AACN News—September 1999—Association News

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Vol. 16, No. 9, SEPTEMBER 1999


Nursing Organizations Respond to Challenge to Improve End-of-Life Care

Representatives of 23 organizations met in June 1999 at George Mason University, Fairfax, Va., to draft an agenda for the nursing profession to improve end-of-life care.

The meeting was organized by AACN, under a grant from the Soros Foundation, Open Society Institute, Project on Death in America, in response to the social mandate for change and the challenges issued by the Institute of Medicine and the U.S. Supreme Court, among others. The nursing organizations involved represent a combined membership of more than 700,000.

Leading the conference were Cindy Hylton Rushton, RN, DNSc, FAAN, of Johns Hopkins University, Baltimore, Md.; Colleen Scanlon, RN, JD, of Catholic Health Initiatives, Portland, Ore.; and Betty R. Ferrell, RN, PhD, FAAN, of City of Hope National Medical Center, Duarte, Calif.

The three-day meeting was facilitated by the Department of Communications at George Mason University. An innovative interactive management method was used to tabulate the group process and achieve consensus on goals and priorities.

Following are the priorities established by the group:

• Developing nationally recognized nursing standards for care of the dying
• Improving end-of-life care content in undergraduate and graduate education
• Increasing nursing research on end-of-life care
• Increasing nursing efforts to remove regulatory and reimbursement barriers to comprehensive palliative care services
• Improving mechanisms for sharing information on end-of-life care between nursing organizations and individual nurses
• Making the relief of pain a priority in improved end-of-life care

Nurses, who represent the largest group of healthcare professionals, are intimately involved in all clinical settings in caring for dying patients. The nursing organizations that attended the meeting recognize the need for nursing’s professional involvement to meet the challenges for better care at the end of life and for collaboration with other professions.

The participating organizations, individually and collectively, will now pursue activities to address gaps in care of the dying.

Other organizations that participated in the meeting are the Academy of Medical Surgical Nurses, American Society of Pain Management Nurses, American Academy of Nursing, American Academy of Nurse Practitioners, American Association of Colleges of Nursing, American Association of Legal Nurse Consultants, American Association of Nurse Anesthetists, American Nurses Association, American Nurses Credentialing Center, American Society of Ophthalmic Registered Nurses, Association of Nurses in AIDS Care, Association of periOperative Registered Nurses, Association of Pediatric Oncology Nurses, Association of Rehabilitation Nurses, Hospice and Palliative Nurses Association, National Association of Clinical Nurse Specialists, National Institute on Aging, National Institutes of Health, National Institute of Nursing Research, National Student Nurses Association, Oncology Nursing Society, Project on Death in America, Robert Wood Johnson Foundation, Sigma Theta Tau, International and Society of Urologic Nurses and Associates.

For more information about this effort, contact Barbara Mayer, RN, MS, director of professional development at AACN, (800) 809-2273, ext. 342.

Work Group Focuses on Ethics Issues

In addition to participating in the end-of-life consortium, AACN has an Ethics Integration Work Group. This volunteer group will identify an ethics agenda for AACN and resources that will assist nurses in dealing with ethics issues.

Meet the Board

The elected members of the AACN Board of Directors make valuable contributions to the association and to critical care nursing practice. They represent diverse perspectives and backgrounds. Throughout this fiscal year, members will have a chance to get to know these national leaders better through this new “Meet Your Board” feature. Each has responded to a set of questions about their practice and volunteer experiences.

Nancy L. Munro
RN, MN, CCRN, ACNP
Director
Munro is an acute care nurse practitioner in the cardiovascular recovery room at Surgical Critical Care Services, Washington Hospital Center, Washington, D.C.

Q:What attracted you to the practice of critical care nursing?

A:I think I was attracted because of some of my “retentive” personality characteristics, which love to deal with detail. Many critical care nurses have a similar perspective. I wanted to work in critical care since I graduated from school, and I have never regretted my decision. Caring for critically ill patients and then watching those patients return to everyday life makes me feel like I make a difference.

Q:What is the most rewarding aspect of your practice?

A:Two aspects are very rewarding for me. One is the aspect of helping people return to a life pattern that will hopefully improve their lifestyle. The other is helping develop other nurses. I am very proud of the nurses with whom I have worked and trained over the years, because I can see that they make a difference in other people’s lives. Most importantly, these nurses believe that they do “make a difference,” even in these difficult times in healthcare.

Q:What motivated you to commit your time to volunteer service at the national level?

A:Through volunteer service, I believe I am making a contribution to nursing outside of my job. AACN is a great resource for professional development and, through my participation at the national level, I believe that I can help strengthen this resource and help association members use their talents, which will promote the longevity of AACN. I plan to continue to use AACN resources long after I complete my national service. In addition, I am having a great time!

