AACN News—August 2003—Association News

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Vol. 20, No. 8, AUGUST 2003

Critical Care Survey Update: Second Collection Cycle in Planning Stages

After analyzing data submitted by facilities and critical care units in response to the landmark Critical Care Survey early this year, AACN has decided to modify and relaunch the process.

This ambitious project, designed to profile critical care units in the U.S., includes gathering, analyzing and reporting key variables affecting the critical care environment, especially where critical care nurses are concerned. The information gleaned from the survey will help AACN and critical care nurses in all roles better define what makes a unit and a hospital a humane and healing environment for patients and nurses alike.

Data collection on the first survey closed in March. In analyzing the data, survey investigators determined that the number of completed surveys was insufficient to provide reliable findings. However, the surveys collected have been important in informing modification of the survey tool and of the delivery and online collection mechanism. The survey has been streamlined considerably, and additional features have been employed to ease the burden on respondents.

After review and pre-testing are completed, the modified survey is scheduled to be launched this fall. Data collection and analysis are scheduled to be complete by the end of 2003. The survey report is expected to be released in early 2004.

AACN extends sincere appreciation to all of the facilities that participated in the survey and to the individual nurses who facilitated the process. Those facilities that submitted a completed survey for the first collection cycle have received a personal thank you and compensation for their efforts. As promised, each of these facilities will also receive a free copy of the survey findings when they are available.

For the latest updates, call the Critical Care Survey Information Line at (800) 394-5995, ext. 7337.

AACN Celebrates First Anniversary of ECCO Program

It is hard for us to imagine that just one year ago this month we were announcing the availability of our first major Internet-based education program, the Essentials of Critical Care Orientation (ECCO). Since that time, more than 80 healthcare sites across 30 states and in two countries internationally have implemented the program.

We have been privileged to be a partner in re-envisioning the critical care nursing orientation process to incorporate this educational tool. Following are some of the responses we have gathered from program users over the course of the year.

From Allina Hospitals & Clinics

Abbott Northwestern Hospital, Minneapolis, Minn.

Megan Brede, RN, BSN, CCRN, nurse education coordinator for cardiovascular critical care
We have a lot of nurses who float between ICUs and work with very different types of patients so a broad base of skills is important. Once we got to know ECCO we realized this program offered the foundational information each orientee needed while addressing the more difficult pieces to teach (such as the oxyhemoglobin dissociation curve) with graphics and animation that made these concepts clear. Visualization and action really help in the learning process (you won't find the Doll's Eyes animated in a textbook like in the ECCO program).

St. Francis Regional Medical Center, Shakopee, Minn.

Heather Froehlich, RN, MSN, CCRN, learning and development specialist
With this solution, we can offer a structured orientation into critical care written to national standards that will always be on the cutting edge. The program really is easy to navigate. I have been in critical care for 15 years and this is a much nicer way to learn. I would recommend this program to other hospitals.

From Mercy Hospital, Miami, Fla.

Sonia Wisdom, RN, BSN, CCRN, nurse clinician for critical care
The educators determined that using the ECCO program had the potential to reduce their overall orientation costs by shortening the classroom portion of the orientation program by two weeks.
After conducting an in-depth review of the content, Wisdom indicated it was very interactive and she liked the organization of the learning material. In addition, she thought the content was clear, consistent, systematic and easy to understand and is at an appropriate level for a new critical care nurse.

From the U.S. Naval Hospital, Yokosuka, Japan

Lt. j.g. Noel Ysip, RN, BSN, Nurse Corps, United States Navy, ICU staff nurse
ECCO is a baseline assessment of critical care knowledge and skills that can be used as a tool for evaluating learning needs. It helps in a big way in developing orientation packets that can be tailored to the needs of the unit. Improved patient care + decreased acuity + staff satisfaction = patient satisfaction.

Cmdr. Janet Hughen, RN, MSN, Nurse Corps, United States Navy, department head, Medical/Surgical Nursing
ECCO has been an invaluable tool for us.

Ensign Daniel Yawn, RN, BSN, Nurse Corps, United States Navy, Multi-Service Ward staff nurse
If you're stuck on the night shift, you get some really quiet time between one and four in the morning. You can make good use of that time. Even on your off days, you can log on from home. The availability and flexibility of the program is first rate.

From Rush-Presbyterian- St. Luke's Medical Center, Chicago, Ill.

Susan Huerta, RN, MS, director of nursing systems
We desired flexibility rather than being locked into standard courses that could not be as individualized. With the ECCO program, we can be flexible in terms of when we offer the course, and we can tailor the education to meet each individual nurse's needs. One of the benefits of using this program is we don't have to ask nurses to come back to work on a day off or to stay awake all day after working all night to participate in an orientation class. Since it can be accessed 24/7, nurses can progress through the assigned modules in snippets, sitting for 30 minutes to 1 hour, whenever they have time.

