Vol. 19, No. 2, FEBRUARY 2002
In the Circle: Award Honors Excellent
The following excerpts are from exemplars
submitted in connection with the Excellence in Management Award for 2001, a part
of AACN�s Circle of Excellence recognition program. This award recognizes nurse
managers who demonstrate excellence in coordination of available resources to
efficiently and effectively care for acute or critically ill patients and
families. Recipients were provided complimentary registration, airfare and hotel
accommodations for NTI 2001 in Anaheim, Calif.
Judy E. Davidson,
San Diego, Calif.
I look forward to Mondays with mixed pleasure
and guarded anticipation. What makes this, my clinical day, different? Mondays
help me not lose sight of what it means to be a nurse.
It has been years since I�ve pulled shifts.
�What do you think about playing some music, Mr. Henry?� His wife hums along,
brings up stories of the past�good times and memories. Making death right and
good and as special as birth is a rewarding experience. His skin becomes dense
and clammy, and his breathing deep and irregular. �He is leaving us now. He is
having no pain. Is there anything else you wanted to tell him before he is gone?
He won�t last much longer.� I pat one hand; she caresses the other. She leans
forward and speaks softly in his ear. In a moment he is gone. We cry together.
I wouldn�t trade Mondays for anything. It�s what
makes management doable. I realize that the new insulin syringes purchased to
make us safe don�t work. You can�t see the marks on them. The doors to the
storeroom are so heavy they hurt your wrists. The pressure needed to tear open
the new IV bags hurts your thumb and hand. We need more footstools. The soap is
too harsh. The nurses need lotion, not just soap. The back door doesn�t close
smoothly. The housekeeper doesn�t know that the hopper needs to be cleaned. The
DKA protocol is too cumbersome to really use; three months of committee work
down the drain.
Details revealed on Mondays prioritize goals for
unit management. More importantly, they feed the nursing spirit.
Karin Henderson, RN, MSN, CCRN, CS
High Point, N.C.
High Point Regional Health System
I was promoted to a management position in a
critical care, step-down unit two-and-a-half years ago. I was now in a position
where, instead of taking care of one patient, I could influence the care of
multiple patients. With my advanced degree as a nurse practitioner, I really
knew little about management. However, my hunch was that a professional caring
environment with management making a personal investment in staff would bring
positive results. Caring for nurses is my priority. I truly believe that this is
the highest duty of management. With the help of the nurses on my unit, we
turned a struggling unit into a wonderful place for nurses to practice and
patients to receive care.
How? We rolled up our sleeves and changed our
environment by using the following approaches:
� A new voice�I used small focus groups on every
shift to gain insight and enlist staff as the authors of change in their unit.
� No more pyramids�The charge nurses and I
formed a circle structure where management was accountable to each other.
� Extra training�To be truly accountable to each
other, we promoted the increase in numbers of staff who can run the unit.
� Empowerment�We did not just schedule
committees and interview committees, but used encouragement and accountability
to help each other grow.
Today, we have a unit that is overstaffed, with
nurses on a waiting list to work with us. Our unit is a different place today
than when our change process began. We have formed an environment where nurses
can grow, be mentored, express ideas and effect change. Heaven? No. But amazing
things happen every time nurses are given the opportunity to grow.
RN, BSN, CCRN
Lafayette General Medical Center
Managed care did not trickle through to our area
until 1997. At that time, I realized that the way we care for our patients must
change if we were to compete in the healthcare market. Having recently accepted
a management position and being an ICU nurse, I recognized the challenges that
bedside nurses faced in caring for their patients.
Our 20-bed ICU was quickly becoming a unit of
not only unstable acute patients but also of hemodynamically stable patients who
could not be weaned off the ventilator. Our 10-bed medical ICU was congested
with long-term care vent patients. Our immediate strategic goal was to
facilitate a plan that would join the hands of the ICU, MICU and telemetry units
in caring for our patients. I met with each unit team to talk about our goals
and how we would accomplish them. The staff and I decided we would become a
29-bed specialty care unit.
One particular area of patient care that we
viewed as an opportunity to decrease costs was angioplasties. I empowered the
staff to work as a team in developing standards that would maintain the quality
of care for this population. We devised orientation packets and solicited the
assistance of the catheter lab and ICU staff to help with teaching the telemetry
nurses to pull sheaths and hold pressure.
