AACN News—May 2003—Practice

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Vol. 19, No. 5, MAY 2002

To Improve Patient Care, Find the Time for Research

By Paula Lusardi, RN, PhD, CCNS, CCRN
Advanced Practice Work Group

Research activities are crucial to improving patient care and generating nursing knowledge. With knowledge, practice and experience, the advanced practice nurse is ideally situated to participate in research activities that are tightly linked to clinically significant patient-care problems.

Historically, research involvement has been a major component of the clinical nurse specialist role.1 Since the CNS role was developed in the 1960s, research activities have been mandated by professional organizations, including the American Nurses Association,2-4 American Association of Colleges of Nursing5 and AACN.6,7 In addition, research activities have been galvanized through early research conferences, including the Western Interstate Commission for Higher Education Regional Program for Nursing Research Development,8 the Conduct and Utilization of Research in Nursing Project9 and a burgeoning variety of local, national and international research conferences. The essential components of the researcher role that are described in the literature10,11 and the mandate to participate in research activities make the advanced practice nurse the crucial link between research and improved patient care.

However, implementing the research role can be problematic.11,12 The greatest obstacle is the multiplicity of time demands. The need to ensure quality patient care, provide staff education and participate in policy, procedure and standard setting, as well as a variety of unit-based and hospitalwide projects, makes keeping abreast of the latest developments in a specialty area a daunting task for even the most seasoned APN. As a result, research activities often take a back seat to other demands.

The best approach may be to integrate research into daily activities. Of course, the APN's ability to do this depends on a number of factors, including the organization's commitment to research activities, the availability of adequate resources, and the APN's personal commitment and understanding of specific levels of research competencies. Whether you are a new or experienced APN, the following questions will help you determine an appropriate level of participation in research activities:

Is your organization ready to have research conducted?
Organizational readiness is key to the APN's success in conducting research activities.

Cronenwett12 suggests questions to assess an organization's readiness. Gawlinski and Henneman13 pose a similar group of questions that focus on the readiness of the staff nurse and nurse manager. If you answer "yes" to most of these questions, you have a good start toward organizational support and unit sophistication for your research endeavors (see Table).

Is the organization committed to the resources needed to carry out research activities?
Although the organization and unit may be committed to nursing research activities, resources must be available to support them. Cronenwett12 proposes a number of resources that should be in place for the APN to successfully participate in research activities and nursing studies-time-clear priorities that include rewards and support for time spent on research projects or activities; space, both psychological and physical, in which to think, read and write; secretarial support; adequate library facilities; necessary equipment and supplies; funds to support computer time, coding and data entry, printing instruments and travel to present papers; access to a critical mass of peers who are engaged in research; and time and travel costs to meet with those who are not in your institution.

What is your desired level of involvement in research activities? What competencies are needed at basic and advanced levels?
The APN must understand his or her level of competence to carry out research activities. McQuire and Harwood11 propose a tri-level comprehensive, pragmatic and competency-based approach to APN research involvement. The first level centers on the interpretation and use of research; the second on the evaluation of practice outcomes; and the third on participation in collaborative research that generates knowledge from clinically significant questions and defines optimal nursing interventions.

By using the following guide, the APN can evaluate the appropriate level of research activities as a function of his or her abilities, experience and education:

� If you are a new APN, you may want to focus on the Level I competency, interpretation and use of research. Focus on incorporating relevant research findings into your practice and assisting others to incorporate research into individual or unit practice. If you have been in practice a little longer, you may want to develop programmatic or departmental research utilization processes.
� If you are somewhat comfortable with research activities, you may want to focus on the Level II competency, evaluation of practice. Use existing data to evaluate individual or aggregate nursing practice and collaborate in conducting evaluation studies. If your education, experience and interest warrant a more advanced level of research activities, identify specific outcome criteria and conduct an evaluation study.
� With increasing research sophistication and peer support, you may focus on the Level III competency, participation in collaborative research. This level encourages the APN to identify clinically significant research questions and conclude with collection of outcome data.

What is your personal commitment to the research role?
A personal commitment to participate in research activities is crucial to the success of the research role. Inquiry focused on research activities by CNSs in the mid-1980s suggested a discrepancy between how much time the CNS wanted to devote to research activities and the actual time.14 A brief survey at my own institution showed the discrepancy is similar today. Eisz15 (as cited in Cronenwett12) proposed the following questions that the APN can ask to assess his or her commitment to the research role.

