Critical Care Societies Promote �The Power
of You� Letter-Writing Campaign
Join your
colleagues May 17 through 19, during
National Critical Care Awareness and
Recognition Month, to educate Congress on
the growing critical care workforce shortage
and its implications for the future. AACN
and three other critical care professional
societies�American College of Chest
Physicians, American Thoracic Society and
Society of Critical Care Medicine�are
partnering on a letter-writing campaign that
outlines the crisis and calls for federal
action. Through this effort, our collective
concerns can be heard as one voice.
May 17 through
19, you can contact your congressional
representatives through AACN�s Legislative
Action Center advocacy website and ask them
to work with us. Letters will be available
for you to sign and send electronically, or
you can draft your own letter to express
your concerns. Through this collective
effort, critical care professionals can
prompt health policy discussions to ensure
the best critical care medicine for the
future.
Practice
Alert: PULMONARY ARTERY PRESSURE MEASUREMENT
Expected
Practice:
� Verify the
accuracy of the transducer-patient interface
by performing a square waveform test at the
beginning of each shift.
� Position the
patient supine prior to PAP/RAP (CVP)
measurements. Head of the bed (HOB)
elevation can be at any angle from 0� (flat)
to 60�.
� Level the
transducer air-fluid interface to the
phlebostatic axis (4th ICS 1⁄2 AP diameter
of the chest) with the patient in a supine
position prior to PAP/RAP measurements.
� Obtain PAP/RAP
measurements from a graphic (analog) tracing
at end-expiration.
� Use a
simultaneous ECG tracing to assist with
proper PAP/RAP waveform identification.
� PA catheters
can be safely withdrawn and removed by
competent registered nurses.
Supporting
Evidence:
� The square
waveform test, or dynamic response test,
determines the ability of the transducer
system to correctly reflect pressures in the
pulmonary artery.1-5 This test can identify
system problems, such as air bubbles in the
tubing, excessive tubing length,
loose-fitting equipment and patient
problems, such as catheter patency. Any of
these problems may affect accuracy of
PAP/RAP measurements and should be corrected
prior to pressure measurement. Experts
recommend the following situations as
appropriate to perform the square waveform
test: on the initial system setup, at least
once each shift, after opening the catheter
system (eg, for rezeroing, drawing blood, or
changing tubing), and whenever the PAP
waveform appears to be damped or
distorted.1-4,6
� Consider the
following changes in PA pressures as
clinically significant (ie, not reflective
of the normal variability in PA pressures):
∆PAS > 4-7 mm Hg; ∆PAEDP > 4-7 mm Hg; ∆PAWP
> 4 mm HG.7,8
� Studies in a
variety of patient populations have found
that PAP/RAP measurements are accurate when
the head of the bed is elevated to any angle
between 0� and 60�, as long as the patient
is in the supine position.9-11 Two studies
have also shown that PAP/RAP readings are
accurate with the patient in a lateral
position, if the angle of rotation is
exactly 30� or 90� with the head of the bed
flat and the location of the transducer
air-fluid interface changed to the
appropriate external landmarks for lateral
positioning (30� lateral: distance from
surface of bed to the left sternal border;
90� right lateral: 4th ICS/midsternum; 90�
left parasternal border).1,12-14 When
utilizing a 30� side-lying angle, a method
of ensuring an accurate angle is needed and
should be readily available to the bedside
practitioner.13
� Leveling the
transducer air-fluid interface to the left
atrium corrects for changes in hydrostatic
pressure in vessels above and below the
heart.1,3 In the supine position, the
external landmark for the left atrium is the
phlebostatic axis (4th ICS1⁄2AP diameter of
the chest).15,16 Studies have found that
improper positioning of the air-fluid
interface can lead to significantly
different PAP/RAP readings.17,18 Once the
correct location for the phlebostatic axis
is identified, a mark should be placed on
the chest wall and a laser pointer level or
a carpenter�s level should be used to
properly level the transducer air-fluid
interface anytime the patient is
repositioned.1,2,18
� Changes in
patient position, even slight HOB ≠ or �,
require releveling of the transducer
air-fluid interface before obtaining PAP/RAP
measurements.
� Changes in
intrathoracic pressure during respiration
significantly alter hemodynamic pressures.
