Brandi Holcomb, RN, MSN, APRN, CCRN, AGACNP-BC

By Erin Flynn Jay

Brandi Holcomb decided to become an adult-gero acute care nurse practitioner (AGACNP) because she wanted to elevate her practice as a registered nurse. She was ready for the next level of advanced practice nursing.

Now as a board-certified AGACNP for two and a half years, Holcomb chose to certify with the ANCC. The AACN also certifies adult-gero acute care nurse practitioners.

The most difficult part of becoming certified for Holcomb was the actual preparation. The amount of information is so vast. She used an audio review course on CD, which she purchased one year prior to graduation. Holcomb listened to the CDs every day. She also participated in a live review course.

Holcomb tested almost immediately after she completed the review course. This was beneficial because the pertinent information was fresh in her mind. She said there was nothing she wished she did differently to prepare for the exam. The process involved graduation, review course, certification, State Board of Texas licensure as an APRN, and then credentialing with the facility. The process took approximately 2 months from beginning to end.

Holcomb felt well prepared after the completion of her AGACNP program at the University of Texas at El Paso under the direction of Dr. Kathleen Cox. Then the review was just that: a good review of her program.

With recertification not until 2021, she has been diligent with upkeep of her continuing medical education (CME) and plans to recertify with CME credits.

Holcomb works in an extremely busy cardiothoracic surgical practice in a community hospital in Tyler, Texas. Her daily census of cardiothoracic surgical patients ranges from 20 to 35 patients. She primarily manages patients in cardiovascular intensive care unit (CVICU) and other patient units throughout the facility and is also responsible for preoperative admissions and discharges. The surgical group is collaborative, sharing the workload between the cardiovascular (CV) surgeons, nurse practitioners, and physician assistants.

Her typical day begins at 4:00 am. She reviews charts remotely prior to arrival in the CVICU at 6:00 am for rounds with her three cardiothoracic surgeon colleagues. After rounds, she discharges patients that are ready for discharge. “These early discharges allow for seamless patient flow and prepare for admissions and surgical recovery patients. I participate in interdisciplinary rounding with the nursing staff, case management and pharmacy on every patient in the CVICU regardless of if they are on my surgical service,” said Holcomb. “I provide advanced practice oversight of the CVICU and assist with needs or barriers for each of the patients. I assist in communication amongst disciplines and the different service lines. I also serve as a mentor/educator to the CVICU nursing staff.”

Holcomb’s typical day is 12 to 14 hours in length, four days a week. Her hospital specializes in cardiovascular care and consists of CVICU, telemetry, cardiac observation/vascular, and pulmonary intermediate care IMC. She serves as one of the advanced practice clinicians to the heart hospital and responds to emergency situations as they arise.

Holcomb’s favorite part of being an AGACNP is continuity of patient care. “I have the opportunity to provide care to a very complex cardiothoracic surgical patient population and watch them get well and regain quality of life. These are ill patients with multiple comorbidities and on occasion illness prevails. I have had the privilege of caring for these individuals and their families,” she said.

Holcomb feels that having a vast experience as a critical care registered nurse prior to becoming an advanced practice nurse has afforded her the ability to provide quality and compassionate care.

Holcomb is currently pursuing a doctor of nursing practice (DNP) degree at the University of Texas at Arlington. She is also an active member of the Texas Nurse Practitioner Association (TNP), American Association of Critical-Care Nurses (AACN), and the Society of Thoracic Surgeons (STS).

The patient experience in her unit is unique. “We were afforded an awesome monetary gift from a local family that allowed for the additional construction of a freestanding heart hospital in Tyler, Texas. The cardiothoracic patient population experience is unique in that we operate functionally in the universal bed model,” said Holcomb. This means patients present to registration the day of procedure and are then escorted to a private patient suite where they undergo preoperative preparation and optimization and are cared for in one place throughout the process from admission to discharge.

Once checked in, patients are greeted by CVICU nursing staff and prepared for surgery. The anesthesia and CV operating room staff meet the patient and family before transfer to the CV operating suite. Immediate post-operative recovery is performed in the private patient suite with highly skilled and trained registered nursing and respiratory staff. “This care is overseen by the CT surgeon, myself and my advanced practice colleagues. The average length of stay is four to five days,” concluded Holcomb. “Our patients are discharged from the same private patient suite. The episodes and levels of care are brought to the patient in a concierge type of manner. Patient-centered care is what this model is all about. The nursing staff is trained to care for all phases of cardiac care.”

Holcomb assisted in the implementation of the universal bed model as a CVICU RN and now assists in the oversight as a board certified AGACNP. This is an accomplishment that she is very proud of.

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