AACN News—October 2001—Association News

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Vol. 18, No. 10, OCTOBER 2001

Work Group Brings Diversity to Curriculum for NTI

By John Dixon Jr., RN, MSN
Chair, 2002 NTI Work Group

Much like the reality television show “Survivor,” the 2002 NTI Work Group brought together a group of volunteers who were not previously acquainted to work effectively as a collective in overcoming challenges and embracing new experiences.

Meeting for three days in Costa Mesa, Calif., the group officially began its assignment to review abstracts and select speakers for not only the National Teaching Institute,™ but also the Advanced Practice Institute, which are scheduled for May 4 through 9 in Atlanta, Ga.

The group represented a range of role and area diversity to reflect the demographics of AACN members. For example, I am associate director for quality and care coordination at Baylor University Medical Center, Dallas, Texas. Other members of the 2002 NTI Work Group are Lillian Ananian, RN, MSN, nurse manager in the cardiac interventional unit and coronary care unit at Massachusetts General Hospital, Boston, Mass; Linda Bucher, RN, DNSc, associate professor in the Department of Nursing of the College of Health and Nursing Sciences at the University of Delaware, Newark, Del.; Diane Byrum, RN, MSN, CCNS, CCRN, critical care clinical nurse specialist at Northeast Medical Center, Concord, N.C.; Janet Denmark, RN, MSN, critical care educator at Inova Health System, Alexandria, Va.; Celeste Smith, RN, BSN, CCRN, staff nurse in the ICU/CCU at Memorial Hermann Hospital, Houston, Texas; and Teresa Solberg, RN, MSN, CCRN. part-time staff nurse at Sacred Heart Hospital, Yankton, S.D., and assistant professor of nursing at the University of South Dakota, Vermillion. Sheila Melander, RN, DSN, ACNP, FCCM, is the liaison from the Advanced Practice Work Group. She is an educator in the cardiovascular-surgical ICU at the University of Indiana, Evansville.

Debbie Brinker, RN, MSN, CCNS, CCRN, is the AACN board liaison to the group. Education Director Barbara J. Mayer, RN, MS, Program Development Specialist Bonnie L. Baker, RN, MHA, and Clinical Practice Specialist Linda J. Bell, RN, MSN, CCRN, were staff liaisons for the group.

On Day 1, the group quickly unified around its goal to finish the program within three days. During introductions, the members were enthusiastic. Individuals commonly commented that being appointed to the group was an honor and a great opportunity and responsibility to serve their fellow members. Each committed to going the extra mile to ensure that NTI 2002 would be the best yet.

As the first order of business, evaluations from NTI 2001 were reviewed. Although these focused primarily on identifying content needs, participants’ comments about the overall program were also included. The work group used these evaluations as a framework on which to build the program. Considerations included session types, content level, topic diversity and balance. However, the work was not over at the end of the day. Each member also had “homework” that evening in preparation for the next day.

Day 2 was the most important. A Speaker Review Panel had initially evaluated more than 600 abstracts and compiled a recommended list. The myriad abstract titles and session summaries were indicative of the breath and depth of clinical expertise and talent of AACN’s members. Work was intensive, as individual proposals were pieced together to create a working program. Although the official workday ended in the late afternoon, the group continued to discuss program options throughout dinner that evening. (Yes, in addition to the challenges, there were rewards.)

On Day 3, session offerings were finalized and the program was carefully assessed. The fact that, only 72 hours earlier this group of strangers had come together and now shared a sense of accomplishment, was amazing. The collective pride, not only in achieving our goal, but also in AACN and our profession, was evident. We believed that what we were doing would make a difference in the lives of both nurses and patients. Being a volunteer involves an element of sacrifice and each member of the group served the organization well.

Like the cast of “Survivor,” this group of strangers who previously had known each other only via e-mail and phone calls, had worked diligently and met the challenges head on. In effectively accomplishing their mission, they had quickly become a dynamic, cohesive team. However, unlike the television show, the winner-take-all outcome for us goes to our colleagues who attend NTI 2002.

At the end of Day 3, everyone was elated to hear, “We have an NTI.” The 2002 NTI Work Group “tribe” had spoken! We are enthusiastic about the program that we have put together for you and look forward to greeting each of you in Atlanta.

On the Agenda

Following is a report by AACN board member Debbie Brinker, RN, MS, CCNS, CCRN, on discussions and actions that took place during a joint meeting of the AACN Board of Directors and AACN Certification Board of Directors in August 2001. The meeting was the first for newly elected members of each board, who attended two days of orientation sessions prior to the formal meeting. In addition to serving on the AACN board, Brinker is a director representing the AACN board on the AACN Certification Corporation board.

Agenda Item: Critical Care Orientation Program
The board approved funding to develop a major new product that is designed to meet the need for a standardized, orientation curriculum for new critical care nurses. Called Essentials of Critical Care Orientation, this new electronics-based program will be based on the fundamental, skills and knowledge that nurses new to the critical care setting need. The format, which will be appropriate to all critical care settings, including progressive care/telemetry, will be self-paced and interactive.

Board members were extremely enthusiastic about this new, premier product. Because of the pressures of the nursing shortage, the Essentials of Critical Care Orientation program was viewed as a high priority resource to answer the immediate teaching needs in critical care nursing.

Among the benefits cited were that the delivery method provides flexibility as to when and where nurses can complete the orientation modules and the fact that nurses not only can tailor and self-regulate the time spent on specific topics according to their knowledge and experience levels, but also can review a topic at any time.

Agenda Item: Organizational Ethics
To enhance the effectiveness of discussions and ensure that AACN and AACN Certification Corporation leaders follow ethically sound values, the boards devoted time to formalizing their leadership processes. In addition to exploring leadership styles on an individual basis, the boards focused on organizational values and how effective dialogue contributes. Having an understanding of your own as well as others’ styles helps with teamwork. The purpose of dialogue is not to come to consensus, but to put everything on the table.