An unexpected outcome was that the telemetry
nurses were becoming more confident in their ability to care for all of their
patients. This translated to new respect between physicians and nurses on the
unit, and we were able to decrease the cost per patient discharged by more than
50%. I was proud to lead a great team to maintain high standards and efficiently
care for our patients. I truly believe that, to be an effective leader, you have
to love your team of people, not your position of leadership.
Research Corner: Myth vs. Reality: Holding
Intubated Infants in the NICU
By Sandra L. Smith, RN, PhD, APRN
Research Work Group
Jay is a 26-week gestation infant who now is 28
days old and weighs 985 grams. He is intubated and receiving mechanical
ventilation. His ventilator settings are PIP 20, PEEP 5, SIMV 30, I-Time 0.32.
His fraction of inspired oxygen requirement ranges from 0.30 to 0.45 to maintain
his oxygen saturation within the neonatal ICU�s standard of care range. He is
receiving and tolerating well full enteral feedings via a nasogastric tube.
Jay�s mother believes that holding her premature infant will be good for him and
will help him to �feel and grow better.� The nurse is aware of the literature
regarding skin-to-skin holding (also known as kangaroo care) and agrees.
However, the other nurses are skeptical.
Myth: Intubated infants are physiologically more
stable when they are held than when they are in the incubator.
Reality: The NICU culture has been moving toward
the family-centered care paradigm, which inherently demands that families be
included in the care of their infants. Although holding is a seemingly benign
act, it can be extremely stressful for the fragile, intubated, very low birth
weight infant. There are no published studies regarding the effect of swaddled
holding on the physiological responses of the intubated VLBW infant, and the
research on the effects of skin-to-skin holding has been conducted primarily on
the healthier, premature infant, who is no longer intubated nor mechanically
ventilated. Few studies have been published describing the physiological effects
of skin-to-skin holding on the intubated VLBW infant.
The belief that all infants should be held is
based upon term, healthy infants. Critically ill, premature infants, including
intubated VLBW infants on full enteral feedings, are a different population and
appear to respond differently to external stimuli than the healthy term infant.
Skin-to-skin holding of the well, term newborn
and the convalescing premature infant has been shown to be safe. In fact, term
infants held skin-to-skin immediately after birth cried significantly less than
infants placed in cribs. In addition, there were no differences in infant
temperature between the group of infants held skin-to-skin and those placed in
cribs.1-3 These findings suggest that skin-to-skin holding may be supportive and
comforting to the term infant immediately after birth.
Reports on preterm infants differ because the
gestational ages, birth weights, and age and weight at the time they were
enrolled vary widely from study to study. Spontaneously breathing, premature
infants cared for in incubators were reported to remain normothermic during one
and three hours of skin-to-skin holding.4-7 Investigators have also reported
that infants maintain normal heart rates, respiratory rates and oxygen
saturations during skin-to-skin holding, suggesting that it is not detrimental
to the convalescing premature infant.7,8
The limited data on the more critically ill
premature infants are contradictory. Two groups of investigators studied a small
group of infants receiving nasal prong, continuous positive airway pressure.9,10
Both studies showed no significant differences in heart rates, respiratory
pattern or oxygen saturation during skin-to-skin holding or incubator care.
However, the rectal temperature of one 770-gram infant did decrease to 37.2�C
during skin-to-skin holding, illustrating the sensitivity and fragility of these
very small infants.
Few investigations have been published on the
physiological stability of intubated VLBW infants during holding, and the
results of two recently published reports are inconclusive. Neu and colleagues11
studied 15 mechanically ventilated, premature infants weighing between 745 and
1876 grams. These infants had significant decreases in oxygen saturation during
the transfer to and from the incubator and parent for skin-to-skin holding.
These investigators also reported that the infants had normal temperatures and
no differences in oxygen saturation during skin-to-skin holding compared with
incubator care. Smith12 studied 14 intubated VLBW infants with a mean study
entry weight of 994 grams. These infants were randomly assigned to receive
incubator care for two days, followed by two hours of intermittent, skin-to-skin
holding for two days, or vice versa. The infants in this study demonstrated a
14% increase in fraction of inspired oxygen requirement during skin-to-skin
holding compared with incubator care to maint ain adequate oxygen saturations
between 85% and 96% (the study site standard). The patterns of oxygen saturation
were also more variable during skin-to-skin holding compared with incubator care
in these fragile infants. Infants in this study also became hyperthermic during
skin-to-skin holding, most likely because of the transfer of heat from the
mother�s chest to the infant. Although not statistically significant, infants
during the skin-to-skin holding phase of the study gained less weight (6.8
grams/kg/day) than during the incubator phase (12.6 grams/kg/day).13
In summary, the data regarding the safety and
efficacy of skin-to-skin holding on intubated VLBW infants are conflicting.
