Find out what it is like to work at the Trust from some of our nurses.
The Trust’s heart division includes five wards at Royal Brompton and four at Harefield.
We treat patients with a variety of heart conditions including congenital heart disease and heart failure and carry out investigations and interventions such as angioplasties and pacemaker and defibrillator implantation.
Carol Gadd - Cardiothoracic clinical services manager, Harefield
Stuart Craig - Practice educator in cardiology, Royal Brompton Hospital
The lung division is based on both sites. We treat patients with:
- chronic lung infections
- fibrosing lung disease
- cystic fibrosis
- occupational and environmental lung disease
- sleep disorders.
Many of our patients receive lifelong care with us.
Paul Lidgate - Matron, respiratory division
Elaine Shattock - Band 5 staff nurse, Foulis Ward
The Trust’s transplant service is based at Harefield Hospital. Patients include:
- those undergoing assessment for transplantation
- those readmitted with post-transplant complications
- those needing artificial device implants.
Harefield has one of the world’s most established VAD (ventricular assist device/artificial heart) programmes.
Faizal Soodhoo - Senior staff nurse, transplant unit
Our paediatric unit is based at Royal Brompton and consists of:
- Rose Ward
- the paediatric intensive care unit (PICU)
- the paediatric high dependency unit (PHDU).
The unit cares for children from birth to 16 with a range of cardiac and respiratory conditions, including congenital heart disease and cystic fibrosis.
Laura Ettery - Sister, paediatric high dependency unit (PHDU), Royal Brompton Hospital
Nimla Pentayya - Clinical ward sister
The theatres and catheter labs at Royal Brompton and Harefield provide a seven day, 24-hour service.
Surgery performed includes:
- coronary artery bypass grafts (CABG)
- valve surgery
- device implants
- primary angioplasty
- heart and lung transplants and thoracic surgery.
The teams use endoscopic, minimally invasive and robotic techniques, and are involved in developing new surgical techniques.
Val McDonald - Cardiac theatre sister, Royal Brompton Hospital
Nerea Fernandez - Anaesthetic nurse, theatres, Harefield Hospital
The critical care units care for patients after cardiac and thoracic surgery.
They take patients who require interventions such as intra-aortic balloon pumping, and those who are waiting for a heart or lung transplant.
There is an adult critical care unit at both sites, and Royal Brompton also has a paediatric intensive care unit.
Each hospital has a high dependency unit – a step down from intensive care and a step up from the ward.
Sophie McKee - Sister, adult intensive care unit, Royal Brompton Hospital
Philippa Roberts - Senior staff nurse, HDU, Harefield Hospital
As clinical services manager, Carol Gadd leads several nursing teams within cardiology. She is a firm believer in the idea that a successful team is one where everyone’s talent is recognised.
“The key is to understand how different people function, to build trust and respect and to value everyone’s talent. You can then build a team around those values. If staff are happy, then the patients are happy.”
Many patients come to Harefield for planned procedures such as angiograms and angioplasties. But the hospitals' primary angioplasty service means that Carol’s staff also see many emergency cases.
“Our local paramedics have received specialist training to identify patients who could benefit from being transferred directly to Harefield for primary angioplasty rather than to their nearest accident and emergency department. This gold standard service can prevent patients from having a severe heart attack.”
Statistics have shown that the service is not only the fastest in the country but also that patients taken to specialist heart attack centres such as ours are more likely to survive.
“Seeing patients coming to us distressed and in a very bad way, and then going out soon after with a positive outcome, is hugely rewarding.”
As one of a large team of practice educators at Royal Brompton, Stuart values the opportunity to look at nursing practice in detail and support staff in their work.
“Education and development are given great priority in the Trust. There is support throughout the organisation for education and, as a specialist hospital, we have a great environment in terms of opportunities for development.”
Stuart works alongside staff who are newly qualified, new to the organisation, or new to cardiology as well as those undertaking specialist courses or who are taking on new responsibilities.
He works on one of Royal Brompton’s adult heart wards, which takes patients who have coronary heart disease, heart rhythm abnormalities, heart failure, congenital heart disease and pulmonary hypertension. Many patients undergo procedures in the catheter laboratory, such as angiogram, angioplasty, pacemaker and ICD insertion or ablation.
Others require specialist tests and investigations.
“As well as delivering classroom sessions and running study days, most of my work is clinically based. I love the fact that within my nursing role I still have a great deal of patient contact.”
Paul Lidgate joined Royal Brompton in 1994 as a staff nurse and is now matron for the respiratory division.
He strongly believes that the Trust is the best place to work if you’re interested in respiratory nursing.
“All patients in the lung division have acute or chronic respiratory disease, and that means a very specific type of nursing is needed. The nursing care aims to optimise patients’ health and well-being through treatment and education, and I support the nursing teams to provide individualised, often complex patient care.
