Nurses at a major London hospital are taking on more and more advanced clinical responsibilities, including a procedure usually reserved for a specialist doctor.
Paola Ferraro, senior sister at Barts Heart Centre, St Bartholomew’s Hospital in central London, recently acquired permission to have two of her experienced nurses trained in performing radial access.
“We observe doctors [doing these procedures] thousands of times”
This procedure involves inserting a catheter into the wrist, via the arm, which is then threaded through blood vessels in order to diagnose and treat conditions including clogged arteries and arrhythmia.
It is a less uncomfortable alternative to femoral access, which goes through the leg, and has a faster recovery time.
Radial access was something that, traditionally, only doctors would be trained in, Ms Ferraro told Nursing Times.
Allowing nurses to do it, she said, frees doctors up to spend more time with patients as well as giving her nurses the chance to progress in their career without leaving their clinical role to become a manager.
“This has always been something only doctors do,” she said. “Gaining entry this way isn’t something part of a nurse’s training, so this is about breaking boundaries.
“We observe doctors thousands of times doing this procedure. When you’re waiting for the doctors to scrub, you’re almost thinking – I wish I could do it.”
Two experienced band 6 nurses at Barts Health NHS Trust were chosen, out of five applicants, for the radial access training. It involved a one-month-long theoretical course, followed by simulation practice.
Under observation by a doctor, the nurses practiced between 100 and 150 test runs on a synthetic wrist, before they moved on to performing it on a patient.
Once they have been signed off, the nurses then perform the punctures a further 50 times under observation on patients, before completing a further 50 on their own before they are considered fully trained.
Sara Bagnoli, one of the two nurses on the course, said it was a “dream come true” to be given the chance to perform a procedure usually only done by an experienced doctor.
She said: “How many times have we watched doctors do these sheathes? So many.
“Now, thinking that it’s something I can do, it gives me a lot of satisfaction from my nursing career point of view.
“I can see my future in nursing here, which is really good,” she told Nursing Times.
Ms Bagnoli began her theoretical training in February, and was signed off – having completed the simulations – in March to perform on patients at Barts.
She has now completed 43 supervised radial accesses, and hopes to be performing the procedure solo by the middle of this month.
Ms Ferraro suggested that, as well as freeing up time for doctors, opening up procedures such as radial access to nurses would help to improve retention among talented clinical staff.
She said: “We have highly skilled lab nurses here who are trained in intervention and electrophysiology, but they hit the point where they either hit managerial level, or become a clinical leader, or leave entirely.
“We don’t want to lose talented nurses but give them a way to develop,” she noted.
She also highlighted the training of some nurses in the insertion of implantable loop recorders (ILRs), another way to check for arrhythmia in cardiac patients.
The hope is that radial access would not be the last advanced procedure that nurses were trained in, Ms Ferraro said: “It’s really changed the atmosphere here.
“And it has helped morale. It has not created competition between nurses and doctors, we work together as a team – it’s all about empowering colleagues with new skills.
“If we think about it, any area in nursing can be expanded to advanced practices like this,” she said.