Obtaining accurate PAP/RAP measurements
requires reading pressure waveforms during
end expiration only.1-4,9,19 Digital
readouts on pressure monitors reflect
pressures obtained throughout respiration
and are significantly different from
end-expiratory pressures, requiring pressure
to be read from graphic waveform
tracings.6,20,21
� Levels of
evidence supporting validation of PAP/RAP
waveform measurement with simultaneous ECG
tracings include clinical literature, expert
opinion and sound theoretical principles of
hemodynamic measurement.1-4
� Studies and
surveys show that after education and
clinical monitoring to assess competency,
registered nurses can safely withdraw or
remove PA catheters.22-24 Before
incorporating withdrawing or removing PA
catheters into nursing practice, verify that
it is within your state�s scope of practice
for registered nurses.
What You
Should Do:
� Always
identify and mark the phlebostatic axis,
obtain PAP/RAP with the patient in the
supine position and the head of the bed
elevated between 0� and 60�, read pressures
from a graphic (analog) recording at end
expiration, and periodically perform a
square waveform test.
� Ensure that
your critical care unit has written practice
documents, such as a policy, procedure or
standard of care, that include these
expected Practice Alert standards.
� Determine your
unit�s rate of compliance with these
Practice Alert standards.
� If compliance
is < 90%, develop a plan to improve
compliance:13
� Consider
forming a unit task force to address the
need for changes in PAP/RAP measurement
practices.
� Educate staff
about the inaccuracies that can occur in
PAP/RAP measurements with improper
techniques (Education Toolbox at
www.aacn.org).
� Incorporate
content into orientation programs, initial
and annual competency verifications.
� Develop a
variety of communication strategies to alert
and remind staff of the importance of these
PAP/RAP practices.
Need More
Information or Help?
� A Web-based
educational program on pulmonary artery
pressure measurement is available at
www.pacep.org.
� PAP/RAP
Practice Alert information is available at
www.aacn.org
� Square
waveform test information
� Identifying
correct PAP/RAP waveforms from simultaneous
pressure and ECG tracings
� Identifying
correct phlebostatic axis location for
leveling transducers in the supine position
� Audit tool for
measuring compliance with PAP/RAP expected
practice standards
� Power Point
slide program for PAP/RAP measurement
education sessions
� Talk with a
clinical practice specialist for additional
information or assistance (www.aacn.org).
References
1. Keckeisen M,
Chulay M, Gawlinski A, eds. Pulmonary and
artery pressure monitoring. In AACN�s
Protocols for Practice: Hemodynamic
Monitoring Series. Aliso Viejo, Calif: AACN;
1998.
2. Quaal S.
Quality assurance in hemodynamic monitoring.
AACN Clin Issues. 1993;4:197-206.
3. Daily E,
Schroeder J. Techniques in Bedside
Hemodynamic Monitoring. St Louis, Mo: Mosby-Year
Book; 1994.
4. Quaal S. Ask
the experts. Crit Care Nurse. 1995;10:92-93.
5. Gardner R.
Direct blood pressure measurement: Dynamic
response requirements. Anesthesiology.
1981;54:227-236.
6. Ahrens T,
Penick J, Tucker M. Frequency requirements
for zeroing transducers in hemodynamic
monitoring. Am J Crit Care. 1995;4:466-471.
7. Moser D, Woo
M. Normal fluctuation in pulmonary artery
pressure and cardiac output in patients with
severe left ventricular dysfunction
abstract. Am J Crit Care. 1996;5:236.
8. Nemens EJ,
Woods SL. Normal fluctuations in pulmonary
artery and pulmonary capillary wedge
pressure in acutely ill patients. Heart
Lung. 1982;11:393-398.
9. Dobbin K,
Wallace S, Ahlberg J, et al. Pulmonary
artery pressure measurement in patients with
elevated pressures: effect of backrest
elevation and method of measurement. Am J
Crit Care. 1992;1:61-69.
10. Wilson A,
Bermingham-Mitchell K, Wells N, et al.
Effect of back position on hemodynamic and
right ventricular measurements in critically
ill adults. Am J Crit Care. 1996;5:264-270.
11. Woods S,
Mansfield L. Effect of body position upon
pulmonary artery and pulmonary capillary
wedge pressures in noncritically ill
patients. Heart Lung. 1976;5:83-90.
12. VanEtta D,
Gibbons E, Woods S. Estimation of left
atrial location in supine and 30� lateral
position abstract. Am J Crit Care.