Jessica P. Palmer, RN, MSN, and Dorrie Fontaine, RN, DNSc, FAAN, facilitated the discussion on behalf of the Organizational Ethics Committee, which is comprised of representatives from both boards. The committee’s charge is to ensure that enduring structures and processes are in place for AACN to be an ethical organization. The discussion was centered on the values statement that ethical leaders will act with integrity by:
• Communicating openly and honestly
• Keeping promises
• Honoring commitments
• Promoting loyalty in all relationships

Agenda Item: Leadership Reports
The leadership of both boards provided updates on their recent activities:

ACCP meeting—AACN President Michael L. Williams, RN, MSN, CCRN, represented AACN at the American College of Chest Physicians Board of Regents meeting, where he reiterated AACN’s interest in continuing the alliance through joint leadership meetings. An invitation for the president of ACCP to attend an AACN board meeting was extended.

DHHS meeting—Williams met with representatives of the Department of Health and Human Services to discuss issues surrounding the nursing shortage and workplace. Among the ideas being pursued are a joint task force of the DHHS and the Department of Labor to examine the nursing shortage issue and funding to retrain individuals from other areas into nursing.

COMPACCS meeting—Williams and Fontaine met with representatives of ACCP, the Society of Critical Care Medicine and the American Thoracic Surgeons to discuss the COMPACCS (Committee on Manpower for Pulmonary and Critical Care Societies) study related to the shortage of nurses and physicians in critical care. Instead of replicating or expanding the study, the parties have decided to work toward highlighting its results and pursuing public policy changes based on the study.

CDC meeting—Williams represented AACN at a Centers for Disease Control meeting to examine the relationship between nurse staffing and patient outcomes in the ICU. Although the results of studies conducted in this area have not been released, the preliminary data indicates that infection rates and other complications go up when staffing levels are down.

Agenda Item: Certification Board and Officers
The AACN Certification Corporation Board selected director Beth Glassford, RN, MSHA, CHE, to serve a two-year term as secretary-treasurer. The action followed approval of a new process whereby the secretary-treasurer position will be filled by one of the directors, all of whom are nominated and appointed to the board. In the past, the secretary-treasurer has been appointed from among those specifically nominated for that position. The AACN Board of Directors instituted the same process last year to select its secretary and treasurer.

Agenda Item: Licensure Requirement for CCRN Exam
The AACN Certification Corporation Board approved a change in the eligibility requirements to take the CCRN exam. According to the change, critical care nurses who obtained licensure under the Canadian Nurses Association Testing Service exam are now eligible to sit for the CCRN certification exam.
Previously, only nurses licensed under the National Council Licensure Examination were eligible to take the exam.
Some states grant licensure to Canadian nurses who have passed the CNATS exam.

Agenda Item: Agreement With AACN Certification Corporation
The boards reaffirmed the Memorandum of Understanding and extended the Services Agreement between AACN and AACN Certification Corporation for FY02. These legal documents, along with the by-laws, govern the relationship of the two entities. In addition to reinforcing the legal separateness and, thus, protecting AACN’s nonprofit tax status, the documents were drawn up to ensure that the missions and values of the two organizations are aligned and to document their operational relationship.

Membership Numbers Build in Recruitment Drive

AACN members and chapters are responding to a call to recruit new members and strengthen the voice and influence of their professional association in addressing the needs and issues of critical care nurses in today’s healthcare environment.
For example, Melissa L. Drain, RN, DNSc, CCRN, of Austell, Ga., and Peggy Lynn Ennis, RN, of Central Point, Ore., have extended the benefits of AACN membership to 17 and 16 new members, respectively. And, in the Medford, Ore., area, the Pacific Crest Regional Chapter has recruited 22 new members. The Atlanta Area Chapter in Georgia isn’t far behind, with 18 new members recruited.

They are participating in AACN’s Critical Links Member-Get-A-Member campaign. Recruiting just one new member entitles participants to an AACN pocket reference. However, the rewards continue to build.
All member recruiters need to do to earn rewards is make certain that their name and AACN member number are included on the new members’ application forms.

The Critical Links campaign, which was launched in May 2001 at AACN’s National Teaching Institute™ and Critical Care Exposition in Anaheim, Calif., ends April 1, 2002. The top recruiters, both individuals and chapters, will be recognized at NTI 2002 in Atlanta, Ga.

Following is additional information about the rewards that await member recruiters, as well as the list of members who recruited new members during the August 2001 reporting period or who have accumulated five or more new members since the campaign began.

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.

In addition to the pocket reference members receive for recruiting their first new member, recruiting five new members earns them a $25 gift certificate toward the purchase of AACN resources. They receive a $50 AACN gift certificate for recruiting 10 new members.

Each month, members who have recruited at least one new member in the month are also 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 are also 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

Who Recruited New Members in August?

Following are the cumulative totals for members recruiting new members during August in AACN’s Critical Links Member-Get-A-Member campaign, as well as those who have accumulated five or more new members and cumulative totals for chapters since the campaign began.