� Do I truly value nursing research? In what ways?
� Will participation in research activities help me accomplish some of my life goals? Which ones?
� Are there sufficient payoffs for doing nursing research in my work setting? What are they?
� If I had more time for research-related activities, what would motivate me to get involved?
� What do my current activities say about my commitment to nursing research?
� Am I satisfied with my current research involvement?

What are some practical suggestions to increase and sustain research activities?
Research activities are a key factor in evaluating nursing care, improving patient outcomes and generating new nursing knowledge. With enhanced focus on the importance of research activities, increasing collaboration with doctorally prepared nurses and acquisition of Magnet status, APNs understand the need to find time to participate in research activities. Following are a few practical suggestions to increase the time to become involved in research activities.

� Decide what you want to do in terms of research activities and stick to your desires.
� Research always starts with a great idea. Begin with a clinically significant problem, and focus on theory-driven and research-based practice issues.16
� Review the literature in your area of interest. Literature stimulates many other ideas and reveals apparent gaps in the research.
� Collaborate with peers and a doctorally prepared nurse. If a university system is nearby, suggest collaboration with a doctorally prepared faculty member.
� Collaborate with other nurses and disciplines during research activities.17-19
� Block out regular time on your calendar to meet with other research colleagues for intellectual stimulation, support and enthusiastic talk.
� Negotiate for specified hours for research activities. Determine specified hours or days that will be devoted to research activities and block out your calendar at those designated times.
� Access funding and research resource Web sites online, including the AACN site at www.aacn.org > Clinical Practice > Research.
� Consider continuing your education at the doctoral or postdoctoral level.

1. Riehl JP, McVay, JE. The clinical nurse specialist: Interpretations. New York, NY: Appleton Century Crofts; 1973.
2. American Nurses Association. Nursing: A Social Policy Statement. Kansas City, Mo; 1980.
3. American Nurses Association. The Role of the Clinical Nurse Specialist. Kansas City, Mo; 1986.
4. American Nurses Association. Nursing: A Social Policy Statement. Washington, DC; 1995.
5. American Association of Colleges of Nursing. The Essentials of Master's Education for Advanced Practice Nursing. Washington, DC; 1996.
6. American Association of Critical-Care Nurses and American Nurses Association. Standards of Clinical Practice and Scope of Practice of the Acute Care Nurse Practitioner. Washington, DC: American Nurses Association, 1995.
7. Bell L, ed. Scope of Practice and Standards of Professional Performance for the Acute and Critical Care Clinical Nurse Specialist. Aliso Viejo, Calif: AACN; 2002.
8. Krueger J. Utilization of nursing research: the planning process. J Nursing Admin. 1978;8:6-9.
9. Horsley J, et al. Using Research to Improve Nursing Practice: A Guide. New York, NY: Grune and Stratton; 1983.
10. McGuire DB, Harwood K. The CNS as researcher. In: Hamric A, Spross J, eds. The Clinical Nurse Specialist in Theory and Practice (2nd ed). Philadelphia, Pa: WB Saunders; 1989:169-204.
11. McGuire DB, Harwood K. Research. In: Hamric A, Spross J, Hanson C, eds. Advanced Nursing Practice: An Integrative Approach. 2nd ed. Philadelphia, Pa: WB Saunders; 2000:245-278.
12. Cronenwett L. The research role of the clinical nurse specialist. JONA. 1986;16:10-11.
13. Gawlinski A, Henneman E. Research utilization in the critical care setting. In: Gawlinski A, Kern L, eds. The Clinical Nurse Specialist Role in Critical Care. Philadelphia, Pa: WB Saunders; 1994:196-215.
14. Robichaud A, Hamric A. Time documentation of clinical nurse specialist activities. J Nursing Admin. 1986;16:31-36.
15. Eisz M. Freeing up time for nursing research. Part I: making the commitment. Momentum. ANA Council of Clinical Nurse Specialists. 1984;2:1,4.
16. Brown SJ. Direct clinical practice. In: Hamric A, Spross J, Hanson C, eds. Advanced Nursing Practice: An Integrative Approach: 2nd ed. Philadelphia, Pa: WB Saunders; 2000:137-182.
17. Sneed N. Collaboration as a means to achieving the clinical nurse specialist role expectations. Clin Nurs Spec. 1986;1:70-74.
18. Martin J. Implementing the role of the clinical nurse specialist: one institution's approach. Clin Nurs Spec. 1990;4:137-140.
19. Rehwaldt M, et al. Collaborative research under the unification model. Nursing Connections. 1991;4:29-35.

