Cardiovascular nurses are registered nurses who focus on health promotion, genetic risk assessment, disease and injury prevention, sign and symptom recognition, cardiovascular disease management, and self-care knowledge and adherence to improve patient outcomes for those at risk or living with cardiovascular disease and illness. Cardiovascular nurses provide evidencebased practice to improve patient functional capacity and quality of life, and to enhance the heart-health of communities. Cardiovascular nurses develop, implement, and participate in nursing and interprofessional cardiovascular research to address the knowledge gaps in the prevention, diagnosis, and treatment of cardiovascular disease. Practice-based research by cardiovascular nurses provides a better understanding of the impact of healthcare practices and nursing interventions on patient outcomes.

Many titles or terms describe patients across organizations and settings, including healthcare consumers, clients, individuals, families, caregivers, groups, communities, and populations. For this professional resource, patient serves as the preferred term and includes, depending on the context of use, individuals, families, groups, communities, and/or populations.

Key elements of cardiovascular nursing include:

The high incidence and prevalence of cardiovascular disease, the obesity epidemic, the dramatic growth in the population of older adults and adults with congenital heart disease, and the increasing costs associated with advanced treatment technologies are all contributing to escalating healthcare costs. Cardiovascular nurses play a key role in providing, coordinating, and improving cost-effective quality patient care across all sites where cardiovascular care is provided.

Cardiovascular care at the healthcare organization delivery level emphasizes collaborative practices, disease management, education, research, and administration to ensure quality care. Key elements of cardiovascular nursing care at this level include the development, initiation, and maintenance of systems and processes that promote teamwork, effective communication, collaboration, efficiency, and patient satisfaction.

Cardiovascular nursing research is a well-developed aspect of the cardiovascular nursing role. Cardiovascular nursing research has broadened the scientific foundation of cardiovascular practice and continues to provide evidence of effective approaches and processes to quality cardiovascular nursing care.

The first scope and standards for cardiovascular nursing were developed and published in 1975 in collaboration with the American Heart Association (AHA) and updated in 1981. In 1993, the American Nurses Association Council on Medical-Surgical Nursing Practice published The Scope of Cardiac Rehabilitation Nursing Practice. Since that time, the scope of practice of cardiovascular nursing has expanded dramatically, coinciding with the exponential growth of new evidence-based nursing science regarding cardiovascular disease epidemiology and pathophysiology across the life span, and its assessment,
diagnosis, treatment, and outcomes. The 2008 Cardiovascular Nursing: Scope and Standards of Practice is available in Appendix A.

The cardiovascular nursing scope of practice statement initially included hospital-based care for individuals experiencing acute, chronic, and critical cardiovascular illnesses. It has since evolved to include prevention, risk modification, and care across the full spectrum of healthcare settings for those who are stable, those with unstable acute or chronic cardiovascular illness, those dependent on life-support devices, and those with major comorbidities that affect cardiovascular illness assessment, diagnosis, treatment, and outcomes. The current practice of cardiovascular nursing requires extensive clinical knowledge and expertise to provide highly specialized acute, chronic, critical, or end-of-life care to patients, whether they are hospitalized or reside in home, community-based, or hospice care settings. Cardiovascular nurses partner with patients, families, communities, and other healthcare providers to enhance self-care and community support, utilizing evidence-based, innovative models of symptom and disease management to improve patient outcomes. Cardiovascular nurses also play a critical role in facilitating safe patient transitions among care providers and settings.

The great complexity of cardiovascular disease and its many associated comorbidities creates crucial roles for cardiovascular nurses as caregivers, direct-care providers, coordinators, educators, administrators, case managers, and quality specialists who optimize patient outcomes associated with specific cardiovascular diagnoses. Cardiovascular nurses provide multiple and complex treatments, many of which are initiated or directed by nurses. To effectively care for this population, cardiovascular nurses must have additional in-depth knowledge of hematologic, pulmonary, sleep-disordered, renal, metabolic, and immunologic conditions.

Patient education content must be tailored to meet the self-care needs of patients with multiple medical and psychosocial conditions. The cardiovascular nurse must be prepared to teach patients and families about diverse topics ranging from health promotion and disease prevention to end-of-life symptom management. Patient education topics include both prevention and risk reduction strategies (such as diet, exercise, and activity recommendations), as well as disease management topics focused on treatments, medications, complementary and alternative therapies, and diagnostic tests. In addition to this type of factual content, patient self-management skills and self-efficacy behaviors have to be assessed and incorporated in educational programs to reduce health risks and improve disease management success.