“Because patient care is proactively managed, we’re able to deliver a truly excellent nursing service, which is obviously something that gives us great job satisfaction.”
Training and education are important to Paul, and he ensures that all nurses are given development opportunities, whatever stage they are in their career. There are also practice educators on the wards, who provide support at all times.
Elaine has been at Royal Brompton since 2015.
“I came to Foulis ward on a rotation and I never left as I like it so much. I like working in respiratory medicine as you get to know the patients.
"Many of them have cyclical admissions, which means they come in every six to eight weeks for treatment. Sometimes they’re in for 10 days, sometimes longer.”
The patients on Foulis Ward have chronic long-term conditions such as cystic fibrosis (CF), asthma and bronchiectasis. They tend to be susceptible to infections so need intravenous (IV) antibiotics, and one of Elaine’s roles is to put the IV lines in.
Asthma patients may need IV steroid treatment to open up their airways and CF patients need physiotherapy every day to clear theirs.
“It’s been an eye-opener to see what they have to do to stay well. I also didn’t realise how difficult some people’s asthma can be.”
Some patients are waiting to be assessed for a transplant while others are being optimised for surgery.
“The patients here are quite young – 16 to 30 is the average age, although some are older. Most patients are experts in their own condition and very independent and we encourage that.”
The ward has two bays and the rest are side rooms – CF patients can’t mix with one another as they carry bugs that are dangerous to other CF patients.
“Some patients have been at Royal Brompton since they were babies. For some CF patients, it’s their first time on an adult ward. You build a good relationship with them and everyone is more relaxed – straight away they trust you.
“There are lots of long-serving members of staff, which shows what a good place it is to work. Anyone who’s interested in respiratory conditions should come and work here as you won’t get this experience anywhere else.”
For Faizal, the opportunities for personal development, the support and the friendly atmosphere are what make Harefield so special.
He first started working on the transplant unit in 2005 after completing a student placement the previous year.
“I didn’t know much about transplantation when I started, but it’s a really good place to learn, and there are lots of development opportunities.
"During my time here I’ve completed a degree in cardiothoracic nursing, sponsored by the hospital.”
Patients on the transplant wards are either pre or post-transplant, and the nursing care is a mix of assessment, rehabilitation and education.
For post-transplant patients, the nurses help with rehabilitation along with other health professionals such as physiotherapists.
Because transplant patients have suppressed immune systems, they have to take medication for the rest of their lives, so the nurses teach them about self-care and how to spot the signs of infection.
“Patients rely on the nursing staff a lot. They can be on the wards for quite a long time so we build strong relationships with them and their families.
“The transplant unit is a very rewarding place to work. I see patients who can barely take a step when they arrive who leave smiling and walking.
“I remember one congenital heart disease patient I looked after who got called for a transplant at night. I went to theatre with him and watched the whole operation and actually held his damaged heart in my hands! That moment will stay with me forever.”
Laura joined Royal Brompton in 2014 on the 18-month rotation programme, but it didn’t take her long to realise that the paediatric high dependency unit (PHDU) was where she wanted to stay.
Laura looks after babies and children before or after surgery, many of whom have congenital heart disease.
“Some of them need non-invasive ventilation, and we have lots of cardiac babies who need tracheostomies because their condition has led to respiratory problems.
“Babies with tracheostomies can’t go on the ward and need constant monitoring.”
Many of her patients are in for months at a time and Laura gets to know the families well. To help staff find out about the children they’re caring for, Laura came up with the ‘all about me’ project, which is for children who are inpatients for three weeks or longer.
She puts together a folder containing information about the child, such as the family tree, and their likes and dislikes, which helps the nurses get to know the child quickly and provides continuity of care.
“It works really well. I’ve been presenting it at conferences, and lots of other trusts are interested in it.”
Laura advanced quickly into a band 7 sister role.
“I’d say to anyone interested in Royal Brompton, come and work here, the opportunities are here for you. People want you to progress, and it’s such a friendly place to work.”
Nimla started working at Royal Brompton in 2004 as a band 5 staff nurse and hasn’t looked back.
“When I started I was new to cardiac and respiratory but I was given lots of support. The education here is superb and includes in-house training and university courses.
"In 2007 I did a conversion course to become a paediatric nurse, and I’ve also done a high dependency course and cystic fibrosis course.”
The children Nimla cares for are aged 0 to 16 and have a range of cardiac and respiratory conditions including congenital heart disease, cystic fibrosis (CF) and bronchiectasis.
“I was always interested in working with kids. We get many long-term patients because of the nature of their conditions. I’ve known some of them since they were born so you build strong bonds with them.
