AACN News—December 2005—Practice

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Vol. 22, No. 12, DECEMBER 2005

Advanced Practice Issues and Resources Examined
Work Group Convenes to Plan for Year’s Activities

By Kristine J. Peterson, RN, MS, MSN, CCRN, CCNS
Chair, Advanced Practice Work Group

A range of topics was on the table when the 2006 Advanced Practice Work Group met in August in Costa Mesa, Calif., for a lively and productive two days of discussion on a variety of topics relevant to advanced critical care practice.

Much of the work focused on the 2006 Advanced Practice Institute, part of AACN’s National Teaching Institute and Critical Care Exposition May 20 through 25 in Anaheim, Calif. The API will continue to be a valuable resource for advanced practice nurses in acute and critical care. Content will include topics of interest to clinical nurse specialists and acute care nurse practitioners, covering the age continuum and novice to expert practice as well as clinical and role development.

Speaker abstracts submitted for the 2006 API were reviewed in advance by the group, which then narrowed the list to 20 concurrent and five preconference sessions. These sessions will include severe acute pancreatitis, differential diagnosis, a range of pharmacology offerings, complementary and alternative therapies, post-traumatic stress syndrome, and skill sessions. In addition, sessions on evaluating the significance of research findings and implementing evidence-based practices were chosen.

Both CNSs and ACNPs are represented on the group. The members are Kristine J. Peterson, RN, MS, MSN, CCRN, CCNS (chair), Elisabeth Bradley, MSN, CCRN, APRN, Kathleen Ellstrom, RN, CNS, PhD, Pamela Popplewell, RN-BC, MSN, CCRN, ACNP-C, Ellen Prewitt, RN-BC, MSN, CCRN, ACNP-C, Lynn Rodgers, RN-BC, MSN, CCRN, APRN, Robin Watson, RN, MN, CCRN, and Roberta Kaplow, RN, PhD, CCNS, CCRN (board liaison). AACN Clinical Practice Specialist Linda Bell, RN, MSN, is the national office staff liaison.

The group also received an update on national AACN activities from Kaplow and reviewed AACN resources available to APNs. Included in the review were print resources in the AACN Bookstore, the PDA Center and the online PDA tutorial, the weekly Critical Care Newsline e-newsletter, the Volunteer Database, the Legislative Action Center and the AACN Clinical Issues journal. A number of suggestions were discussed and applied to the 2006 Advanced Practice Institute plans as appropriate.

Kaplow also led an in-depth discussion of the two proposals from the American Association of Colleges of Nursing—the new position of clinical nurse leader and the doctor of nursing practice as the entry level for advanced practice in nursing. The discussion centered on the drivers, rationale and implications of these proposals.

Because of the complexity and intense interest in these proposals, the group decided the dialogue should be continued on a broader scale. To that end, the group requested a session on this topic to be scheduled at the 2006 API, where APNs will be able to participate in a balanced and informative discussion of these proposals.

The group’s work will conclude with a series of informative articles in AACN News on topics relevant to APNs.

Stay tuned. This is a group of enthusiastic and well-informed APNs. Please contact any member of the group with your ideas for resources and information of interest to APNs.

Members of the AACN Advanced Practice Work Group are (from left)
Kristine J. Peterson, Linda Bell, Elisabeth Bradley, Robin Watson,
Pamela Popplewell, Lynn Rodgers, Ellen Prewitt, Kathleen Ellstrom
and Roberta Kaplow.

Practice Resource Network

Q: With so many new patient treatments and interventions, how do you determine if the procedure falls in your scope of practice?

A: RN scope of practice is regulated by the state and may vary from state to state. If you are unsure if the practice or procedure is within the scope of practice, contact your state board of nursing.

You should also ask if your state has a process that allows RNs to practice in areas that are not defined. This usually involves development of a standard of practice that defines:

• The procedure.
• Who can perform the procedure.
• Under what circumstances or in what clinical setting the procedure can be performed.
• The education needed before the procedure can be performed.
• The mechanism for assessing and reassessing competencies.

Following are some questions to ask to help determine if the practice falls in the nurse scope of practice:

• Was the skill taught in your basic nursing program?
• Has the task become routine in nursing literature and in nursing practice?
• Does carrying out the skill pass the reasonable and prudent standard for nursing?
• Is the skill listed in the policy and procedure manual? The skill or procedure needs to be listed in your facility’s policy and procedure manual, because the skill can be within your scope of practice but not appropriate in the setting.

Do you have a practice question? Call the AACN Practice Resource Network at (800) 394-5995, ext. 217.