Q:What personal rewards do you receive because of your volunteer service?

A:The best aspect of volunteer activity is the relationships and friendships that have enriched my life. Describing how wonderful an experience this position has been is difficult. Simply being able to get to know people from all over the country has made me a different and better person, because I have gained perspectives on issues that I probably would not have considered in the past. However, this is not a transient experience, because some of these friendships will last a lifetime. The best way for me to summarize my experience is to say that AACN’s vision is my personal vision, and this volunteer opportunity has helped me live it.

Elizabeth M. Nolan
RN, MS, CS
Treasurer

Nolan is a clinical nurse specialist in the University Hospital/Heart Care Program at the University of Michigan Health System, Ann Arbor, Mich.

Q:What attracted you to the practice of critical care nursing?

A:Actually, the general medicine unit where I worked was converted to a cardiac care and step-down unit in the late 1960s. My “critical care orientation” consisted of a few days with the nurse manager going over the manual (Meltzer and Pinneo). The work was challenging, and I had the opportunity to learn and apply new skills, including arrhythmia interpretation and defibrillation. The CCU also allowed for more patient-centered practice, with time to teach patients and provide them emotional support, whereas, nursing on the general medicine unit often felt like “beat the clock.”

Q:What is the most rewarding aspect of your practice?

A:Being part of a team of committed professionals, who put patients and families first. In evaluating our cardiovascular ICU Bereavement Program as well as distributing the Critical Care Family Needs Inventory, I have been reading comments by families about the kindnesses provided by the staff as well as about the staff’s skills and knowledge. This experience has been a reminder for me of the contribution these critical care nurses make to patients and families.

Q:What motivated you to commit your time to volunteer service at the national level?

A:My initial nursing education was in a diploma program. Although we were encouraged to be active in a professional organization, as a younger nurse, I did not feel connected to my nursing organization or see the benefit of involvement. When I returned to school to get a bachelor of science in nursing degree, I once again heard this message about being involved. It was at about this time that AACN was established. Its programs and publications were targeted to a thinking, clinical nurse, and the information was timely and relevant. After attending my first National Teaching Institute, I was hooked! AACN is a great organization and I wanted to be a part of it.

Some colleagues and I formed an AACN chapter in Ann Arbor, Mich. My involvement at the local level made me more aware of opportunities to contribute at the national level. Although volunteering requires a time commitment, whether at the local or national level, I have always felt that I have gained more from participating than I contributed. AACN resources are available to all members, but participation makes you more aware of these resources.

I have been able to apply skills I learned from my AACN activities to my job. Because my boss recognizes that I have brought ideas and skills to my work, which I learned via AACN, I was able to negotiate the time necessary to serve in my national board position.

Q:What personal rewards do you receive because of your volunteer service?

A:I am reminded of the expression “think globally, act locally.” Trying to make a difference in healthcare seems overwhelming for one person. Being a part of a 65,000-member association enhances the chance of having an impact.
As an AACN volunteer, you gain a broader perspective and a larger network of colleagues. You have the opportunity to talk to nurses who often are facing the same challenges you are. In addition, I am familiar with the myriad resources to meet clinical, education and research needs, because I have been able to work closely with the AACN national office staff that produces the publications, educational programs and certification programs.

Denise Thornby
RN, MS
President-Elect

Thornby is a nurse educator in the Education & Professional Development Department at Virginia Commonwealth University, Medical College of Virginia Hospitals, in Richmond, Va.

Q:What attracted you to the practice of critical care nursing?

A:I graduated in the mid-'70s, when there was a significant nursing shortage. I wanted to work at an academic medical center, and thought obstetrics-gynecology would be fun, but there were no open positions. I inquired about positions in the recovery room, because I had enjoyed that clinical experience while in school. Again, there were no open positions. At the hospital where I had worked while in school, I had admired the nurses who knew how to take care of very sick patients. This small hospital had no ICU, only a room. I was told there were positions available in the ICU. I was pleased to be employed, but a little concerned about being an ICU nurse. I had only seen, not touched or cared for, a ventilator patient.

So, I ended up in critical care by luck. Although naive, I was a motivated new graduate who fell in love with critical care nursing and caring for adult and pediatric cardiac surgery patients. I stayed in that unit for eight years, eventually becoming the nurse clinician-education coordinator. It was quite a journey for someone who at first wasn’t even sure what types of patients were cared for in a cardiac surgery ICU.

Q:What is the most rewarding aspect of your practice?

