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Vol. 23, No. 10, OCTOBER 2006


Survey Provides Insight Into Work Environments
Most Rate Unit Health Higher Than Organizational Level


To further our quest to improve the health of work environments where nurses practice, AACN collaborated with Nursing Spectrum and Bernard Hodes Group to conduct their first RN Work Environment Survey. The project was designed to help the partner organizations better understand the environments in which nurses work and what elements of the work environment most influence their decisions to stay in a position or to move on. The survey also explored what factors, if improved, would cause nurses to reconsider their decision to leave their positions or organizations.

The findings were reported in the October 2006 issue of Critical Care Nurse. A preview of the findings was presented at the Trends in Critical Care Nursing conference, sponsored by the Southeastern Pennsylvania Chapter of AACN in late September.

The findings suggest that the majority of critical care nurses are very satisfied with nursing as a career; however, for many, issues remain in the work environment that cause dissatisfaction with their current roles. When asked to report on the health of elements in their organizational environments versus their unit environments, the majority rated their units considerably healthier than the organization as a whole on most factors. Improved leadership emerged as one of the primary factors that would influence nurses’ decisions to leave their current positions.

The survey followed by one year the release of the AACN Standards for Establishing and Sustaining Healthy Work Environments (available at www.aacn.org/HWE). The comprehensive study explored a variety of work environment issues including:

• The state of communication and collaboration among nurses, physicians, administrators and patients and their families
• Levels of respect nurses receive from their colleagues and patients and families
• The prevalence of physical and mental abuse of nurses
• Levels of support for professional development
• Perceived meaningfulness of recognition nurses receive from their organizations and colleagues
• Quality of patient care and skill of nursing colleagues

Member-Get-A-Member:Drive Totals for August Produce Impressive Results


Although Diane Lane, RN, MSN, Hermitage, Tenn., remained the leader during August, with 46 new members recruited in AACN’s Member-Get-A-Member Campaign, two other members also turned in double-digit performances. Diane Casperson, RN, BS, BSN, CCRN, CRN, of Beresford, S.D., was impressive with 11 new members recruited. Barbara Rogers, RN, BS, BSN, CCRN, of Grand Rapids, Mich., also added 11 new members to her total.

On the chapter side, the Greater Richmond Area Chapter continued to hold the lead at 30 new members recruited through August, but the Southeastern Pennsylvania Chapter is closing the gap, adding five more members to bring its total to 25. Not far behind are the Greater Cincinnati Chapter at 21, the Houston Gulf Coast Chapter at 20 and the Heart of the Piedmont Chapter at 16. The San Diego Area, Greater Phoenix Area and Greater Portland chapters each recruited 15 new members.

Since the beginning of the campaign May 1, a total of 594 individuals and chapters have recruited 1,835 new members. The campaign ends Aug. 31, 2007. The recruitment period was extended for this year’s campaign to move the program to a 12-month cycle.

Participation in the Member-Get-A-Member drive gives recruiters a chance to receive rewards, including a $1,000 American Express gift check that will be awarded to the top individual recruiter. The top recruiter is also eligible for three Grand Prize drawings for $500 gift certificates. Every recruiter who enrolls five new members during the program will be eligible for the drawing.

In addition, as individuals recruit new members, they are entered into a drawing for a $100 American Express gift check each month they recruit. Bonnie Mann, RNP, MS, MSN, CCRN, APRN, ARNP-BC, San Antonio, Texas, won the gift certificate in August.

After recruiting their first five new members, participants will receive a $25 gift certificate toward AACN products and services, and $50 after recruiting a total of 10 new members.
The chapter that recruits the most new members during the campaign will receive a $1,000 honorarium check and will be eligible for Grand Prize drawings of three $500 honorarium checks for their chapter treasuries. In addition, chapters are eligible for monthly drawings for a free NTI registration any month they recruit a new member. The winner for August was the San Fernando Valley Chapter.

To see the full list of recruiters and their totals through July, visit the AACN Web site.

Audio Conference Focuses on Effective Decision Making


Effective Decision Making is the last in a series of 90-minute audio conferences focusing on the AACN Standards for Establishing and Sustaining Healthy Work Environments. The series is sponsored by AACN and Joint Commission Resources.

The presentation, which includes time for questions, is scheduled from 12:30 to 2 p.m. (EST) on Nov. 9.

