AACN News—July 2001—Association News

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Vol. 18, No. 7, JULY 2001

Nursing Shortage Foreshadows Crisis: AACN Steps Up Efforts to Address Growing Problem

With the nursing shortage now dominating much of the discussion surrounding healthcare concerns, AACN is moving ahead on a variety of fronts to address the problem.

At a news conference in May 2001, AACN was joined by representatives of the American College of Chest Physicians and Peter Buerhaus, RN, PhD, FAAN, a recognized expert on the nursing shortage, in emphasizing the repercussions of the shortfall. AACN and ACCP also announced that they will join forces to find solutions to the growing problem.

“This is a problem so big that only through collaboration can we mitigate its potentially devastating effects,” said AACN CEO Wanda Johanson, RN, MS.
ACCP President Robert G. Johnson, MD, FCCP, who is chairman and professor of surgery at St. Louis University in Missouri, agreed, saying that nurses and doctors are both struggling with the shortfalls.

“There is not a member of our organization who doesn’t feel the impact of this crisis,” he said.

AACN and ACCP are particularly concerned about the growing shortage because of the potential implications for critical care, where the patients are most in need of medical care. Patients in critical care and coronary care units require significantly more attention, including intensive round-the-clock intervention and bedside care—demanding higher nurse-to-patient ratios. The complexity and severity of these patients’ medical conditions require the attention of the most highly skilled members of the nursing staff.

Impact on Care
The shortfalls are already affecting patient care, according to 2000-01 AACN President Denise Thornby, RN, MS. She reported that all the hospitals in her hometown of Richmond, Va., were forced to close their emergency rooms for four hours in February 2001, because they lacked critical care nurses to staff their operations.

Johnson agreed that nurse staffing was having a ripple effect, noting that heart surgeries are frequently delayed because of insufficient staffing. These delays also result in backlogs for elective surgery.

Johnson stressed that patients are not suffering from poor care, but that nurses are suffering as they attempt to maintain quality care.

“Patient care is still being delivered at incredibly high levels, but it is being done against incredibly long odds,” he said.

Worse Times Ahead
The news conference was scheduled in conjunction with AACN’s National Teaching Institute™ and Critical Care Exposition in Anaheim, Calif., where Buerhaus, who is professor of nursing and senior associate dean of research at the Vanderbilt University School of Nursing, was a keynote speaker.

At the news conference, Buerhaus said that his research into the nursing shortage indicates that the shortfalls are the tip of the iceberg as the majority of the nursing population, as well as the baby boomer generation moves into retirement age.

“There will be the same number of RNs in 20 years that we have right now, but the demand then will be much greater,” Buerhaus said.

A recent study by Buerhaus, funded by the Department of Health and Human Services, underscored the importance of the presence of RNs in reducing serious medical complications, including pneumonia, shock, gastrointestinal bleeding, urinary tract infections and length of hospital stay.

“We are at a point where we need to take this information and do something with it,” Buerhaus said. “We need to realize that these
shortfalls will cause problems for patients.”

Thornby said she has talked with nurses across the country who are on the front line in handling the consequences of shortages.

“Nurses are not worried about working too hard. They are scared to death for their patients,” she said. “They cannot watch everyone closely enough.”

Thornby said that more research into determining staffing needs is another logical next step in addressing the crisis. Also needed is additional funding from Congress to allow hospitals to recruit and train new nurses. Buerhaus said that legislators are aware of the growing crisis and that there is bipartisan support for addressing the shortage.

Finding Solutions
Recognizing that the shortfall is more than a problem of recruitment and retention, AACN has partnered with several of the nation’s largest professional nursing organizations to address public policy and workplace issues. Among the initiatives AACN has supported are restrictions on mandatory overtime, “whistle-blower” protections, the development of new standards to determine staffing levels by patient acuity and a stronger role for nurses in professional decision-making, policy-setting and clinical advisory roles.

In the largest collaborative effort among nursing associations working to pass legislation to stem the nursing shortage, AACN and 22 of the nation’s other leading associations have released a consensus document outlining the issues that must be addressed in any comprehensive effort to alleviate the nation’s nursing shortage. The associations represent all levels of nursing practice, education, administration and research professionals in a wide variety of settings and specialties.

Characterizing this shortage as unprecedented, the nursing community is calling for swift action to ensure access to high-quality patient care nationwide. Those actions include recruiting and retaining nurses, expanding nursing education, community involvement, public awareness of the nursing shortage and addressing a shortage of nursing faculty.

The associations, which collectively represent nearly all of the nation’s 2.7 million nurses, are urging federal policy-makers to take immediate action to implement a comprehensive set of initiatives to increase the number of nurses and enhance the flexibility allowed in nursing education and clinical practice. This comprehensive approach combines public policy initiatives with nursing association efforts to highlight the rewards of nursing, bring more nurses into the profession and provide opportunities for professional advancement.

