AACN News—October 2003—Practice

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Vol. 20, No. 10, OCTOBER 2003


In the Circle
Award Cites Multidisciplinary Team Collaboration

Editor's note: Part of the AACN Circle of Excellence recognition program, the AACN Multidisciplinary Team Award recognizes a multidisciplinary team that clearly practices key principles of collaboration and multidisciplinary practice. The recipients were given $2,500 to fund projects. In addition, individual recipients were presented a personalized plaque. Following are exemplars submitted in connection with these for 2003.

Code Blue Team
Evansville, Ind.
Deaconess Hospital

Leaders in the Cardiovascular Services Department identified an opportunity to improve the effectiveness of the Code Blue Team. Applying the hospital's continuous quality improvement process to enhance quality and document patient outcomes, the team was restructured to include one RN from each unit, a pharmacist, a respiratory therapist, emergency department physicians and ad hoc members from various disciplines. A specially trained response team that included the specific roles of code coordinator, medication nurse, documentation specialist, respiratory therapist and ED physician was developed. Five subcommittees-public relations, policy and procedures, education, audits, and equipment-were also established to enhance the Code Blue Team's work. In addition, specialized role training sessions were developed; mock code blue drills were initiated; the National Registry of Cardiopulmonary Resuscitation was started; new standardized crash carts were instituted; and new biphasic defibrillators were purchased.

Through collaboration of the multiple disciplines, enhanced code blue processes and initiation of a designated response team, the Cold Blue Team documented positive code blue patient outcomes. For 100% of six clinical indicators monitored, the hospital performed better than the national benchmark. Nursing staff anxiety about code blue events was reduced, and confidence with code blue proficiency was enhanced. Physician satisfaction with code blue events increased, and hospitalwide patient satisfaction improved.

General Thoracic Surgery Team
Rochester, Minn.
Mayo Clinic

The General Thoracic Surgery Team, which included representatives from the multiple disciplines that provide care across the continuum for the thoracic surgical patient, participated in an Institute for Healthcare Improvement service breakthrough series on quality improvement techniques. Lessons learned included listening to and involving patients and their families to improve care. Patient satisfaction surveys were used to provide feedback on areas to focus quality improvement. Staff satisfaction was also addressed as a key component in providing quality patient care.

The General Thoracic Surgery Team used the survey results to focus quality improvement activities. Pain management, discharge planning, patient safety, sleep at night and overall staff satisfaction were identified. Mutual respect and trust within the multidisciplinary team allowed the team to focus on the patients. The General Thoracic Surgery Team acted as the "mothership" for other teams formed to address issues identified through the surveys.

The General Thoracic Surgery Team meets monthly. Representatives from the other teams provide progress reports. Ideas are generated to help provide direction and feedback. Surveys continue as a means for obtaining feedback.

The idea of multidisciplinary teams has become the way work is accomplished. Acknowledgment of the contributions of all team members reinforces a positive culture that promotes exchange of ideas for improvement in patient care practices. Staff who work in other areas float into our unit and comment that the approachability of all, including the surgeons, makes their float experience a positive one. The trusting, respectful environment that is evident on a daily basis has also been a great recruitment tool.

General Thoracic Surgery Pain Team
Rochester, Minn.
Mayo Clinic

Managing pain for the postoperative thoracotomy patient is a challenge on the thoracic surgical intermediate-general care unit, and the thoracic surgical staff works closely with the Inpatient Pain Service to manage the patients with epidurals postoperatively. Staff satisfaction surveys, which included feedback from nurses, surgeons, residents and physician assistants, indicated the need to improve the process for managing postoperative pain. In response, the General Thoracic Surgery Pain Team was formed, including physicians, physician assistants, and nurses from the postanesthesia recovery area, intensive care, intermediate-general care unit and the Inpatient Pain Service. Members identified topics such as staff knowledge and attitudes about pain, pain assessment, and knowledge of pharmaceuticals and the Inpatient Pain Service processes.

As a result, staff education was included in quarterly team days and pain resource manuals were developed. An algorithm was developed to assist surgical residents with management of postoperative pain once the epidural is removed. The algorithm is part of resident orientation and has been placed as a quick reference in patient charts. Twelve nurses were identified as pain resource nurses. The pain resource nurses received additional education by "shadowing" in the Inpatient Pain Service, and revisions to Inpatient Pain Service order sets resulted in a decrease of unnecessary calls to the service.