Nancy Silva, RN, MS, clinical nurse specialist for surgical intensive care and postanesthesia recovery
I think participants have an increased comfort level knowing that they'll have access to the structured content once their orientation is complete. This ability to review the information provides support to new nurses as they begin to work with patients.

From Martha Jefferson Hospital, Charlottesville, Va.

Linda O. Lathan, RN, MSN, CCRN, FNP-C, nurse educator
As a small community-based institution seeking to expand service lines and develop new programs, we recognized that nursing education was a vital part of each new program's success. We were faced with considerable time restraints not only due to the short timeline for program implementation but also nursing shortages as well as nursing staff with limited experience. For all new staff in the ICU, the program was a part of their orientation as is suggested by the ECCO schedule. Our preliminary results reveal that the orientees feel that it is a valued part of their orientation. The flexibility of the program has met our needs to date and has allowed us to provide education to a greater number of nurses than would be possible with the traditional didactic method.

From Benefis Healthcare, Great Falls, Mont.

Kris Lattin-Jackson, RN, MSN, CCRN, cardiac clinical nurse specialist
As we strive to keep up with changing educational needs, we see this program as a powerful adjunct to the classroom and preceptor piece in providing the theoretical, didactic information for a strong, critical care education foundation. A strong educational foundation causes better application at the bedside, so the ultimate outcome is better patient advocacy and improved collaboration with physicians, which leads to improved nurse/physician satisfaction.

From Lee Memorial Health System HealthPark Medical Center, Ft. Myers, Fla.

Mary Pat Aust, RN, BSN, director of ICUs
The flexibility the program allows us to have is the main benefit. Other benefits include access to the gold standard of critical care nursing knowledge and that the content is continually reviewed and updated. I like that I can track an individual's progress through the program. One of the best features for me is the ability to review each individual's test results and discuss the questions with them.

From the University of Kentucky Hospital, Lexington

Karen Hall, RN, MSN, critical care staff development specialist
The education that occurs during orientation can be overwhelming at times, due to the amount of content the students are expected to learn. Being able to go back into the program to review content before taking a test, or if something is unclear, is really helpful. She added that the students like the convenience of being able to use ECCO from their homes.

From Denton Regional Medical Center, Denton, Texas

Paul St. Laurent, RN, BSN, CCRN, former critical care educator
ECCO is also a great recruiting tool for either new or experienced nurses. What I like most about it is the flexibility it gives us as a facility and the fact that it allows us to hire potentially exceptional nurses we may have lost in the past.

Nurses Critical in Care of Rhode Island Fire Victims

Editor's note: Mary-Liz Bilodeau, RN, MS, CCNS, CCRN, CS, BC, is the Chapter Advisory Team representative for AACN Region 1, serving Connecticut, Maine, Massachusetts, New Hampshire and Vermont, as well as Rhode Island, where a deadly fire swept through a crowded nightclub in West Warwick on the night of Feb. 20, 2003. More than 100 people were hospitalized with inhalation and burn injuries. Bilodeau's position as the critical care clinical nurse specialist and acute care nurse practitioner for the Burn Service at Massachusetts General Hospital, Boston, which received some of the fire victims, provided her a unique perspective on the important role critical care nurses played in caring for these patients. Following is her account.

By Mary-Liz Bilodeau, RN, MS, CCNS, CCRN, CS, BC

Caring for patients with burn injuries is both physically and emotionally challenging, but the commitment and compassion of critical care nurses were again evident in the aftermath of the Rhode Island nightclub fire in February 2003.

As the magnitude of the tragedy began to emerge in the early hours of Feb. 21, seven area hospitals were mobilized to accept multiple burn patients. Rhode Island Hospital, Kent Hospital and Miriam Hospital are located near the scene of the fire. In neighboring Massachusetts, Massachusetts General Hospital, Shriners Burns Hospital, Brigham and Women's Hospital, and the University of Massachusetts Medical Center also received injured patients.

As the Chapter Advisory Team representative for AACN Region 1, I was in contact with several of the Rhode Island nurses.
Peter Ginaitt, RN, EMT, who was responsible for triage at the scene, explained that the decision was made to use emergency department nurses to assist with initial assessment and triage.

"Their nursing expertise and professionalism made for an outstanding combination resulting in effective triage," he said.