Michele Benoit, RN, BSN 10
Michael Beshel, RN, BSN, CCRN, CEN  9
Virginia Blaize  1
Michael C. Blanchard, RN  6
Lisa M. Boldrighini  5
Connie T. Bolton, RN, BSN, BS  1
Elizabeth J. Brady-Avis, RN, MSN, CCRN, CRNP  3
Deborah K. Braxton, RN, MSN  1
Donna Bright, RN, BA, CCRN  1
Alisa R. Caple, RN, BSN  1
Sasipa Charnchaichujit, RN  8
Karen Clary, RN, BSN, CCRN  1
Kathleen Corban, RN, BSN, CCRN  5
Cynthia G. Cox, RN, BSN, CCRN, FNP  7
Jennifer Yun-Doung Do, RN  2
Melissa L. Drain, RN, DNSc, CCRN 17
Cynthia L. Egly  1
Peggy Lynn Ennis, RN 16
Myrna Fontillas-Boehm, RN, BSN, BS, CCRN  6
Heather M. Frame, RN, BSN  1
Eva Mae Francis, RN, ADN, CCRN  1
Carla J. Freeman, RN, BSN, CCRN  5
Diane E. Fritsch, RN, MSN, CCRN, CS  1
Eileen K. Fry-Bowers, RNC, MS, CCRN, CCNS  1
Lisa Gerbic, RN ,BSN, MBA  1
Tammy L. Gillham, RN, CCRN  1
Lita T. Gorman, RN, BSN, CCRN, CEN  6
Carol Guyette, RN, BSN, CCRN  8
Charlene A. Haley-Moyer, RN, MS, CCRN  5
Katherine Hardin, RN, BSN  1
P. Jo Ann Harmon, RN  1
Mary E. Hillberg, RN, BSN, CCRN, CEN  1
Mary E. Holtschneider, RN, BSN  4
Patricia Jennings, RN, ADN, CCRN  5
Patricia M. Juarez, RN, MS, CCRN  1
Louisa K. Kamatuka, RN, MSN, CCRN, CS  2
Lori E. Kennedy, RN, BSN, CCRN  7
Nancy D. King, RN, MSN, CCRN, NP  3
Colleen Kowalchuk, RN, CCRN  2
Julie B. Kruithof, RN, MSN, CCRN  1
Jenneine A. Lambert, RN, MN  1
Jeraldine P. Laope, RN, BSN, CCRN  1
Laura L. Madden, RN, BSN, CCRN 1
Michele L. Manning, RN, MSN, CCRN, CS  3
Barbara J. Martindale, RN, BS, CCRN  1
Martie C. Mattson, RN, MSN, CCRN  7
James Mears, RN  6
Marlene Merdes, RN  1
Arlene Messina, RN, ADN  5
Christine C. Morrison, RN, MSN, AA  1
Eileen M. Patterson, RN, ADN, CCRN  1
Victoria A. Ramik, MS, CCRN, CS, APRN  1
Carol Reitz-Barlow, RN, DNS, CCRN  5
Kathryn E. Roberts, RN, MSN, CCRN  1
Stephanie R. Sanderson, RN, ADN, CCRN  1
Robin K. Selbach, RN, BSN, MBA, CCRN        1      
Marcia Lorraine Simmonds, RN  1
Rena Sivills, RN, BSN  1
Eileen Hellwig Stoll, RN, MSN, CCRN  1
Paula Marie Tost, RN, BS, CCRN  1
Heidi A. Wagner, RN, BSN, CCRN  1
Janis L. Watts, RN, BSN, CCRN  4
Holly L. Weber-Johnson, RN, BSN 11
Donna M. Williams, RN, MS, CCRN  1
Michael L. Williams, RN, MSN, CCRN  1
Cherie L. Wright, RN, BSN, CCRN  4
Atlanta Area Chapter 18
Greater Akron Chapter  1
Greater Austin Chapter 12
Greater Birmingham Chapter  4
Greater Chicago Area Chapter  1
Greater East Texas Chapter 13
Greater Evansville Chapter  1
Greater Memphis Area Chapter  1
Greater Miami Chapter  1
Heart of Acadiana Chapter  8
Heart of the Piedmont Chapter  3
Northeast Indiana Chapter  2
Pacific Crest Regional Chapter 22
Puget Sound Chapter  1
Siouxland Chapter  5
Smoky Hill Chapter  5
Southeastern Pennsylvania Chapter 10
Vermont Green Mountain Chapter  8

August Rewards
Congratulations to the reward recipients in our monthly membership campaign drawings for August. Each month, one chapter will receive a complimentary registration to NTI 2002 and one individual will receive a $100 American Express gift certificate. The recipients are randomly selected from those who recruited at least one new member during the month.
The recipients in August were:
• Chapter—Greater Evansville Chapter
• Individual—Melissa L. Drain, RN, DNSc, CCRN

Chapter Finds Rewards in Group Discount

The Atlanta Area Chapter of AACN is taking advantage of the AACN Group Membership discount and the 3-Person CCRN Exam discount to attract interest.

The success of the program has added 44 new members to the chapter roster since August 2000, bringing the total chapter membership to 332.

Here is how the program works:
• The chapter purchases one-year AACN memberships at the $69 rate offered to nurses who join or renew their memberships in groups of five or more.
• The chapter then resells the memberships for the regular $78 rate, but throws in a free one-year chapter membership.

Kathy Graham, RN, BSN, CCRN, the Region 6 Chapter Advisory Team representative and immediate past president of the chapter, said the idea to use the group memberships actually grew out of a chapter initiative to encourage nurses to take the CCRN certification exam.

“We had a CCRN review course in August of last year, where we had 180 participants and even had to turn people away.” Graham explained. “We had seen an announcement for the Group Membership discount and bought 10 memberships, which sold immediately.”

Realizing that the plan was a good one to build membership, the program has continued. The chapter had another 70 participants enroll in a CCRN Review Course in January. Another course is scheduled on Mondays and Tuesdays for three weeks, beginning Oct. 29, 2001. Graham noted that the 3-Person CCRN Exam discount enhances the benefits for members.

“We have been trying to revitalize our chapter and encourage members to be more active,” Graham said. “We have been trying to capitalize on the fact that we have 15 to 20 big hospitals in the Atlanta area. We have lot of members from a couple of the hospitals, but only a few members from the others.”

The chapter has also offered the Group Membership discounts at seminars throughout the year.

Leadership Lessons Learned: Helping to Develop Leaders Is Our Legacy!


Editor’s note: Following is another in a series of articles by members of the AACN Board of Directors on leadership lessons they have learned from their experiences.

By Bertie Chuong, RN, MS, CCRN

What makes a leader? How do we become leaders? How do we help others develop into leaders?

When identifying leadership influence, most people automatically think of political leaders like John Fitzgerald Kennedy, Martin Luther King Jr., Gandhi and Nelson Mandela. Although these political leaders have had an influence on my personal life, a number of nursing leaders have clearly affected me in my professional life, including Florence Nightingale, Virginia Henderson and Florence Wald. Past AACN presidents, namely, Marianne Chulay, Joan Vitello, Gladys Campbell, Melissa Fitzpatrick, Anne Wojner and Denise Thornby, also are models of brilliant nursing leaders.