Ultimately, patients and caregivers need to be able to manage the cardiovascular condition and common symptoms, to recognize indicators of declining function, and to understand when to seek assistance from healthcare providers. As the catalyst for optimizing patient management and self-care, cardiovascular nurses must acknowledge cultural differences and incorporate patient preferences in order to ensure a mutually acceptable plan of care.

A cardiovascular nurse demonstrates a strong interest in the population, a quest for knowledge, and a desire to increase professional competence in this specialty. The term cardiovascular nurse signifies the expectation of a level of cardiovascular care knowledge (basic or advanced) and skills related to the patient’s needs or the care setting. This knowledge and these skills entail synthesis of data, selection of evidence-based interventions, delivery of care, and evaluation of care delivery that ultimately help individuals or groups attain, maintain, or restore cardiovascular health, or meet a peaceful death.

Many professional organizations serve the educational and professional needs of cardiovascular nurses. This revised cardiovascular nursing scope and standards document continues to describe cardiovascular nursing practice based on the participation and contribution of numerous nursing organizations whose constituency includes cardiovascular nurses. (Summary descriptions and hyperlinks to the websites of these organizations appear in Appendix B.) This document will continue to be the foundation for cardiovascular nursing and will require regularly scheduled periodic assessment and evaluation to consistently represent the current state of the art and science for cardiovascular nursing practice.

Cardiovascular care is collaborative in nature. Cardiovascular nurses partner with physicians, licensed independent providers, and many other healthcare team members in a wide range of practice settings, including acute care, skilled nursing and rehabilitation facilities, and home settings. An essential nursing role in these settings is direct or indirect contact with individuals who have actual or potential cardiovascular disease. Cardiovascular nurses work at the bedside in acute care settings (emergency, perioperative, acute, progressive, and intensive care for children and adults), transplant programs, cardiac rehabilitation, offices and clinics, community health, home care, and hospice or palliative care.

Many cardiovascular nurses work in practice settings such as family practice, pediatrics, internal medicine, and gerontology, with large patient populations who are aging and at risk for or have cardiovascular disease. Cardiovascular nurses work in other diverse settings as well, such as telemonitoring, cardiac catheterization, hybrid surgical/interventional and/or electrophysiology laboratories, noninvasive imaging, radiology, exercise testing, transplantation programs, and the pharmaceutical, information technology, and device industries. They also work in organizations to develop, implement, and evaluate care systems so that cardiovascular outcomes can be improved, as well as in professional societies and government organizations that develop and evaluate health policy.

Cardiovascular nurses provide specialized care by managing and directing clinics focused on cardiovascular risk reduction, anticoagulation, lipid management, hypertension management, heart failure, cardiac rhythm management, life-sustaining and lifesaving devices, infusion therapies, genetics counseling, peripartum care, and pediatric or adult congenital heart disease. Other cardiovascular nurses serve as educators and researchers in academic and practice settings. The nurse educators focus on the provision of prelicensure, graduate, and doctoral educational content to prepare the next generation of cardiovascular nurses. Cardiovascular nurse education, professional development, and advanced specialized clinical knowledge and skills must be commensurate with the nursing practice needs of the patient population and setting.

Cardiovascular nurses include licensed registered nurses (RN) and advanced practice registered nurses (clinical nurse specialists and nurse practitioners), nurse educators, administrators, case managers, quality specialists, and researchers. An RN, regardless of specialty, is licensed and authorized by a state, commonwealth, or territory to practice nursing. The RN is educationally prepared for competent practice at the novice level upon graduation from an accredited school of nursing and qualified by national examination for RN licensure.

The RN is educated in the science and art of nursing with the goal of helping individuals and groups attain, maintain, and restore health whenever possible. Experienced nurses may become proficient in one or more practice areas or roles and may focus on patient care in clinical nursing practice specialties, such
as cardiovascular nursing. Specialized cardiovascular knowledge and experience may be acknowledged through an identified certification process, in which specific nursing educational requirements and demonstration of knowledge in cardiovascular nursing practice have been delineated and validated through certification. Examples are certifications from:

Cardiovascular nurses have a broad knowledge base in anatomy, physiology, pharmacology, pharmacogenomics, pharmacotherapeutics, nutrition, psychology, sociology, and developmental theory. Clinical competencies beyond those obtained in basic nursing education include assessment and management of cardiovascular conditions, education and counseling skills for comprehensive cardiovascular risk factor reduction, disease management, and encouragement of patients in a lifelong pattern of healthy living.