"For example, CF patients generally come in every three months to have intravenous antibiotics, and congenital heart disease patients may come in for more surgery. It’s lovely seeing them again and rewarding seeing them going home.”
Nimla works closely with the paediatric intensive care unit (PICU) and the long-term ventilation team, which facilitates the use of ventilators for children at home.
She also works closely with the Trust’s school, which all of the school-age patients attend – if they’re too sick to leave their beds, the teachers come to the bedside.
“Rose Ward is my second home! The fact I’ve been here so long says it all. The hours are flexible, it’s a very good team and we support one another. I’m very happy here.”
Val McDonald sees her role as a lynchpin of cardiac theatres.
“The cardiac theatre sister pulls everyone together. People come to us if they need to know anything about theatre and we troubleshoot any problems.”
It is a busy job – theatre staff work a nine-and-a-half hour shift, four days a week.
“It can be non-stop from the time you arrive at work to going home. Getting through the day’s entire operating list can sometimes present a big challenge.
"The most rewarding part of the job is getting all the patients safely through theatres, and ensuring that theatre staff are happy.”
Motivation and passion, together with a chance to develop, are what keep Val and her colleagues focused.
“Theatre is a labour-intensive discipline so nurses need to be committed, but there’s plenty of scope for development because theatres have become more specialised.”
Val began her career working in the general surgery ward of a district hospital. She then developed her specialisation in cardiac surgery at Royal Brompton and went on to work elsewhere to gain wider experience.
She returned as a sister in 2006.
“The atmosphere, the buzz and the people drew me back to Royal Brompton and have kept me here."
Originally from Spain, Nerea came to the UK in 2000 and worked in several hospitals before joining Harefield in 2014.
As an anaesthetic nurse, Nerea works with the anaesthetist to prepare patients for surgery.
“Before any operation, I meet patients in the theatres' reception area, talk to them about their operation and check all the paperwork. I make sure everything is ready in the anaesthetic room before the patient is brought in – the most important thing is to be prepared for any emergency situation that could arise.
"When the patient arrives, I insert the IV lines to administer the anaesthetic, and the intubation tube is then put into the windpipe, which keeps the airways open.
“Once the patient is asleep, I help the anaesthetist put two lines into the neck – one to administer drugs, one for fluids.”
Nerea says that attention to detail is very important in her job, and you have to be very organised. She generally works on two cases a day, including heart and lung transplants.
“You see procedures here, such as transplants, that you won’t see anywhere else. That’s one of the great things about working here. Also, the mentors are fantastic.”
Harefield was the first centre in the UK to adopt the organ care system, or 'heart in a box', which enables a donor heart to beat outside the human body. Part of Nerea’s job is to go to other hospitals with a specialist team and ‘retrieve’ organs for transplant.
Nerea enjoys the satisfaction of seeing a seriously ill patient recover.
“It’s magical. Some of our patients have been sick for years, so it’s rewarding, for example, to see a patient who has been given new lungs doing very well.”
Sophie started at Royal Brompton in 1983 when she came to do a year-long cardiothoracic course.
She liked it so much that she applied for the job on the adult intensive care unit (AICU) and has been there ever since.
“I enjoy the acute management of patients and the teamwork. I also enjoy supporting and guiding new nurses. I’ve been here a long time and the hospital has been very good to me. It’s very flexible and family friendly.”
To work in AICU you need ward and HDU experience. You also need to understand how to operate all the different machines.
“It’s a high tech area. I’ve had lots of training over the years on new equipment.”
It’s one-to-one care most of the time and patient contact is very important to Sophie.
“We talk to them whether they’re unconscious or awake. If patients are unable to speak they communicate by other means, such as writing down messages.”
Sophie enjoys Patient Day when long-term patients come back to talk about their experiences on AICU.
“Their feedback is useful as it helps us to improve the way we deliver care. It’s also gratifying to see patients who were very ill-looking well again.”
Philippa would love to be a sister one day but for now, as a mum with two young children, working seven shifts a month in the high dependency unit (HDU) at Harefield suits her perfectly.
“It’s very flexible here and I love it. I worked in a general hospital in Watford for two years before coming to Harefield in 2008.
"I wanted to work in a specialist field like cardiology, and since I’ve been here I’ve completed a degree in cardiothoracic nursing as well as an HDU course at Bucks University. There’s a lot to learn.”
All patients in the HDU are level 2 patients who have had cardiac or thoracic surgery and 'stepped down' from ITU.
“It’s a nurse-led unit and we have a good working relationship with the doctors. The patients are critically ill, so the ratio is two patients to one nurse. Our work includes removing drains and lines from their bodies and monitoring them.”
Although most patients move to the wards after a few days, Philippa likes the fact that she’s got lots of time to speak to patients and their families.
“Patients often say it’s the best hospital they’ve been to. Seeing them happy is a reward in itself.”