Lessons learned from these leaders have contributed significantly to my own development as a nursing leader. Who has influenced your leadership abilities? What characteristics or attributes do they have in common? Why do you think people follow these leaders?

Finding a Vision
The common denominator for the leaders in my life is that they each pursued a “vision” or “dream.” For JFK, it was for a new society where each of us contributed to the betterment of our country. For Martin Luther King Jr., it was for all men to be treated equally. For Florence Nightingale, it was for all nurses to be trained in primary nursing skills. And, for Denise Thornby, it is to encourage nurses to make waves to positively influence patient care. These individuals emanate enthusiasm, passion and courage. They are inspirational risk-takers whose dreams continue to influence our lives today. The lesson learned from these leaders is that their passionate commitment to their dreams kept driving them, even in the worst of times.

Learning Leadership
In my practice setting and as an AACN board member, I have discovered that some leadership characteristics may be innate, while others clearly must be learned. This may be the reason that clinical nurses sometimes fail to see themselves as leaders when, in fact, they already possess many important leadership qualities and do not realize that other leadership skills can be thoughtfully acquired.

You are the future of nursing. Now is the time to examine your leadership attributes. Begin by asking yourself: What is it in nursing that you are passionate about? What do you want to change in your practice setting? What is it that keeps you coming back to the bedside during these stressful times?

Whether you are a newer nurse or more senior staff, being a leader will assist you to influence others, strengthen nurse-patient relationships, collaborate with physicians and other health professionals, and make minute-to-minute bedside clinical decisions that affect the quality of care you provide for patients and their families. Every day, clinical nurse leaders in formal and informal leadership roles make their contributions to safe, quality, cost-effective patient care on a daily basis.

Promoting Leadership
AACN has been promoting leadership education for more than 20 years. The association defines leadership as the “the ability to influence others.” Over the last two years, the AACN Leadership Development Work Group has defined four skill sets that are the essential tools for today’s nursing leaders: self-awareness, dialogue, navigating change and conflict management. These skills can be used in any arena—at the bedside; within a unit committee, hospital committee or AACN chapter committee; or even at home. They are not static; they are dynamic skills that will help our new leaders successfully lead in this new millennium.

Self-awareness is important to all nurses. As our patient population becomes more diversified, developing this skill is essential. We can influence others by a tone of voice or an expression. Our first impression must be one of greeting and assurance. Our patients look to us for guidance and wisdom. We must project a caring spirit to our patients.

Dialogue is a much broader skill than simply “listening,” “making conversation” or even “discussing” an issue. In a dialogue, you have to work at finding common ground to seek a new insight as you work on an issue.

Dialogue can be difficult, because suspending your assumptions on a subject and allowing a new approach to be considered can be uncomfortable. Developing leaders must constantly challenge how they listen. Do they really know everyone else’s thoughts about what is being discussed? How should they take an issue forward? What do they need to know first, and then how do they need to challenge themselves with what they have found out?

Navigating change means overcoming resistors, which can be difficult for the most experienced. In our practice of critical care, I continually ask staff, “Why are we doing this that way?” Sometimes, the answer is because that is what the science shows us, but sometimes it is not! Assist new leaders in tackling change with a positive attitude. Facilitate implementing a change with them, and celebrate when they achieve their success!

Conflict management requires practice. I consider every conflict as a potential win-win situation for whomever the conflict involves. Avoiding conflict is a natural response. We must assist new leaders to confront conflict, while pointing out crucial components along the way. Controlling emotional responses is probably the most difficult. Seeking mutual benefits assists in overcoming most conflicts. Try to end a conflict in a way that each party can “save face.” You won’t always “win.” However, honing this skill will help you be positive and more likely to lead objectively.

Through my work environment, my many volunteer roles and my involvement in AACN, I enjoy developing my skills as a leader. I encourage all of you to continue to grow in your leadership abilities and never lose sight of your visions or dreams. Commit yourself to that which you are passionate about. Look for ways to make your optimal contribution. And, never stop working on your ability to lead, influence, mentor and support those around you!

Influencing Practice: Group Building on Skills Needed for Effective Leadership

By Mary G. McKinley, RN, MSN, CCRN
Leadership Development Work Group

The 2001-02 Leadership Development Work Group is pursuing strategies that will help develop critical care nurses’ abilities to positively impact work and care environments and maximize patient outcomes. The group is seeking additional ways to integrate essential leadership skills identified by last year’s group into the work of AACN.

Meeting in Costa Mesa, Calif., in August 2001, the 2001-02 group reviewed the history of AACN’s commitment to leadership development and AACN’s Leadership Framework, as well as four key skills needed to influence—dialogue, navigating change, conflict management and self-awareness—which have been highlighted in AACN News and at the NTI. Members of the work group will continue to write articles for AACN News throughout the year and plan additional presentations on leadership skills at NTI 2002 in Atlanta, Ga.

In addition, through a collaborative leadership approach, AACN presented a session on these skills at the Nursing Management Congress sponsored by Nursing Management. AACN President Michael Williams, RN, MSN, CCRN, Past President Denise Thornby, RN, MS, and Leadership Development Work Group Cochair Bonnie Sakallaris, RN, MSN, CCRN, were the presenters.

The group is working to develop a blueprint or handbook for "making a difference," which will present information on each of the skills and provide practical examples on how the skills can be applied in a number of different venues. To help nurses learn how the skills can be developed and used every day, the examples will cover chapter, institutional and clinical settings.

Members of the 2001-02 Leadership Development Work Group are Lisa Pettrey, RN, MS (cochair), Bonnie Sakallaris, RN, MSN, CCRN (cochair), Stephanie Calcasola, RN, MSN, Suzette Cardin, RN, DNSc, CNAA, FAAN, Anne LaVoice Hawkins, RN, MS, Mary McKinley, RN, MSN, CCRN, AACN President-elect Connie Barden, RN, MSN, CCNS, CCRN (board liaison), Dorrie Fontaine, RN, DNSc, FAAN (board liaison) and Susan Yeager, RN, MS, CCRN (board liaison).