Current research suggests that the intubated VLBW infant may be physiologically
stressed during skin-to-skin holding, a situation that may have uncertain,
long-term effects. Nurses must weigh the perceived benefit to the mother of
holding her baby during this critical phase of the infant�s illness against the
physiological stress that will be placed upon the infant�s immature systems.
Studies of physiological responses during traditional, swaddled holding are
needed to determine if this method of holding may be less stressful and more
supportive of the intubated VLBW infant.
1. Christensson K, Siles C, Moreno L, et al.
Temperature, metabolic adaptation, and crying in healthy full-term newborns
cared for skin to skin or in a cot. Acta Paediatr. 1992;81:488-493.
2. Christensson K. Fathers can effectively
achieve heat conservation in healthy newborn infants. Acta Paediatr.
3. Michelsson K, Christensson K, Rothg�nger H,
Winberg J. Crying in separated and nonseparated newborns: sound spectrographic
analysis. Acta Paediatr. 1996;85:471-475.
4. Bauer J, Sontheimer D, Fischer C, Linderkamp
O. Metabolic rate and energy balance in very-low-birthweight infants during
kangaroo holding by their mothers and fathers. J Pediatr. 1996;129:608-611.
5. Bauer K, Uhrig C, Sperling P, & Versmold HT.
One hour of skin-to-skin care was no cold stress for VLBW infants, as oxygen
consumption and central-peripheral temperature gradient did not increase.
Pediatr Res. 1995;37(4):196A.
6. Bauer K, Uhrig C, Sperling P, Pasel K,
Wieland C, Versmold HT. Body temperatures and oxygen consumption during
skin-to-skin (kangaroo) care in stable preterm infants weighing less than 1500
grams. J Pediatr. 1997;130:240-244.
7. Ludington-Hoe SM, Hadeed AJ, Anderson GC.
Physiologic responses to skin-to-skin contact in hospitalized premature infants.
J Perinatol. 1991;11:19-24.
8. Messmer PR, Rodriquez S, Adams J,
Wells-Gentry J, Washburn K, Zabaleta I, & Abreu S. Effect of kangaroo care on
sleep time for neonates. Pediatric Nursing. 1997;23(4):408-414.
9. Leeuw R, Colin EM, Dunnebier EA, Mirmiran M.
Physiological effects of kangaroo care in very small preterm infants. Biol
10. Hurst NM, Valentine CJ, Renfro L, Burns P,
Ferlic L. Skin-to-skin holding in the neonatal intensive care unit influences
maternal milk volume. J Perinatology. 1997;17:213-217.
11. Neu M, Browne JV, Vojir C. The impact of two
transfer techniques used during skin-to-skin care on the physiologic and
behavioral responses of preterm infants. Nurs Res. 2000;49:215-223.
12. Smith SL. Physiologic stability of intubated
VLBW infants during skin-to-skin care and incubator care. Advances in Neonatal
13 Smith SL. Physiological responses of
intubated very-low-birthweight infants during skin-to-skin care. Dissertation
Abstracts International. 2000;61(02):784. (University Mircrofilms No.
The Power of One: Proper Translation Key
in Family-Centered Decision Making
By Christine Westphal, RN, MSN, CCRN
Ethics Work Group
Mr. and Mrs. Ang had immigrated from Korea seven
years ago with their son, grandson and their families. After struggling
initially, the family had become successful owners of a local market, with all
three generations living and working together.
Late last year, Mr. Ang died suddenly. The
eldest son Chin made certain his now 80-year-old mother was well cared for and
protected. Protection of the elderly, widowed and infirm is an expectation in
Korea, as well as many other Asian and Middle Eastern cultures.
A resilient woman, Mrs. Ang continued to be
active in the family business after Mr. Ang�s death, putting in long hours. Over
time, her family began to notice that she seemed to tire more easily and was
often short of breath. At closing time one evening, Chin found his mother seated
on a crate in the back room of the store, short of breath and diaphoretic. He
At the emergency department, Chin served as the
interpreter as the healthcare team assessed Mrs. Ang, who had suffered a
myocardial infarction and was in pulmonary edema. With aggressive treatment, she
was stabilized, without the need for emergent intubation, and transferred to the
Upon admission to the ICU, the nurse, Jon,
assessed both Mrs. Ang and the family dynamics. Although Mrs. Ang was responding
to diuretics, oxygen and inotropes, Jon knew that she would require a cardiac
catheterization. Because she was physiologically vulnerable and at risk for a
respiratory or cardiac emergency, Jon wanted to clarify her wishes for
resuscitation in the event that she became further compromised. He also
recognized that the Ang family was close and interdependent, and would likely
need additional support.
