AACN News—January 2005—Practice

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Vol. 22, No. 1, JANUARY 2005

5 More Hospitals Earn Beacon Award for Critical Care Excellence

Critical care units at five more hospitals have earned the AACN Beacon Award for Critical Care Excellence, a designation that recognizes the nation’s top units.

Achieving Beacon Award status are the cardiovascular care unit at Lynchburg General Hospital, Lynchburg, Va.; the intensive care unit/cardiac care unit at Norwalk Hospital, Norwalk, Conn.; the medical intensive care unit at Methodist Hospital, Houston, Texas; the cardiovascular care unit at Mount Carmel Medical Center, Columbus, Ohio; and the surgical/trauma intensive care unit at Tampa General Hospital, Tampa, Fla.

The latest awards bring to nine the total number of units that have received the Beacon Award. Each has been recognized for exhibiting the highest quality standards in nurse recruitment and retention, patient outcomes, staff training, healthy work environments, leadership, and evidence-based practice and research.

The criteria for becoming a Beacon Award winner includes:
• Recognized excellence in the intensive care environments in which nurses work and critically ill patients live
• Recognized excellence of the highest quality measures, processes, structures and outcomes based upon evidence
• Recognized excellence in collaboration, communication and partnerships that support the value of healing and humane environments
• A program that contributes to actualization of AACN’s mission, vision and values

“Although it has just been awarded for the second time, the significance of the Beacon Award is becoming well-established in our field,” said AACN President Kathy McCauley, RN, PhD, BC, FAAN, FAHA. “These are not easy standards for a critical care unit to meet. Each of these units has set an example for others to follow, and we proudly designate them as Beacon Award winners.”

The previous winners, announced last spring, are the adult medical-surgical ICU at Baystate Medical Center, Springfield, Mass.; the medical ICU at Georgetown University Hospital, Washington, D.C.; the coronary care unit at Methodist Hospital, Houston, Texas; and the surgical ICU II at the University of California-Davis Medical Center, Sacramento.

AACN membership is not required to receive the Beacon Award, which is presented twice yearly. Applications must be made online.

Complete application information and requirements are available online at www.aacn.org.

Do You Want to be an API Speaker?
Tips for Writing a Successful Abstract

By Kelly A. Thompson-Brazill, RN, MSN, AP
Advanced Practice Work Group

Do you hope to be a speaker at AACN’s Advanced Practice Institute, offered as part of the National Teaching Institute and Critical Care Exposition each year? Now is the time to start thinking about speaker abstracts for API 2006, scheduled for May 20 through 25 in Anaheim, Calif.

Following are answers to some frequently asked questions about writing API abstracts. Combined with the online submission process, we hope this makes it easier for you to find success in getting your presentation selected.

Who Attends the API?
The API is primarily for acute care nurse practitioners and clinical nurse specialists, though other nurses who are involved in education and leadership also attend. Although not the focus audience, other NTI participants may also attend API sessions.

What Topics Are Chosen?
The Advanced Practice Work Group, which helps evaluate topics and speakers, is interested in topics that are both scientific and related to clinical practice. Abstracts that describe cutting-edge technology, new research and the latest guidelines are often the most interesting.

What Should I Write About?
The best topic for you is a subject that you know very well and that you are comfortable presenting to a large group of colleagues.

What Is the Level of Expertise? How Do I Choose This?
The level of expertise describes the level of clinical experience participants need to get the most out of the session. Abstracts for the API can
target novice, intermediate or expert APNs. Determine the appropriate level by asking yourself, “To whom am I speaking?” and “What do I want the audience to learn?” For example, an abstract on transitioning from bedside RN to ACNP would be geared toward novice, not expert, APNs.

What Types of Outcomes Do I Choose?
This depends on what you want the participants to gain from your presentation and how it will affect their practices. Your abstract will score higher if your outcomes are more specific. For example, an outcome for a presentation on adrenal insufficiency would be to describe the steroid-dosing regimen used to treat the disorder.

How Do I Determine the Appropriate Prerequisite Knowledge?
Prerequisite knowledge is previously learned information participants need to understand a presentation. Address the required knowledge, based on your topic. For example, if you are planning to lecture on the clinical implications of endothelial cell dysfunction, the participants will need a graduate level pathophysiology review. If you are speaking about donation after cardiac death, the audience needs familiarity with the organ donation process.