Representing AACN for the audio conference is Kevin Reed, RN, MSN, CNA, BC, chair-elect of the AACN Certification Corporation Board of Directors and director of clinical operations in neuroscience and critical care at Clarian Health Partners, Methodist Hospital, Indianapolis, Ind. He is also adjunct faculty at the Indiana University School of Nursing, Department of Environments for Health, Indianapolis.

Representing JCR is Roberta Fruth, RN, MN, PhD, CNA, CNAA, a JCR consultant and a past AACN board member.

Patient Safety and Quality of Care
In addition to the Healthy Work Environments series, AACN and JCR are partnering on a series of audio conferences that focus on patient safety and quality of care. Intensivists, Hospitalists and Advanced Practice Nurses is the topic that will be discussed in the last in this series on Dec. 14.

Participants can sign up to participate in the audio conferences as individuals or with multiple attendees using one telephone line in a conference room. The price is $249 per connection.

For more information, call (877) 223-6866 or visit the JCR Web site.


Encounter With AACN Board Exceeds Expectations
Community Liaisons Join AACN National Leadership Meeting

By Julia Garrison, RN, MSN, CCRN, PCCN-CMC, and Cathy Ryan, PhD, RN, APN, CCRN

The AACN National Board of Directors includes two community liaisons chosen from the AACN membership at the spring and fall board meetings each year. This year, we were selected and had the opportunity to attend the spring Board Meeting in Denver, Colo. from April 8 through 11, 2006 Although we expected to observe a well-defined organization at work, we found that our experience far exceeded our expectations. AACN is much more complex than we envisioned and we felt like valued and respected team members because we were given the opportunity to provide input throughout the meeting.

What was exceptional to us about this experience? We both thought we had a pretty good understanding of the organization’s goals, initiatives and mission because we had been long-time, active AACN chapter members. We found that Board of Directors members truly live the vision of a healthy work environment. Dialogue was encouraged, and all input was respected and valued equally. The diverse backgrounds and expertise of the members contributed further to a culture of creative thinking. The directors are AACN’s visionaries and determine what path the organization will take related to different issues. We were also very impressed with the commitment in time and effort contributed by each board member.

Perhaps like many of you, we had not anticipated the role of the AACN staff. In addition to keeping the national office running smoothly, answering questions from members, and handling a multitude of office tasks, we found that the AACN staff members truly live the mission of the organization. They are charged with operationalizing AACN’s strategic plan and objectives. Their commitment, knowledge and expertise were impressive.

At the conclusion of the meeting, we left Denver energized, with new insights. We have a deeper appreciation of the involvement of the board and are personally motivated to pursue further volunteer opportunities at the national level. We found that the officers respect the members’ needs. They desire input and feedback from all members; they are very approachable and desire interaction with members. We also left with a deeper appreciation of AACN’s staff. They are experts in what they do and enjoy meeting members and taking care of chapters’ needs.

This was a pivotal experience in our involvement with AACN, and we hope that others who want to be involved at the national level will apply for this experience. We plan to pursue other opportunities for involvement with the organization. We are proud to be affiliated with AACN.

AACN Welcomes Elsevier as a Corporate Circle Member


Some of the most prominent organizations in the medical/healthcare industry partner with AACN by providing direct financial support for AACN initiatives. Companies that participate at certain levels become members of AACN’s Corporate Circle. Companies that contribute at lower levels but still support NTI and AACN initiatives are recognized as Corporate Circle Associates. Corporate Circle Members and Associates benefit from recognition on the AACN Web site, AACN publications (AACN News, American Journal of Critical Care, Critical Care Nurse), and at NTI, including the Program and Proceedings book.

For its sponsorship of the Excellence in Education Award, a part of the AACN Circle of Excellence Awards program, Elsevier has entered the Corporate Circle as a Bronze Member. The AACN Circle of Excellence Awards program rewards both individual nurses and chapters that have made a difference in the healthcare profession and their communities. The awards program recognizes contributions and achievements that exemplify AACN’s mission, vision, values and ethic of care, and applauds excellence. These awards and their corporate sponsors are promoted throughout the year and especially each May when the awards are presented at the National Teaching Institute & Critical Care Exposition┬«.