John Fedo, RN, MSN, CCRN, CNA, a member of the Ocean State Chapter of AACN in Providence, R.I., who works in the ED at Rhode Island Hospital, said the commitment of the nurses in both the ED and the ICU was outstanding. Staff worked long hours to provide care to this very complex population, he said.

Fedo said that he also assisted in the burn unit on several occasions. In addition, burn nurses from different areas of the country-members of one of the Burn Specialty Teams from the National Disaster Medical Assistance Team-traveled to Rhode Island to augment staffing.

As the clinical nurse specialist and nurse practitioner for the Burn Service at Massachusetts General Hospital, I am privileged to work with an amazing group of nurses. One of them is Emilyn Bellavia, RN, BSN, CCRN, a senior staff nurse who was working the unit the night of the fire.

A burn nurse for more than 30 years, she began to contact colleagues as soon as word came that there were multiple burn casualties. Bob Droste, RN, and Mike Wilson, RN, also senior staff in the Burn Unit, arrived shortly after the first two patients were admitted at about 3 a.m. By morning, Massachusetts General had accepted 10 patients. Another arrived later that morning.

Bellavia said that being able to depend on her colleagues made planning for this influx easier.

"I knew that we would rise to the occasion," she said. "We always do."

As the Burn Unit filled, patients were admitted to the surgical ICU and the medical ICU. And, for the first time in its history, the pediatric Shriner's Burns Hospital accepted adults, admitting four patients.

One of the most difficult problems faced by the staff at Massachusetts General was the number of unidentified patients. Unit staff, the nursing administration, Social Services and Psychiatry worked for 36 hours straight, until all the patients had been identified.

Nurses in these units then began to forge relationships with the patients and their families, providing valuable support in this crisis. The nursing expertise has guided them through the numerous surgical procedures, lengthy dressing changes and the psychological impact of the injuries.

By mid-April, all but the most critically injured patients had been discharged, and the one remaining patient continues slow progress toward discharge.

The extent of the contribution of every nurse who touched the lives of these patients is difficult to describe. As encouraged by immediate past AACN President Connie Barden, RN, MSN, CCNS, CCRN, they definitely used their bold voices, fearless and essential, to care for and to advocate for this extremely complex group of patients. And daily, they exemplify the "Rising Above" theme of current President Dorrie Fontaine, RN, DNSc, FAAN, as they continue to ensure expert, compassionate critical care.

Scene and Heard

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

Our Voice in the Media
An article titled "Fostering a Humane Workplace," written by immediate past President Connie Barden, RN, MSN, CCNS, CCRN, was featured in the June 1, 2003, issue of Nursing Spectrum. Barden stressed the fact that a lack of collaboration creates danger for patients. "Despite the shortage of nurses, nurses regularly report disrespect and non-collaboration in the workplace," Barden wrote in the article. "This type of treatment used to be a given, a part of the culture, but now we have to be vigilant to ensure that everyone is respected." She cited unhealthy work environments as a key reason nurses turn away from the bedside.

An article titled "Improving Care of Older Americans," which appeared in the June 2003 issue of the American Journal of Nursing, quoted AACN Practice and Research Director Justine Medina, RN, MS. "Recent data show more than half of all patients admitted to intensive care units nationwide are over age 65, and at least 25% are over age 75," Medina said. "Despite this, critical care nurses don't tend to think of themselves as practicing geriatric nursing. AACN will use its grant (from the ANA and the Hartford Foundation) to broaden the geriatric content in its certification exam for critical care nurses ... to help nurses distinguish more clearly between normal age-related physiologic changes and pathophysiologic changes."

In May 2003, a letter to the editor by AACN member Jennifer Wagner, RN, MSN, CCNS, was printed in the Canton Repository, Canton, Ohio. In the letter, titled "Nurses Face Many Workplace Challenges," Wagner noted that, during the opening session of AACN's National Teaching Institute and Critical Care Exposition in San Antonio, Texas, then AACN President Barden had challenged nurses to use bold voices. "Nursing is faced with the challenge of nursing shortages and declining work conditions while striving to maintain standards of care that are safe for our patients and their families," Wagner wrote. "To make a bold voice means identifying challenges in the workplace, collaborating with colleagues to find solutions to the challenges and remaining actively involved in the solutions. Although this statement was directed at the members of the AACN, making bold voices should be a commitment of all nurses so that we can create a healthy and caring work environment."

The June 3, 2003, Pacific edition of Stars and Stripes featured ECCO, AACN's Essentials of Critical Care Orientation program. Titled "Online Program Brings Academic Opportunities to Busy Navy Nurses," the article focused on the benefits of the program, which had debuted at the U.S. Naval Hospital, Yokosuka, Japan. "Nurses can complete required training on a schedule they choose," the article noted. Ensign Daniel Yawn, who recently completed the program, was quoted as saying, "The availability and flexibility of the program is first rate."