How Do I Choose a Title?
Make the title interesting, but more importantly, make sure it relates to the abstract’s content. An example of a title for a presentation on high anion gap metabolic acidosis is “Bridging the GAP: Acidosis and Metabolic Mayhem.” The reviewers and audience should be able to understand something about the content from the title.

What Is the Session Type?
There are a number of session types for API presentations. Concurrent sessions last 75 minutes. Mastery sessions are three hours. Preconference sessions are either half or full day and are most useful for skills workshops such as central line insertion.

What Types of Formats Are Accepted?
When devising your presentation strategy, think outside the traditional lecture box. Choose a format that is both exciting and well-suited to your topic. Examples of nontraditional sessions include a pro-con debate about the relevance of prone positioning; an interactive diagnostic-reasoning session about the etiology, diagnosis and treatment of acute renal failure; or a presentation about a new type of diagnostic technology where the participants actually practice interpreting the scans.

How Do I Know When My Abstract Is Ready for Submission?
Ask yourself the same questions that members of the APWG will ask during the abstract review process. These questions include:
• Do I easily understand what the abstract describes?
• Does the content flow logically?
• Is the purpose clearly stated?
• Is this written at the AP level?
• Is the content concise?
• Is this abstract developed enough for presentation at API?
• Is this a session I would attend?
• Will this appeal to a large number of API participants?
• Are the outcomes specific?
• Is the abstract formatted appropriately?
• Is it over the maximum number of allowed characters?
• Is it written in active voice?
• Are the grammar and spelling correct?

When you think that you have answered all these questions, show your abstract to as many people as possible. Ask them to evaluate the abstract on these criteria. Make changes as needed. The first draft of the abstract is never the final draft. Remember that the submitted abstract is reviewed in a blinded process; the reviewers will evaluate only on the merits of the information you have provided.

Once these steps are complete, you are ready to “Live Your Contribution” by sharing your knowledge and expertise with APNs from across the country and around the world!

Additional information about the API speaker abstract process is available online at www.aacn.org.


Submit Abstracts Online for NTI 2006

June 1 is the deadline to submit speaker proposals, including chapter-related proposals, for NTI 2006, May 20 through 25 in Anaheim, Calif. Abstracts can be submitted online at www.aacn.org.

Task Force Updating ACNP Practice Scope and Standards
Collaboration Enhances Goals

By Mary E. Holtschneider, RN, BSN, MPA, EMT
AACN Board Liaison
ACNP Task Force

The role of the acute care nurse practitioner has grown tremendously the past decade, with more ACNP programs added to schools of nursing curricula and more healthcare organizations increasing their usage of ACNPs in clinical settings. Given these changes, AACN convened a task force in November to update the ACNP scope and standards of practice, originally developed in 1995 under a collaboration by AACN and the American Nurses Association and titled “Standards of Clinical Practice and Scope of Practice for the Acute Care Nurse Practitioner.”

The task force, chaired by Deborah Becker, RN, MSN, APRN-BC, CRNP, brought together a diverse group of ACNPs representing different areas of practice, academics and geographical areas. In addition, Carol J. Bickford, RN, PhD, BC, senior policy fellow in ANA’s Department of Nursing Practice and Policy, and Kitty Werner, MPA, executive director of the National Organization of Nurse Practitioner Faculty, were invited to share their organizations’ perspectives.

The 1995 scope and standards document as well as a variety of other resources were used to provide a basis for the new standards and to develop thoughts on how ACNPs will grow as a profession over the coming years.

For example, the ANA’s “Scope and Standard of Practice” delineates the standards of practice for all nurses, including advanced practice nurses. The ANA’s “Nursing’s Social Policy Statement” discusses the knowledge base for nursing practice, including specialization in nursing and advanced practice as well the regulation of nursing practice.

The NONFP publication, titled “Acute Care Nurse Practitioner Competencies,” describes the entry-level competencies for graduates of ACNP programs. Although these competencies are specific to ACNPs, they are used in conjunction with the core competencies identified for all nurse practitioners.