Scene and Heard

AACN continues to seek visibility for our profession and the organization. Following is an update on recent outreach efforts:

Media Highlights
• The Aug. 6, 2001, issue of NurseWeek, which addressed how the nursing shortage exacerbates job-related stress, featured quotes from AACN Practice Director Justine Media, RN, MS.
• Medina was also widely quoted in the Aug. 24, 2001, issue of the Virginian-Pilot newspaper, which explored the nursing shortage and the U.S. Navy’s approach to recruitment and retention.
• AACN Public Policy Specialist Janice Weber, RN, MSN, contributed to a July 15, 2001, article in the Florida Sun-Sentinel newspaper about the expansion of four county hospital emergency rooms.
• The cover story for the Sept. 10, 2001, issue of the US News & World Report, which addressed the issue of family presence in emergency rooms, includes input from Medina.
• The Aug. 6, 2001, issue of Tradeshow Week featured a review of AACN’s National Teaching Institute and Critical Care Exposition in May 2001 in Anaheim, Calif.
• The Washington Post again used AACN’s photos featuring critical care nurses at work in its “Healthcare Careers” supplement.
• AACN and its relationship with nursing shortage expert Peter Buerhaus, RN, PhD, FAAN, and the American College of Chest Physicians with respect to the staffing crisis was mentioned in the “Staffing Watch” section of Hospitals & Health Networks.
• The nursing shortage news conference in conjunction with NTI 2001 continued to receive coverage, this time in the BBI Newsletter, which published the content of the media release issued by AACN following the news conference.

Our Voice at the Table
• AACN continued to communicate with the Department of Health & Human Services regarding the nursing shortage and workplace issues.
• AACN member Donna Luebke, RN, CCRN, CNP, was selected to serve on the United Network for Organ Sharing Critical Care Advisory Council. The goal of the council is to provide critical care staff with the needed educational tools regarding organ donation after cardiac death.
• AACN President-elect Michael Williams, RN, MSN, CCRN, is serving a four-year term on the Mended Hearts National Advisory Council.
• AACN Public Policy Specialist Janice Weber, RN, MSN, represents AACN at the ongoing Nursing Shortage Forum, a group of 23 National Nursing Organizations to address ongoing nursing issues. A consensus document on recommendations for solutions to the nursing shortage related to Title VII was developed and endorsed by AACN.
• Williams, AACN Director of Professional Practice Wendy Berke, RN, BSN, MHA, and Clinical Practice Specialist Linda Bell, RN, MSN, CCRN, attended the Acute Care Nurse Practitioner educational meeting to discuss the group’s plans for organizational affiliation.
• Weber and AACN Clinical Practice Specialist Katie Schatz, RN, MSN, NP, attended the ACNP 2001 Summit and business meeting.
• AACN was Invited to cosponsor the 2002 State of the Science Conference, along with American Colleges of Nursing and Sigma Theta Tau International. AACN member Charlene Winters, RN, DNSc, CS, was appointed as AACN’s representative to the conference planning committee.
• AACN has joined the Academy for Health Services Research and Health Policy.
• AACN member Tamara Bauer, RN, MBA, CCRN, CFRN, represents AACN as a member of the Commission on Accreditation of Medical Transport Systems Board of Directors.
• AACN member Nancy Munro, RN, MN, CCRN, ACNP, represented the association at the WomenHeart National Coalition annual meeting in May 2001.
• The National Advisory Council on Nurse Education and Practice Nursing Workforce requested AACN’s views regarding recommendations for future Title VIII legislation. AACN submitted written documents with recommendations to the group.
• AACN joined the Council for the Advancement of Nursing Science as an organizational partner on the Membership Council of the American Academy of Nursing.
• AACN received an invitation from the UCSF-Stanford Evidence-based Practice Center to nominate individuals to serve on the review panels to help define indicators of complications and patient safety. Nominated and selected to represent AACN were Janet Davies, RN, MSN, Kathleen Ellstrom, RN, PhD, CS, CNS, Patricia O’Malley, RN, PhD, CCRN, Brenda Snyder, RN, MS, CCRN, and Bruce Williams, RN, MSN, CCRN, CEN, CS.
• AACN member Linda DeLamar, RN, MSN, CRNA, represented AACN on the American Society of Perianesthesia Nurses Development of Clinical Guidelines for the Prevention of Unplanned Perioperative Hypothermia taskforce.
• AACN Clinical Practice and Research Specialist Kathy Schrader, RN, DNSc, CEN, was nominated to represent AACN as a peer reviewer for the UCSF-Stanford Evidence-based Practice Center to evaluate the usefulness of IT/DSSs for use by health care providers and public health officers in the event of a bioterrorist attack.
• Bell was appointed as AACN’s representative to the Joint Commission on the Accreditation of Healthcare Organizations Liaison Network to facilitate ongoing communication and information exchange between organizations.
• AACN signed on to support the American Academy of Pediatrics FY2002 appropriations request for Emergency Medical Services for Children.

Are You Prepared, or Are You Merely Worried?

Worrying may be where we all start when we first think about needing long-term care. We will age. We will get sick or badly injured. Family and friends will not necessarily be able to help out as much as they (or we!) would like.

What about nursing homes, home health aides, respite care, bathing, eating, toileting. Then our thoughts turn to dollars. Who pays? How much money does this take? That college nest egg? Is long-term care how we want to use our savings?

According to a recent survey conducted by John Hancock and the National Council on Aging, more than two-thirds of Americans are worried about financing long-term care for themselves and their loved ones. Most people are confused about whether long-term care is covered under traditional health benefit plans or Medicare or Medicaid. It’s time to find out a little more on this topic?

Get Smart
Here is our starting point: Long-term care is a system of health and custodial services to support and care for people who have chronic, thus “long-term,” nonremediable, physical or mental conditions—conditions that aren’t likely to dramatically improve. To continue, test yourself and learn the answers to the quiz at right from John Hancock Life Insurance Company and the National Council on Aging so that you can be up on current facts and myths about long-term care.

Be Prepared.
Worrying might indeed be a permanent human condition. However, the best way to manage that condition is perhaps to get the facts on such a worrisome topic as long-term care needs, and take control by having some options to help manage this possibility in the future.