Table: Ask yourself

Organizational level
1. Are the basics of safe and effective nursing care being delivered?
2. Do a majority of your nurses know what research is?
3. Could a large number of nurses describe nursing studies that have influenced nursing practice in your institution?
4. Does your setting have an Institutional Review Board for the protection of human subjects?
5. Is at least one nurse a member of the IRB? Do you know who he or she is?
6. Does the Department of Nursing have a process for screening research proposals that affect nursing or nursing care or assisting in developing these proposals?
7. Is the screening and approval process clear and efficient enough to encourage nurse investigators to conduct studies in your institution?
8. Is the commitment to research reflected in your organization's mission statement, philosophy and goals?
9. Is the commitment to the investigative function of nurses reflected in the Department of Nursing's philosophy, mission statement, goals, job description and performance appraisals?
10. Have previous experiences with nurses doing research established a high level of credibility for nursing studies within the medical staff, hospital administration, and department of nursing?
11. Do nursing managers see a relationship between research and current needs of their division or unit?

Division or unit level
1. Does the unit subscribe to a research journal?
2. Does the unit have a journal club?
3. Are there mechanisms in place for sharing the results of research studies?
4. Is practice based on research findings?
5. Have any research studies been conducted in the unit?
6. Is anyone interested in conducting studies or implementing research-based findings into practice?

The Power of One: Protecting Patient Privacy Need Not Be a Burden

By Cynthia Janacek, RN, BSN, CCRN, CC
Ethics Work Group

Routinely, I receive calls about or encounter visitors who are distant family members, neighbors or friends of my patients. Our institution's policy regarding patient privacy is to not give out information over the phone or in person except to a designated patient spokesperson or family member. However, callers or visitors are often extremely insistent that information be given to them. They will rephrase a question, emphasize how close they are to the patient or become angry because they do not understand the regulations guiding our behavior.

Because we have so much to accomplish in a day, the need to guard privacy can seem burdensome at times. Documentation, the sharing of information, talking on the phone with the healthcare team, discarding reams of paper that contain patient information, and giving report to our "buddy," charge nurse or at shift change are all just part of the day.

However, any of these activities subject us to violating Healthcare Insurance Portability and Accountability Act regulations. A patient's name, medical record number, account number, date of birth and social security numbers are just some of the individual identifiers that are protected under HIPAA regulations. Other unique identifiers include driver's license number, date of admission, device ID number (such as on a pacemaker or stent), e-mail address, date of death and photographs. As clinicians, we must be aware of the identifiers and become more accountable in today's healthcare environment.

Passed in 1996, HIPAA regulations were instituted in 2000 to require those covered by the act to " train all their members of its workforce on the policies and procedure with respect to protected health information" (Federal Register, Volume 65, Number 250, Dec. 28, 2002, pp 82826-82827). Compliance with the training requirement was mandated to be completed by April 2003. Covered entities are healthcare providers and provider organizations, including all members of the workforce, whether paid or unpaid, such as volunteers, students, contractors and physicians.

As a unit educator and an active bedside practitioner, I have a few easy reminders to guide me in protecting patient privacy. First, I share only the minimal amount of information necessary to accomplish a task. The laboratory technician who comes in to draw the patient's blood does not need to know the family dynamic problems you have been dealing with all day. The same is true for the hospital volunteer who is also a friend of the family and who happens to hear you describe your issues with the nurse who is helping you turn your patient. Closing doors and curtains, clearing computer screens, and disposing of papers in a timely fashion are always a good idea.

Second, the AACN Synergy Model for Patient Care calls for us to serve as patient advocates and moral agents. When considering sharing information, ask yourself, "Would I want this information shared about me and does this person need to know?" By answering these questions, you will be able to safeguard your patient's privacy in a professional manner.

Our challenge is to be the caretaker of each patient's privacy and confidentiality. If we ask ourselves the questions and follow our hospital guidelines, the task of safeguarding information will not be a burden, but part of being a professional at the bedside.

NTI 2004 Research, Creative Solutions Abstracts Due Sept. 1

Sept. 1 is the 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.

Abstracts must be relevant to the care of acute and critically ill patients or to critical care nursing and must be noncommercial in nature. The first author must be a nurse holding current AACN membership. Only completed research and finished projects are eligible, and abstracts must not have been previously published or presented nationally.

The designated presenters of accepted abstracts receive a $75 reduction in NTI registration fees. All other expenses are the responsibility of the presenter, who can be either the first author or a designate of the author.