Because standards of practice are used by many entities, including schools of nursing, regulatory agencies, attorneys, healthcare organizations and state boards of nursing, they must meet accepted guidelines.

“This process is moving forward in a very thoughtful manner,” said AACN Clinical Practice Specialist Linda Bell, RN, MS, MSN, who is the staff liaison to the task force. “And, having the ANA and NONFP representatives at the table as part of the discussion has been most helpful.”

The task force members are now in the process of writing the standards document, which is scheduled for release later this year.

“I am amazed at how easily the members of this group, representing acute care nurse practitioners from across the country, were able to come together, share thoughts and visions of the profession, work together to define our present practice and describe where we envision ACNP practice is going,” said Becker. “All members were enthusiastic about our charge and excited to be a part of defining the scope and standards of our practice.”

Other members of the task force are Deborah L. Bingaman, RN, MS, CCNS, CPNP, Denise Buonocore, RN, CCRN, APRN-BC, Jill N. Howie, RN, NP, Marilyn P. Hravnak, RN, PHD, CCRN, APRN-BC, Joan E. King, RN, PHD, ACNP, Sheila Melander, RN, DNS, APRN, ACNP, and Jacqueline Rhoads, RN, PhD, ACNP-BC, ANP-C, CCRN.

Members of the ACNP Task Force are (from left, seated)
Deborah Becker, Sheila Melander, Jacqueline Rhoads
and Mary Holtschneider and (from left, standing)
Marilyn P. Hravnak, Jill N. Howie, Carol J. Bickford,
Denise Buonocore, Deborah L. Bingaman, Joan E. King,
Linda Bell and Kitty Werner.


Mentorship Grant
Up to $10,000 is available to support research by a novice researcher working under the direction of a mentor who has expertise in the area proposed for investigation. The application deadline is Feb. 1.

Critical Care Grant
Up to $15,000 is available to fund research that focuses on one or more of AACN’s research priorities. These five priority areas, identified as relevant to AACN and its members, are:

• Effective and appropriate use of technology to achieve optimal patient assessment, management or outcomes
• Creating a healing, humane environment
• Processes and systems that foster the optimal contribution of critical care nurses
• Effective approaches to symptom management
• Prevention and management complications

The application deadline is Feb. 1.

Evidence-Based Clinical Practice Grant
Six awards of up to $1,000 each are available each year to fund projects that stimulate the use of patient-focused data or previously generated research findings to develop, implement and evaluate changes in acute and critical care nursing practice. The application deadline is March 1.

To find out about AACN’s research priorities and grant opportunities, visit the Research area of the AACN Web site or e-mail research@aacn.org.

Public Policy Update

RN Supply Growth Largest in 2 Years
Nearly 118,700 registered nurses joined the U.S. healthcare workforce in 2003, many of them age 50 and older or foreign-born, according to a study published online in Health Affairs. A surge of RNs in their 20s and early 30s—many with two-year associate degrees—also contributed to the growth, and the number of men entering the nursing workforce increased from 60,000 in 1987 to 160,000 in 2003.

The expansion surpassed 2002, when the pool increased by about 85,900 full-time nurses. The combined, two-year increase, an average of 5%, was the highest since researchers began collecting data two decades ago.

Although the apparent success of industry efforts to promote nursing and increase access to nursing education helped hospitals, it didn’t erase the nursing shortage, said Peter Buerhaus, study co-author and senior associate dean for research at Vanderbilt University School of Nursing. Despite the increases, the researchers say the nursing shortage is far from fixed.

With the workforce projected to peak at 2.3 million in 2012 and shrink to 2.2 million by 2020, the Health and Resource Service Administration forecasts that 2.8 million full-time RNs will be needed by 2020. The report is available online at content.healthaffairs.org.

Study Examines Errors in Patient Care
A University of Pennsylvania School of Nursing study provides the first detailed description of the nature and prevalence of errors by hospital staff nurses. During a 28-day period, 393 RNs kept a detailed journal of their errors and near-errors. Thirty percent of the nurses reported at least one error during the period, and 33% reported a near-error. Although the majority of errors and near-errors were medication-related, the nurses also reported a number of procedural, transcription and charting errors.