Chin was willing to participate in his mother�s
care. However, Jon was concerned that Chin might not be able to accurately
translate some of the complex medical terms. He was also concerned that Chin
might be reluctant to communicate information to his mother that might upset
her. At the same time, Jon recognized that Mrs. Ang might be reluctant to answer
personal health questions in the presence of her son. Thus, as an advocate for
Mrs. Ang and her family, Jon sought out a medically competent translator to
assist with the communication.
Jon recalled that the hospital had contracted
for a language translation service, which provided the hospital with
interpreters via telephone, as well as translation of documents in more than 140
languages. The service guaranteed that a translator would be available within
However, Jon also knew that the service could
not always provide interpreters fluent in �medical language� and that, because
the message is more than simply words, having the translation in person would be
more effective. He remembered that a nurse in the ambulatory clinic spoke
As Jon waited for the bilingual nurse to arrive,
Chin expressed concern about alarming his mother with information about her
condition and possible treatments. He explained that, because he could give
consent for anything his mother needed, it was not necessary to involve her. Jon
explained to Chin that, because Mrs. Ang was alert and able to participate in
decision making, she had a right to make her own decisions and not disclose
information to anyone, if she so chose. This position upset Chin greatly. Afraid
that the stress of the medical information and decision making could make his
mother sicker, he begged Jon to let him talk to his mother in his own way. Jon
was torn. Although he understood the need to be sensitive to the unique cultural
and spiritual needs of patients and their families, he felt obligated to protect
the patient�s rights.
Jon sought advice from his manager, who
consulted Carolyn, the on-call resource from the hospital Ethics Committee.
Carolyn explained that a patient�s right to truth-telling, confidentiality and
self-determination is based upon western values and beliefs that may not be
espoused by all patients. She further explained that a patient, based upon his
or her own values and beliefs, can defer these rights and give permission to
another to act on his or her behalf. The team met with Chin and explained that
his request to protect his mother and make decisions on her behalf could only be
honored if Mrs. Ang agreed.
The team, along with the bilingual nurse, went
to Mrs. Ang�s bedside. To avoid influencing his mother�s decision, Chin was
asked to remain outside. The nurse explained Mrs. Ang�s rights as a patient to
her, but also told her that she could allow her family to receive information
and make decisions on her behalf if she wanted. Mrs. Ang expressed that Chin had
always taken care of her and that she trusted him to decide what was best for
her. She expressed that she trusted him to tell her what she would need to know.
Jon�s clinical judgment, advocacy, caring,
collaboration and system thinking helped him to effectively meet the needs of
Mrs. Ang and her family. The �power of one� did, indeed, make a difference!
Sharing the Experience: Program Experience
Editor�s Note: In celebration of the 10th
anniversary of the AACN Wyeth-Ayerst Nursing Fellows Program, AACN invited
alumni mentors and fellows to share their thoughts about and experiences with
the program. These accounts will be published in AACN News throughout this
By Judy Graham-Garcia, RN, MS, CCRN, FNP,
ACNP, Wyeth-Ayerst Fellow
and Janie Heath, RN, MS, CCRN, ANP, ACNP,
Participating in the 2000 AACN Wyeth-Ayerst
Nursing Fellows Program exceeded all of our expectations. Although we knew that
being recognized by such a prestigious program was an honor and that being
associated with such renowned nursing colleagues was a privilege, we did not
know that we would receive �the royal treatment� at the NTI. From the fruit and
cheese basket that arrived at our hotel to welcome us to the special treatment
we received at the opening and closing sessions and in the exhibit hall, the
experience was truly first class.
We will always appreciate the opportunity AACN,
Wyeth-Ayerst and the American Journal of Nursing provided us to have our study,
�The Value of Urgent Smoking Cessation in the Veteran Population,� published in
the AJN supplement.
This program has been a significant stepping
stone for our professional and personal relationship on many levels. From a
scholarly perspective, we completed another study on the �Assessment of
Professional Development in Critical Care Nurses,� which was published in the
American Journal of Critical Care. From a professional perspective, we continue
to stay passionate about AACN and encourage nurses to become active in their
local chapters. From a personal perspective, our mentoring relationship
continues today, despite the fact that we are several hundred miles apart.