Participation by all members of the team and implementation of the described activities have increased healthcare provider knowledge of pain management for the thoracic patient, as measured by a staff knowledge and attitudes test. Staff satisfaction surveys have shown that there has been a positive trend in satisfaction in the ability to meet patients' pain management needs. The team is a valued resource for those caring for thoracic surgical patients and continues to be supported in meeting on a quarterly basis to monitor survey results and address new concerns as they are identified.


Shawnee Mission Regional Cardiac and Vascular Center, Surgical Cardiovascular Quality Improvement Team
Shawnee Mission, Kan.
Shawnee Mission Med. Center

The Shawnee Mission Regional Cardiac and Vascular Center Surgical Cardiovascular Quality Improvement Team was established to optimize the care of heart surgery patients and their families. The team is made up of representatives of each discipline and department that participates in the care and outcome of this patient population. Frontline staff, physicians, managers and administrators all come to the table to have an equal voice in addressing process improvement issues.

This group recognized that our outcomes compared favorably to key quality indicator benchmarks monitored in the National Society of Thoracic Surgeons database. Although current performance met standards, we believed there was significant potential to further improve quality and control costs. Interdisciplinary collaboration among members of the team with the cardiovascular clinical nurse specialist and surgeon supported multifaceted synergistic results. Process improvement initiatives focused on decreasing blood utilization, atrial fibrillation, ventilator times, wound infections, length of stay and readmissions.

Multiple improvements made by this collaborative interdisciplinary team over a three-year period resulted in a saving of approximately $1.5 million, a high level of patient satisfaction and clinical outcomes that were consistent with a center of excellence. Clearly, this team has demonstrated how representation and involvement of key stakeholders throughout the continuum of care can yield powerful results.

Group Tackles Needs of Advanced Practice Nurses

Volunteers Meet
in California
to Examine Initiatives

Members of the 2003-04 Advance Practice
Work Group are (from left, seated) John
Dixon, Carol Rauen and Linda Bell and
(from left, standing) Riza Mauricio, Mary
Lou Sole, Nancy Munro, Kristine Peterson
and Kelly Thompson-Brazill.


By Carol Rauen, RN, MS, CCNS, CCRN
Chair, Advanced Practice Work Group

The 2003-04 Advanced Practice Work Group met for the first time in August in Costa Mesa, Calif., to tackle initiatives related to issues and practice needs of advanced practice nurses in acute and critical care. Specifically, the group is accountable to AACN members and the national Board of Directors for:

� Reviewing and making recommendations regarding resources to support advanced practice critical care nurses
� Evaluating topics and speakers for the Advanced Practice Institute held in conjunction with the National Teaching Institute
� Continuing to develop the API based on a gap analysis and to review the call for abstracts to provide diverse clinical topics with patient management and
pharmacology focus

� Selecting topics and accepting assignments to write the advanced practice column in AACN News

The five members who were appointed to the group for 2003-04 were selected from a list of 60 incredibly talented and accomplished professionals who volunteered to serve. In an effort to ensure that the needs and interests of most APNs would be represented, consideration was given to choosing members who represented different regions of the country, different work environments and different specialties. The members for this year are Chair Carol Rauen, RN, MS, CCNS, CCRN, assistant professor at Georgetown University School of Nursing and Health Studies, Washington, D.C.; Riza Mauricio, RN, MSN, CCRN CPNP, pediatric nurse practitioner, Critical Care Services, Texas Children's Hospital, Houston, and instructor-faculty for the Department of Pediatrics Intensive Care Services, Baylor College of Medicine, Texas Medical Center, Houston; Nancy Munro, RN, MN, CCRN ACNP, nurse practitioner for Cardiac Thoracic Services at INOVA Alexandria Hospital, Alexandria, Va., and a part-time faculty member at the University of Maryland School of Nursing, Baltimore; Kristine Peterson, RN, MS, CCRN, CCNS, cardiovascular and critical care clinical nurse specialist at Methodist Hospital, Park Nicollet Health Services, St. Louis Park, Minn.; Mary Lou Sole, RN, PhD, CCNS, FAAN, professor and coordinator of the CNS track at the University of Central Florida School of Nursing, Orlando, and an ICU staff nurse at Orlando Regional Medical Center; and Kelly Thompson-Brazill, RN, MSN, ACNP, nurse practitioner in Trauma and Surgical Critical Care at University Health Systems of Eastern Carolina, Greenville. John Dixon, RN, MSN, is the AACN Board of Directors liaison, and Clinical Practice Specialist Linda Bell, RN, MSN, is the national office staff liaison

The group's agenda focuses on four areas:

Information Sharing
Dixon and Bell reviewed AACN's major strategic initiatives: staffing, workplace environment and end-of-life issues. AACN's advanced practice members are positioned well to influence these important issues.