The document, titled “Assuring Quality Health Care for the United States: Supporting Nurse Education and Training,” outlines a comprehensive plan of action to stem the nursing shortage and strategies to addresses the complex nature of the shortage. Following are the provisions that the nursing associations are seeking:
• Increased funding for loan and scholarship programs to bring more young people into nursing
• Increased funding for recruitment and retention of minority nurses
• Increased funding for scholarships, loans and stipends aimed at developing nursing faculty at schools and universities
• Establishing a National Nurse Corps to serve communities hardest hit by the nursing shortage
• Adopting tax incentives for employers and for individuals to increase the supply of nurses in the pipeline
• Creating Department of Labor initiatives to recruit and retain nurses
• Developing models for collaboration between communities and states to design programs to recruit and retain nurses
• Increasing funding for research on the impact of nursing practices on patient outcomes
• Improving the process for data collection on the nursing profession

The full text of the document can be accessed via the AACN Web site at http://www.aacn.org. Click on “Clinical Practice,” then “Public Policy.”

The facts
In his keynote address at the NTI, Buerhaus noted that enrollment in nursing education programs continues to decline at a time when large numbers of nurses will reach retirement age in the next two decades.

The aging population of the profession is unique to nursing, he noted. Between 1983 and 1998, the number of RNs under 30 years of age decreased 41%, compared with a 1% decrease in the overall U.S. work force.

Buerhaus said that when he was a critical care nurse in the 1970s, one-third of the nurses were younger than 30. Today, more than 60% of the nursing work force is 40 years of age or older, with only 9% 30 or younger.

The fact that graduates from nursing programs are increasingly older also contributes to the increase in the average age of the RN work force. This average age is expected to increase 3.5 years, reaching 45.4 years in 2010. After 2010, the profession will actually decrease in number as nurses retire.

Although government surveys project a need for 2.5 million nurses in 2020, Buerhaus projects a nursing work force of just 2 million nurses.

The disparity between supply and demand may be even greater if the next generation of nurses displays less loyalty to the profession than past generations and more nurses leave hospitals to take care of elderly family members at home, he said.

“When society needs us most, our profession won’t be there,” Buerhaus said. “There have been shortages in the past, and there is a cyclical pattern, but we have never gotten to this point before. There has never been a shortage in our history that comes near this. This can shut the system down. RNs are the oil of the healthcare machine.”

Hospital officials, legislators and Medicare administrators are aware of the problem. In the meantime, the healthcare industry must prepare for an older work force, develop ways to better utilize the scarce RNs and look for ways to retain and reward nurses currently working. More efforts should also be made to improve recruitment in groups that have long been overlooked, such as minorities and men. Foreign-educated RNs also could be a valuable resource.

Critical Links: New Member Recruitment Campaign Is Under Way

Critical Links, the new AACN Member-Get-A-Member campaign, is under way. The campaign, which ends April 1, 2002, offers member recruiters the chance to receive valuable rewards. In fact, for recruiting just one new member, participants will receive an AACN pocket reference.

All member recruiters need to do is make certain that their name and AACN membership number are included on the new members’ application forms.

The top recruiters, both individuals and chapters, will be recognized at AACN’s National Teaching Institute™ and Critical Care Exposition, May 4 through 9, 2002, in Atlanta, Ga.

Following are the rewards that await the top recruiters:

Individual Rewards
The reward for the top individual recruiter overall is $500 or an American Express gift certificate. The top recruiter is also eligible for the first-, second- and third-place prize drawings:
1st Prize—Round-trip tickets for two to anywhere in the continental U.S., including a five-day, four-night hotel stay.
2nd Prize—Round-trip tickets for two to anywhere in the continental U.S.
3rd Prize—Four-days, three-nights hotel accommodations at a Marriott Hotel.

However, you don’t have to be one of the top recruiters to earn valuable rewards. In addition to the pocket reference you receive for recruiting your first new member, you will receive a $25 gift certificate toward the purchase of AACN resources when you recruit five new members and a $50 AACN gift certificate when you recruit 10 new members.

Each month, members who have recruited at least one new member in the month will also be entered into a monthly drawing for a $100 American Express gift certificate.

Chapter Rewards
In addition to a $250 gift certificate toward the purchase of AACN resources, chapters reporting the largest increase in membership numbers or the largest percentage increase will receive special recognition at NTI 2002 in Atlanta, Ga. Each month, chapters that recruit new members will also be entered into a drawing for one complimentary registration for NTI 2002.

To obtain Critical Links Member-Get-A-Member recruitment campaign forms, call (800) 899-2226. Request Item #1316. Or, visit the AACN Web site at http://www.aacn.org and click on “Membership” for campaign information.

Chipping In to Help Kids

Denise Thornby (left), 2000-01 AACN president and AACN CEO Wanda Johanson presented a check
for $2,500 from AACN to Kirk Douglas for the Kirk & Anne Douglas Playground Awards project.
Douglas was the keynote speaker at the opening session of AACN’s National Teaching Institute™
n May 2001 in Anaheim, Calif. Through the program, 125 schools in Los Angeles County, Calif.
are in the process of installing new playground equipment, developing outdoor fitness areas and

improving school communities. In a letter to AACN, Sonia Hernandez, president and CEO of the
LA County Alliance for Student Achievement, which administers the program, expressed appreciation
to AACN and the 65,000 critical care nurses it represents.

