Kristin Kociol, David Molway and Elaine Shea

When a patient called the Brigham Advanced Cardiac Disease Clinic with reports of edema in his ankles and calves while traveling, Kristin Kociol, BSN, RN, recognized the symptoms as early signs of heart failure exacerbation.

She collaborated with David Molway, MSN, RN, CNP, to initiate the center’s evidence-based protocol for oral diuretics.

The protocol authorizes nurses to titrate oral diuretics to support and expedite the treatment of patients requiring routine management of heart failure.

Kociol followed the protocol and made the nursing care decision to double the patient’s oral diuretic and schedule a follow-up with him three days later, with Molway’s support.

During the patient’s follow-up appointment, Elaine Shea, BA, RN, CHFN, found that the symptoms had improved and no further intervention was needed at that time.

Within the full scope of their practice, Kociol and Shea demonstrated authority and autonomy in making nursing care decisions that resolved the patient’s symptoms.

Within the Center for Advanced Heart Disease, the care of heart failure patients requires close collaboration among nurses, nurse practitioners and physicians.

Why it’s Magnet: Magnet requires an example of clinical nurses having the authority and freedom to make nursing care decisions within the full scope of their practice as part of the Exemplary Professional Practice component (EP12) of the Magnet model.