“Given the prevalence of other types of errors, an exclusive focus on medication administration errors, often a typical practice, may miss many important and potentially hazardous situations,” said Ann E. Rogers, an associate professor in the university’s School of Nursing.

The findings, presented in the November 2004 issue of Applied Nursing Research, were derived from a previous study that examined staff nurse fatigue and patient safety.

“Although nurses pride themselves on being able to juggle multiple tasks at once, too many distractions from multiple sources make errors inevitable,” Rogers said. “Other reports have shown that a nurse may be interrupted, on average, at least 19 times during a three-hour period by at least 13 different types of sources.”

Approximately 33% of actual medication errors were because of late administration of drugs to patients, which in some cases was due to inadequate numbers of nurses on duty. In one example, a nurse reported a 90-minute delay in giving medications to one patient and a 40-minute delay to another because she could not leave the bedside of a third unstable patient. As hospitalized patients become more ill, with complex care requirements, and the nursing shortage intensifies, such situations may become more common.

Other errors can be attributed to workplace distractions. According to the participants in the study, frequent interruptions by staff, students or even the telephone made administering medications and carrying out other patient-care activities challenging.

Procedural errors, such as omitting a routine task or making charting and transcription errors, often arise from garbled communication within the immediate work area. Although it might be impossible to avoid all distractions, the use of technology such as bar code medication administration systems and paperless charting systems have been shown to reduce errors.

The study itself demonstrates that nurses will report errors when they feel safe and when the reporting system is not burdensome. According to Rogers, it is important to acknowledge the vigilance and astuteness that led to the nurses catching many of their own errors before they reached the patient.

Congress Approves $388 Billion Appropriations Bill for FY2005
Congress approved a $388 billion, fiscal year 2005 omnibus appropriations bill that includes funds for the Department of Health and Human Services. The legislation combines nine separate appropriations bills that Congress had not yet approved. Following is a summary of some of the health-related provisions in the bill:

• The bill would provide $100 million to help ensure an adequate supply of flu vaccine doses in the future.
• Funds earmarked for HHS as well as the labor and education departments would increase discretionary funds 2.8% to $142.3 billion, before a 0.8% across-the-board reduction. The legislation provides the National Institutes of Health $28.5 billion, an $849 million increase from FY2004.
• The bill would also increase spending for nurse education and Nurse Reinvestment Act programs by $10 million to $151.8 million, while cutting funds for hospital bioterrorism preparedness by approximately $22 million. The funding is subject to an across-the-board reduction of 0.83% for all nondefense, nonsecurity discretionary programs in the bill. Title VIII nursing programs received a 5.7% increase for nurse education, practice and retention programs, and the loan repayment and scholarship program. The part of the bill that would finance the Department of Veterans Affairs and the Department of Housing and Urban Development, as well as related independent agencies, would provide $128.6 billion for FY 2005. Included are $93.5 billion in discretionary funds, without the across-the-board reduction. The legislation includes $1.4 billion more in discretionary funds than President Bush requested, in part to expand healthcare programs for veterans. Federal expenditures for veteran healthcare programs will increase by $1.5 billion in FY 2005 to $28.3 billion, which does not include an additional $2 billion in expected fee collections. In addition, the bill would provide $5.5 billion for the National Science Foundation for FY 2005, a $61 million decrease from FY 2004.
• Financing for FDA and most U.S. Department of Agriculture operations is $83.3 billion, including $17 billion in discretionary funds, a 0.7% increase from FY 2004 and 2% more than requested by President Bush. Lawmakers removed a provision that would have helped facilitate the reimportation of prescription drugs from Canada.

Regulation of Healthcare Drives up Consumer Costs
Doing away with outmoded and questionable healthcare regulations would significantly lower healthcare costs, according to a Cato Institute policy analysis by Christopher J. Conover, an assistant research professor at Duke University. Conover also found that, though providing some marginal benefits, regulations make coverage unaffordable for millions of Americans and even cause premature deaths.