Widely known for nursing books and knowledge resources published under the Elsevier Saunders and Elsevier Mosby imprints, Elsevier is an international leader in publication and dissemination of literature covering the broad spectrum of scientific endeavors. Elsevier publishes many of AACN’s educational reference books, including the AACN Procedure Manual for Critical Care and AACN Core Curriculum for Critical Care Nursing. For its support of AACN’s awards and recognition programs, Elsevier is welcomed into the Corporate Circle as a Bronze Member.

Look for the AACN Corporate Circle Member logo on brochures and other promotional materials you may receive from NTI exhibitors. Also look for the logo prominently displayed in the exhibits hall at NTI 2007 in Atlanta, Ga. You’ll know these companies actively support acute and critical care nursing through their contributions to AACN.

For more information on AACN’s Corporate Circle program, contact the Development Office at (800) 394-5995, ext. 333 or e-mail development@aacn.org.

Scene and Heard



AACN continues to seek visibility for our profession and the organization. Following is an update on recent outreach efforts.

Our Voice in the Media

Johanson

NurseZone (June 23, 2006)—“Wanda Johanson, RN, MN: Creating Healthy Workplaces” was the title of an interview with AACN’s CEO. In part, she said, “It’s been a passion of mine to make sure we have excellent systems, and that we can be driven by innovation, managed by facts, and focused on our customers, who are our nurses.” The article added that “the association strives to ensure nurses have the resources to incorporate evidence-based practice into their care. AACN experts prepare practice alerts on a variety of topics and make them available for free to anyone, not just members, since effecting change must involve the entire team.”

Robert Wood Johnson Foundation (June 2006)—“Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace” included a section on the AACN Standards for Establishing and Sustaining Healthy Work Environments. “The principles that guide Magnet hospitals complement the six guiding principles that were developed by AACN … Labeled as essential standards, these prominent, evidence-based guidelines support establishing and sustaining a healthy work environment.”

Nurse Leader (June 2006)—“Creating Healthy Workplaces: Laying the Groundwork by Listening to Nurse Managers.” This article included a section on the AACN Standards for Establishing and Sustaining Healthy Work Environments. “AACN issued a call to action for nurses and healthcare professionals, healthcare organizations and professional associations to ‘fulfill their obligation of creating healthy work environments in which safety becomes the norm and excellence the goal.’” The article also compared AACN’s standards with the principles of the Nursing Organizations Alliance.

Nursing Spectrum (June 2, 2006)—“AACN to State BONs: Don’t Bow Out of Nursing Specialty Regulation.” This “daily news item” noted that “AACN urges the council not to abandon the regulation of advanced practice nursing by sanctioning the licensure of a lower level generalist and leaving the further definition, education and utilization of specialists to the pressures of the marketplace. Doing so would hurt consumers of advanced practice nursing and further fragment services.”

Daily Journal (June 21, 2006)—“Nursing Team Honored at Awards Event” was the title of an article about South Jersey Health Regional Medical Center’s Cardiac Intensive Care Unit receiving AACN’s Beacon Award for Critical Care Excellence. Gladwyn Baptiste, president of the medical staff, said, “This is like the Academy Awards for hospitals.”

Bridgeton News (June 23, 2006)—“SJC Cardiac Intensive Care Receives Excellence Award” also announced the South Jersey Health Regional Medical Center’s CICU’s award. Elizabeth Sheridan, chief operating officer, said, “I’m so proud. Earning a Beacon Award sends a loud message that our nurses are providing exceptional care and their commitment to evidence-based practice is unwavering … In the future, we would like to have all our ICUs earn a Beacon … When best practices are followed, we can be confident that our patients are receiving the finest care.”

Wichita Eagle (June 4, 2006)—“More ICU Patients Will Tax Physicians Trained to Care for Them” was the title of an article that addressed the issue of the number of critical care patients exceeding the supply of internists. The article noted that “the Critical Care Workforce Partnership, a group comprising the nation’s largest critical care societies, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine and AACN, is lobbying for help in Congress.” The key areas are supporting electronic monitoring, transitioning patients to hospitals providing the best care and opening the visa approval process.

Business Times (June 1, 2006)—“Norwalk Hospital Nursing Team Receives National Award” quoted Geoffrey Cole, president and CEO of Norwalk Hospital, as saying, “We are very proud that our critical care nursing team at Norwalk Hospital has been selected for the second year in a row to receive the prestigious Beacon Award. This national award recognizes our critical care team for achieving the highest quality outcomes and for being an inspiration to other critical care units throughout the country.”

