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It's all smiles and laughs as Nancy Marco makes her way through morning rounds.
She goes from one room to another, checking on patients who are ready to be discharged. Each visit feels like a warm reunion between old friends, even if they have never met.
As one of 19 nurse practitioners (NPs) at the Peter Munk Cardiac Centre, and one of two NPs in the cardiac electrophysiology (EP) unit, Nancy treats patients with heart rhythm abnormalities such as bradycardias (slow heart rhythms), tachycardias (fast heart rhythms), and heart flutters.
Considered a role model by her colleagues, Nancy spends hundreds of hours a year educating nursing students and novice nurses. Her mentorship was recently recognized with the Wightman-Berris Academic Teaching Award from the University of Toronto.
The award marks a career – 34 years and counting at UHN – during which Nancy's leadership has helped expand the EP program to provide more efficient care for patients.
Optimizing cardiac care
A passion for medicine ran in the family. Nancy's father was a doctor and her mother, a nurse. Originally from Florida, she moved to Toronto in 1982 after marrying a Canadian.
Nancy started at the Toronto General Hospital in the cardiac critical intensive care unit. In 1996, she became a care leader on the EP side of the cardiology unit, before transitioning in 1998 to an advanced practice nurse role directly with the EP program, where she has been ever since.
Nancy received her nurse practitioner master's degree from the University of Toronto in 2009. Nurse practitioners are registered nurses with advanced university education, knowledge, and the clinical competence and skills to complete comprehensive assessments, diagnose within scope of practice, and treat complex conditions.
With the help of her colleagues, EP nurse coordinators Sharlene Abdool and Juliet Wilson, Nancy helped develop the EP interventional program from a twice-per-week ablation and device implant program to a full-time program. She put together proposals for admission and discharge criteria, educated nurses in the units, and created pre and post-procedural education materials for the patients.
She also created the EP nurse practitioner-led follow-up clinic to improve care for patients transitioning from inpatient to outpatient care settings. This clinic decreases length of stay and emergency visits, and provides specialized post-procedural care.
'Comforting to our patients'
Zelia Souter works with a multidisciplinary team, including NPs, in her role as a cardiology nurse manager. From admission to discharge, she says NPs are foundational to continuity of care and in educating patients and families on their conditions.
"Many of our patients have to come back for a second visit, a third visit, and to touch base with someone whom you've already had a relationship with in a previous admission, is really quite comforting to our patients," says Zelia.
Susan Campbell has been a cardiac patient at UHN since 1981, when her heart condition turned into atrial fibrillation – the most common arrhythmia – which causes a fast and irregular heartbeat. She was referred to the EP clinic where she met Nancy almost a decade ago.
"I came to realize that if I had questions or fears, I could text or email Nancy and I would get a phone call back within an hour," says Susan. "That's the sort of person she's been for me."
Susan says her experience has opened her eyes to the depth of the expertise of NPs. For patients who may not be able to get in touch with their physician for questions or concerns, nurse practitioners can offer immediate support.
Teaching the next generation
Nancy's commitment to her field and patients is one of the reasons why fellow nurse practitioner Irena Kostic nominated her for the award. A former-student-turned-colleague, Irena now works alongside Nancy in the EP unit.
"I feel 100 per cent supported all the time," says Irena. "She's a great model for the profession."
An adjunct faculty member at the University of Toronto's Faculty of Nursing, Nancy passes her knowledge and experience to the next generation of NPs first-hand, in the hospital, armed with a passion for teaching, career-mentoring, and helping new graduates. She says seeing her students succeed means more patients are getting the best care.
"You make a difference in their life and you help get them through a procedure," says Nancy. "You get them through the whole gamut of everything that's going on with them."