that makes Trovato-Vass proud of her own accomplishments in particular, and of the evolving role of NPs in general. "I have seen more nurses interested in the advanced practice realm -- and not just as nurse anesthetists -- but as nurse practitioners as well," she remarks. "I also feel that more people and physicians are aware of the nurse practitioner role and what a nurse practitioner actually does in practice. I still think there needs to be. . .an increase in public awareness, but that comes with time. The physicians in the area [where] I live are becoming more receptive to nurse practitioners and a little less threatened. I knew of three nurse practitioners locally when I began the program; now I know of 14. I think that is great, but there aren't enough of us locally. We did recently form a nurse practitioner group which holds monthly educational meetings with dinner or brunch where we all get together and discuss practice, ways to make our role more public and obstacles that we need to overcome. For a small town in West Virginia, I think that we are doing well."
As she helps to advance her profession, Trovato-Vass also plans to further her own career. "I have so many avenues I am interested in exploring," she says. "I am considering adding the acute care nurse practitioner degree to my FNP in the future. There are specialized advanced nurse practitioner areas for clinical interest in cardiopulmonary problems such as heart-lung transplant, interventional cardiology, and heart failure at the University of Pittsburgh. I am currently doing guest lectures at Wheeling Jesuit University for the MSN, FNP program, as well as participating as a presenter in a pharmacology conference for nurse practitioners as a guest lecturer in November. "I may also continue my education and pursue a Ph.D.," she adds. "I have been asked why I just don't go ahead and do it, but, then again, I like being an NP!"
Janel Trovato-Vass, RN, MSN, FNP-C, earned her undergraduate degree from West Liberty State College, West Liberty, WV, in 1992. She attended Wheeling Jesuit University in Wheeling, WV, graduating with a with a Master of Science in Nursing, specializing as a family nurse practitioner, in 2002. Trovato-Vass is also active in her local chapter of Sigma Theta Tau International Honor Society of Nursing.
Jeneane Brown is a freelance writer from Horsham, PA, and is on the editorial staff of NEWS-Line for Nurse Practitioners.