An article written by Tina Wiseman, AACN education resource specialist, was published in the June 24, 2003, issue of Vital Signs, a publication of the Sun-Sentinel Company serving southern Florida. Titled "Essentials of Critical Care Orientation: Leveraging the Power of the Internet for Nursing Education," the article quotes Sonia Wisdom, RN, BSN, CCRN, nurse clinician for critical care at Mercy Hospital, Miami, Fla., as saying, "(ECCO) allows us to provide ongoing education, even when an educator is not present … We can trust that the content is current, evidence-based theory provided by the leaders in critical care education-AACN … Virtually all the preparation to teach a class is done because objectives, outlines and other handouts such as CE certificates are already built into the program. This really shortened the prep time for the first implementation."

The May 6, 2003, issue of the Dallas Morning News featured an article titled regard what becoming a CCRN requires. The article noted that, though certification isn't mandatory, AACN supports it because it denotes demonstrable knowledge in the specialty and a higher standard of care to patients, employers and other nurses. Certification also enhances patient safety and nurse recruitment and retention.

Teresa Wavra, RN, MSN, CCNS, CCRN, AACN clinical practice specialist, was quoted about AACN's position on staffing ratios in the June 1, 2003, issue of Critical Care Alert, a publication of Thomson American Health Consultants. She explained, "AACN's position is that staffing ratios depend on the needs of the patient and the competency level of the nurse. Each patient has unique needs, and just conforming to a staffing ratio doesn't guarantee a level of patient care." Citing AACN's position paper titled "Maintaining Patient-Focused Care in an Environment of Nursing Staff Shortages and Financial Constraints," Wavra said it is difficult to determine the potential effects of adhering to the staffing ratios as mandated by law.

In a June 16, 2003, news release, Nellcor announced that it had partnered with AACN and the American Organization of Nurse Executives to facilitate the donation of Nellcor pulse oximeters and educational resources to 150 U.S. schools of nursing. Nellcor will donate an N-395 Pulse Oximeter and educational materials to each of the schools selected by AACN and AONE. Each school will also have access to the expertise of Nellcor's field-based team of hospital clinical consultants.

An article titled "A Primer on Critical Care Nursing" appeared in the May 2003 issue of Healthcare Purchasing News. The article discussed NTI, the role of critical care nursing, where AACN members practice, how the nursing shortage affects critical care and the future of critical care nursing. In the same issue, the Washington Report noted that AACN had submitted written testimony to the Institute of Medicine's Committee on Work Environment for Nurses and Patient Safety.

The "AACN Update" section in the May 2003 issue of Chest Soundings, the American College of Chest Physicians newsletter, included information on the NTI, AACN's testimony to the IOM, AACN's first critical care survey and its white paper titled "Safeguarding the Patient and the Profession: The Value of Critical Care Nurse Certification."

AACN President Dorrie Fontaine, RN, DNSc, FAAN, was interviewed on KCSN radio, Northridge, Calif., about family presence during resuscitation and invasive procedures. She discussed research sponsored by AACN and the Emergency Nurses Association regarding the fact that few hospitals have a policy allowing family members to be present during CPR or invasive procedures. The findings were published in the May 2003 issue of the American Journal of Critical Care and in the June 2003 issue of the Journal of Emergency Medicine. AACN supports a policy of family presence to better meet patients' and families' needs.

AACN member and volunteer Pat Carroll, RN, BC, MS, CEN, RRT, was interviewed on the CNN Headline News for Your Health segment about antibiotics.

During the NTI, Fontaine was interviewed by Jim Leonard of the National Public Radio station in San Antonio, Texas, about the need for critical care nurses, what they do and how they are helping the city recruit interested high school students and advising them about the benefits of a career in critical care

Janie Heath, RN, MS, CS, CCRN, ANP, ACNP, a member of the AACN Board of Directors, was interviewed on the Lillian Brown show on the National Public Radio station in Washington, D.C., about the role of the critical care nurse and how to become one and why. Other topics focused on the work environment, including AACN's involvement in solutions for the nursing shortage, patient safety, and quality of care at the end of life.

Our Voice at the Table
Ramón Lavandero, RN, MSN, MA, FAAN, AACN director of Development and Strategic Alliances, was an invited panelist at a celebration to honor retiring Indiana University School of Nursing Dean Angela Barron McBride.