1993;2:264.
13. Bridges EJ,
Woods SL, Brengelmann GL, et al. Effect of
the 30 degree lateral recumbent position on
pulmonary artery and pulmonary artery wedge
pressures in critically ill adult cardiac
surgery patients. Am J Crit Care.
2000;9:262-275.
14. Kennedy GT,
Bryant A, Crawford MK. The effects of
lateral body positioning on measurements of
pulmonary artery and pulmonary wedge
pressures. Heart Lung. 1984;13:155-158.
15. Paolella L,
Dortman G, Cronan J, et al. Topographic
location of the left atrium by computed
tomography: reducing pulmonary artery
catheter calibration errors. Crit Care Med.
1988;16:1154-1156.
16. Courtois M,
Fattal P, Kovacs S, Tiefenbrunn A, Ludbrook
P. Anatomically and physiologically based
reference level for measurement of
intracardiac pressures. Circulation.
1995;92:1994-2000.
17. Kee L,
Simonson J, Stotts N, Skov P, Schiller N.
Echocardiographic determination of valid
zero reference levels in supine and lateral
positions. Am J Crit Care. 1993;2:72-80.
18. Bartz B,
Maroun C, Underhill S. Differences in
midanteroposterior level and midaxillary
level of patients with a range of chest
configurations. Heart Lung. 1988;17:309.
19. Ahrens T.
The effects of mechanical ventilation on
hemodynamic waveforms. Crit Care Clin North
Am. 1991;3:629-639.
20. Ahrens T,
Schallom L. Comparison of pulmonary atery
and central venous pressure waveform
measurements via digital and graphic
measurement methods. Heart Lung.
2001;30:26-38.
21. Lipp-Ziff E,
Kawanishi D. A technique for improving the
accuracy of the pulmonary artery diastolic
pressure as an estimate of left ventricular
end-diastolic pressure. Heart Lung.
1991;20:107-115.
22. Wadas TM.
Pulmonary artery catheter removal. Crit Care
Nurse. 1994;14;62-72.
23. Roundtree
WD. Removal of pulmonary artery catheters by
registered nurses: a study in safety and
complications. Focus Crit Care.
1999;18:313-318.
24. Zevola, DR,
Maier B. Improving the care of
cardiothoracic surgery patients through
advanced nursing skills. Crit Care Nurse.
1999;19:34-44.
Other
Articles of Interest
1. Gawlinski A.
Facts and fallacies of patient positioning
and hemodynamic measurement. J Cardiovasc
Nurs. 1997;12: 1-15.
2. Bridges E.
Monitoring pulmonary artery pressures: just
the facts. Crit Care Nurse. 2000;20:59-78.
3. Leeper B.
Monitoring right ventricular volumes: a
paradigm shift. AACN Clin Issues.
2003;14:208-219.
4. Quall SJ.
Improving the accuracy of pulmonary artery
catheter measurements. J Cardiovasc Nurs.
2001;15:71-82.
Practice
Resource Network
Q:
I�m starting to work on the AACN Beacon
Award for Critical Care Excellence
application and am not sure what is needed
in the comment section of the question. Can
you help?
A:
The comment section for each question, which
is limited to 300 words, is designed to
provide you the opportunity to explain or
describe what makes your unit unique or
excellent. It allows you to illustrate the
processes in place for you to meet or exceed
the listed standard. If your unit does not
meet the listed standard, you have the
opportunity to explain what actions are
being taken so your unit can meet the
standard. Areas to expand on may include
methods of monitoring and evaluating people,
processes or outcomes and methods of
communicating information, findings or
changes. These comments will have a primary
influence on the reviewers� decision with
respect to the total application
presentation.
Q:
How frequently are the applications reviewed
and how soon after I submit the application
can I expect a response?
A:
The reviewers have 90 days from the time the
application is received to review and
provide written comments. Evaluation
feedback will be provided to units that do
not succeed in obtaining the award with
their first application submission. The
units will have a chance to use the feedback
to provide additional detail to their
original responses and resubmit their
application for further consideration at no
additional cost.
For more
information on the Beacon Award for Critical
Care Excellence, go to our website.
Grants
July 1 is the
deadline to submit applications for funding
by the AACN Small Grant Program. Following
is information about the grants that are
available:
AACN Clinical
Inquiry Grant
Five $500 awards
are available to qualified individuals
carrying out clinical research projects that
directly benefit patients or families.