AACN has so many resources and opportunities
available to all of its members, and we are now dedicated to spreading the
excitement and encouraging others to apply to this wonderful nursing fellows
Advanced Practice Roles: CNS or NP? What�s
in a Name?
By Julie Stanik-Hutt, RN, PhD, CCRN, ACNP
and Sandra J. Cagle, RN, MSN, CCRN, ACNP
Advanced Practice Work Group
Does a clinical nurse specialist or nurse
practitioner work at your hospital? Is there really a difference between these
two advanced practice roles? Are credentials, such as CCNS and ACNP, just more
Advanced practice nurse is a generic, umbrella
term that encompasses NPs, CNSs, nurse anesthetists and nurse midwives. The NP
and CNS roles were created in the early 1970s, whereas nurse anesthetists and
nurse midwives have been advanced nursing roles for more than 50 years.
Advanced practice nurses are RNs who have
acquired advanced preparation for expanded clinical practice by earning a
master�s degree in nursing. Their distinct training and skills differentiate
them from other RNs.
What Is a CNS?
A CNS is an expert in clinical nursing who is
familiar with the theory and research related to a nursing specialty area, such
as critical care nursing. Traditionally, CNSs influence patient outcomes through
direct clinical practice, as well as education, research, consultation and
management. They are uniquely prepared, by experience and education, to manage
the complexities of negotiating our complex healthcare delivery systems. CNSs
may fill positions with job titles such as case manager, nurse educator
(hospital or university based), quality improvement manager or community
Nurses preparing for CNS positions take courses
in specialized areas, such as pathophysiology, advanced health assessment,
critique and application of research. They also complete courses related to
management of the clinical care system, including systems management, teaching
and learning theories, performance and quality improvement, and management of
change. Those aspiring to become CNSs may also complete clinical practicums to
gain experience in subroles, such as educator, researcher or consultant.
CNSs practicing in critical care can become
certified by successfully passing the CCNS exam offered by AACN Certification
Corporation. Most states do not require national certification or special
licensure for practice as a clinical nurse specialist. However, several states
now recognize CCNS certification as meeting the criteria for advanced practice
nursing designation or licensure.
What Is an NP?
An NP provides direct care to a specific
population of patients, such as adult, children, women, acutely ill adults and
neonates. They diagnose and manage common acute and stable chronic health
problems, responsibilities traditionally reserved only for physicians. In
addition to the traditional RN skills, NPs can perform comprehensive physical
examinations, order and interpret diagnostic tests, obtain specialty consults,
and perform and prescribe therapeutic measures, including most classes of
medications. They also incorporate health promotion and disease prevention, as
well as patient and family education, into their practice. NPs, who are
individually accountable for their practice and decisions, collaborate closely
A nurse preparing to be an NP completes courses
related to the direct care of individuals, including differential diagnosis,
clinical decision making, medical therapeutics and pharmacology. NP students
must also complete more than 500 hours of clinical practice that is closely
supervised by experienced NPs and physicians. Following graduation, NPs take
national certification exams and are usually specially licensed by their states
to practice. The educational preparation, certification and scope of practice of
an NP focuses on a specific patient population, such as adults, children, women
or acute care.
An acute care nurse practitioner is an NP who
has completed the ACNP examination administered by the American Nurses
Credentialing Center and whose practice focuses on acutely and critically ill
individuals. These NPs are employed in hospitals and ICUs, as well as in
specialty medical practices. They manage hospitalized patients with complex, but
often stable, medical problems, such as uncomplicated myocardial infarction,
pneumonia, exacerbation of chronic obstructive pulmonary disease, diabetic
ketoacidosis, postpercutaneous transluminal coronary angioplasty, postcoronary
artery bypass graft or common complications of organ transplantation. They may
be credentialed to perform bedside procedures, such as insertion of central
venous and pulmonary artery catheters and arterial lines; lumbar punctures,
thoracentecis or paracentecis; insertion and removal of chest tubes; or wound
NP or PA?
When explaining to someone what an NP does, the
inevitable response seems to be, �Oh, like a physician�s assistant.� Although
NPs and PAs may fill similar roles in community and hospital settings and the
functions of their roles may appear similar, there are clear differences.