Randy Bauler, AACN exhibits director, was selected by the American Society of Association Executives to attend its Future Leaders Conference in Maryland. The three-day conference was attended by about 60 executives from nonprofit companies. In addition to formal presentations, team-building exercises, small discussion groups and networking opportunities were provided. Bauler also led a concurrent session titled "How to Make Advance Space Selection Work for You" at the Healthcare Convention & Exhibitors Association's annual conference in Palm Springs, Calif. Assisting Bauler was Kimberly Buckley of Freeman Decorating, Anaheim, Calif. The session explored the benefits and challenges of offering advance selection of exhibit space.

Letter to JAMA Demonstrates Effectiveness of Bold Voice

As this monthly "Scene and Heard" feature demonstrates, critical care nurses can use their bold voices in many ways. A recent example that pointed up the strength just one bold voice can have appeared in the May issue of AACN News in the form of a letter written by longtime AACN member Robert Welton, RN, MSN.
His comments echoed his letter to the editor of the Journal of the American Medical Association (printed April 2, 2003) in response to an article titled "Why This Nursing Shortage is Different," which appeared in JAMA on Dec 4, 2002. Welton was addressing two statements in the JAMA article-specifically "as long as hospitals ... disrespect their nurses in general" (page 2744), and "it is clear that hospital management will have to pay significantly more attention to improving the working conditions of nurses than they have in the past" (page 2744).
Welton responded that "physicians' behavior can have profound effects on nurses' working conditions and job satisfaction. Simply telling a nurse that he/she did a "nice job" with a patient, or "that was a great save, thanks" can help nurses feel good about both their work and their jobs." He also discussed the impact of disruptive physician behavior on working conditions and job satisfaction by saying, "Comments intended to intimidate, undermine confidence, imply incompetence, or verbal abuses beyond the bounds of fair professional comment can do more than ruin nurses' entire shift; they also undermine essential teamwork and collaboration."
It is clear that Welton used his bold voice to point out that physicians have a major role in influencing nurses' working conditions. AACN encourages members to use their articulate, professional "bold voice" in the same way to get our messages out to the public.

Myth Versus Fact
Setting the Record Straight About Liability Insurance

Myth: All professional liability plans are the same.

Fact: Different plans have different coverage limits.
Although the purpose of professional liability plans is to protect you in the event of a lawsuit, how you are protected can differ. In fact, two plans with identical coverage limits can be different. For example, some companies reimburse you for expenses if you are sued. The AACN Professional Liability Insurance Plan pays for you, so you do not need to pay anything up front.

To make obtaining individual coverage easier, AACN sponsors a professional liability insurance plan for its members. For additional information, contact Marsh Affinity Group Services, a service of Seabury & Smith, 1440 Renaissance Dr., Park Ridge, Ill. 60068-1400; phone, (800) 503-9230. Or, visit the AACN Web site at http://www.aacn.org > Membership > Benefits > Personal Resources.

Numbers Continue to Build in Member Recruitment Effort

With 13 new members recruited, Ngozi I. Moneke, RN-BC, BSN, CCRN, of Freeport, N.Y., maintained her lead in AACN's Critical Links member recruitment campaign as of the end of June. However, a new name showed up near the lead as a result of June recruitment numbers.

Catherine P. Rodgers, RN, ADN, CCRN, of South Daytona, Fla., joined Caroline Axt, RN, MS, of Oakland, Calif., and Linda J. Lopazanski, RN, CCRN, of Fords, N.J., each at 10 new members recruited. Close behind were Barbara M. Eachus, RN, BSN, CCRN, of Philadelphia, Pa., at nine new members; Victor A. Duarte. RN, of Fort Collins, Colo., at eight; Kathleen M. Richuso, RN, MS, MSN, of Chapel Hill, N.C., Maria A. Laxina, RN, MA, MS, Nutley, N.J., Dawn Kregel, RN, BS, BSN, of Denton, Texas, Teresa J. Seright, RN, ADN, CCRN, of Minot, N.D., and Dawn LeQuatte, RN, of Denver, Colo., all at seven; Betty C. King, RN, MSN, AA, of Encino, Calif., Cathy L. Blonski, RN, of Danbury, Conn., and Marisue Rowe, RN, ADN, of Jacksonville, Ark., all at six; and Barbara M. Bundage, RN, MSN, of Long Beach, Calif., and Diane M. Casperson, RN, BSN, CCRN, of Beresford, S.D., both at five.

Their efforts helped boost the total number of new members recruited by both chapters and individuals to 522 since the campaign began May 1.

The top individual recruiter when the campaign ends March 31 will receive a $500 American Express gift certificate. All individual campaign participants receive an AACN pocket reference when they recruit their first new member. After that, individual recruiters receive $25 gift certificates toward the purchase of AACN resources when they recruit five new members and $50 AACN gift certificates when they recruit 10 new members.