In addition, four awards will be presented for oral research abstracts reflecting outstanding original research, replication research or research utilization. Each of these awards provides an additional $1,000 toward NTI expenses.

Following is additional information about the abstracts:

Abstracts can focus on any aspect of critical care nursing research, including reports of research studies or reports of research utilization. Only abstracts of completed projects will be accepted. Abstracts reporting research studies must address the purpose; background and significance; methods; results; and conclusions.

Creative Solutions
Abstracts should focus on specific strategies and practice innovations that are used by nurses to solve difficult, unique or interesting problems in patient care, nursing practice, nursing management or nursing education. The creative solution must have been implemented, with outcomes evaluated. Abstracts must address the purpose of the project and include a description of the creative solution, as well as evaluation and outcomes.

Guidelines and resources are now available online at www.aacn.org > Education > Speaker Material/Information > Call for Research & Creative Solutions Abstracts. The application will be available online in July.

Practice Resource Network

Q: Confronted by the knowledge explosion, how can nurses ensure that the care they deliver is based on current scientific evidence?

A:. Nurses have an obligation to ensure that their clinical practice is based on science and research. Just like assessment and evaluation, utilizing current evidence is the standard of practice for acute and critical care nurses. Using scientific or expert evidence to deliver care for the most vulnerable and complex patients advances the science of nursing. To meet the expectations of patients and their families, nurses must find, analyze and use available information and evidence.

How can nurses close the gap between research and clinical practice? One way is to look for tools that have been systematically reviewed to analyze the available science evidence and to make recommendations based on the quality of that evidence.

For example, AACN's "Protocols for Practice" present the latest literature, knowledge and scientific evidence and make practice recommendations based on the strength of that evidence. Each protocol is written by an expert or experts in a specific area of practice.

To assist in evaluating everyday practices, recommendations are rated according to the level of information available to support the devices used and patient care situations. The easy-to-use rating system uses the following levels:
I. Manufacturer's recommendation only
II. Theory based, no research data to support recommendation; recommendations from expert consensus group may exist
III. Laboratory data only, no clinical data to support recommendations
IV. Limited clinical studies to support recommendations
V. Clinical studies in more than one or two different populations and situations to support recommendations
VI. Clinical studies in a variety of patient populations and situation to support recommendations.
Higher levels of evidence allow bedside nurses to be more confident in validating current practices and in integrating recommendation into their clinical practice.

In addition, each of the protocols includes information about the current technology, the accuracy and precision of the technology, related occupational hazards, ethical considerations, competency issues, rationale for the practice recommendation and areas for future research.

The protocols can be used:
� As a clinical tool to guide the use of research at the bedside.
� To educate and teach staff about a specific technology or patient situations.
� As a clinical reference and continuing education source.
� As a supplement to unit policy and procedure.
� As a means to stimulate research at the bedside.

The AACN Protocols for Practice are available online at http://www.aacn.org > Bookstore > AACN Product Catalog or by calling (800) 899-2226.

If you have a practice-related question, call AACN's Practice Resource Network at (800) 394-5995, ext. 217, or post your question online at http://www.aacn.org > Clinical Practice > General Practice Information > PRN > InfoLink Discussion.

Public Policy Update

Congressional Nursing Caucus Formed
A bipartisan Congressional Nursing Caucus has been formed in the U.S. House of Representatives to educate members of Congress about the nursing profession and how nursing issues affect the delivery of safe, quality care.

Founded by Reps. Lois Capps (D-Calif.) and Ed Whitfield (R-Ky.), the caucus was formed after consultation between congressional leaders and the American Nurses Association. It will conduct regular briefings to reinforce the important role of nursing in the delivery of direct and indirect health services throughout the nation.

AACN supports this effort and will identify opportunities to communicate with legislators as we follow developments.

Voluntary Medical Error Reporting
A bill passed by the House of Representatives would protect nurses and other healthcare providers from retaliation for reporting medical errors. In March, the House voted 418-6 to pass The Patient Safety and Quality Improvement Act (H.R. 663), which would create patient safety organizations to facilitate anonymous, voluntary reporting of medical errors.

The PSO, which would be certified by the Department of Health and Human Services, would analyze the reported errors, determine causes and develop recommendations intended to reduce medical errors. Under the bill, any information reported to PSOs would remain confidential. The approved bill would create new provisions in the Public Health and Service Act, overseen by the Energy Committee.