Interdisciplinary projects are especially
invited.
End-of-Life/Palliative Care Small Projects
Grant
One award of
$500 is available. Eligible projects may
focus on any age group, patient education,
staff development, CQI projects, outcomes
evaluation projects or small clinical
research studies. A broad range of topics
may be addressed, including bereavement,
communication issues, caregiver needs,
symptom management, advance directives and
life support withdrawal.
Medtronic-Physio-Control
Small Projects Grant
One award of
$1,500 is available. Funds will be awarded
for projects involving patient education,
competency-based education, staff
development, CQI, outcomes evaluation or
small clinical research studies. Topics
should focus on aspects of acute myocardial
infarction, cardiac resuscitation, sudden
cardiac death, use of defibrillation,
synchronized cardioversion, noninvasive
pacing or interpretive 12-lead
electrocardiogram. Collaborative projects
involving interdisciplinary teams, multiple
nursing units, home health, subacute and
transitional care or other institutions and
community agencies are encouraged.
To find out
about AACN�s research priorities and grant
opportunities, visit our website.
Public
Policy Update
Study: 20% of
Terminal Patients Die in Hospital ICUs
More than 20% of
terminally ill patients in the U.S. die in
expensive ICUs, though nine of 10 Americans
say they would prefer a low-tech approach to
death, according to researchers at the
University of Pittsburgh School of Medicine.
Analyzing 552,157 deaths in six states using
1999 hospital discharge data, researchers
found that 38% of the deaths occurred in the
hospital and 22% in the ICU. Extrapolated
nationally, more than half a million
Americans die annually in ICUs. End-of-life
ICU use was highest among infants, at 43% of
ICU deaths, and lowest for people older than
85, at 14%. Terminally ill ICU patients had
an average stay of 12.9 days at a cost of
$24,541, compared with 8.9 days at a cost of
$8,548 for terminally ill patients not in
the ICU. The study was published in the
March issue of Critical Care Medicine.
Senators
Support More Funds to Develop Nursing
Workforce
Forty-one
senators have signed a letter urging the
Labor and Health and Human Services
Appropriations subcommittee to increase
funding for nurse education and development
programs by $63 million in fiscal year 2005.
The letter, circulated by Sens. Barbara
Mikulski (D-Md.) and Susan Collins
(R-Maine), says adequate funding for the
programs is needed to fulfill the promise of
the Nurse Reinvestment Act. The senators
note that nursing programs turned away more
than 11,000 qualified students last fall,
partly because of a shortage of faculty, and
that the Health Resources and Services
Administration could fund only a fraction of
the applications it received for nursing
student loan repayment and scholarships in
FY2003. To read the letter and send a
message to your senator, go to www.aacn.org
> Public Policy.
Voters Cite
Healthcare Reform as Major Campaign Issue
According to a
nationally representative survey conducted
for the Commonwealth Fund between Sept. 3,
2003, and Jan. 4, 2004, nearly six in 10
Americans say presidential and congressional
candidates� views on healthcare reform will
be a �very important� factor in determining
whom they vote for this November. More than
three in five adults said they favor
repealing the recent federal tax cut to
guarantee health insurance security for
everyone. About 26% of adults reported being
uninsured for some time during the previous
12 months, of which three out of five
reported problems getting the care they need
because of cost. Roughly 41% of Americans
aged 19 to 64 said they had problems paying
their medical bills or were paying off
medical debt. A majority of Americans (59%)
said the cost of health insurance should
continue to be shared by individuals,
employers and the government. The survey
report, titled �The Affordability Crisis in
U.S. Health Care: Findings From The
Commonwealth Fund Biennial Health Insurance
Survey,� is available online at
www.cmwf.org.
Secretary of
Labor Announces $24.4 Million Healthcare
Initiative
U.S. Secretary
of Labor Elaine L. Chao has announced a new
national healthcare initiative worth $24.4
million to address critical worker shortages
in the industry. The High Growth Job
Training Initiative is a strategic effort to
better prepare workers to take advantage of
new job opportunities in high-growth sectors
of the American economy. Through executive
forums with leaders of expanding industries,
critical workforce gaps and issues are
identified. Solutions, such as grants, are
then created in cooperation with employers,
educational institutions and the public
workforce system. Part of the President�s
High Growth Job Training Initiative, the
first two announced were $3 million to The
Johns Hopkins Health System and $1.5 million
to the State of Maryland. The Johns Hopkins
Health System grant will fund training for
current workers, provide GED and diploma
preparation and upgrade training for
positions experiencing critical worker
shortages. Between 450 and 500 employees
will benefit from the project. Operated by
the Governor�s Workforce Investment Board,
the second grant will address the lack of
faculty for healthcare professions by
funding scholarships for nurses who pursue
credentials to teach at the college and
university level. Additional funding will
train current workers for future healthcare
jobs and support scholarships for LPNs and
other incumbent workers seeking credentials
as registered nurses.