A:As a clinician for many years, I found caring for very sick, challenging patients—especially pediatric cardiac surgery patients—most rewarding. As an educator, I have found a great deal of satisfaction in helping new staff become competent and comfortable in their practice. I also have enjoyed setting standards and influencing how we care for patients. I planned to be a clinical nurse specialist when I finished graduate school, but again there were no positions available. Instead, I became the nurse manager in a surgery trauma ICU. This was a challenging but rewarding position, because I now could influence the patient care environment. I also found coaching and mentoring extremely rewarding. In addition, I served in a director-level position, where I had the opportunity to coach and influence managers to create an optimal environment within their units.

Today, I am working in my hospital’s Education & Professional Development Department, where I work with managers and staff to create healing, caring patient care environments. In this position, I believe I can make the biggest difference in working with staff and managers to create effective teams as well as in promoting AACN’s vision. Professional renewal activities and coaching are a current focus and, perhaps, the most personally rewarding aspect of my job, because I help nurses and their managers deal more effectively with changes and stressors so that they, in turn, can make their optimal contribution.

Although I no longer provide care for patients at the bedside, I know I make my optimal contribution by assisting and supporting other nurses so that they can.

QvWhat motivated you to commit your time to volunteer service at the national level?

A:I became involved in my local chapter after I was invited by a member to participate. This affiliation was an important turn in my career, because I acquired skills such as conducting an educational program, leading a committee, working with a group to lead the chapter, learning to use the computer and dealing with conflicts. I served my chapter in a variety of roles, including two terms as president.
When I saw a call for volunteers in AACN News for the Chapter Coordination Committee, I thought I had something to offer. I consider chapters a very important part of AACN and have always been committed to their support.

Q:What personal rewards do you receive because of your volunteer service?

AThis is difficult to describe. The rewards are many, including:
• Learning and growing in my leadership, speaking and writing skills
• Working with people who share a common vision and values
• Having the opportunity to meet people from all over the country
• Participating in the work of our association, and seeing my part in a project or initiative
• Having the opportunity to coach and mentor others
• Making new friends and establishing relationships that will last a lifetime
I have found AACN to be an oasis in times of personal and professional struggle. Being part of something that is positive, future-focused and principle-centered has helped sustain me. I appreciate the opportunity to give back to people and to an association that has given me so much.

South American Tour an Opportunity to Exchange Practice Information

AACN will sponsor an international study tour to South America from September 20 to 30, 2000. Buenos Aires, Argentina, and Rio de Janeiro, Brazil, are included on the itinerary.

Professional visits will include tours of healthcare facilities as well as ample opportunity to exchange clinical practice information with colleagues in both countries. The professional program is expected to provide up to 14 contact hours of continuing education credit.

Cost for the tour is $2,895 per person for a shared twin room. For single occupancy accommodations, $695 will be added.

Included in the cost is round trip airfare from Kennedy Airport in New York, New York, or Miami International Airport in Florida. Also included are eight nights of hotel accommodations; breakfast each day; and four lunches. In addition, organized sightseeing tours are planned in Buenos Aires and Rio de Janeiro as well as to Iguazu Falls, where Argentina, Brazil and Paraguay converge.

For more information about the South America Study Tour, contact Interport, Ltd., 510 31st St. Suite G, Newport Beach, CA 92663; phone, (949) 673-3596; fax, (949) 673-1007.

Public Policy Update

AACN engages in a variety of activities to address and protect the needs and interests of its members and to ensure that AACN positively contributes to advancing the nursing profession. Following is a summary of the types of activities in which AACN has recently been involved:
• Letters were sent to U.S. Sens. Barbara Boxer (Calif.) and Diane Feinstein (Calif.) asking that a significant portion of the tobacco settlement funds be returned to the states for use in tobacco prevention programs.
• Letters were sent to President Clinton and to U.S. Reps. Ron Packard (Calif.) and Christopher Cox (Calif.) urging them to oppose any amendments to the supplemental appropriations bill that would waive the federal share of the tobacco settlement to the states without requiring that states spend a significant portion on tobacco control.
• Signed Campaign for Tobacco-Free Kids—AMICUS Brief to U.S. Supreme Court in support of Federal Drug Administration (FDA) jurisdiction over tobacco products.
• Signed on to Campaign for Tobacco-Free Kids “Fix It” ad in support of using tobacco settlement funds for tobacco prevention.

