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Nurse Profiles

Critical Care Nurse Highlights Distinguished Career

From chief flight nurse to a leader in her field, she shows how far nurses can journey in their careers.

By Linda Childers
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W
hen Anne Alexandrov, PhD, RN, CCRN, ANVP-BC, NVRN-BC, FAAN, first started her nursing career, she never envisioned one day becoming a leading international authority on acute stroke nursing.
A professor of nursing and neurology at the University of Tennessee Health Sciences Center (UTHSC), Alexandrov is also the chief nurse practitioner of the UTHSC Mobile Stroke Unit. This year, the American Association of Critical Care Nurses (AACN) named Alexandrov as their 2022 Distinguished Research Lecturer. She will deliver the Distinguished Research Lecture during AACN’s National Teaching Institute and Critical Care Exposition, set for May 15-18 in Houston. “I was a diploma graduate when I first started my nursing career working in critical care and flight nursing in Washington, D.C., before moving to Houston,” she said. In Texas, Alexandrov entered the stroke care field purely by chance in 1991. “I was asked by my service line director to oversee patient management, including the administration of alteplase recombinant tissue plasminogen activator (rt-PA) or placebo in the randomized, double-blind, placebo-controlled National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study at our practice site in Houston,” Alexandrov said.
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Through the study, Alexandrov met Jim Grotta, MD, a neurologist at the University of Texas (UT) and now Director of Stroke Research, Clinical Institute for Research and Innovation, Memorial-Hermann-Texas Medical Center, whom she credits as being one of the most important mentors in her career. “Dr. Grotta welcomed my assistance with the NINDS rt-PA Stroke Study, which proved to be a phenomenal experience,” Alexandrov said. As the study was underway, she finished her master’s degree in critical care and emergency nursing, then continued on to complete her PhD focusing on integrated systemic and intracranial hemodynamics. Grotta also mentored Alexandrov during completion of her PhD and later hired her as an assistant professor of neurology at UT-Houston. “Jim didn’t see my nursing background as a limitation in what I could do in medicine; he believed there was no ceiling on the knowledge I could attain.” Alexandrov said being in the right place at the right time and a willingness to “walk through doors that happened to open” were pivotal in her career. “My doctoral education and training focused on the hemodynamics of large vessel ischemic stroke,” she said. “I had read about the work Dr. Andrei Alexandrov [whom she would later marry] was doing in Canada using transcranial Doppler (TCD), and to my amazement, Dr. Grotta told me he had recently hired him. So, just as I was struggling to learn TCD to measure blood flow in my subjects, Andrei who is the leading international expert in TCD and carotid duplex imaging, joined the team and became another important mentor in my career.” She credits both of them with developing her as a clinical trialist and helping open doors that allowed her to pursue research traditionally beyond the preparation of nurses in the 1990s and early 2000s. “First, Dr. Grotta made me a fellow in his physician-only vascular neurology fellowship, the first nurse ever to be admitted to such a program and one of the few programs available in the world to train neurologists in acute stroke at that time,” said Alexandrov. “Second, Andrei enrolled me as the first nurse to complete a neurosonology fellowship. Combined with my doctoral education, this additional clinical education and training provided me with the ability to further my knowledge about acute ischemic stroke.” As an advanced practice provider (APP), Alexandrov was credentialed to independently diagnose stroke and prescribe alteplase rt-PA, which she says was unheard of for an APP to do in the early 2000s.
Wanting to open doors for more advanced practice nurses, Alexandrov developed the NET SMART (Neurovascular Education and Training Acute Stroke Management and Reperfusion Therapies) post-graduate fellowship training program for advanced practice nurses in 2008. Through this hybrid distance-accessible program, she has mentored over 100 APRNs from the U.S. and across the globe, who are now working as leaders in acute stroke care and improving clinical practice settings and overall acute stroke care systems. Currently, Alexandrov is the principal investigator of a multi-site clinical trial entitled ZerO Degree head positioning In Acute Ischemic Stroke (ZODIAC). Alexandrov received funding for the five-year project from the National Institutes of Health (NIH) to study how head-of-bed positioning affects stroke symptoms and clinical outcomes in the pre-thrombectomy period. “It has been well-documented that acute ischemic stroke patients who still have viable brain tissue often experience clinical deterioration when the head of their bed is elevated to 30 degrees or higher,” said Alexandrov. “Our pilot work and other small studies show that zero-degree head-of-bed positioning improves blood flow in patients with hyperacute large artery strokes and this in turn can produce clinical improvement of stroke symptoms.” Ultimately, Alexandrov would like to see her research support use of a simple nursing practice that could improve blood flow in large vessel ischemic stroke by laying a patient flat prior to thrombectomy and thus preventing their neurological condition from worsening. “It can often take two to three hours for a patient to be transferred to a stroke facility and every minute in which reperfusion is delayed kills on average 1.9 million neurons,” said Alexandrov. “Our hope is our research will allow nurses to perform an innovative adjunct rescue procedure where they position the patient with HOB at zero-degrees and administer rt-PA to eligible patients to improve blood flow and support brain viability until they can undergo thrombectomy.”
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Alexandrov said being in the right place at the right time and a willingness to “walk through doors that happened to open” were pivotal in her career.
ABOUT THE AUTHOR
Linda Childers is a freelance writer.