Skip to main content

We use small files called cookies to help us improve your experience on this website and to provide services like web chat. We also use cookies to measure the effectiveness of public health campaigns and understand how people use the website.

Read our cookies policy to find out more about cookies and how we use them.


Information for health care workers is available on Coronavirus guidance documents are available on

UHL Advanced Nurse Practitioners record world-first for stroke and syncope patients

Nora & Sheila
ANPs Nora Cunningham and Sheila Ryan pictured after completion of their first loop recorder implantation procedure at UHL in mid-November: “It’s great to be able to play a key role in the journey of patients through University Hospital Limerick.”

TWO advanced nurse practitioners (ANPs) at University Hospital Limerick (UHL) have become the world’s first nursing team to carry out the surgical implant of a tiny monitor enabling stroke or syncope (sudden temporary loss of consciousness) patients to have their heart rate and rhythm monitored from their own homes.

The UHL ANP Older Person team of Nora Cunningham and Sheila Ryan are among the first nurses qualified to conduct the procedure, which previously had to be performed by cardiologists. Nora and Sheila have spent most of the past two years researching and training, after they proposed that a nurse-led service could relieve pressures on cardiologists in the hospital’s busy cardiology department and significant reduce wait times for patients in need of the implant.

With only one other cardiology nurse delivering the service in Ireland, Sheila is the only syncope nurse in the country qualified to carry out the implantation, and Nora becomes the world’s only stroke nurse qualified in the procedure. Together, they are believed to be the only qualified nursing team that can perform the procedure.

In addition to the benefits of the implantable loop recorder device, which provides data on a patient’s heart rate and rhythm over an extended period, the pioneering ANP team is showing how nurse-led teams can enhance the patient experience and improve efficiency of service delivery at UHL.

For Nora and Sheila, the important achievement is what their qualification can deliver for patients.

Nora said: “I’m delighted to be able to lead out on this service and to be the first Stroke Nurse in the world to take on this role. It will facilitate a fantastic service for patients at UHL, and it represents the future for our health service through innovation and the passion for change. None of this would have been possible without the tremendous support of Senior Nurse management and our Medical Consultants.”

Sheila added: “As ANPs, it’s great to be able to play a key role in the journey of patients through University Hospital Limerick.”

The implantable loop recorder monitors a patient’s heart rate and rhythm for up to three years, and provides the most reliable picture of the health of patients who have experienced strokes or loss of consciousness.

Without such data, clinicians are unable to reliably determine the cause of a stroke or a loss of consciousness in patients. Extended monitoring enables the cause to be determined and treated effectively.

Patients with the implant are monitored at home, and can contact the nursing team for advice if they experience symptoms. And if an abnormal rhythm is detected, nurses will contact the patient to organise a management and treatment plan.

However until now, the implant procedure was completed in the cardiology department at the hospital, and so the Stroke and Syncope Service at UHL could do nothing to influence waiting lists for the implant.

Due to competing demands on cardiologists from within the busy cardiology department at UHL, patients were waiting for up to six months to have the implant procedure.

Implant Procedure

Now, thanks to the breakthrough of establishing a nurse-led service within Stroke & Syncope, Nora and Sheila have significantly enhanced this particular aspect of the patient experience at UHL.

Patients who require the service will have more timely access to it, as well as benefiting from the reassurances that come from treatment and care provided within their homes.

Mairead Cowan, Director of Nursing for Medicine at UL Hospitals Group, said: “I’m so proud of Nora and Sheila and their fantastic achievement. This is a very exciting example of the transformations and innovations in patient care that have been made possible through investment in Advanced Nurse Practitioners at our hospitals.”