AACN President Dorrie Fontaine, RN, DNSc, FAAN, President-elect Kathleen McCauley, RN, PhD, CS, FAAN, and CEO Wanda Johanson, RN, MN, also addressed the group. Fontaine explained her "Rising Above" theme for the year and how APNs could help to foster this natural follow-up to the "Bold Voices" theme promoted by immediate Past President Connie Barden, RN, MSN, CCNS, CCRN. All three wanted to hear our views on advanced practice nursing and how AACN can best serve this section of the membership.

In addition, the group had the opportunity to explore how PDA technology can assist APNs in their practice. AACN Education Resources Specialist Marianne Martineau demonstrated software that is available through AACN's online PDA Center (www.aacn.org > Bookstore > PDA Center) and sought suggestions from the group regarding other helpful technology.

AACN Resources and Opportunities
In keeping with AACN's efforts to continually evaluate its resources and education with respect to meeting the needs of members faced with a rapidly changing acute and critical care environment, the group reviewed and provided recommendations regarding resources for APNs:

� Catalog products-The AACN Resource Catalog lists numerous products to help APNs support their practice, including guidelines, reference cards, books, lectures
on tape, CE opportunities, journals, certification review materials, patient and family brochures, and PDA resources.

� Web site-The AACN Web site (www.aacn.org) includes an area dedicated to advanced practice nursing. Included in the valuable information that has been
assembled specifically for APNs are educational opportunities, public policy and licensure issues, CDC updates, certification, chapters, links to other helpful sites,
and list serve information. This site is updated on a regular basis, so you will want to add it to your regular "surfing" routine to stay informed. Because this area is
available only to AACN members, you must log on first. Then, click on the Clinical Practice Link and Advanced Practice.

� Journals-As part of their membership fee, all AACN members receive Critical Care Nurse and the American Journal of Critical Care, which contain important articles
and information for APNs. Subscriptions to both are also available to nonmembers. AACN members are also eligible for discounts on subscriptions to the "must get"
AACN Clinical Issues: Advanced Practice in Acute and Critical Care.

� Affiliations-AACN has cultivated affiliations with several nursing, medical and allied health organizations. These affiliations serve multiple purposes for our
association and its members, including discounts on products and services afforded by the organizations. In addition, these types of collaboration can add strength
to public policy initiatives. Links to these organizations' information, articles and guidelines can be found on the AACN Web site.

� Educational opportunities-Because of the wide range and changing needs of AACN members who are APNs, the NTI has been expanded to include the API. This
conference-within-a-conference is dedicated to the educational needs of the APN. Other educational opportunities include the journals and CE options.

� Volunteer opportunities-Many exciting ways exist for APNs to share their expertise by volunteering with AACN. Work groups are a perfect example. Other options
are serving on a review panel, writing certification test items, reviewing or authoring manuscripts for a journal, serving as a mentor, and serving in a leadership
position at the local or national level.


API Curriculum
One of the Advance Practice Work Group's major charges is to evaluate topics and speaker selection for the API. The goal for the API is to meet the diverse educational needs of APNs. The work group discussed these needs and reviewed abstract proposals that were submitted as advanced practice topics. An exciting collection of topics and speakers has been assembled to meet the educational needs of APNs in areas such as pharmacology, advanced physiology, new diagnostic and treatment options, and advanced skills.

AACN News Articles
This is the first of six columns that will be written by members of the Advanced Practice Work Group for AACN News in the coming year. The following topics will be discussed:

� Maintaining identity as nurses when functioning in an acute care nurse practitioner role
� Title protection for the clinical nurse specialist
� The NP-CNS blended role
� How the APN can contribute to a healthy workplace environment
� Blueprint of the API in May 2004 in Orlando, Fla.

As you can see, the Advanced Practice Work Group spent a busy weekend concentrating on its accountabilities. Members are confident they will continue to articulate the voice of APNs as they assist AACN in meeting the needs of APNs throughout the year. Representing and serving the APN membership is both exciting and humbling.