After reviewing 47 healthcare regulations, Conover found that the cumulative red tape cost society a net $169.1 billion in 2002. Thus, over the next 10 years, the net cost of healthcare regulations will be more than three times the $534 cost of the new Medicare prescription drug benefit program. Specifically:

• In 2002, medical liability amounted to a net cost of $80.6 billion. Overall, 5.2% of healthcare expenditures are spent on overly generous lawsuit awards and measures taken by businesses to avoid liability risk.
• The FDA’s regulation of pharmaceuticals and medical devices imposed a net cost of $41.8 billion in 2002.
• Regulation of hospitals and other health facilities cost $25.1 billion, mostly due to hospital accreditation and licensure requirements.

Although FDA rules governing new drugs protect society against faulty pharmaceuticals, they also cost the lives of those who must wait for better pharmaceuticals to be approved. The study estimates that by making Americans $169.1 billion poorer each year, healthcare regulations induce 22,205 deaths annually.

Public Policy Snapshot

Survey Shows RN Salaries on the Rise

Nurse salaries are generally on the rise, according to the results of the annual salary survey by Nursing2004. The survey polled more than 1,700 nurses.
According to the survey, the overall average annual income in 2004 of $54,574 is significantly higher than the $49,634 average reported in 2003 and $10,000 more than the average reported the first year of the survey in 2001. Following are highlights of the 2004 survey, which is available online at www.nursing2004.com:

• More than 25% of the respondents earn at least $65,000, up 15% from 2003.
• The average starting, hourly salary increased by 5%, from $18.49 in 2003 to $19.33.
• The average annual income for a nurse with a BSN was $56,900, almost $6,000 more than for an associate degree respondent. For the BSN nurse, the increase was 9.5% from 2003 and, for the AD nurse, it was 6%. Nurses with an MSN earned $11,300 more on average than the BSN respondents. The MSN average salary increase was 12%.
• Average salaries ranged from $32,200 for staff LPN/LVNs to $49,600 for staff RNs to $72,400 for advanced practice nurses.
• Certified nurses averaged almost $10,000 more per year than their colleagues who were not certified.
• 72% reported that their employers pay a shift differential, with a significant increase in facilities offering shift differentials for charge nurses.
• Nurses with more than 15 years’ experience received more continuing education reimbursement, conference and travel fees, certification fees and flexible scheduling benefits than those with less experience.
• The number of nurses working full time increased significantly in 2004, with 63% of respondents reporting that they were compensated on an hourly basis. However, significantly more respondents, 37% compared to 26% in 2003, were salaried in 2004.
• Although hiring bonuses were offered by a few facilities, the decline was significant compared with 2003.

Stating the Facts

Nurses Launch Radio Ad Campaign to Protest Staffing Law Changes
The California Nurses Association has launched a statewide radio ad campaign to protest the state’s decision to modify its nurse-to-patient staffing ratio regulations. The Department of Health Services is maintaining the current 1:6 staffing level in hospital medical-surgical units, which was scheduled to drop to 1:5 on Jan. 1. It also clarified a requirement that hospitals comply with the ratio regulations “at all times” and gave emergency departments more flexibility in complying with the regulations when they experience an unforeseen influx of emergency patients. In addition to the radio ads, CNA staged a rally at the state capitol in December.

Hospital Association Board Votes to Oppose Staffing Ratios

The Kansas Hospital Association Board of Directors has approved a position statement that opposes the imposition of nurse-patient ratios. The Kansas State Board of Nursing originally approved such a position statement, which was later adopted by the Kansas State Nurses Association and the Kansas Organization of Nurse Leaders. The KHA version adds an introductory paragraph stating that the process of determining hospital staffing is best determined at a local level.

Safe-Staffing Bill Pitched for Nursing Shortages
State Sen. Richard Moore, the Senate head of the Massachusetts Legislature’s joint Committee on Health Care, has filed a bill intended to help boost nurse staffing levels. The bill contends that the move would be a more cost-effective way to establish safe staffing ratios than a mandatory law that could cost the hospital industry between $250 million and $480 million.

Dubbed the Patient Safety Act, the measure would let nursing leaders set safe staffing levels at hospitals with input from staff nurses instead of using a state mandate attempted in past legislative sessions.

Moore’s bill would also require the Department of Public Health to monitor staffing and require hospitals to report to the agency any variations in staffing plans. In addition, the law would provide financial aid for nursing school students who agree to work in a Massachusetts hospital.
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