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

Receiving the American Express gift certificate in the drawing for June was Vicki A. Riddle, RN, of Hamilton, Ohio.

In addition, all recruiters are eligible for prize drawings that offer round-trip tickets for two to anywhere in the continental United States, including a five-day, four-night hotel stay; round-trip tickets for two to anywhere in the continental United States; and four-day-three-night hotel accommodations in the continental U.S.

To participate, recruiters must have their membership number included in the referral line of the membership application or the chapter name for chapter referral credit.

PDA Center

PDA Version of Drug Guide Released
You can now purchase Lippincott Williams and Wilkins' 2003 Nursing Drug Guide through the AACN PDA Center. And, through Sept. 30, you can save 15% when you purchase the latest AACN Reference/Drug Guide Bundle. In addition to the Nursing Drug Guide, you will receive Griffith's 5-minute Clinical Consult for only $99. This new bundle is available in either Palm OS or Pocket PC formats. To order online, visit http://www.aacn.org > Bookstore > AACN PDA Center > Special's and What's New.

Preview Audio-Visual Tutorials
For a preview of some of the exciting new tutorials that will demonstrate, via case study, the use of a PDA in nursing practice, visit the online AACN PDA Center. Select "PDA Tutorials" to check out the Adult Critical Care Preview Tutorial. Up to six tutorials are in development, with the first two scheduled to be available in September.

Apply for ICU Design Citation by Aug. 15

Aug. 15 is the deadline to submit applications for the 2003 ICU Design Citation, part of AACN's Circle of Excellence recognition program.

Cosponsored by AACN, the Society of Critical Care Medicine and the American Institute of Architects Committee on Architecture for Health, this award recognizes ICU designs that enhance the critical care environment for patients, families and clinicians.

In addition to a $1,500 cash award-$500 from each of the sponsoring organizations-the recipient is provided complimentary registration for one person to attend the organization's annual meeting and a plaque to display in the unit.

For more information, contact the Society of Critical Care Medicine at (847) 827-7659.

In the Circle: Award Recognizes Excellence in Leadership

The AACN Excellence in Leadership Award, part of the AACN Circle of Excellence recognition program, honors nurses who demonstrate the leadership competencies of empowerment, effective communication and continuous learning, and the effective management of change. Following are excerpts from the exemplars submitted in connection with the awards for 2003:

Donna Cheek, RN, MSN, MHA, CCRN
Nags Head, N.C.
Outer Banks Hospital
Role models have been important in shaping my dreams, visions and achievements by encouraging participation, independent decision making and constructive feedback. They have motivated growth instead of complacency.

The maturing of my leadership skills over the years has been premised on the philosophy that, until you walk in another person's shoes, do not cast stones. I continue to support and encourage this philosophy today.

As I have moved through various leadership roles, I have learned to accept that leadership rewards are not as tangible as those received at the bedside. They come in different packages and present results, such as staff taking hold of an idea and seeing it through to completion, a nurse accomplishing CCRN certification and mending peer relationships by utilizing communication skills.

I had the opportunity to be part of planning a hospital in an area where population fluctuated dramatically, environmental challenges were seasonal and the closest acute care facility was an hour and a half away. We opened the hospital with an interdisciplinary approach to patient care, giving each healthcare provider an equal opportunity to contribute to the philosophy rooted in transformational leadership. We experienced both successes and challenges.

From a diploma graduate to a dual master's degree-prepared nurse and from a staff nurse to vice president of clinical operations, I have been blessed with role models and mentors who helped shape me.
Through their guidance, I have learned that to lead, you must have someone to lead. Without staff support and involvement, I realize I would not be able to achieve my vision. It is always a team effort, and it is my obligation to demonstrate congruence in my words and actions to encourage growth and participation. As I continue my journey in leadership, I commit to encouraging involvement from every member of the healthcare team in the hope that I too will earn the title of role model and mentor along the way.

Lisa Pettrey, RN, MS
Columbus, Ohio
Grant Medical Center
Lisa Pettrey not only has the ability to convey a sense of vision, but also illustrates the mission in such a way that mobilizes and excites others in moving forward to meet the goals of the organization. One of Lisa's strengths is conflict resolution, and her mentoring of staff members in managing conflict has enhanced their leadership abilities. She has helped to create a team atmosphere within the institution, which has helped to align the workforce. Lisa has taught her management staff personality trait recognition, which allows them to understand individual and team dynamics. She has assisted her managers in facilitating staff retreats away from the workplace.

