IAANMP: Meet the Members

Meet Norma Caples: RANP Heart Failure

Working as an Advanced Nurse Practitioner (ANP) in Heart Failure (HF) is both a privilege and a professional challenge. The dynamic and multifaceted nature of the role ensures that no two days are ever the same. My working day typically begins at 7.30am, a routine shaped by years of balancing patient care, research, and service development.

Service innovations and development

A major focus of my role has been leading service developments that enhance access, quality, and the patient experience for individuals living with HF.  One of the most impactful of these has been the establishment of an ANP-led HF diagnostic clinic for patients with NT-proBNP levels exceeding 2,000pg/mL.

Following the European Society of Cardiology (ESC) guidelines, these patients should be assessed promptly and undergo transthoracic echocardiography (TTE). Previously, such patients were placed on general cardiology waiting lists, with delays extending beyond two years in some instances. The newly implemented model ensures review within three weeks.

During their visit, patients receive a same-day TTE conducted by a cardiac physiologist, followed by my comprehensive clinical assessment and diagnosis. I provide education on HF self-care and initiate guideline-directed medical therapy where appropriate. Complex cases are discussed weekly with the cardiology consultant, and referrals are made to my clinical nurse specialist (CNS) colleagues for medication optimisation.

I also led the development of our home-based intravenous (IV) furosemide service in collaboration with community intervention teams. This service enables safe, timely decongestion in the home setting, supporting hospital avoidance, particularly for frail and vulnerable patients. The initiative was recognised nationally with a HSE Integrated Care Award in 2019.

In 2021, I introduced the first community-based IV iron service for HF patients in Ireland. The initial infusion was administered in Dungarvan Primary Care Centre, and since then, 176 patients have availed of this service. Patient feedback has been overwhelmingly positive, with many citing the convenience of receiving treatment closer to home, in conjunction with their scheduled HF clinic visit.

Clinical practice and oversight

Our HF service is supported by four experienced CNSs based at University Hospital Waterford and one CNS working within the integrated care hub. Ongoing service evaluation informs resource allocation and supports responsive, patient-centred care.

In addition to leading the ANP-led diagnostic clinic, I provide clinical oversight for patients with HF with preserved ejection fraction and those with severely reduced ejection fraction (≤20%). These patient cohorts often present with complex management needs, requiring comprehensive assessment, medication optimisation, and interdisciplinary collaboration to ensure safe, evidence-based care.

Interprofessional collaboration is central to daily practice, involving general practitioners, consultants, pharmacists, and integrated care teams. Effective communication is essential to reduce preventable admissions and ensure continuity of care. Increasingly, the focus of my role has extended toward strengthening community-based HF management and enabling more patients to receive high-quality care outside hospital settings.

Research, audit, and education

Audit and research are integrated into my practice, and I view them as essential to the ANP role. My current research focus is a PhD at Trinity College Dublin, funded through a scholarship. My project evaluates the effectiveness of a HF self-care mobile app compared with traditional paper logbooks for daily weight monitoring, a key component of HF self-care.

My research work consistently stems from a curiosity to explore how we can enhance patient care. Some of these findings have led to the development of our new service models, as well as presentations at national and international conferences and peer-reviewed publications. I believe that, as nurses, we are natural innovators; we problem-solve every day. Sharing our work is critical, as we often face similar challenges and can benefit from collective learning.

Leadership and professional involvement

I also believe that leadership and professional development are fundamental aspects of my ANP role. I was honoured to receive an Honorary Fellowship from the National Institute for Cardiovascular Prevention in 2023 and was named Irish Nurses Cardiovascular Association (INCA) Cardiovascular Nurse of the Year in 2024. 

I have served as Lead Nurse for the Irish National Heart Failure Programme and the National Heart Programme. I am a former President of both the Irish Association of Heart Failure Nurses and the INCA. I continue to contribute to the Irish National Heart Programme, the Irish Heart Foundation, and European-level cardiovascular initiatives through the Association of Cardiovascular Nursing and Allied Professions (ACNAP) and the European Association of Preventive Cardiology.

It is vital to engage with our national professional organisations, including INCA for cardiovascular nursing and the IAANMP, as well as European associations such as ACNAP, the European Society of Cardiology arm for nurses and allied professionals. Being part of these associations keeps us at the forefront of evidence-based practice, enables us to influence policy, and helps advance our professional standards through shared learning and collaboration.

Closing reflections

My day typically concludes around 18.30. Despite its intensity, working as an ANP in HF remains profoundly rewarding. Nursing has taken me on an incredible journey, from working with inspiring colleagues to collaborating on national and international platforms. While I am always honoured when our work is recognised, it consistently begins with the same question: “How can we improve this for the patient?”.

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