Step Inside the Circle of Excellence: Awards Nomination Deadline Extended to Aug. 10

The deadline to nominate yourself or a colleague for an AACN Circle of Excellence Award for 2002 has been extended to Aug. 10, 2001. The annual recognition program honors individuals who have made a difference in healthcare and the lives of patients and their families.

Circle of Excellence award recipients are recognized in a variety of ways. Many will receive complimentary airfare, hotel accommodations and registration to AACN’s National Teaching Institute™ and Critical Care Exposition, scheduled for May 4 through 9, 2002, in Atlanta, Ga.

Following are the awards that will be presented for 2002:
• Ross Products-AACN Pioneering Spirit Award
• AACN-Marguerite Rodgers Kinney Award for a Distinguished Career
• AACN Honorary Member Award
• AACN Lifetime Member Award
• AACN Excellence in Clinical Practice—Non-Traditional Setting
• AACN Excellent Student Nurse Award
• AACN Excellence in Research Award
• Oridion-AACN Excellent Clinical Nurse Specialist Award (formerly part of the Oridion-AACN Excellent Advanced Practice Nurse Award)
• AACN Excellent Nurse Practitioner Award (formerly part of the Oridion-AACN Excellent Advanced Practice Nurse Award)
• AACN Mentoring Award
• AACN Excellence in Caring Practices Award
• Eli Lilly-AACN Excellent Preceptor Award
• 3M Health Care-AACN Excellence in Clinical Practice Award
• Bard-AACN Excellence in Education Award
• AACN Innovision Award
• AACN Excellence in Leadership Award
• AACN Multidisciplinary Team Award
• Seabury& Smith-AACN Community Service Award
• AACN Excellent Nurse Manager Award
• AACN Distinguished Research Lecturer Award
• Media Award

Chapter Awards
• Pioneering Spirit Award
• AACN Sharon Connor Excellence in Chapter Leadership Development Award
• Outstanding Chapter Communications System Award
• Outstanding Chapter Educational Program Award
• President’s Award for chapters (deadline March 1, 2002)
• CCRN Certification Drive Award (submit rosters as of Dec. 31,2001, and highlight the members who have achieved CCRN status during the year.

To obtain the Circle of Excellence awards guide, call (800) 899-2226 and request Item #1011, or visit the AACN Web site at http://www.aacn.org. Click on “Membership,” then “Awards, Grants, Scholarships.”

Creative Touch Wins NTI 2002 Registration

Beverly Benmoussa

A first-time NTI attendee took home the top prize in the box decorating contest sponsored by the Mail Home Service at NTI 2001 in Anaheim, Calif.

Beverly Benmoussa, RN, of Whitmore Lake, Mich., received complimentary registration for NTI 2002, May 4 through 9 in Atlanta, Ga., for the creative touch she added to her shipping box.

The second-place prize, a $50 gift certificate good toward purchases from the AACN Resource Catalog, went to Karen Mellott, RN, MS, CCRN, of Richmond, Va. Mickie Gilbert, RN, CCRN, CNN, of Oakland, N.J., received complimentary shipping of her Mail Home box for her third-place entry. In addition, honorable mentions in the contest went to Nena Bonul of Houston, Tex.; Diane Racht, RN, CCRN, of Franklin, Tex.; and Cyndie Hampton, RN,
of Medford, Ore.

NTI Leaves Lasting Memories: Participants Share Their Impressions of Experience

Kathy Bushell (right) and colleague Lisa Ayers
(center) had the chance to meet national leaders
Denise Thornby and Michael L. Williams at the NTI.

AACN is pleased with the success of its recent National Teaching Institute™ and Critical Care Exposition. Approximately 5,000 nurses attended the annual conference in May 2001 in Anaheim, Calif.

As always, the association will use feedback from participants to build and strengthen NTI programs and activities. In the meantime, AACN appreciates the many participants who have taken the time to share their views. One first-time participant, Kathy Bushell, RN, even sent along a photo she had taken when she met 2000-01 AACN President Denise Thornby, RN, MS, and 2001-02 President Michael L. Williams, RN, MSN, CCRN, at the Participant/Exhibitor Event at Knott’s Berry Farm.

Following is Bushell’s letter, as well a an e-mail response from another participant, Ann M. Neubauer, RN:

I attended my first NTI conference and am still feeling the effects—a grin on my face, a gleam in my eye, the pride of being a critical care nurse.

The conference exceeded all the wonderful things I had heard about NTI; yet, I almost didn’t attend. How could I take time out for a nursing conference? I was needed at work. I was needed by my family. What difference could a conference make?

Well, I did go to NTI (thanks to St. Joseph’s Hospital, Eureka, Calif.), and it was the best decision of my life.

The week at NTI was rejuvenating to my spirit, energizing to my soul and challenging to my mind. The classes were wonderful and educational—a confirmation of my knowledge and an exploration of new ideas.