For more information about the AACN Long-Term Care Insurance Plan or to request an enrollment package, call John Hancock at (800) 708-0706; TTY, (800) 255-1808; Monday through Friday 8:30 a.m. to 4:30 p.m. (EDT).

John Hancok 1999 Long-Term Care Quiz

1. Most long-term care is provided in a nursing home.
True False

2. Nearly 40% of the long-term care population is younger than 65.
True False

3. People 55 to 64 pay more than $1,500 per year on average for a long-term care policy.
True False

4. Medicare is not the primary funding source for most older people’s long-term care costs.
True False

5. The average length of stay in a nursing home is more than four years.
True False

6. Disability insurance and long-term care insurance cover the same things.
True False

7. On average, a one-year stay in a nursing home costs about $25,000.
True False

8. People have to spend all or almost all of their assets to get Medicaid benefits.
True False

9. The averag lifetime chance of needing long-term care for an individual 65 years or older is more than 40%.
True False

10. Nursing homes expenses for Alzheimer’s disease patients are covered by Mediare.
True False

Myriad Issues Face Congress in Coming Months

By Janice Weber, RN, MSN
AACN Public Policy Specialist

Although recent projections that federal surpluses will be much lower than expected have raised issues for all sides, some of Congress’ most heated debates over the next two months will focus on controversies that have little or nothing to do with spending taxpayer dollars.

In addition to some unfinished business—a patients’ bill of rights, energy policy, campaign finance and stem-cell research—Republicans would like to tackle new trade legislation and Democrats want to raise the minimum wage.
Each of these issues pushes hot economic, political or philosophical buttons. For example, healthcare and the minimum wage affect Americans’ wallets. Stem-cell research and energy policies evoke strong passions about science, ethics and the environment. The government’s executive and legislative branches will battle over some issues, such as the effort to restrict money in politics and the drive to grant presidents more authority to negotiate trade agreements.

Congress is also scheduled to finish 13 spending bills for the next fiscal year by the end of this fiscal year. The most contentious negotiations on the spending bills are predicted to be over education and defense. Democrats want to spend more on education than President Bush. Bush and the Pentagon want more money for defense than Congress’ budget resolution allows.

However, as one legislative problem is disposed of, another takes its place. Following is information about legislation already on the table that congressional leaders will be under pressure to resolve by the end of October:

Patients’ Bill of Rights
Both the House and the Senate have passed legislation giving individuals greater leverage over their health insurers. Each bill offers a range of protections for patients, including guaranteed access to specialists and emergency care, and direct access to gynecologists and obstetricians. However, they differ on the legal recourse that patients would have if an insurer denies them care. Bush has vowed to veto anything like the Senate version, which is tougher on insurers.

Energy Policy
The House passed a sweeping energy bill that would provide $33 billion in tax incentives, much of it for the oil and gas industry to engage in new exploration. The bill also would promote conservation and alternative power sources, such as solar and wind energy, and would allow limited drilling in the Arctic National Wildlife Refuge. The Senate is still drafting its energy bill, where the tax breaks are expected to be smaller. Senate Democrats have vowed to block drilling in the Arctic refuge, even if that requires employing parliamentary procedures to delay the bill.

The House and Senate each passed legislation to set new accountability standards for schools. However, the bills differ on monetary issues. The Senate favors more spending than the House. Although final terms are being negotiated in a conference committee, Democrats prefer to wait until the separate education spending bill is enacted as part of the regular budget process, which will determine how much money is available.

Money and Politics
The Senate passed legislation to ban “soft” money—the unlimited and unrestricted funds that political parties raise from unions, corporations and wealthy individuals. Although the House was ready to vote on similar legislation, Democrats and a handful of moderate Republicans rebelled at the rules that Republican leaders who oppose the bill had written to govern the debate. Supporters of the measure are circulating a petition to force House Speaker J. Dennis Hastert (R-Ill.) to schedule a vote on it.

Faith-Based Social Work
The House passed legislation that would allow religious organizations to receive federal money to provide social services, such as drug and alcohol counseling, assistance for homeless people and welfare assistance. Included is a provision to exempt religious groups from state or local anti-discrimination laws. Sen. Rick Santorum (R-Pa.), the bill’s leading Republican advocate in the Senate, said he would strip that language from his measure to make it more palatable to Democrats. Despite pressure from Bush, the Senate is not likely to take up the measure until early next year.

Human Cloning
The House passed legislation to ban cloning of human cells, including embryos for use in stem-cell research. The Senate has yet to act. However, Majority Leader Tom Daschle (D-S.D.) has said he opposes cloning, even for research purposes. Senators from both parties have voiced support for research on embryonic stem cells, which can produce many of the body’s cells and which scientists think may eventually be able to repair or replace damaged or destroyed human cells or tissues. Other senators may weigh in now that Bush has established a policy allowing a limited number of embryonic stem cells to be used for scientific experiments.

Following is information about other issues Congress is expected to address:

Trade Promotion
Presidents would be given greater freedom to negotiate trade deals with other countries by eliminating Congress’ ability to amend them. Congress would be able to vote only for or against final trade packages as negotiated by the president. Bush wants such authority, which his predecessors had between 1974 and 1994. Democrats want assurances that presidents will address environmental and labor issues in any agreements.

Minimum Wage
Democrats want to increase the minimum wage from $5.15 to $6.65 per hour over the next three years. Republicans want to attach tax breaks for small businesses.

Call to the Nursing Profession Promises Plan of Action

Leaders of national nursing organization convened a summit in Washington, D.C., in September 2001 to address issues surrounding decreased nurse staffing in many settings today, as well as predictions of an unprecedented shortage of nurses in the next decade. AACN CEO Wanda Johanson, RN, MN, was one of the leaders invited to participate on the steering committee to plan this Call to the Nursing Profession meeting to create a comprehensive plan to ensure that consumers continue to receive safe, quality nursing care, to retain nurses who are currently practicing and to recruit more people into the profession.