Distinguished Research Lecturer Award Nominations Due Dec. 1

Dec. 1 is the deadline to submit nominations for the Distinguished Research Lecturer Award for 2005. The recipient will present the Distinguished Research Lecture at the 2005 NTI in New Orleans, La. The lecture is sponsored by a grant by Philips Medical Systems.

The ideal candidates for this award should:

� Be nationally recognized for publications, presentations, and/or mentorship in research relevant to acute and/or critical care clinical practice,
� Be viewed as a consultant in their area of expertise,
� Have made significant contributions to acute and critical care nursing practice through research,
� Be a dynamic and interesting speaker (nominators should cite an example of nominee's expertise in public speaking).

Following are past recipients of the award:

1982 Ada Lindsey, RN, PhD
1983 Karin Kirchhoff, RN, PhD
1984 Pamela Mitchell, RN, MS, CNRN, FAAN
1985 Susan Woods, RN, MN
1986 Kathleen McCormick, RN, PhD, FAAN
1987 Susan Karen Donaldson, RN, PhD
1988 Kathleen Stone, RN, PhD
1989 Carolyn Murdaugh, RN, PhD, CCRN
1990 Marguerite R. Kinney, RN, DNSc, FAAN
1991 Kathleen Dracup, RN, DNSc, FAAN
1992 Ellen Rudy, RN, PhD, FAAN
1993 Elizabeth Hahn Winslow, RN, PhD
1994 Elaine Larson, RN, PhD, FAAN
1995 Dorothy Brooten, RN, PhD, FAAN
1996 Marita Titler, RN, PhD, FAAN
1997 Marianne Chulay, RN, DNSc, FAAN
1998 Suzanne Burns, RN, MSN, RRT, CCRN
1999 Barbara Riegel, RN, DNSc, CS, FAAN
2000 Sandra Hanneman, RN, PhD, FAAN
2001 Barbara Daly, RN, PhD
2002 Barbara Drew, RN, DNSc, FAAN
2003 Kathleen Puntillo, RN, DNSc, FAAN
2004 Cathleen Guzzetta, RN, PhD, HNC, FAAN

The recipient for 2005 will be selected in January by the Distinguished Research Lecturer Panel. The awardee receives a $1,000 honorarium and $1,000 toward NTI expenses, as well as a plaque.

The 2005 Distinguished Research Lecturer nomination form is available online at www.aacn.org > Membership > Awards > Distinguished Research Lecturer. For more information, call (800) 394-5995, ext. 321; e-mail, dolores.curry@aacn.org.

Practice Resource Network

Q: Can you tell me the difference between protocols, standards, guidelines and clinical pathways? These terms seem to be used interchangeably, so I'm not really sure what the correct usage is.

A: This is a very good question, because the terms are used in different ways, making it difficult to understand the use based on the context of the topic.

Standards
The American Nurses Association defines standards as "authoritative statements that describe a level of care or performance common to the profession of nursing by which the quality of nursing practice can be judged."1 These broad standards provide a foundation for evaluating all nursing practice, regardless of specialty or level of education. Nursing standards can also be used as a basis for determining an expected legal standard of care.2

Guidelines
Guidelines, on the other hand, have been defined by multiple organizations, including JCAHO and the U.S. Agency for Health Care Research and Quality. Guidelines are generally accepted as being a systematic set of recommendations that are evidence-based and that provide direction for patient care.2 Guidelines, such as those posted by the National Guideline Clearinghouse at www.guideline.gov, are based on available evidence about patient populations and should be flexible enough to consider the individual patient presentation and needs.

Protocols
Dorland's Illustrated Medical Dictionary3 defines protocols as "an explicit, detailed plan of an experiment, procedure or test." AACN has used the term "protocols" to describe a series of documents "designed to provide the latest research findings in patient care in a format that is easy to understand and integrate into clinical practice � Users are encouraged to select those elements that are applicable to guide practice in the users' own setting."4 Protocols can be considered as the "if, then" statements to guide practice-if this happens, then do this. Some protocols, such as the ACLS protocols, are written as algorithms. Others, such as a particular research protocol or chemotherapy administration protocol, use a more directive approach.