The American Hospital Association supports the voluntary provisions for reporting provided in the bill, while American Nurses Association says that reporting medical errors should be mandatory, not voluntary.

Senate Health, Education, Labor and Pensions Committee Chairman Judd Gregg (R-N.H.) has introduced a similar patient safety and medical errors bill in the Senate. He was joined by Majority Leader Bill Frist (R-Tenn.) and Sens. James Jeffords (I-Vt.) and John Breaux (D-La.) in filing the Patient Safety & Quality Improvement Act of 2003 (S.720) March 27. Although no hearings are currently scheduled, a committee spokesperson said the panel might meet on patient safety before marking up the bill.

Many of the bill's provisions enjoy wide support from both parties. However, Sen. Edward Kennedy (D-Mass.) has objected to language that establishes liability protections for certain information related to a medical error to enable healthcare providers to evaluate mistakes. Kennedy has maintained that such information should be available as evidence for plaintiffs in malpractice lawsuits. In the 107th Congress, Kennedy introduced legislation (S 3029) as competition to the GOP bill (S 2590). Both sides cite Institute of Medicine recommendations on preventing medical errors as the basis for their positions.

House GOP leaders tied the patient safety issue to the Health Act (HR 5), a medical malpractice reform bill, passing both measures on parallel tracks. Whether the Senate will adopt a similar strategy "remains to be seen," the committee spokesperson said.

Virus Suspected as SARS Agent
The World Health Organization reported that scientists at the University of Hong Kong have isolated a virus as the causative agent for Severe Acute Respiratory Syndrome. Canadian researchers released findings suggesting that the metapneumovirus, a member of the Paramyxoviridae family, is responsible for SARS, though conclusive determinations have yet to be made. Work on determining a diagnostic test that can be used clinically is under way.

SARS is characterized by influenza-like symptoms, such as fever, myalgias, headache, sore throat, dry cough, shortness of breath, or difficulty breathing. Some cases have resulted in hypoxia, pneumonia, acute respiratory distress, and death. Transmission is believed to occur by exposure to large droplet aerosols through close, direct contact with persons suffering from SARS.

Healthcare workers have been identified among the cases and remain a primary at-risk group, secondary to caring and treating patients with SARS. The use of appropriate infection control measures such as Airborne and Contact Precautions are strongly urged for individuals presenting with the listed symptoms. Clinicians are urged to report suspected cases to their local or state health departments.

JCAHO Report Details Strategies for Preparedness
The Joint Commission on Accreditation of Healthcare Organizations recently issued a white paper detailing recommendations for creating and sustaining communitywide emergency preparedness systems.
The report details more than 40 recommendations for enlisting the community in preparing a local response to disaster preparedness, focusing participants on key preparedness system priorities and establishing accountability, leadership and funding. JCAHO prepared the recommendations in consultation with a 28-member panel that included representatives from various federal and state agencies, front-line emergency care providers, emergency preparedness planners and public health and hospital community leaders.

Nursing Groups Protest Pelvic Examinations Without Consent
AACN joined 13 other national nursing organizations in a March 25 letter to the Association of American Medical Colleges to protest the practice of medical students performing pelvic examinations without consent on women who are under anesthesia. This practice was reported in the March 12, 2003, Wall Street Journal article titled "Using the Unconscious to Train Medical Students Faces Scrutiny." The groups maintain that individuals, have a right to expect that they will be informed of planned procedures while they are under sedation; that they will know who will be performing such procedures; and that they will have the option to decline the participation of a student or anyone else unrelated to their primary reason for having the procedure. The letter calls on the AAMC to condemn the practice and move to have member schools cease the practice immediately.

Thompson Outlines Health Reform Priorities
Health and Human Resources Secretary Tommy Thompson says that an overhaul of the nation's healthcare system should include Medicare reform, as well as changes to Medicaid, assistance for the uninsured, medical liability reform and improved patient safety in hospitals. Speaking at a discussion hosted by the Republican Main Street Partnership, Thompson renewed the administration's call for caps on noneconomic damages in medical malpractice lawsuits. He also said that HHS is developing a demonstration project that would allow healthcare providers to offer patients injured by medical errors an immediate apology and compensation to avoid lawsuits. Injured patients would be able to reject the offer and file suit.

Thompson also proposed a new program to assist hospitals in implementing new technologies to better protect patients against errors.