A PA has completed a formal educational program
and usually completes a national certification exam. PA programs are usually for
two years and offered by a community college. However, some are in four-year
colleges and even graduate programs. Prior experience in healthcare is not a
prerequisite. A PA may obtain a patient�s medical history, perform physical
exams, assist the physician in developing and implementing patient management
plans, record progress notes and perform common routine diagnostic procedures.
Although the scope and regulation of PA practice varies by state, it always
requires supervision by a physician.
Although an associate�s degree is all that is
required to become a PA, an NP must have a master�s degree in nursing. NPs are
independently licensed; a PA is not. A physician must supervise the practice of
a PA. NPs already have a background in professional nursing practice and
approach patient problems from that perspective. A background in healthcare is
not a prerequisite to practice as a PA, who is educated in the medical model of
care. In addition, some PAs are trained by their supervising physicians to
perform routine procedures, such as suturing and wound care, or to assist in
surgery. Both NPs and PAs may write medical orders. However, the PAs� orders
must be cosigned by the physician (sometimes before they are carried out).
As you can see, both NPs and CNSs are advanced
practice nurses. They fill different but complementary roles. Depending on the
individual practice, the roles of the CNS and NP may even overlap. Both NPs and
CNSs approach problems from a shared nursing as well as distinct subspecialty
background. They both make important contributions to patient care.
Now, the next time you encounter a clinical
problem, you�ll know which advanced practice nurse to call for help. When you
run into a CNS or an NP, ask him or her to tell you about the job. You may
discover that being an NP or a CNS means doing something you�d like to do.
March 1 is the deadline to apply for the AACN
Evidence-Based Clinical Practice Grant. This grant funds multiple $1,000 awards,
up to a total of $6,000 per year, to stimulate the use of patient-focused data
or previously generated research findings to develop, implement and evaluate
changes in acute and critical care nursing practice.
New projects, projects in progress and projects
required for an academic degree are eligible for funding. Projects may include
research utilization studies, CQI projects or outcomes evaluation projects.
Interdisciplinary and collaborative projects are encouraged and may involve
interdisciplinary teams, multiple nursing units, home health, subacute and
transitional care, other institutions or community agencies.
Funds may be used to cover direct project
expenses, such as printed materials, small equipment or supplies, including
computer software. Funds may not be used for salaries or institutional overhead.
To obtain an application, call (800) 899-2226
and request Item #1013, or visit the AACN Web site at www.aacn.org > Clinical
Practice > Research.
Compassionate Care Videos Available in
Both Family and Professional Versions
Two videos titled �Compassionate Care in the
ICU: Creating a Humane Environment� are now available through AACN. Funded by an
educational grant from the critical care/surgery division of Ortho Biotech, each
version of the videos was produced in cooperation with the Society of Critical
One version is geared to families and the other
to professionals. Both are hosted by Mitchell Levy, MD, associate professor of
medicine at the Brown University School of Medicine, Providence, R.I., and chair
of the Robert Wood Johnson Critical Care End of Life Work Group.
The professional version, which features a
candid discussion of the complex psychological, emotional and legal issues
surrounding end-of-life care, is intended to help ICU practitioners begin
cultivating the compassionate skills needed to assist patients and loved ones.
The family version focuses on the complex
decisions faced in the ICU and the importance of advance planning and
communication. It also answers questions about the withdrawal of life support
and addresses the issues of pain and symptom management.
To order either of these videos, call (800)
Evidence-Based Practice Issue Available at
Because of the popularity of the November 2001
issue of AACN Clinical Issues (Vol. 12, No. 4), Lippincott Williams & Wilkins
has made back issues available for the special price of $29.95. This issue
focused on the role of experienced and advanced practice nurses in
evidence-based practice and how they can incorporate research findings into
The issue included articles on the following
� Integrating Clinical Reasoning and
� Champions for Evidence-Based Practice: A
Critical Role for Advanced Practice Nurses
� Quality Care Outcomes in Cardiac Surgery: the
Role of Evidence-Based Practice
To order, call (800) 638-3030. Use code
AACN Clinical Issues is available to advanced
practice AACN members at a 30% discount. To subscribe to this journal at the
reduced, member rate of $53.90, call (800) 638-3030 and ask for membership
AACN Online Quick Poll
Does your hospital have a policy and procedure
for doing �non-heart beating� or asystolic donation ?
Number of Responses: 363
The AACN Online Quick Poll is a voluntary survey
on a variety of topics and is not scientifically projectable to any other
population. AACN presents these surveys to give our users an opportunity to
share their opinions on particular topics. Participate by visiting the AACN Web