Additional
information is available online at
www.dol.gov.
Budget Debate
Targets NIH Funding
The FY2005
�budget crunch� is forcing lawmakers to make
�some difficult choices� on healthcare
spending. Recent reports of growth in
entitlement spending�specifically Social
Security and Medicare�combined with growing
tension over four decades of growth in
healthcare spending, is pressuring lawmakers
to reduce discretionary spending. The
National Institutes of Health, whose funding
has increased 107% since 1998, is �a
tempting target for cutbacks,� as
illustrated by the resurgence of criticism
over some NIH studies that some lawmakers
say are not the best use of federal funds.
Already, the Bush administration has
requested only a 2.7% increase in NIH
spending over the previous year. The
decrease is significant after annual
increases of 15%.
Schwarzenegger Doesn�t Plan to Change
California Nurse-to-Patient Ratio
Requirements
California Gov.
Arnold Schwarzenegger has indicated he does
not plan to become involved in the
controversy over the state�s
nurse-to-patient ratio requirements this
year.
Under the rules,
which took effect Jan. 1, nurses do not have
to care for more than eight patients at a
time. The rules also call for one nurse per
five patients in medical-surgical units by
2005, as well as one nurse per four patients
in specialty care and telemetry units and
one nurse per three patients in step-down
units by 2008. In addition, the regulations
state that only registered nurses can care
for critical trauma patients and that at
least one registered nurse must serve as a
triage nurse in emergency departments.
According to an
anonymous weekly survey launched in January
by the California Healthcare Association,
nine of 10 California hospitals are not
complying with the rules.
House
Approves Organ Donor Reimbursements
The House has
voted 414-2 to approve a bill (HR 3926) that
would reimburse organ donors for travel and
other nonmedical expenses involved in
transplant surgery. Beginning Oct. 1, the
bill would allow the Department of Health
and Human Services to spend $5 million a
year to reimburse qualified donors and
provide another $15 million for grants to
states, public awareness campaigns and
studies on improving recovery and donation
rates. The bill also would fund new programs
to coordinate organ donations at hospitals
and procurement agencies. The bill now goes
to the Senate, which passed a similar
measure (S 573) in November.
Medical
Errors Legislation Stalled
The
CongressDaily news service recently examined
how legislation that would address medical
errors has stalled in Congress. The House
voted 418-6 about a year ago to approve a
bipartisan patient safety bill (HR 663).
Although members of Congress say that
medical error legislation could lead to
better care and fewer medical malpractice
lawsuits, they remain divided over two
different bills. The House bill would create
Patient Safety Organizations that would
collect and analyze confidential reports of
medical mistakes and suggest ways to avert
future errors. Any information reported to
PSOs would remain confidential. The House
bill would give the Health and Human
Services secretary the authority to �demand
access to regional patient safety groups�
data.�
The Senate bill
was drafted by Senate Health, Education,
Labor and Pensions Chair Judd Gregg (R-N.H.)
and other leading senators. The proposal
would also set up a patient safety database,
but would not require regional groups to
report patient safety lapses. The proposal
would not protect the identities of those
reporting errors. th bills are stalled by
lawsuits.
Public Policy
Snapshot
1 in 10 ED
Patients Admitted to ICU
Findings from
the National Hospital Ambulatory Medical
Care Survey: 2002 Emergency Department
Summary revealed that 12% of emergency
department visits resulted in hospital
admission. Included were direct admission to
the ICU, critical care unit or coronary care
unit, which occurred in about 1 of 10
admissions.
