Abstract
Situation: Toronto Western Hospital (TWH) is a Regional Stroke Centre, meaning that patients suspected of stroke bypass other centres to access TWH. This designation results in care for neurologically complex patients, requiring efficient stroke protocols and proficient, knowledgeable clinicians. Notification of a patient en-route to the Emergency Department with a suspected stroke sets off a cascade of events that require a streamlined, coordinated approach; a Code Stroke.
Background: There were many factors reinforcing the need to reevaluate TWH’s Code Stroke protocol, including the change to administration of tenecteplase for ischemic stroke, significant wait times and subsequent unsafe patient ratios in the Emergency Department, and the change to a new documentation system, posing practice and medicolegal concerns. In addition, TWH’s Neurovascular unit has nearly doubled its census in the past 3 years, leading to mass hiring and a substantial decrease in skill mix. The large amount of new graduate nurses, further complicated by COVID-19’s impact on preparedness to practice, has led to a need for an additional role to support the practice and operational needs of the unit. A needs assessment was conducted, and development of the Neurovascular Response Nurse (NVRN) began.
Methods: NVRNs are critical care-educated nurses specializing in neuroscience nursing, who receive additional training in Code Stroke processes, functional vascular anatomy, post-thrombolytic management, and deterioration response. Many of these nurses have experience in leadership or Charge Nurse roles, education and preceptorship, and quality improvement projects. As an NVRN, they provide guidance to new hires, address practice gaps, and work with the Charge Nurse, Manager, and Educator to support the unit.
Results: This role has fostered a healthier work environment across the hospital. Time from thrombolytic administration to critical care bed admission decreased significantly, from 613 minutes to 57 minutes. Facilitating prompt access to a neurocritical care bed supports offloading in the Emergency Department and reduced burden of care for nurses an increasingly strained department. New neurovascular nurses report benefits from the mentorship, practice guidance, and orientation to the unit. Nurses of all experience levels value the help with complex or deteriorating patients, and report an increase in job satisfaction due to the support offered and seamless transitions.
Notes
References: Bryant-Lukosius D, Dicenso A. A framework for the introduction and evaluation of advanced practice nursing roles. J Adv Nurs. 2004 Dec;48(5):530-40. doi: 10.1111/j.1365-2648.2004.03235.x. PMID: 15533091.
Canadian Institute for Health Information (CIHI). NACRS emergency department visits and lengths of stay [product release]. Accessed February 20, 2023.
Heran, M., Lindsay, P., Gubitz, G., Yu, A., Ganesh, A., Lund, R., ... & Shamy, M. (2022). Canadian Stroke Best Practice Recommendations: Acute Stroke Management, Practice Guidelines Update, 2022. Canadian Journal of Neurological Sciences, 1-94. Chicago
Sigma Membership
Lambda Pi at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Acute Care, Transition to Practice, Onboarding, Implementation Science
Recommended Citation
Bingham, Emma, "Fostering Excellence Through Development of a Code Stroke Response Nurse" (2025). Creating Healthy Work Environments (CHWE). 24.
https://www.sigmarepository.org/chwe/2025/presentations_2025/24
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Phoenix, Arizona, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Fostering Excellence Through Development of a Code Stroke Response Nurse
Phoenix, Arizona, USA
Situation: Toronto Western Hospital (TWH) is a Regional Stroke Centre, meaning that patients suspected of stroke bypass other centres to access TWH. This designation results in care for neurologically complex patients, requiring efficient stroke protocols and proficient, knowledgeable clinicians. Notification of a patient en-route to the Emergency Department with a suspected stroke sets off a cascade of events that require a streamlined, coordinated approach; a Code Stroke.
Background: There were many factors reinforcing the need to reevaluate TWH’s Code Stroke protocol, including the change to administration of tenecteplase for ischemic stroke, significant wait times and subsequent unsafe patient ratios in the Emergency Department, and the change to a new documentation system, posing practice and medicolegal concerns. In addition, TWH’s Neurovascular unit has nearly doubled its census in the past 3 years, leading to mass hiring and a substantial decrease in skill mix. The large amount of new graduate nurses, further complicated by COVID-19’s impact on preparedness to practice, has led to a need for an additional role to support the practice and operational needs of the unit. A needs assessment was conducted, and development of the Neurovascular Response Nurse (NVRN) began.
Methods: NVRNs are critical care-educated nurses specializing in neuroscience nursing, who receive additional training in Code Stroke processes, functional vascular anatomy, post-thrombolytic management, and deterioration response. Many of these nurses have experience in leadership or Charge Nurse roles, education and preceptorship, and quality improvement projects. As an NVRN, they provide guidance to new hires, address practice gaps, and work with the Charge Nurse, Manager, and Educator to support the unit.
Results: This role has fostered a healthier work environment across the hospital. Time from thrombolytic administration to critical care bed admission decreased significantly, from 613 minutes to 57 minutes. Facilitating prompt access to a neurocritical care bed supports offloading in the Emergency Department and reduced burden of care for nurses an increasingly strained department. New neurovascular nurses report benefits from the mentorship, practice guidance, and orientation to the unit. Nurses of all experience levels value the help with complex or deteriorating patients, and report an increase in job satisfaction due to the support offered and seamless transitions.
Description
Last year, Toronto Western Hospital introduced a new nursing role: the Neurovascular Response Nurse. This presentation will outline the positive impact of a nursing role dedicated to mentorship, safe transitions, and Code Stroke response on a healthy work environment.