Public Policy Snapshot

Medical Errors and Patient Safety Facts

According to information provided by the 2003 Health Policy Tracking Service of the National Conference of State Legislatures:
� Medical errors are the eighth leading cause of death in the U.S.
� The cost associated with medical errors in lost income, disability and healthcare costs is as much as $29 billion annually.
� The most common types of preventable medical errors were related to technical errors, diagnosis, failure to prevent injury and medication errors.
� A Harvard survey found that shortages of nurses and overwork, stress or fatigue of health professionals were among the leading causes of medical errors.
� Currently, 17 states-Colorado, Florida, Kansas, Maine, Massachusetts, Nebraska, Nevada, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas and Washington-have laws or regulations requiring mandatory reporting of medical errors or adverse events in hospitals.

Information Online

Nurses for a Healthier Tomorrow Coalition
AACN is an active member of Nurses for a Healthier Tomorrow, a coalition of 43 nursing and other healthcare organizations that have banded together to address the nursing shortage and boost the attractiveness of nursing as a profession. The spring issue of the NHT newsletter is now available online. The newsletter includes information on NHT activities, as well as other nursing-related news. To access, visit http://www.nursesource.org/NHTNewsletter to read newsletter.

National Alliance for the Primary Prevention of Sharps Injury
AACN is a corporate member of the NAPPSI alliance, a prominent multidisciplinary powerhouse formed to educate and influence the course of needlestick safety in the healthcare workplace. An association newsletter that keeps members up to date is available online at www.nappsi.org/newsletter.php More info:http://www.nappsi.org.

The Latest on Smallpox

IOM Panel Urges Reassessment of Smallpox Vaccination Plans
An Institute of Medicine committee established to advise the Centers for Disease Control and Prevention on its implementation of the nation's smallpox vaccination program has urged the CDC to continue to make every effort to evaluate the progress and safety as the vaccination campaign expands to a larger pool of potential recipients.

CDC Recommends Deferring Heart Patients From Smallpox Vaccinations
The Centers for Disease Control and Prevention is recommending that people who have been diagnosed with heart disease be temporarily deferred from receiving the smallpox vaccine while heart problems in seven vaccinated healthcare workers, one of whom died, are investigated. The CDC said it will provide states with questions about heart problems to use in screening volunteers for the vaccine. The precaution was announced in response to three cases of myocardial infarction, one of which resulted in death; two cases of angina and two cases of myopericarditis were reported through the CDC's real-time monitoring system. A total of 25,645 people have been vaccinated in the civilian program, the agency said.

Smallpox Emergency Personnel Protection Act Defeated
The Smallpox Vaccination Compensation Fund Act (H.R. 1463) was defeated in the House of Representatives in March by a vote of 206 to 184. Nurses won the battle to beat back this unacceptable smallpox vaccination bill. Now, the fight moves on to the Senate. Along with the American Nurses Association, AACN does not oppose a smallpox compensation program. AACN believes legislation must provide adequate education, prescreening, surveillance and compensation for nurses and other first responders.

Nursing's Agenda for the Future Group Identifies Priorities for Driving Changes

Changes in the economic value of nursing, education and delivery models were identified by the members of the steering committee for Nursing's Agenda for the Future as priorities for driving positive changes.

The committee met in December to review the initiative's progress the first year, evaluate the current structure and process for efficiency, and identify priority work for the coming year.

Steering committee members also discussed options for a major action plan that would address these priorities to significantly advance the agenda.

The group seeks to quantify nursing's contribution to cost and quality of healthcare. Expectations are that the findings from this research will demonstrate nursing's current and potential value in reducing the cost of healthcare delivery and will position nurses to participate in key policy discussions and budget priorities at the local, state and federal level. Funding strategies are in development, with the goal of raising half the needed funds for the project within the community of nursing and half from external sources.

Additional information about Nursing's Agenda for the Future is available online at http://www.nursingworld.org/naf.

AACN Legislative Action Center Links to Legislation and Legislators

Get involved! You can easily track legislation and contact your elected representatives through AACN's online Legislative Action Center at www.aacn.org > Public Policy. This tool to enhance grassroots activism features an "action alert" regarding key legislation, such as enactment of the Nurse Reinvestment Act, as well as a database of elected officials, both nationally and by state.

Download or view the status and a brief summary of pertinent nursing legislation, with information posted within 24 hours of public availability. At the same time, you can connect with elected officials, agencies and organizations. E-mail members of Congress, the president and other government officials; find legislators by a ZIP code or name search; and find out how legislators voted on identified issues. Compose your own messages or send messages prewritten by AACN.

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