Number and
percent of ED visits with corresponding
standard errors, by visit disposition:
United States, 2002
|
Disposition |
# of
visits in thousands |
Standard
error in thousands |
% of
visits |
Standard
error of % |
|
All
visits |
110,155 |
4,416 |
 |
|
|
Admit to
Hospital1 |
13,471 |
721 |
12.2 |
0.5 |
|
Admit to
ICU/CCU2 |
1,405 |
162 |
1.3 |
0.1 |
1 Includes those
admitted to ICU/CCU.
2 ICU/CCU is
intensive care unit/critical care unit or
coronary care unit and is a subset of those
admitted to hospital.
The full report
can be viewed online at http://www.cdc.gov/nchs/.
Check Out
These Health Policy Reports
� A recent Sigma
Theta Tau report on the state of nursing
globally laid out a number of similarities
in the profession, but also showed dramatic
differences in such areas as education. The
third and final outing of the Arista Think
Tank series was made up of five sessions in
different regions of the world aimed at
discovering the role of nurses and
challenges facing the profession. A copy of
the executive summary is available online.
� A report
released by the Immigration Policy Center
says that foreign-born professionals play a
crucial role in filling severe shortages
within the two largest healthcare
occupations: physicians and nurses. However,
recent changes in immigration policy have
made it tougher to meet this need. According
to the report, U.S. immigration policies are
restricting the ability of healthcare
providers to recruit needed nurses,
physicians and other health professionals.
The report is available online at
www.ailf.org.
� A study
published in the March/April 2004 issue of
the journal Health Affairs examines factors
such as professionalism, regulation and
market forces that are driving hospital
patient safety initiatives. The study,
conducted between September 2002 and May
2003 by the Center for Studying Health
System Change, is based on interviews with
the largest hospitals in 12 U.S.
communities. An abstract of the study is
available online at
www.healthaffairs.org.
� Two reports in
the April 8, 2004, edition of the New
England Journal of Medicine respond to an
Agency for Healthcare Research and Quality
report on racial health disparities that
some had complained was edited to downplay
differences in health outcomes among whites
and minorities. The report, requested by
Congress to track healthcare quality and
differences in use of services, found in
part that African-American and low-income
U.S. residents have a higher mortality rate
for cancer than the general population
because they are less likely to receive
tests for certain forms of the disease and
other preventive services. The report also
cited a number of other healthcare
disparities. In a January letter to Health
and Human Services Secretary Tommy Thompson,
eight Democrat lawmakers said that HHS
�watered down� the report, alleging that the
final version included revisions that �alter
the report�s meaning, undermine efforts to
address disparities and fit a pattern of the
manipulation of science by the Bush
administration.�
� The Agency for
Healthcare Research and Quality has issued
four new briefs on bioterrorism and health
system preparedness: Addressing the Smallpox
Threat: Issues, Strategies, and Tools;
Disaster Planning Drills and Readiness
Assessment; Optimizing Surge Capacity:
Hospital Assessment and Planning and
Optimizing Surge Capacity: and Regional
Efforts in Bioterrorism Readiness. The
briefs are available on the AHRQ Web site at
www.ahrq.gov.
� The U. S.
General Accounting Office has released a
report on the Occupational Safety and Health
Administration�s voluntary workplace safety
and health strategies that says the results
are promising but should be fully evaluated
before they are expanded. The GAO assessed
the types of strategies used, the extent of
their use and their effectiveness. GAO also
obtained suggestions from specialists for
additional voluntary compliance strategies.
The report, titled �Workplace Safety and
Health: OSHA�s Voluntary Compliance
Strategies,� is available online at
www.gao.gov.
� The Center on
an Aging Society�s brief, the fifth in a
series on chronic conditions, states that
health providers and systems are increasing
their commitment to cultural competence, or
providers� ability to deliver health
services that meet patients� social,
cultural and linguistic needs. The brief
adds that greater attention to that issue
could help improve access to and quality of
care, as well as health outcomes for certain
populations. The brief, titled �Cultural
Competence in Health Care: Is It Important
for People With Chronic Conditions?� is
available online at
ihcrp.Georgetown.edu
> Center on an Aging Society.
For more
information about these and other issues,
visit our website.
AACN
Online Quick Poll
A recent report
by the National Academy of Sciences suggests
that to reduce �error-producing fatigue�
that endangers patients, nurses should be
prohibited from working more than 12 hours
in any 24-hour period or more than 60 hours
a week. Do you agree?
Yes 64%
No 28%
Not sure 7%
Don�t care 2%
Number of
Responses: 1,502
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 our website. |