Competencies addressing the physiological, psychosocial, educational, cultural, and spiritual needs of patients living with chronic cardiovascular illness are essential, including skill in helping patients and families address end-oflife issues. Cardiovascular nurses must be knowledgeable of the principles of ethical practice and have resources available to evaluate the merits, risks, and social concerns of cardiovascular interventions. In addition, cardiovascular nurses must be educated in patient advocacy across the age spectrum and all healthcare environments.

The core of cardiovascular nursing practice centers on the use of critical thinking and decision making based on scientific information and theory combined with evidence-based guidelines related to cardiovascular care. In providing comprehensive care across the continuum from prevention to end of life, the cardiovascular nurse uses the nursing process to assess individual, family, group, and population needs to form an appropriate diagnosis, identify goals, design a mutually agreed-upon plan of care, coordinate and provide
therapeutic interventions, document the care, and evaluate the action plan using an interprofessional case management approach.

Strong assessment skills are the foundation of quality cardiovascular nursing practice. These include both cardiac and vascular system assessment, in addition to assessment of all affected systems. Intensive knowledge of cardiovascular physiology, including the principles of electrophysiology and arrhythmia recognition, is necessary to accurately assess and appropriately respond to life-threatening conditions.

The evolution of knowledge and technologies has created complex equipment to monitor, evaluate, and manage cardiovascular patients and their disease. This equipment varies in complexity from simple diagnostic tools, such as the stethoscope and sphygmomanometer, to complex imaging systems that can diagnose a congenital heart defect before 20 weeks gestational age, facilitate reconstruction of damaged or defective hearts, and help clinicians guide catheters into coronary arteries. Patient monitoring systems likewise have evolved from simple bedside monitors of electrocardiograms to implantable devices to record and/or manage arrhythmias.

Cardiovascular nurses are monitoring critically ill patients remotely using telehealth electronic ICU technology. With the development of small chip microprocessors, cardiac rhythm management devices have become even more complex with the ability to monitor hemodynamic changes, analyze cardiac rhythms, and provide therapy for potentially fatal arrhythmias. Mechanical circulatory support devices have evolved from a bridge to cardiac transplantation to destination therapy for individuals with end-stage heart failure. As a result of the constant change in cardiac-related technologies, cardiovascular nurses must be committed to lifelong learning through completion of continuing education and training programs.

Many cardiovascular nurses learn to use and monitor the data from catheters and devices associated with medical, surgical, and preventive care for all ages of patients with cardiovascular conditions. Examples include pulmonary artery catheters, thoracic impedance or hemodynamic monitoring devices (internal or external systems), cardiac rhythm management devices, and mechanical circulatory support devices. With expertise in these advanced technologies, cardiovascular nurses can monitor the patient, evaluate the function of and manage information provided by the devices, and improve patient safety. This also includes assessment of patient responses and teaching patients and families about the temporary and long-term use of these devices.

A strong cardiovascular knowledge base is necessary for cardiovascular nursing administrators, researchers, case managers, quality specialists, and educators who may not provide direct clinical care. The combination of cardiovascular disease management expertise with leadership and expertise in these other areas provides opportunities to positively impact the health and well-being of cardiovascular patients and improve patient outcomes.

Registered nurses with graduate education and advanced specialized clinical knowledge and skills may be recognized by their licensure jurisdiction as advanced practice registered nurses (APRNs), including clinical nurse specialists (CNSs) and nurse practitioners (NPs). See the 2008 APRN Consensus Model for details about APRN preparation as an NP or CNS (http://nursingworld. org/consensusmodel). These APRNs demonstrate a greater depth and breadth of nursing knowledge, data synthesis, advanced nursing skills, and significant autonomy.

NPs specializing in cardiovascular care require expanded knowledge and skills to provide expert care to individuals, groups, or populations at risk for or diagnosed with cardiovascular disease. They conduct comprehensive assessments and promote health and prevention of cardiovascular injury and disease. An NP specializing in cardiovascular care develops differential diagnoses, orders tests and procedures, performs physical examinations, interprets diagnostic and laboratory tests, makes diagnoses, and prescribes pharmacologic and nonpharmacologic therapies for the management and treatment of acute and chronic cardiovascular illness and disease.