Nurses League Travel Award 2014
I applied for the nurse’s league travel award as I thought this opportunity would be an excellent way
to enhance my nursing skills. I studied at the University of Liverpool and since qualifying have
worked at the Royal Liverpool Hospital (RLH). I am currently a staff nurse on an acute cardiac unit,
and was interested mostly in the differing comparisons of where I work to that of a similar large
hospital in Australia. I was able to carry out my observational visit in the largest tertiary and
quaternary hospital in Queensland the Royal Brisbane and Women’s Hospital (RBWH), with a total
capacity of 933 beds. I thought this would allow a good basis to comparison as both RLH and RBWH
are inner city large public teaching hospitals, with acute cardiac wards offering invasive and noninvasive procedures.
A programme was organised for me to observe the nurses role on the Cardiac Care Unit (CCU), I was
able to watch procedures such as angiograms, angioplasties and Pacemaker insertion in the catheter
lab, I was also able to observe the role of the specialist nurses including Cardiac Rehab and Heart
Failure Nurses.
Prior to visiting one of my main objectives was to compare the admission rates and readmission
rates between the two hospitals. However this was difficult to assess as a hospital close by to the
RBWH had recently started performing angioplasties, which in turn meant a decrease in the number
of admissions to the RBWH.
Additionally, I wanted to compare the initial treatment of acute coronary syndrome in terms of what
medication was used, any the differences to the U.K, why it was used, and what the benefits were. In
the RLH, as a dual antiplatelet, Aspirin and Ticagrelor are used unless contraindicated. Ticagralor is a
fairly new drug and only introduced within the last 18 months- 2 years, the drug of choice was
previously Clopidrogel. It was interesting to see in the RBWH Clopidogrel was still being used
however they were actually in the process of changing over to Ticagrelor, as research shows Aspirin
paired with Ticagrelor reduced the incidence of vascular death and myocardial infarctions, more so
than Aspirin and Clopidogrel.
I found the role and the daily routine of the nurses on the CCU were very similar to that of the
nurses where I work. I did enjoy watching pre and post care of an angioplasty, as this procedure is
not performed in the RLH. Through observing such procedures taking place I feel I will be able to
now reassure patients more easily and honestly when they are feeling anxious. The nurse/ patient
ratio on CCU was one nurse to two patients, whilst in comparison my current ward has a one nurse
to four patient’s ratio. Having fewer patients allowed the nurses time to be heavily involved in
patient education in terms of cardiac rehabilitation sessions. I found the ward to be very well run as
they use the LEAN approach. This minimises any ‘wasted’ time, whereby in order to assist the flow of
patients there is a morning bed meeting, including various members of the Multi- Disciplinary Team
(MDT), discussing every patient on the ward and having a plan in place, so everybody who may be
involved in a potential discharge of a patient would be forward planning this. The planning of patient
flow appeared to work really well as everybody knew what was expected, this will be an idea I will
bring back to my ward manager.
I will also suggest making a welcome sheet for new or agency staff. This is used on CCU, providing
details to the nurse about the ward, what they are able to do and helpful terminology. I thought this
was a really good idea as when going to a new work place having a reference guide including a skills
set for agency staff could be extremely helpful.
I enjoyed working with the specialist nurses, as this is not my role at home; it was interesting to see
what was involved in their job. There is an excellent re- habilitation programme provided to patients
from both Heart Failure Nurses and Cardiac Rehab, patients are referred onto further programmes
once they are well enough. Speaking to patients it was clear they enjoyed these sessions and they
felt they were progressing physically and also socially by meeting people in a similar condition. I am
interested to speak to the specialist nurses at the RLH to look at our current rehabilitation
programmes and to see if I can make any new suggestions.
Patients at the RBWH are also given an informative DVD to take home, which includes details of
their newly diagnosed condition and suggested life- style changes such as diet and exercise to help
manage and control symptoms. I will show this to nurses at home and discuss how we could use
something similar to benefit our patients.
I thoroughly enjoyed my visit to RBWH, my overall aim was to come home with skills/ ideas to
benefit patient care. I feel I will be able to put forward some ideas on my return, which will hopefully
have a positive impact. I would like to thank the staff at RBWH for allowing my visit to take place and
The Royal Infirmary Nurses League for this wonderful opportunity.
Jennifer Wharton Staff Nurse
HEC
Royal Liverpool University Hospital.