NTI made my laugh and cry, made me sad and happy, made me proud and patriotic. It was an emotional, powerful and wonderful experience, filled with new friends and knowledge. I gained a new respect for AACN and its mission and goals, as well as its support of quality nursing.

Words cannot express how NTI touched my soul. I will never forget my educational and personal growth. I will make waves, so that my experience will touch others.

Thank you to everyone involved.
Kathy Bushell, RN
Eureka, Calif

I would like to personally thank the organization for the wonderful conference that took place at NTI. The conference was my first and, without a doubt, will not be my last. I was overcome with emotion after Denise Thornby’s opening speech. To be in the company of such well-educated, compassionate people was just remarkable. I had often thought that I was alone in my journey as an ICU nurse. Working alongside some ICU nurses who just showed up each day for work and weren’t motivated to make a difference can be difficult. But, I couldn’t be further from the truth. The truth is, I had the opportunity to network with other ICU nurses who were as motivated to learn, obtain certification and participate in our association. Together we all can make a difference! Denise really captured those feelings and motivated me to “make waves and have the courage to practice it.” I know others at the conference felt the same way. I just wanted to share with you how life-changing the NTI conference was for me. Thanks again for a wonderful experience and I look forward to next year’s conference.
Ann M. Neubauer, RN
Miami, Fla.

Nursing Leadership Focus of Congress

AACN will sponsor four educational sessions on nursing leadership topics at the Nursing Management Congress, Sept. 9 through 12, 2001, in Orlando, Fla. The congress is sponsored by Nursing Management.

“This partnership allows AACN’s leadership group to present timely topics to a new audience of nurse managers and nurse executives from facilities across the United States,” commented Melissa A. Fitzpatrick, RN, MSN, FAAN, editor in chief of Nursing Management and a past president of AACN. “It offers Nurse Management Congress attendees the opportunity to learn from the expertise of critical care nursing’s best presenters.”

The keynote speaker for the Congress is author Kare Anderson, Emmy-winning former television commentator and former Wall Street Journal reporter who is the founder of the Say It Better Center in Sausalito, Calif.

For more information about this conference, call (800) 346-7844, ext. 1212; e-mail, jgeorge@lww.com.

Three ‘Pioneers’ Honored for Their Contributions

Three individuals who have made significant contributions that have influenced acute and critical care nursing were honored at AACN’s National Teaching Institute™ and Critical Care Exposition in May 2001 in Anaheim, Calif.

Carla C. Joliat, RN, BSN, MSN, of Amesbury, Mass.; Cynda Hylton Rushton, RN, DNSc, FAAN, of Baltimore, Md.; and Wanda Salas of San Juan Capistrano, Calif., were presented the Ross Products-AACN Pioneering Spirit Award during the opening session of the NTI. The award is part of the AACN Circle of Excellence recognition program. The recipients were presented a plaque and $500 honorarium, as well as complimentary registration, airfare and hotel accommodations for the NTI.

Following are excerpts from the exemplars nominating these individuals for the Ross Products-AACN Pioneering Spirit Award for 2001.

Carla Joliat
Agilent Technologies
Carla Joliat began her professional career as an active duty Army officer. Her clinical experience includes positions as general surgery staff nurse, assistant head nurse, and post-open heart surgery unit charge nurse and unit manager for critical care and intermediate care. She has been CCRN certified most of her clinical career.

When Joliat became a clinical applications specialist for the healthcare manufacturing industry in 1982, she probably didn't realize she had also become a pioneer. During her 19 years with Hewlett-Packard/Agilent Technologies, Joliat has acquired both field and divisional experience. She is a sought-after clinical consultant within her business unit, including in assessing clinical validity of potential business partner offerings, managing highly visible customer satisfaction issues, evaluating safety and regulatory issues and developing customer training and education strategies for the worldwide patient monitoring market.

As a Hewlett-Packard/Agilent employee, Joliat has consistently consulted on product development and support strategies, as well as tactics. She has been an expert liaison between clinical trial sites and research and development to ensure optimization of product features and human interface. In the United States and abroad, Joliat has worked closely with both medical and nursing leaders to ensure high quality and clinical efficacy in monitoring products.

She is widely recognized in clinical and corporate environments as a motivational manager. In her career, she has been hired in at least two cases to successfully revitalize floundering departments. She has a solid track record of success in assessing and optimizing coworkers to add breakthrough value. Her strong mentoring skills have helped numerous employees advance in the HP/Agilent organization and influence the nursing profession in a wide variety of roles.

Cynda Hylton Rushton
John Hopkins University and Children’s Center
Cynda Hylton Rushton has a history of being on a journey, not only with AACN in her membership activities since 1979, but in her career-long work transforming end of-life care for critically ill children and adults. She has been an active member of AACN since the beginning of her nursing career, where she initially cared for pediatric and neonatal patients in the critical care environment. She expanded her skills and influence through her education and focus on palliative care and bioethics. Rushton believes that this important work is “nursing’s” work and that through it we can create a vision of hope.