Attending the summit with Johanson were AACN President-election Connie Barden, RN, MSN, CCNS, CCRN, and AACN Certification Corporation Chair Elizabeth Nolan, RN, MS, CS. Discussions revolved around 10 key issues identified as of concern for nurses, the profession and the public:
• Work environment
• Economic value
• Education
• Legislation, regulation and policy
• Delivery systems and nursing practice models
• Diversity
• Recruitment and retention
• Professional and nursing culture
• Public relations and communications
• Leadership and planning

As a result of the meeting, an overarching plan will be developed and implemented in an ongoing effort by each nursing organization, consistent with its mission, to address nurse staffing, the nursing shortage and the impact on the public.
“We know that the plan must be bold and that all of the factors that drive shortages must be addressed,” said American Nurses Association (ANA) President Mary Foley, RN, MS. “The plan will demonstrate nursing’s commitment to forging long-term solutions to address the complex factors that have resulted in cyclical shortages of nurses.”

Nurse leaders will advance this plan to stakeholders outside of nursing with a Call to the Nation planned for 2002. At the 2002 meeting, groups representing the spectrum of consumers, purchasers and providers of healthcare will be invited to support the plan to ensure high quality nursing care.

The concept for the Call to the Nursing Profession originated with the ANA and was further developed in concert with other nursing organizations. Other members of the steering committee are the American Academy of Nursing, American Association of Colleges of Nursing, American Association of Nurse Anesthetists, American Nurses Association, American Nurses Credentialing Center, American Organization of Nurse Executives, American Psychiatric Nurses Association, Association of periOperative Registered Nurses, Association of Women’s Health, Obstetric and Neonatal Nurses, Emergency Nurses Association, Infusion Nurses Society, National Black Nurses Association, National Council of State Boards of Nursing, National League for Nursing, National Student Nurses Association, Nursing Organization Liaison Forum, Oncology Nursing Society, and the Honor Society of Nursing, Sigma Theta Tau International.

Public Policy Update

Nurse Staffing
Issue: California's hospitals will wait longer than expected to learn how many patients their nurses can legally care for under the state's first-of-its-kind staffing law.

Background: The state's Department of Health Services has yet to issue draft regulations, for which hospitals and nurses have been lobbying since the Legislature approved the landmark legislation in 1999.

As of early September, the DHS had not scheduled a definitive date to release preliminary regulations, said spokesperson Lea Brooks. Hospitals and nursing groups that have proposed their own ratios have been waiting for the government’s proposal since spring. The DHS, Brooks said, is still engaged in the “complex effort” of gathering and analyzing data to determine appropriate ratios.

The process of determining which ratios to implement has provoked controversy between California's hospitals and nursing unions. One point of contention is whether a nursing shortage complicates the task of hiring enough nurses to meet minimum-staffing requirements.

Pros/Cons: Hospitals have proposed a nurse-to-patient ratio of 1-to-10 in medical-surgical units, far from the 1-to-4 ratio proposed by the Service Employees International Union (SEIU) Nurse Alliance and the United Nurses Associations of California, which represent a combined membership of 46,000 nurses in California. The California Nurses Association has proposed a ratio of 1-to-3 in medical-surgical units.

Advocates for the SEIU believe that the staffing ratios will begin to correct the problems of the nursing shortage and that improved staffing will make it easier for hospitals to recruit and retain nurses. However, the California Healthcare Association and some independent researchers have a different view. They argue that most licensed nurses are already working and that the process of attracting new people to the profession will take too long to meet the law's requirements.

According to an analysis released in July 2001 by the not-for-profit, San Francisco-based Public Policy Institute of California, each hospital in California will need to spend between $200,000 and $2.3 million per year to comply with the mandatory ratios. Even SEIU representatives acknowledge the potential difficulty of staffing under tough new standards.

What’s next? Issuance of the draft ratios by the DHS will be followed by a 45-day public comment period and at least one public hearing. The California Healthcare Association is concerned that failure to codify the ratios until late in the year could make it difficult for the state's 470 hospitals to meet new staffing standards by Jan. 1, 2002, when the law becomes effective.

AACN’s Position: Although AACN recognizes why nurses are seeking mandated nurse-to-patient ratios in response to growing hospital staffing inadequacies, it does not support mandating set ratios. AACN's concern is that mandated ratios carry a strong potential for establishing a ceiling instead of a minimum staffing level, leaving little or no flexibility to base staffing on patient needs that can change rapidly and that must be able to accommodate 1-to-1 or even 2-to-1 nurse-to-patient ratios. In addition, mandated ratios do not factor in consideration of what patients need or other variables, such as the experience or skill level of the nurse or the availability of support services.

AACN believes that the work environment in critical care is constantly changing and that the needs of critically ill patients are too unpredictable for set staffing ratios to be a safe solution. Instead, AACN advocates that staffing must be decided by the frontline caregivers and for nurses to insist on staffing models that effectively meet the needs of the individual patients. An example would be an acuity/classification system that allows for flexibility in addressing the variables that are factors in determining appropriate staffing levels.

Health and Safety Concerns
Issue: Health and safety concerns are a substantial influence on registered nurses’ decisions regarding their careers.

Background: According to an online survey conducted by the American Nurses Association, 88% of the respondents cited health and safety concerns as influencing their decisions on whether to continue working in the profession, as well as on the type of nursing work they choose. Approximately 70% of the respondents said acute and chronic effects of stress and overwork are a top health and safety concern. Other leading health and safety concerns, according to the survey, include disabling back injuries, fear of contracting HIV or hepatitis from needlesticks, possibilities of tubercolosis or other disease infection, on-the-job assault, latex allergies and fatigue-related car accidents following a shift.

Although the 4,826 nurses who responded to the survey represented a cross-section of ages, experience and types of facilities, the highest percentage were between 41 and 50 years old and had more than 10 years experience.

Hospital Workforce
Issue: A partnership of national, state, regional and metropolitan associations has launched a nationwide "Help Wanted" postcard campaign seeking approval of the American Hospital Preservation Act, rural hospital relief, Medicaid safety net support and greater federal investment in nursing and other health professions education.