Lisa inspires others to strive toward a higher level of achievement. She fosters continuous learning through role modeling and providing opportunities for growth. Many staff have been encouraged to submit for awards and poster presentations at local and national conferences. Although these were new experiences for her staff, they always felt that Lisa was there with guidance and support.

Lisa demonstrates creativity with problem analysis and solutions. She sees change as a process rather than an end and incorporates her ideology that continued improvements are needed to establish high standards of care. She facilitates use of current research-based literature in the development of practice guidelines and has taught staff to challenge traditional assumptions.

Lisa's positive, "can do" attitude has become an important part in the daily struggles of managing change. Assessing possible issues through her daily routine of walking rounds throughout the units, she elicits feedback from staff to better visualize the "big picture" of coordination of patient care efforts and workplace issues.

Juan "Ray" Quintero, RN, MSN, CCRN
Yorktown, Va.
Virginia Commonwealth University Health System
My area of responsibility had a negative reputation. Health providers did not want to work there, and the staff was fragmented with agency nurses and supplemental staffing. I knew that things would not change if I could not rally the staff in a new direction that would involve an accepted vision with goals.

I pulled together a leadership council of staff with diverse talents, skills and experience. Our goal was to become a model unit, have satisfied staff and provide the best care. The council gave me the power to negotiate with all applicants. I was able to recruit three ICU nurses from other hospitals, because I was able to negotiate and meet their quality of life needs. We soon had nurses who volunteered to perform payroll, help with education, do scheduling, coach staff and perform quality improvement. I made myself available 24 hours a day, seven days a week, using the numerous calls as opportunities to teach and, more importantly, convince my staff I would be accessible.

At the end of the first year, we were 85% staffed, the orientation was fully operational, the leadership council was effective, and much of the staff had volunteered for the many roles that we needed. I give most of the credit to my staff. The bottom line is that best practices have been initiated, quality care is provided and best outcomes are achieved.

On the Agenda

Following is a report by AACN board member Janie Heath, RN, MS, CS, CCRN, ANP, ACNP, on discussions and actions that took place during a June 2003 board conference call.

Agenda Item: NTI Report
The board received a preliminary report on NTI 2003 in San Antonio, Texas, sharing feedback on what went well and what can be enhanced. The board was pleased with the attendance, which substantially exceeded projections.

The board has a strong interest in ensuring that AACN's major annual conference is the best it can be. A variety of measures, both qualitative and quantitative, are used each year to assess how the NTI can best meet the needs of the critical care nurses who attend. The opportunity to talk with key speakers and award recipients, as well as to connect with members, is essential to the board's ongoing efforts to help ensure that AACN continues to be the undisputed leader in critical care nursing education and resources.

The board also discussed the importance of the opportunity to meet with and strengthen relationships with industry partners.

Agenda Item: Open Dialogue
The board had the opportunity to review a draft of a white paper being prepared by the American Association of Colleges of Nursing on the role of the clinical nurse leader. The diversity of the board's composition, which reflects different areas of expertise, including clinical and academic education, provided insight into the document, with discussion focusing on possible future nursing roles and models. The board will continue to monitor progress on the new role and delivery models of care and looks forward to an opportunity to be involved in future discussions.

Agenda Item: Critical Care Survey
The board also was updated on the status of the Critical Care Survey, which is being modified in preparation for relaunch later this year.

Are You Committed?

• To identify the most pressing challenge in my immediate work environment.
• To initiate the dialogue with my colleagues to find solutions to this challenge.
• To remain actively involved in the solutions until they are working.

If so, you can make your pledge to do so online. The effort is part of the "Bold Voices" initiative launched by immediate past AACN President Connie Barden, RN, MSN, CCNS, CCRN.

What's Coming Up in the American Journal of Critical Care

• Incidence, Timing, Symptoms, and Risk Factors for Atrial Fibrillation After Cardiac Surgery

• Evaluation of Chemical Dot Thermometers for Measuring Body Temperature of Orally Intubated Patients

• Gastric Feeding in Critically Ill Children: A Randomized Controlled Trial

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

Looking Ahead

August 2003

August 15 Deadline to apply for ICU Design Citation. For more information, contact the Society of Critical Care Medicine at (847) 827-7659.

September 2003

September 1 Deadline to submit research and creative solutions abstracts for AACN's 2004 National Teaching Institute and Critical Care Exposition May 15 through 20 in Orlando, Fla. To obtain abstract information and forms, visit the AACN Web site.

October 2003

October 1 Deadline to submit proposals for the AACN Evidence-Based Practice Grant. To find out more about AACN's research priorities and grant opportunities, visit the AACN Web site. The grants handbook is also available from AACN Fax on Demand at (800) 222-6329. Request
Document #1013.