Rushton’s nursing career has spanned the roles of staff nurse, educator, clinical nurse specialist, clinical ethicist, and profession and change agent focusing on the promotion of palliative care and the promotion of a national nursing agenda to improve end-of-life care for all nursing disciplines.

Supported by funding from the Open Society’s Project on Death in America (PDIA) and with the collaboration of AACN, Rushton, Colleen Scanlon and Betty Ferrell assembled the Nursing Leadership Consortium on End-of-Life Care to focus the profession and to develop a nursing agenda for the improvement of palliative and end-of-life care. She has continued her commitment to this work through the Nursing Leadership Academy for End-of Life Care. Through the Academy, which is also funded by PDIA, 23 nursing specialty organizations have undertaken initiatives to make the improvement of palliative and end-of-life care a strategic organizational priority. These organizations have embraced the Last Acts Precepts of Palliative Care and have committed to various projects to inform and involve their membership in this important work.

The scope and breadth of Rushton’s influence, which started with the smallest patients, now embraces a holistic, interdisciplinary, family and community focus, and includes support for the caregiver model.

Rushton not only is transforming the care that individuals receive at the end of their lives through her own practice, but she also is transforming the profession to encourage a new paradigm that is relational, integrative, interdisciplinary and process-focused, and that incorporates openness, awareness of self and others, honesty, acceptance and trust.

Wanda Salas-Fowler
The relationships of AACN members, volunteer leaders and employees bears the unmistakable stamp of Wanda Salas-Fowler. She spent more than 15 years as a senior staff member of the association representing the second career of a mature businesswoman.

Many of AACN’s proudest, enduring accomplishments might not have happened without Salas-Fowler. At least they would have been very different.

Her official titles changed over the years. For 15 of them, the titles reflected her accountability for what we now call the National Teaching Institute™ and Critical Care Exposition and a series of landmark international critical care nursing conferences. The founding directors framed a vision that the annual conference should be a place where every nurse could learn the latest information about the new specialty of critical care. Nurses designed the educational content. Salas-Fowler did everything else.

She set about growing the NTI into an undisputed leader among nursing and healthcare conferences. To succeed, she recognized that the NTI needed a solid financial infrastructure and a distinctive feel and style.

The financial strength grew from a synergy between participants and exhibitors that would draw them back, year after year. The feel and style was crafted by blending the old and the new. Old knowledge for new practitioners. New knowledge for experienced ones. New devices to treat familiar conditions. New conditions treated with familiar drugs. Above all, reconnecting with old friends and making new ones.

Salas-Fowler also influenced AACN in other ways. She secured the association’s first gifts from industry in the 1970s. One, from 3M, which started as an award to promote professional writing among nurses, became the current award recognizing excellence in clinical practice. The other was from IMED, the forerunner of today’s infusion pump manufacturer, Alaris. This unrestricted gift grew into today’s scholarship program.

Above all, Salas-Fowler influenced the association’s future by recognizing the potential for excellence and mentoring staff members and volunteers to achieve it.

Marie Manthey Honored for Distinguished Career

Marguerite Rodgers Kinney (left) was on hand
for the presentation of the AACN-Marguerite Rodgers
Kinney Award for a Distinguished Career to Marie Manthey.

Marie Manthey, RN, MNA, FRCN, FAAN, a pioneer in developing the primary nursing approach to patient care, became only the second recipient of the AACN-Marguerite Rodgers Kinney Award for a Distinguished Career. The award was presented during the opening session of AACN’s National Teaching Institute™ and Critical Care Exposition in May 2001 in Anaheim,

On hand for the presentation was Marguerite Rodgers Kinney, RN, DNSc, FAAN, who received the first award in 1997, when it was named in her honor.

This award recognizes individuals who are completing or have completed an extraordinary and distinguished professional career, which has had a significant impact on fulfilling the mission and vision of AACN and enhanced the care of acute and critically ill patients and their families. In recognition of the selfless contributions recipients of this award have made throughout their careers, a gift of $1,000 is made to a charitable cause of their choice. Recipients are also given lifetime membership in the association and a replica of the AACN Vision icon.

Manthey, who is president emeritus of Creative HealthCare Management, Minneapolis, Minn., is internationally recognized for developing the primary nursing approach to patient care and continuing to adapt the model to the unique requirements of varied patient populations and healthcare systems. She founded Creative HealthCare Management as a full-service consultation company specializing in professional practice, management training, staff empowerment and work redesign.

Manthey’s interest in the delivery of hospital services began in the 1960s when she developed the concept of primary nursing. She since has designed and implemented primary nursing programs for numerous hospitals in the United States and abroad. She has conducted seminars on a variety of management and leadership topics for more than one million nurses.

As an educator, Manthey has held appointments as associate professor at the University of Connecticut and associate clinical professor at Yale University. She also has served as assistant professor at the University of Minnesota School of Public Health and is currently an adjunct faculty member at the University of Minnesota School of Nursing.

In 1994 Manthey was elected a fellow of the Royal College of Nursing in the United Kingdom, one of only four American nurses to be so honored at that time. In May 1998, she was elected a fellow of the American Academy of Nursing.