Background: The postcards are being sent to congressional offices on Capitol Hill and the White House. National associations that are involved in the campaign include the American Hospital Association, Association
of American Medical Colleges, Catholic Healthcare Association, Federation of American Hospitals, National Association of Public Hospitals, Premier and VHA.

For more information about these and other issues, visit the “Practice” area of the AACN Web site at http://www.aacn.org.

Exhibits and Sponsorships Information Available for NTI 2002

The Exhibit Prospectus and Sponsorships Opportunities brochure for the 2002 National Teaching Institute™ and Critical Care Exposition are now available from the AACN Exhibits Department. Now is the time for your hospital, healthcare organization or company to reserve its exhibit space and confirm sponsorship. More than 6,000 critical care nurses are expected to attend the May 4 through 9 conference at the Georgia World Congress Center in Atlanta.

Exhibit space applications are accepted on a first-come, first-served basis. Two-thirds of available exhibit space is already reserved and remaining space is expected to be reserved by the end of the year. Exhibitors will include technical products—healthcare equipment, devices, supplies and pharmaceuticals; educational resources—publications and training materials; nonprofit healthcare organizations; market research firms; and career opportunity exhibitors—hospitals, healthcare facilities, colleges and universities, and travel nurse companies.

NTI 2002 exhibitors may sponsor educational programs, satellite symposia, events, conference area and official giveaway items. They may also offer continuing education at their display. Print advertising opportunities are available in the official Program and Proceedings book and in the daily newspaper. Online opportunities, including a “featured exhibitor” option, are available on the NTI Web site at http://www.aacn.org.

Further visibility is offered to exhibitors who contribute a product or service to the annual Silent Auction supporting the AACN Scholarship Fund.

To request an exhibit prospectus, sponsorship brochure and exhibits-related information, contact the AACN Exhibits Department (800) 394-5995. Ask for Colin Riegle (ext. 509), Heidi Boydstun (ext. 373) or Randy Bauler (ext. 366). For Silent Auction and scholarships information, contact Darval Bonelli (ext. 531), Ram´┐Żn Lavandero (ext. 505) or Beth Wos (ext. 513) in the Development Office.

AACN Exhibits Director Earns Certification

AACN Exhibits and Sponsorships Director Randy Bauler recently earned certification from the International Association for Exhibits Management (IAEM).

The certified exhibit management (CEM) designation is recognized throughout the worldwide exhibition industry as the mark of professional achievement.

As exhibits and sponsorships director at AACN, Bauler is responsible for the Critical Care Exposition at the National Teaching Institute,™ as well as for company sponsorships of various events, programs and materials.
IAEM is the professional association for more than 3,500 individuals in 45 nations who are involved in the management and support of the global exposition industry.

On the Road

AACN frequently takes its show on the road, as representatives of the AACN National Office exhibit at conferences throughout the country. Following is the exhibit schedule for October and November 2001:

Oct. 23-27—Trends Conference, Philadelphia, Pa.
Nov. 1-4—National Student Nurses Association, Reno, Nev.
Nov. 12-14—American Hospital Association, Anaheim, Calif.

If you are attending these conferences, stop by the AACN exhibit to visit with your National Office team.


The hundreds of AACN members who volunteer each year to serve on national committees play major roles in influencing the practice of critical care nursing. Debuting with this issue of AACN News is a new feature, titled “Timeshare,” which will highlight the significant contributions these volunteers make and keep you up to date on what’s going on in the world of AACN advisory teams, work groups, review panels, appeals panels, think tanks and task forces.

However, we need your help. AACN is inviting all its volunteers—past and present—to share their experiences, to describe what volunteering means to them.

To complement this column, AACN is also enhancing the volunteer section of its Web site at http;//www.aacn.org to include many of these stories online. Visit this area frequently to find out what your colleagues are saying about their volunteer opportunities. Simply click on “Membership,” then “Volunteer Opportunities.”

Send your stories and comments to AACN, Attn: Volunteer Services, 101 Columbia, Aliso Viejo, CA 92656-4109; fax, (949) 448-5541; e-mail, stephanie.demiris@aacn.org.

Coming in the November Issue of AJCC

• Beta Blockers: A New Therapy in Congestive Heart Failure (CE article)

• Using End-Tidal Co2 Measurements to Predict Outcome in Cardiac Arrest

• Early Extubation in Older Adults Undergoing CABG Surgery

• Nurses’ Accuracy in Estimating Backrest Elevation

• Thoughts, Feelings, and Motivations of Bystanders Who Attempt to Resuscitate a Stranger

• Monitoring Urinary Bladder Temperature in the ICU

Subscriptions to Critical Care Nurse and the American Journal of Critical Care are included in AACN membership dues.

Join AACN as a Group and Receive a Discount

Nurses who join AACN or renew their membership as a group of five or more receive a discount on the membership fee.

The group discount program applies to members or affiliate members, as well as to international, student and emeritus memberships.

New and renewing groups of members or affiliate members pay a $69 membership fee per year instead of the $78 annual individual fee. Groups of international members pay $92 per year instead of $104, and groups of student members or of emeritus members pay $46 instead of $52.

This group rate applies only to one-year memberships, and full payment for all members in the group must accompany applications. Membership certificates will be mailed to the individual placing the order for distribution to all members of the group.

For more information about this new program or to obtain a group membership application form, call (800) 899-AACN (2226), or visit the AACN Web site at http://www.aacn.org.

Look Ahead

January 2002

Jan. 15 Deadline to submit proposals for AACN Clinical Inquiry 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 www.aacn.org. Click on “Research.”

February 2002

Feb. 1 Deadline to submit proposals for AACN Datex-Ohmeda 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 www.aacn.org. Click on “Research.”

Feb. 1 Deadline to submit proposals for AACN Certification Corporation 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 www.aacn.org. Click
on “Research.”

Feb. 1 Deadline to submit proposals for AACN 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 www.aacn.org. Click on “Research.”

Feb. 1 Deadline to submit proposals for AACN Mentorship 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 www.aacn.org. Click on “Research.”

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