Clinical Pathways
Clinical pathways are sequential, projected plans of care for specific patient populations, based on the known trajectory of particular surgeries or disease processes. Clinical pathways may be developed within an institution or service line and consider patient management consistent with the practice of the attending physicians and multidisciplinary team, and include the expected patient outcomes. These pathways may be supported by preprinted order sets that include orders most commonly written for that patient population.5

References
1. American Nurses Association. Standards of Clinical Nursing Practice. Washington, DC: 1991:21.
2. American Nurses Association. Legal Aspects of Standards and Guidelines for Clinical Nursing Practice. Washington, DC; 1998.
3. Dorland's Illustrated Medical Dictionary, 30th ed. Philadelphia, Pa: Saunders, an imprint of Elsevier; 2003.
4. American Association of Critical-Care Nurses. Protocols for Practice. Aliso Viejo, Calif.
5. Wojner AW. Outcomes Management: Applications to Clinical Practice. St. Louis, Mo: Mosby; 2001:91.

If you have a practice-related question, call AACN's Practice Resource Network at (800) 394-5995, ext. 217, or e-mail your
question to practice@aacn.org.


Grants

2003-04 AACN Grants Support Clinical Projects and Research

Clinical Inquiry Grant
This program provides awards of $500 each to fund projects that directly benefit patients and families. Interdisciplinary projects are of special interest. Grant applications, which are accepted twice a year, must be received by either Jan. 15 or July 1.

End-of-Life Palliative Care Small Projects Grant
This program provides $500 each for projects that address a range of topics, including bereavement, communication, caregiver needs, symptom management, advance directives and life-support withdrawal. Grant applications, which are accepted twice a year, must be received by either Jan. 15 or July 1.

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.

Public Policy Update

AACN Cosponsors Event Honoring Nurses of 9/11
More than 300 people attended a Sept. 9 Capitol Hill reception in Washington, D.C., hosted by the Americans for Nursing Shortage Relief Alliance. AACN cosponsored the event with other ANSR Alliance members, including the Emergency Nurses Association; the Association of Women's Health, Obstetric, and Neonatal Nurses; American Organization of Nurse Executives; and Johnson & Johnson.

CNN senior correspondent Judy Woodruff was master of ceremonies for the event, which honored nurses serving in the Air Force, Army, Navy and Public Health Service, as well as nurses employed by the Department of Veterans Affairs and the American Red Cross, for their diligent service in the aftermath of the Sept. 11, 2001 terrorist attacks.

Among the speakers were registered nurses serving in the House of Representatives. Lois Capps (D-Calif.), Carolyn McCarthy (D-N.Y.), Eddie Bernice Johnson (D-Texas); U.S. Rep. Ed Whitfield (R-Ky.); and Surgeon General Richard Carmona, MD, and Deputy Surgeon of the Army Kenneth Farmer, MD.

AACN was represented at the event by board member Janie Heath, RN, ms, ccrn, acnp, anp, past board member Nancy Munro, RN, MN, CCRN, ACNP, AACN members Linda Briggs, RN, BSN, Christine Keenan, RN, BS, and Becky Fuzi, RN, MSN, CCRN, and AACN Public Policy Specialist Janice Weber, RN, MSN.

Support Senate Funding Level for Nursing Programs
The U.S. Senate has passed a FY04 Labor-HHS appropriations bill that includes an amendment sponsored by Sens. Barbara Mikulski (D-Md.) and Susan Collins (R-Maine), to provide additional funding to help ease the nursing shortage. The bill adds $50 million to FY04 funding for the Nurse Reinvestment Act and other nursing workforce development programs, bringing the total to almost $163 million, a 55% increase over FY 2003.

The bill now goes to a House-Senate conference committee to reconcile it with the House appropriations bill, which includes level funding of approximately $113 million for nursing programs in FY04. Nursing must hold on to this increase during the conference committee proceedings.

AACN is calling on our members to reach out to your representatives and urge them to agree to the Senate appropriation for Title VIII. Visit AACN's Legislative Action Center at: http://capwiz.com/criticalcare/home/.

Senate Blocks New Overtime Rules
The administration's plan to change the definition of who is eligible for overtime pay faced a serious challenge last month when the Senate voted 54 to 45 in favor of an amendment (S. 1485, Overtime Compensation Protection Act of 2003) that would block the overtime pay changes to the Fair Labor Standards Act. Proponents of the amendment argue that the change would deny an estimated 8 million workers, including many nurses, their right to overtime pay.

AACN fully supported this amendment and thanks members who responded to AACN's "Call to Action" to contact their senators and urge them to support the amendment. The efforts were a key strategy in getting this amendment passed.