Manthey received her nursing diploma from St. Elizabeth’s Hospital in Chicago, and her bachelor’s and master’s degrees in nursing from the University of Minnesota. In June 1999, she received the first honorary doctor of laws degree awarded to a graduate of the University of Minnesota School of Nursing. This degree recognizes alumni who have attained unusual distinction in their field or in public service and who have demonstrated leadership on a local, state, national or international level.

Public Policy Update

Patients’ Bill of Rights
With the Senate now controlled by Democrats, the new majority leader, Sen. Tom Daschle of South Dakota, plans to make patients’ rights and an increase in the minimum wage the top priorities.

With the introduction of a bipartisan bill by Sen. Bill Frist (R-Tenn.), Congress is rekindling the debate over how far Americans should be allowed to go in suing their health plans for denial of care. The bill would limit these lawsuits to federal court, a plan backed by President Bush, where awards and damages are generally smaller.

Federal law currently prohibits patients in federally regulated plans from suing their insurers, and exempts insurers from patient protections approved by state legislatures. The Frist bill, which is also backed by James Jeffords (I-Vt.) and John Breaux (D-La.), would prohibit new state lawsuits and cap noneconomic damages at $500,000 in federal courts. There would be no punitive damages.

After four years of debate, there is now broad consensus in Congress and at the White House that a federal law is needed to give patients and doctors more power in dealing with health maintenance organizations and other managed care plans. Lawmakers generally agree that insurers should pay for reasonable emergency room treatments, access to specialists, visits to obstetrician-gynecologists, routine healthcare for patients in clinical trials and other patient care.

A rival Senate plan, introduced this year by Sens. John McCain (R-Ariz.) and Edward Kennedy (D-Mass.), would allow the filing of HMO cases in state courts and widen the punishments for the death and injuries of patients who are denied necessary healthcare. McCain, who reportedly rankled some of his colleagues when he suggested that the so-called patients’ bill of rights debate could be injected into the current fight over education reform, has filed an amendment to the education bill that essentially mirrors the HMO proposal. The McCain-Kennedy bill would allow for the equivalent of $5 million in punitive damages in federal courts and place no limit on damages in state courts. Bush immediately picked off GOP support by publicly insisting that cases stay in federal courts, a system he says would be easier for employers doing business in more than one state

Nursing Shortage
Nursing advocates who testified at a Senate Health, Education, Labor and Pensions Committee hearing in May 2001 said that efforts to improve nurses’ working conditions and prevent them from leaving the profession would help stem the nursing shortage, according to the CongressDaily/AM reports. Gerald Shea of the AFL-CIO said, “We must challenge the notion that the principal problem is an inadequate supply of nurses, and make sure we pay sufficient attention to the poor working conditions that drive nurses out of the hospital setting.”

Julie Sochalski of the University of Pennsylvania School of Nursing added, “Solutions that are focused on strategies to recruit more nurses will not ameliorate the problem in the long run, if equal attention is not paid to strategies to retain the current and future work force through changes in the workplace that nurses have a prominent role in designing” (Rovner, CongressDaily/AM, 5/18).

Meanwhile, efforts to increase nursing school enrollment continue. Reps. Eliot Engel (D-N.Y.) and Mary Bono (R-Calif.) introduced H. R. 1897,a bill that would provide grants, tax credits and additional training to assist nursing students. Health, Education, Labor and Pensions Chair Jim Jeffords (I-Vt.) and Aging Subcommittee Chair Tim Hutchinson (R-Ark.) have introduced bills authorizing more funding for nurse training and recruitment. And, Health, Education, Labor and Pensions ranking member Edward Kennedy (D-Mass.) is working with Sen. John Kerry (D-Mass.) on another bill that would ban mandatory overtime for nurses.

For more information on the Senate hearing, visit http://www.senate.gov/~labor/. For the full text of the bill, visit thomas.loc.goc

Needlestick Prevention
The Occupational Safety and Health Administration is reaching out to educate employers, healthcare workers and the general public on its revision to the bloodborne pathogens standard. The revision will help reduce needlestick injuries among healthcare workers and others who handle medical sharps.

During the outreach period, OSHA will not enforce the new provisions of the standard that require employers to maintain a sharps injury log and involve nonmanagerial employees in selecting safer medical devices. Enforcement of these new provisions is set to begin on July 17, 2001. Meanwhile, enforcement will continue on requirements that employers select safer needle devices as they become available. These have been required since the bloodborne pathogens standard was effective in 1992.

OSHA’s education effort includes a collection of written materials designed to explain specific aspects of the standard. Materials are available on OSHA’s Web site at http://www.osha.gov.

Medical Privacy
The House Committee on Government Reform will consider legislation that would establish a commission to examine all existing privacy legislation and its effects on business. H.R. 583, the Privacy Commission Act, calls for a 17-member commission appointed by Congress and would establish a commission to determine how lawmakers can protect individual privacy rights while protecting access to information.

