A day in the life of a cardiac care nurse practitioner (with prescribing rights)

October 2015 Vol 15 (5)

Follow Cardiac NP Annette Rief as she cycles and ferries her way to a day's work helping adults manage and live with congenital heart disease.

Annette RiefNAME: Annette Rief

JOB TITLE: Nurse Practitioner for Adult Congenital Heart Disease

LOCATION: Auckland City Hospital

6.00 AM WAKE

I get up, shower, and cycle to the Birkenhead ferry terminal to cross the harbour on the Tiger Cat ferry. Highlight of the trip: a pod of Orcas hunting for stingrays in the harbour.

People pay a fortune to see this and I get it on the way to work. Magical! However, the ferry has to slow down so as not to frighten the whales and I am running a little late. I quickly cycle up the hill to the hospital.


I check emails, texts, planned appointments and get ready for my nurse-led clinic, underway at 8.30. Each year more than 100 children born with heart conditions transition to the adult services for their ongoing care.

So demand for the adult congenital heart disease service has grown substantially over the last decade. Being a nurse practitioner with prescribing rights allows me to work almost independently and help meet that demand. Five patients are booked today. My phone rings just as I am taking the first patient into the clinic room.

It’s a GP requiring urgent advice on a patient and together we make a plan of action. The phone keeps ringing, but all other calls are not urgent and I can call back later.

The first patient is new and frightened; something serious may be going on and he lists a number of potentially serious symptoms. I ask a number of additional questions because chest pain, breathlessness, dizziness and faints can occur for many reasons. Understandably, most people with heart conditions worry a great deal about symptoms like those because they can be a sign of things getting worse.

I encourage my patients to get in touch if they have health worries and usually arrange urgent reviews. This patient’s ECG looks normal and I don’t think the symptoms are typical of heart-related problems, but I check the heart echo scan first and, after reviewing it with one of the consultants, I propose a management plan.

The consultant and I share the plan with the patient, including a few additional baseline tests required over the next few weeks. The patient leaves, relieved, and will return in three months to discuss the test results.

The next patient is well known to me and requires up titration of a medication. The clinic nurse checks show adequate blood pressure, heart rate and oxygenation and the patient has remained well.

So I prescribe an increased dose and give him a follow-up plan, including instructions to call me if he notices any new symptoms. The second patient is also long-standing and is coming for a heart failure check. She is well, her weight is stable and so no changes are required.

The fourth booking is for a lost to follow-up patient who does not arrive but I talk to them on the phone, explain the importance of regular check-ups and negotiate a new appointment time.

The final patient is 35 weeks’ pregnant and this is her last check before delivery. The heart of her unborn baby has been checked and it is normal (patients with congenital heart conditions have a higher chance of having a ‘heart’ baby and get an extra check).

The ECG and heart ultrasound today show her own heart function has remained stable so the consultant confirms that a normal vaginal delivery is likely possible. This is great news and we are very happy for her.


No time to eat just yet, as I check on the first of three cardiac catheter patients in the recovery room. I met them the previous day and am responsible for checking there are no unexpected complications following the procedure. I am lucky, the first patient is well, and so I head off to grab a bite to eat.


I dictate letters from this morning’s clinic, a note to the GP of the patient who didn’t come, and book the additional tests for the new patient.

I then call back the patients from earlier this morning. Both have developed health problems warranting further investigations, so I arrange these and bring forward their regular appointments. Our wait list for heart echo tests is several months long, but for now I am still able to get short notice clinic appointments.

I get another call and decide this caller requires urgent admission to hospital. I fortunately work closely with our cardiology ward 31 and patients with obvious heart problems can be admitted straight away (space permitting), rather then wait for hours in the emergency department.

The admission keeps me busy for the most of the afternoon and in between I check on the other two cardiac catheter cases in recovery. Both are well – phew! At 5pm I round with the consultant and our registrar to check the three cardiac catheter patients. We make a discharge plan for the next day. I notify the registrar about the new inpatient, as we share our workload when possible.


I change back into my cycle gear and leave work exhausted. Luckily it’s not raining and I draw in the blue sky (my office doesn’t have daylight). The way to the ferry is mostly downhill and I get to see the sun set on the way home. I usually cook to relax when I get home but today I am too tired.

So tonight it’s a takeaway – pulled pork burrito – which I eat with my partner on the couch, feet up, watching a movie. Getting off the comfortable couch is hard, but I manage eventually.


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