From a young age Nurse Practitioner Myrian Balitian-Dill may have been destined to go into medicine.

She always enjoyed helping people and got satisfaction in seeing them get back to good health. It didn’t hurt that she was also born into a large family of medical professionals.

“My mom was one of 11 siblings and eight of them are physicians, so you can’t really say ‘I want to be a singer’,” she explained. “It’s kind of in the works for you to go into medicine early on, kind of genetic.”

Ms Balitian-Dill spoke to The Royal Gazette in honour of this week’s Healthy Heart Week. She is currently the only person serving as a Nurse Practitioner in Bermuda; and the only NP working in cardiology.

But if she had it her way there would be a lot more NPs on the Island.

NPs have advanced nursing degrees and extra training so they can diagnose and manage illnesses like diabetes, order and interpret tests and write prescriptions.

She said: “Those roles have historically been taken care of by a physician, so now there is an overlap of roles here.

“I only work in cardiology, but I also have to know when I have reached my limit and the cardiologist has to take over. When you have a complicated case for instance I will call [Director of Cardiology] Dr Sam Mir.”

Ms Balitian-Dill had been working as a nurse for over 20 years, when she decided to become an NP.

After King Edward VII Memorial Hospital developed its cardiac care programme, she started educating heart patients on their illness — and loved the role.

“What we found is when patients came back to us following the procedures they needed more support,” she said. “And some of the management for heart failure and other issues were guideline based and some patients weren’t doing that. Without having a cardiologist full time, I found it hard to make suggestions for their care.”

Now as an NP, Ms Balitian- Dill helps to transition heart failure patients to life outside the hospital so they can manage their disease.

“My role is to empower them with knowledge and they can start becoming engaged in their own care,” she said.

“I tell them about what is going on with their heart and what they need to do to stay out of hospital, like make sure they stay away from salt and take their medication,” she explained.

“The problem is they often have repeat hospitalisation and it can be preventable.

“I try to explain where their symptoms are coming from and explain what type of heart they have. Then I can talk about my role and what kinds of lifestyle changes are required in order for them to stay well because heart failure isn’t something you can cure, but it’s something you can control.”

She often tries to rally up the patient’s ‘team’ — their family, friends, people who live with them and go with them to get groceries — to coordinate home care.

But the real work has to be undertaken by the patient themselves.

“It’s not just ‘Here’s a pill, you can stay well for the rest of your life’,” Ms Balitian-Dill said. “You have to be mindful of how much salt you are eating and read labels and keep track of your weight. Even something like a 2lb weight gain is already a litre of fluid, so we have to instruct the patients on when they need to call us, so it’s about monitoring the condition.”

What makes her job challenging is that it’s often not just one health problem the patient is grappling with. In addition to heart disease, they may also have lung disease or diabetes, so you have to teach them to manage those together.

But she said there was plenty of rewards. “It’s about seeing patients get that ‘ah ha’ moment and finally get what is going on with their health.

“You see them get engaged in their own care. You are allowing them to take care of themselves and be empowered by that.

“I also get to work a lot with nurses on the ward so I like the team approach to healthcare, that’s another thing that’s rewarding to me.”

She said her job was very clinical based, meaning she’s not sitting at a desk for hours in the day.

“Eighty percent of my role is face to face contact with patients,” she said. “But it’s really a team effort. We all have a role in patient care, physicians usually diagnose and I can make sure that plan is implemented.”

According to Dr Mir, Ms Balitian-Dill has helped “tremendously” to improve patient care at the hospital and in the wider community.

He said she actively communicates on a weekly, and sometimes daily basis with heart failure patients to ensure they are doing well at home and helps to tackle health problems before they become life-threatening.

“Studies clearly show significant patient benefit, patient satisfaction, reduced rate of hospital readmission, and reduced healthcare costs when Nurse Practitioners are involved in management of congestive heart failure,” Dr Mir said. “Ms Dill is a shining example of the positive role that Nurse Practitioners can have in improving cardiac care on the Island.”