As the House committee members examine the legislative proposal for creating the commission, they will try to define the scope of the commission’s study. Within 18 months, the commission would produce a report, including nonbinding recommendations, to help guide Congress in creating balanced, privacy-protection legislation. A number of other privacy bills, some seeking to make changes to existing privacy regulations that were introduced in Congress earlier this year.

This bill is basically the same as legislation proposed last year by Rep. Asa Hutchinson (R-Ark.), who sought to form a commission to review all state and federal privacy laws and their effect on each other. The intent of the bill is to explore the full consequences of existing and proposed legislation. There is also concern that some privacy regulations may contradict each other. Because both the Gramm-Leach-Bliley Act’s financial privacy regulations and the Health and Human Services Department’s medical privacy regulations are already in place, much of the commission’s work would actually be a review. Such a review opens up the possibility of change to the existing privacy regulations (A.M. Best via COMTEX, May 8, 2001).

Medical Marijuana
The Supreme Court ruled that California cannabis clubs may not legally distribute marijuana as a “medical necessity” for seriously ill patients. The nation’s highest court unanimously refused to carve out a “medical necessity” exception from the federal law that prohibits the distribution of marijuana as an illegal drug.

The closely watched case marked a watershed for the U.S. medical marijuana movement, which has been mired in legal battles since 1996, when California approved the nation’s first initiative legalizing medicinal use of the drug. The California initiative allowed seriously ill patients to use marijuana for pain relief as long as they have a doctor’s recommendation. Similar measures have been adopted in a number of other states.

The case pitted the cannabis clubs, which say marijuana should be used to alleviate pain and suffering for a wide range of illness including AIDS, cancer and glaucoma, against the U.S. government, which had warned against the creation of “marijuana pharmacies. Saying the case raised “significant questions” about the government’s ability to enforce the nation’s drug laws, Justice Clarence Thomas wrote for the court that federal law classified marijuana as a controlled substance. He said the law only provided one exception—government-approved research projects.

Joining Thomas in the opinion were Chief Justice William Rehnquist and Justices Sandra Day O’Connor, Antonin Scalia and Anthony Kennedy. The five make up the court’s conservative majority. Justice John Paul Stevens, joined by Justices David Souter and Ruth Bader Ginsburg, issued a separate opinion concurring in the judgment. They are among the court’s more liberal members.

Long-Term Care Insurance Brings Peace of Mind

My mother and father were people who saved an awful lot,” says David Walsh. “They denied themselves almost everything—vacations, fancy cars, clothes, what have you. Then, when my mother had to go into a nursing home, I saw all of those savings basically eroded, not in a matter of years, but in a matter of months.”

Watching long-term care costs deplete his parents’ life’s savings deeply affected David and his wife Neila. As a result, they began considering ways to help safeguard their resources in the event of a similar situation. Long-term care insurance offered a solution. Neila says, “We just wanted to be able to help protect our children from having to spend an exorbitant amount of money if we should need care. Just as we tried to protect them with life insurance and medical insurance, long-term care coverage goes one step further.”

David’s employer knew that many other company employees had, like David, seen first-hand how the effects of a long-term care situation could burden a family. AACN also recognized this problem and made available a long-term care insurance plan.

David says, “When this first became available to us--when my employer said that they were going to offer it—we looked at it. I think I was 43 at the time, and the cost was very, very modest—extremely modest. Although we were in the middle of saving for the first two of our daughters to go to college, the actual monthly amount that was taken out we could easily spend. It just gave us peace of mind. Knowing that that amount would basically stay in place through the rest of my working lifetime made it an easy decision.”

If you’d like to gain the peace of mind that comes from knowing you’ve taken steps to help control your finances for the future, it makes sense to consider long-term care insurance as part of your overall financial security. Just as you plan for a secure retirement, you need to plan for the long-term care services you may need. If you have any questions about the AACN Long-Term Care Insurance Plan or would like enrollment information, call John Hancock at (800) 708-0706; TTY, (800) 255-1808, Monday through Friday 8:30 a.m. to
4:30 p.m. EDT.

Submit Abstracts for NTI 2002 in Atlanta, Ga.

Sept. 1, 2001, is the deadline to submit research and creative solutions abstracts for AACN’s National Teaching Institute™ and Critical Care Exposition, scheduled for May 4 through 9, 2002, in Atlanta, Ga.

Accepted abstracts will be designated either as an oral presentation or as a poster presentation. Presenters of selected abstracts receive a $75 reduction in NTI registration fees. All other expenses are the responsibility of the presenter, who can be either the first author or a designate of the author.

To obtain abstract forms, call (800) 899-2226, and request Item #6007, or visit the “Clinical Practice” area of the AACN Web site at http://www.aacn.org. Click on “Research.”

Influencing Practice: Understand the Change Process

Navigating the whitewater created by our ever-changing professional environment can be both difficult and exhilarating. Understanding the change process can be invaluable in making this a positive experience. The following table provides the emerging change leader with a valuable continuum to assist in understanding this process. This table describes the change process and the skills involved in each. The influential nurse can use this table to identify opportunities to increase his or her change management skills and the skills of the nurses they are mentoring.