• Letters were e-mailed or faxed to Boxer and Feinstein as well as to U.S. Reps. Packard and Randy Cunningham (Calif.) requesting their support of the “Dear Colleague” letter by U.S. Sen. Michael Crapo (Idaho), which opposes the proposed tax on association investment income.
• Signed on as an organization to support the Coalition for Nursing Research Funding (CNRF) for the 106th Congress as well as the CNRF Appropriations Subcommittee Letter advocating $90.2 million for the National Institute for Nursing Research (NINR).
• Signed letters from the Coalition for Consumer Health & Safety in support of bicycle helmet legislation in Maryland, Washington, D.C., and North Carolina.
• Signed Coalition for Consumer Health & Safety Transportation Committee letter to U.S. Sens. John McCain (Ariz.) and Ernest Hollings (S.C.), chairman and ranking member, respectively, of the Committee on Commerce, Science and Transportation, in support of the transfer of the Office of Motor Carriers (OMC) within the Department of Transportation from the Federal Highway Administration (FHWA) to the National Highway Traffic Safety Administration (NHTSA).

• Signed letters as a member of the ComCARE Alliance supporting S.B. 800, the Wireless Communications and Public Safety Act of 1999. Letters went to the Senate Commerce Committee and to the cosponsors.
• Signed statement supporting $17 million for the Emergency Medical Services for Children (EMSC) grant program for FY2000.

Liaisons
• DuAnne Foster Edwards, RN, MN, CS, will represent AACN on the Health Care Financing Administration (HCFA) Organ Donation Panel to develop hospital guidelines for organ donation.
• Darlene Bradley, RN, MSN, MA, CCRN, CEN, will represent AACN on the American Heart Association task force to revise the “Guidelines for CPR and Emergency cardiovascular care.”
• AACN Executive Director Phyllis Reading, RN, MN, will represent AACN on the Coalition for Women with Heart Disease Advisory Board.
• AACN Public Policy Specialist Janice Weber, RN, MSN, CCRN, will serve on the American Society of Association Executives (ASAE) FY2000 Public Policy Committee.

For-Profit Healthcare System Driven by Cost

The inclusion of shareholders in the healthcare delivery system has shifted the emphasis from access and quality of care issues to cost issues, Barbara Safriet, associate dean at the Yale Law School in New Haven, Conn., pointed out in a special presentation titled “Health Care Regulation and the Critical Care Nurse” at the recent National Teaching Institute™ in New Orleans, La. The session was cosponsored by Atrium Medical Corporation and GE Marquette Medical Systems.

According to Safriet, a tremendous amount of waste, inefficiency and fraud existed in the not-for-profit system long before its conversion to a for-profit system.

“The major difference is that we now have different stakeholders,” she said. “We now have investors who expect a return on their investment.”

Instead of profits going toward patient care, research or development of new treatments, they are being returned to shareholders in dividends.

Although nursing is normally listed on the expense side of annual hospital income statements, Safriet argued that nurses are actually essential revenue producers.

Other cost-associated changes include the fact that providers were once paid more for doing more, she noted. Now, healthcare providers are paid a set amount for a set procedure, regardless of whether they choose to do more.
To compound the changes, the market has become more fluidic and chaotic with increasing mergers, company downsizing and acquisitions.

Get Help With Your Financial Planning

Are you interested in enhancing your personal and retirement financial planning?

AACN members can get planning assistance through a member benefit agreement with Merrill Lynch. A variety of services are available, including educational seminars.

Under the agreement, Merrill Lynch will waive the first year’s IRA account fee for AACN members. This no-fee option can be continued in subsequent years through Merrill Lynch’s Retirement Asset Builder Service.

For more information about the accounts and services associated with this member benefit, call (888) MLSAVES (657-2837) and ask for ext. AACN (2226). Merrill Lynch has also established a Web site for AACN members. The site can be accessed through the AACN Web site at http://www.aacn.org. Click on “AACN Member Info;” then on “AACN Member Benefits Directory.”

Protect Yourself From the Rising Costs of Long-Term Care

Earmarking a portion of your monthly retirement savings for long-term care can help protect you from the escalating costs of long-term care. In addition, choosing long-term care insurance can help avoid placing an undue burden on those you love.

AACN members are eligible for insurance through John Hancock to help cover the costs of long-term care in a variety of settings, including at home, in an adult day care, in a residential care facility, or in a nursing home. Services from nurses, home healthcare aides, therapists and other types of caregivers are covered.

For more information about the AACN Long-Term Care Insurance Plan or to request an enrollment package, call the John Hancock Customer Service Center at (800) 708-0706 or visit the John Hancock long-term care Web site at http://www.jhancock.com/gltc.com.

Currents

Perinatal Healthcare
The National Perinatal Association will present a conference titled “Shaping the Future of Perinatal Health Care” on Oct. 21 and 22, 1999, in Milwaukee, Wis. For more information, call (813) 971-1008, or visit the association Web site at
http://www.nationalperinatal.org.

Information printed in “Currents” is provided as a service to interested readers and does not imply endorsement by AACN or AACN Certification Corporation.

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