Laura, NP

Laura's Career Journey at MGH

Tell us about yourself!

Hi, my name is Laura Istanboulian and I am a Nurse Practitioner (NP) and Director of the Prolonged and Long-Term Ventilation (PLTV) Centre of Excellence. I have been here at Michael Garron Hospital (MGH) for about 10 years.

What motivated you to join MGH?I was motivated to join MGH while I was completing my Masters of Nursing Practitioner program and working as an Intensive Care Unit nurse at another hospital in Toronto. MGH has a unique and specialized program for the care of patients and families with prolonged ventilation, and when I saw a posting for an NP for this program I knew this was exactly the role for me. On a personal note, my partner and I both delivered our kids here at MGH, and so this hospital holds special significance for our family.

What types of learning, mentorship or professional development opportunities have you had the opportunity to pursue since joining MGH?Over the last 10 years I have had the opportunity to participate in a number of professional development opportunities – both within MGH and at the University of Toronto (U of T). Training sessions include Emotional Intelligence and Advance Care Planning Facilitator Skills. I have also had the opportunity to participate in the Emerging Leaders Program.

Certificate programs I have pursued through my career at MGH include Living Well with chronic obstructive pulmonary disease in Montreal and the Training Enhancement in Applied Counselling and Health (TEACH) smoking cessation program, Managing Urgent Clinical Issues, and End of Life Care Management for Nurse Practitioners at the University of Toronto. Most notably I have started my PhD in Nursing at U of T, hoping to graduate by next year.

I have been fortunate to have a multitude of mentorship opportunities – both clinically and in research methods. These opportunities include clinical mentorship from the physicians in the Respirology division (Dr. Fraser, Dr. Kargel, Dr. Bain, Dr. Vagaon, Dr. Walsh and formerly, Dr. Skrastins) and Dr. Abrahamson. This mentorship has guided me from being a novice NP to a clinician with a specialty focus in chronic respiratory diseases, self-management, smoking cessation and the care of patients with prolonged ventilation. I have been mentored by our bioethicist, Lorrie Hamilton, in having difficult goals of care conversations, and by Dr. Workentin in participating in medical assistance in dying (MAID). I’ve also had a research mentorship by Dr. Fraser and Dr. Louise Rose. This changed my world enabling entry and success during my PhD program.
Can you share your career path at MGH?

2011: Hired as RN to Respirology – prolonged ventilation and weaning program.

2012: Completed NP program and RN-EC exam. NP prolonged ventilation and weaning program, Smoking Cessation, Chronic Respiratory Disease.

2021: PLTV Nurse Practitioner Director Role. The NP Director works complementary to the medical director for the PLTV to ensure we provide safe and high-quality care to patients and families with prolonged and long-term ventilation. The PLTV at MGH is a provincial leader for this patient population. Within MGH the role, which is clinically based, will focus on patient transitions, outcomes, and research and quality improvement. I work closely with the leadership team and our dedicated operational directors as we work hard to expand the program and its specialized care team.

The PLTV program of research focuses on the care priorities of patients and families with prolonged critical illness, uses co-design methods and is founded in community-based research. Nurse-physician co-leadership of this program is an innovative step for MGH and highlights the value MGH places on nurse leadership and growth.

What motivates/inspires you?I am inspired by my patients and my colleagues who provide specialty care for patients with prolonged and long-term ventilation. Having worked in the ICU, being part of a team that helps to recover a critically ill patient (and their family) is extremely meaningful to me. The nurses, physicians and Interprofessional team that wrap their services around this patient population understand the unique physical, emotional, cognitive and spiritual needs they have to promote their recovery. Defining health with patients and families as they navigate their healthcare journey, understanding what motivates them, and then working together to mitigate risks and celebrate successes makes me love my ‘job’.

During the pandemic we were able to create ICU capacity for hundreds of critically ill patients and be part of the recovery journey for many patients and their families. The immense successes of this program helped to balance the tragedies of COVID for me and I am sure many of my colleagues.

Finally, MGH has a strong wellness culture. Healthcare is saturated in fractured perceptions and redefined moments of health. The efforts made by MGH to mitigate burnout also inspire me to come to work each day. These include a strong community built on trust and offering programs that support physical, emotional and spiritual recovery.

If you could share one memorable moment from your time at MGH, what stands out to you?There are so many memorable moments that I can share, but a recent encounter with a patient’s family member stands out the most. Prior to admission, a family member of the patient cold called me. She was uncertain about transferring her loved one out of ICU and into our program. The patient had endured a prolonged and tumultuous critical illness and her family member wanted to understand what we did here at MGH.

These calls are my favorite – since I am able to talk at length about my favorite subject – the care of patients and families with prolonged ventilation and persistent critical illness.

We talked for about half an hour. She asked about the program, our protocols, our successes and how we mitigate risk. At the end of the conversation, she asked me what my role was in the program. When I told her I was an NP she said the deal was sealed. She said that any organization that understood the needs of patients and families who have experienced prolonged ICU admission to the extent that they would welcome and integrate the NP role was one she would trust her loved one with.

This was an important moment for me as a clinician and as an MGH employee. Since then this patient has been admitted and under the care of our excellent team, succeeded in achieving most of her recovery goals.

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