Novice Expert (Change Leader)
Unfreezing Problem Diagnos
Identify symptoms
Collect data
Analyze data
Report data
Have content expertise
Scan environment
Build coalitions
Synthesize data
Identify patterns
Prioritize efforts
Develop Solutions
Participate in brainstorming
Think creatively
Participate in solution analysis
Facilitate brainstorming
Analyze solutions
Develop desired outcome measures
Communicate vision
Movement Overcome Resistance

Implement Change
Participate in implementation
Identify positive motivators

Manage implementation
Reinforce vision
Maintain momentum
Refreezing Re-establish equilibrium
Participate in evaluation
Reinforce behavior changes
Analyze outcome measures
Revise process
Continue to challenge the status quo


Circle of Life Award
Aug. 15, 2001, is the deadline to apply for the Circle of Life Award, cosponsored by the American Medical Association, the American Association of Homes and Services for the Aging and the National Hospice and Palliative Care Organization. The award honors innovative programs to improve the care people receive near the end of their lives. Up to three awards of $25,000 each will be presented to winners to further the work of their programs. Applications are available by calling (312) 422-2700; Web site, http://www.aha.org/circleoflife.

Rotary Blood Pumps
The 9th Congress of the International Society of Rotary Blood Pumps will be presented Aug. 17 through 20, 2001 in Seattle, Wash. Sponsors are the University of Missouri-Columbia School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery; the University Outreach and Extension and the Mid-Missouri Area Health Education Center. For more information, call (573) 882-6954; e-mail, ISRP@health.missouri.edu; Web site, .

Spinal Cord Injury
The 18th annual conference of the American Association of Spinal Cord Injury Nurses will be Sept. 4 through 6, 2001, in Las Vegas, Nev. “Tracing Our Past, Facing Our Future: Strategies for Practice” is the theme. For more information, contact Sara Lerman, MPH, at (718) 803-3782, ext. 324; Web site, http://www.aascin.org.

Surgical Nursing
Ohio State University Medical Center will present “Quest for Excellence: Critical Care and Medical Surgical Nursing” Sept. 24 through 26, 2001, in Columbus, Ohio. For more information, call (614) 293-3341; e-mail, mcanarney-1@medctr.osu.edu; Web site, .

World Congress
The 8th World Congress of Intensive and Critical-Care Medicine Convention will be Oct. 28 through Nov. 1, 2001, in Sydney, Australia. Sponsors are the Australian College of Critical Care Nurses and the Australian and New Zealand Intensive Care Society. For more information, e-mail iccm@icmsaust.com.au; Web site, .

Trauma Conference
The 6th Annual New England Regional Trauma Conference will be presented by New England Level I trauma centers on Nov. 8 and 9, 2001, in Burlington, Mass. For more information, contact Lori Camp at (508) 856-1671 or (802) 847-4712.

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

Looking Ahead

August 2001

Aug. 10 Deadline to submit nominations for 2002 Circle of Excellence Awards. For more information or to obtain an awards booklet, call (800) 899-2226 and request Item #1011, or visit the AACN
Web site at  http://www.aacn.org.

Aug. 15 Deadline to apply for ICU Design Citation, cosponsored by AACN, the Society of Critical Care Medicine (SCCM) and the American Institute of Architects Academy on Architecture for
Health. For more information or to obtain an awards booklet, call (800) 899-2226, or visit the AACN Web site at

September 2001

Sept. 1 Deadline to submit research and creative solutions abstracts for AACN’s National Teaching Institute™ and Critical Care Exposition, scheduled for May 4 through 9, 2002, in Atlanta, Ga. To
obtain abstract forms, call (800) 899-2226 and request Item #6007, or visit the “Clinical Practice” area of the AACN Web site at

Sept. 1 Deadline to submit proposals for Agilent Technologies-AACN Critical Care Nursing Research Grant. To obtain an application, call (800) 899-2226 and request Item #1013, or visit the “Clinical Practice” area of the AACN Web site at http://www.aacn.org.

October 2001

Oct. 1 Deadline to submit proposals for AACN Evidence-Based Clinical Practice Grant. To obtain an application, call (800) 899-2226 and request Item #1013, or visit the “Clinical Practice” area of the AACN Web site at http://www.aacn.org.

Oct. 1 Deadline to submit proposals for AACN Evidence-Based Clinical Practice Grant. To obtain an application, call (800) 899-2226 and request Item #1013, or visit the “Clinical Practice” area of the AACN Web site at http://www.aacn.org.

Oct. 1 Deadline to submit proposals for AACN Clinical Practice Grant.. To obtain an application, call (800) 899-2226 and request Item #1013, or visit the “Clinical Practice” area of the AACN Web site at http://www.aacn.org.

Oct. 1 Deadline to submit proposals for AACN-Sigma Theta Tau Critical Care Grant.. To obtain an application, call (800) 899-2226 and request Item #1013, or visit the “Clinical Practice” area of the AACN Web site at http://www.aacn.org.

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