October 1 Deadline to apply for the AACN Clinical Practice Grant. To find out more about AACN's research priorities and grant opportunities, visit the AACN Web site. The grants handbook is also available from AACN Fax on Demand at (800) 222-6329. Request Document #1013.

October 1 Deadline to apply for the AACN-Sigma Theta Tau Critical Care Grant. To find out more about AACN's research priorities and grant opportunities, visit the AACN Web site. The grants handbook is also available from AACN Fax on Demand at (800) 222-6329. Request
Document #1013.

Janus View

Editor's note: All that we do is rooted in our past, and we have much to learn from the leaders who have gone before us, paved the way and laid the foundation. To strengthen this connection, members of the AACN Board of Directors have interviewed some of our past leaders. For this month, immediate past board member Rebecca E. Long, RN, MS, CCRN, CNS, interviewed Sandra B. Dunbar, RN, DSN, FAAN, a member of the AACN board from 1984 to 1986 and president for the
1986-87 fiscal year. Dunbar is currently professor of nursing and the Charles Howard Candler chair within the Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, Ga.

Long: What lessons did you learn from your experience on the AACN board?
Dunbar: I learned many things! I learned to look at nursing and nursing issues from a broader perspective. Working with a dynamic board of directors and national office staff was a great experience in teamwork. I learned the elements of putting an idea forward with justification, developing a project budget and then succinctly presenting a proposal. I also learned the value of setting priorities and focusing organizational activities on a strategic direction.

Long: What do you consider to be the board's greatest accomplishment during your tenure?
Dunbar: We laid the foundation for many important initiatives that are continuing today. AACN's role in research and developing research priorities began. We initiated the first national study group on suctioning and later conceived the idea of Thunder projects, initially heparin locks and intermittent IV access. AACN also had a key role in developing international collaboration, including inter-
national conferences, during that time. Outstanding conferences in London, the Hague, Netherlands and Montreal, Canada, come to mind as highlights. Our goals were to bring critical care nurses from across the world together to share research and best practices, and to network. We also established initiatives around education and scholarships to deal with the nursing shortage during those years. Another important activity related to the integration of critical care nursing into baccalaureate programs, because it previously had been deemed specialty, master's content.

Long: What was the most challenging aspect of serving on the board?
Dunbar: Meeting the diverse needs of the constituency of our members. Critical care nurses practice under a great umbrella of specialties, which includes diverse settings, patient populations and roles. This must be an incredible continuing challenge for the organization.

Long: What was the most exciting aspect of serving in this role?
Dunbar: The opportunity to work with AACN's dynamic and talented leaders was wonderful. I still value these colleagues and friends from across the country. Making good decisions, both from a professional and financial perspective, was also exciting. In addition, the strides we made in nurse-physician collaboration and strengthening our relationship with the Society of Critical Care Medicine stand out.

Long: What was the most rewarding aspect of serving in this role?
Dunbar: Meeting members from everywhere was incredible. Being part of an organization that made a difference in people's professional and personal lives was the most rewarding.

Long: What are you doing now?
Dunbar: In my position at Emory University, I coordinate the PhD in Nursing program, teaching and mentoring doctoral students. I'm also involved in several ongoing research studies that are externally funded. One, which is funded by the National Institutes of Health, is testing psychosocial interventions for patients with implantable cardioverter defibrillators. The other study, which is funded by the American Heart Association, is examining a family-focused intervention for heart failure patients.
I'm also just completing my term as the program chair for AHA's Council of Cardiovascular Nurses. This committee plans the invited and abstract components of the scientific sessions. I am the chair of the cardiovascular nursing component of the Asian-Pacific AHA conference, scheduled for June in Hawaii.

Long: How do you find balance between volunteer and leadership activities and the rest of your life?
Dunbar: So many exciting things are going on in nursing that you could be busy every minute of the day. As I have continued to struggle to maintain the right balance, I have tried to become involved in professional activities that require less travel, allowing me to spend more time with my family. My husband, David, our 15-year-old daughter Lindsay and I enjoy hiking, biking and kayaking. We are involved in church and community service activities, including delivering Meals on Wheels on holidays and a recent mission trip to Costa Rica.

Long: In these unsettled times in healthcare, do you still think it is important for nurses to belong to organizations such as AACN?
Dunbar: It is absolutely important for nurses to benefit from all that an organization such as AACN offers. Being up to date, staying abreast of new ideas and networking are all available through this organization. I believe it's also important to be part of a group like AACN that is setting standards and influencing policy. In addition, the chapters provide creative outlets that may not be available in the workplace for nurses to learn and grow in many different capacities.
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