Reader's Digest Highlights Nursing Shortage
The nursing shortage has gained widespread attention recently in the national press. The September issue of Reader's Digest includes an article on the growing nursing shortage and its consequences. "Condition Critical" includes firsthand accounts from nurses and examples of patient outcomes affected by inadequate nurse staffing. The article also highlights related research studies and details some of the barriers to successful recruitment and retention of nurses. A follow-up story titled "One Day in Critical Care: A Nurse's Story" is scheduled to appear in the October issue.

HRSA Announces FY04 Grant Opportunities
The Health Resources and Services Administration recently announced its grant offerings for FY04. The information, published in the Federal Register, also includes program eligibility and application information for an estimated $15.46 million in educational loan repayment for nurses and $6 million in scholarships for nursing students who agree to work in a healthcare facility designated with a critical shortage of nurses.

In addition, the grants include $11.4 million for nursing schools and academic health centers to increase nursing education opportunities for underrepresented minorities, $4.8 million for entities providing advanced education nursing traineeships and $3.06 million for projects to strengthen nurse education, practice and retention and to address the nursing shortage.

Secretary Thompson Names New NACNEP Members
HHS Secretary Tommy G. Thompson recently appointed six new members to the National Advisory Council on Nurse Education and Practice, the body that makes policy recommendations to the secretary and Congress on nurse workforce, education and practice improvement issues.

Appointed for three-year terms were Eve Maria Hall, Thurgood Marshall Scholarship Fund, Milwaukee, Wis.; Janice Ray Ingle, RN, DSN, Southern Union State Community College, Opelika, Ala.; Bettye Davis Lewis, RN, EdD, Diversified Health Care, Houston, Texas; Roxanne Struthers, RN, MS, PhD, School of Nursing, University of Minnesota, Minneapolis; Elizabeth Maly Tyree, RN, BSN, MPH, College of Nursing, North Dakota University, Grand Forks; and Eugenia Postoak Underwood, nursing student, East Central University, Ada, Okla.

In addition to advising the secretary and Congress, the advisory committee may make specific recommendations on HRSA's nursing programs. For more information, contact HRSA's Division of Nursing at .

Mass Casualty Nursing Competencies Published
To help nurse educators include mass casualty information in their curriculum, the International Nursing Coalition for Mass Casualty Education has published "Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents." Coalition, of which AACN is a member, was founded in 2001 at Vanderbilt University School of Nursing, to ensure that a competent nurse workforce would be prepared to respond to mass casualty incidents. The competencies identified in the document are intended to apply to all professional nurse roles and practice settings.

ANA Launches Ergonomics Campaign
The American Nurses Association recently launched its "Handle With Care" ergonomics campaign. The campaign seeks to mount a professionwide effort to prevent back and other musculoskeletal injuries through greater education and training, and increased use of assistive equipment and patient-handling devices. The campaign also seeks to reshape nursing education and federal and state ergonomics policy by highlighting the ways technology-oriented safe-patient handling benefits patients and the nursing workforce.

As part of the launch, ANA will be distributing "Handle With Care" campaign kits. Nurses who have experienced a back, neck or musculoskeletal injury and who are willing to serve as spokespersons are asked to contact Cindy Price at cprice@ana.org or Carol Cooke at ccooke@ana.org.


Public Policy Snapshot

7 RNs Among �Most Powerful' in Healthcare

Seven nurses made the second annual list of the "100 Most Powerful People in Healthcare," published by Modern Healthcare magazine. They are:

� Barbara Blakeney, president, American Nurses Association
� Mary Foley, past president, ANA
� Polly Bednash, executive director, American Association of Colleges of Nursing
� Linda Stierle, CEO, ANA
� Rose Ann DeMoro, executive director, California Nurses Association
� Cheryl Johnson, president, United American Nurses
� Pamela Thompson, CEO, American Organization of Nurse Executives
� Kathleen Ann Long, president, American Association of Colleges of Nursing.


AACN Online Quick Poll

What is your unit policy for minimum frequency of vital signs?

Every 1 hour 48%
Every 2 hours 36%
Every 4 hours 12%
No Policy 5%

Number of Responses: 1,174

This poll is a voluntary survey for our users and is not scientifically projectable to any other population. AACN presents these surveys to give our users an opportunity to share their practice and opinions on particular topics. Participate by visiting the AACN Web site.