Grants Support Studies Relevant at the Bedside

Beginning in January 2006, three AACN grants of up to $10,000 each sponsored by Philips Medical Systems will be awarded to qualified proposals relevant to bedside clinical practice. Each grant supports a nurse who is experienced in research in conducting a clearly articulated study relevant to clinical nursing practice in acute or critical care. Funds may be used for original research or replication of existing research.

Proposals for the first round of funding must be received no later than Jan. 1, 2006. Studies selected should be completed in time for oral and poster presentations at the National Teaching Institute and Critical Care Exposition in May 2007 in Atlanta, Ga. The principal investigator will receive funding for travel, two nights’ lodging and complimentary registration for the NTI.

Other Grants
Applications are also due Jan. 1 for the following grants:

Clinical Inquiry Grant—Annually funds 10 awards of up to $500 each for projects that directly benefit patients and their families.

End-of-Life/Palliative Care Grant—Annually funds two awards of up to $500 each for projects that may include bereavement, communication issues, caregiver needs, symptom management, advance directives or life-support withdrawal.

Evidence-Based Clinical Practice Grant—Annually funds six awards of up to $1,000 each for projects that can include research utilization, quality improvement or outcome evaluation.

AACN Mentorship Grant—Funds one $10,000 award for a project providing research support to a novice researcher.

AACN Critical Care—Annually funds one $15,000 award for a project focused on one or more of AACN’s research priorities.

Public Policy Update

Nationwide ICD Registry Effective in April
Medicare will work with the American College of Cardiology to collect data nationwide on the use of implantable cardioverter defibrillators for primary prevention of sudden cardiac death among Medicare beneficiaries. The American College of Cardiology’s National Cardiovascular Data Registry’s ICD Registry will be the new repository of information from more than 1,300 hospitals nationwide, effective April 1, 2006.

In January, CMS announced it would expand Medicare coverage of ICDs based on results of the Sudden Cardiac Death in Heart Failure Trial sponsored by the National Institute of Health’s National Heart, Lung and Blood Institute. The decision increased the number of Medicare beneficiaries eligible for an ICD to nearly 500,000, and required hospitals to submit data to an ICD registry as a criterion of coverage.

For more information, go to www.cms.hhs.gov > media center > press releases and choose the Oct. 27, 2005 release.

Resources on New Drug Prescription Coverage Available
A new Web site providing healthcare professionals tips and tools about the new Medicare prescription drug coverage is available from the Centers for Medicare & Medicaid Services. Enrollment began Nov. 15 for coverage that begins Jan. 1, 2006.

The list of plans that will offer prescription drug coverage under Medicare's new Part D benefit is also available. All the plans meet Medicare requirements for providing access to medically necessary drugs as well as standards for access to convenient retail pharmacies and to drugs in nursing homes.

Access this information under “Spotlight” at www.cms.hhs.gov.

AHA Survey Shows Caregiver Shortage Worsening
The nation's hospitals are pressed by rising patient demand and limited capacity, according to a Modern Healthcare article regarding an American Hospital Association survey of hospital chief executives. CEOs said the shortage of caregivers was worsening, with an overall nurse vacancy rate topping 8%.

To read the full article, go to http://www.modernhealthcare.com/storyPreview.cms?newsId=4419&archive=N. Registration is free.

Keystone Project Reports Patient Safety Improvements
ICUs in four states are safer today following a two-year project to reduce medical errors and improve patient safety, according to the results of the Keystone ICU project announced by the Michigan Health & Hospital Association's Keystone Center for Patient Safety & Quality and patient safety experts from Johns Hopkins. With more than 120 ICUs and 70 hospitals participating, Keystone ICU is believed to be the largest patient safety collaborative of its kind. Find out more at http://www.bchealth.com/news/ImpICUPatSafety.shtml.

For more information about these and other issues, visit the AACN Web site.

Chest Supplement Features Critical Care Family Assistance Program

The Chest Foundation’s Critical Care Family Assistance Program is featured in a supplement to the September 2005 issue of Chest, the American College of Chest Physicians journal. Included is an article titled “A Natural Synergy in Creating a Patient-Focused Care Environment: The Critical Care Family Assistance Program and Critical Care Nursing,” written by Justine Medina, RN, MS, director of Professional Practice and Programs at AACN.

As the philanthropic arm of ACCP, the Chest Foundation provides funding for the Critical Care Family Assistance Program. According to research that appears in the supplement, the program has significantly benefited families, patients and other team members by increasing family satisfaction regarding communication with ICU team members and care of their loved ones, decreasing family stress and patient anxiety, and increasing staff communication and collaboration across hospital departments.

The supplement can be accessed through the AACN Web site.
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