University of Virginia News (June 8, 2006)—“University of Virginia Nurses Win National Awards.” Four university RNs and a team of RNs received AACN Circle of Excellence Awards. “These awards speak volumes about the caliber of nurses we have at the U. Va. Medical Center. I appreciate their talent, their dedication and their professionalism,” said CNO Pamela Cipriano, PhD, RN, FAAN, chief clinical officer.

American College of Nurse Practitioners News (June 8, 2006)—“Coalition for Patients’ Rights (CPR) Calls on AMA to Cease Divisive Efforts to Limit Patients’ Choice of Providers.” The CPR consists of 25 healthcare groups, including AACN, and was formed “to ensure that the growing needs of the American health system can be met and that patients have access to quality healthcare providers of their choice.”

International News Service (June 15, 2006)—“The Acute Care Nurse Practitioner in Hospital-Based Practice” described the role of the ACNP and referenced AACN’s critical care nursing fact sheet, as well as several articles in the American Journal of Critical Care. “According to AACN, critical care nurses rely upon a specialized body of knowledge, skill and experience to provide care to patients and families and create environments that are healing, humane, and caring.”

Healthcare Information and Management Systems Society (June 9, 2006)—“HIMSS Position on Legislatively Mandated Ratios.” “HIMSS joins other healthcare organizations and regulatory agencies in opposing legislatively mandated patient to nurse ratios.” HIMSS supports the position of many other associations, including AACN. The statement included part of AACN’s views on the matter: “Relying on staffing ratios alone ignores variances in patient needs and acuity … staffing is a complex process with the goal of matching the needs of patients … with the skills and competencies of nurses.”

Our Voice at the Table

Kevin Reed, RN, MSN, CNA, BC, AACN Certification Corporation chair-elect, and Linda Bell, RN, MSN, AACN clinical practice specialist, represented AACN at the CNS Summit sponsored by the National Association of Clinical Nurse Specialists in Indianapolis, Ind. Attendees explored the impact of the American Association of Colleges of Nursing’s recommendations for doctor of nursing practice education on the competencies and role of the clinical nurse specialist.

Bell represented AACN as a liaison to the 14th annual JCAHO Invitational Liaison Forum at the Joint Commission on Accreditation of Healthcare Organizations headquarters in Oakbrook Terrace, Ill. This is an annual update on JCAHO’s current and future initiatives.

AACN President Mary Fran Tracy, RN, PhD, CCRN, CCNS, FAAN, discussed her presidential theme, Powered by Insight, and Mary Holtschneider, RN, BSN, MPA, immediate past AACN board member, talked about applying AACN’s Healthy Work Environments Standards to “healthy chapter environments” at the Region 5 Leadership Development Meeting in High Point, N.C. Susan Helms, RN, MSN, CCRN, PCCN, AACN Certification Corporation board member, and Beth Martin, RN, MSN, CCNS, CNRN, immediate past AACN Certification Corporation board member, discussed certification. Tracy also presented an update on AACN’s national initiatives.

Goodyear-Bruch

Caryl Goodyear-Bruch, RN, PhD, immediate past AACN board member, attended a Coalition for Patient Rights meeting at the American Nurses Association in Silver Spring, Md. The group discussed the continued purpose of this interdisciplinary group and increasing the formality of the CPR organization itself. (See page 4.)

Lussardi

Paula Lusardi, RN, PhD, CCRN, CCNS, AACN board member, spoke about healthy work environments at North Shore Medical Center in Salem, Mass. North Shore is in the process of planning and integrating AACN’s standards. About 40 staff members, educators and managers were in attendance.

In the Circle: Media Award


Editor’s note: Part of AACN’s Circle of Excellence Awards program, the Media Award recognizes media excellence in portraying healthcare providers, especially critical care nurses, contributing to a healthcare system driven by the needs of patients and families. Following are excerpts from the exemplar submitted in connection with this award for 2006.

Jill Duval, Editor
Albuquerque, N.M.
New Mexico Woman Magazine
At a publishing conference I attended last year, a woman raised the topic of the national nursing shortage. Although I was aware of it, I hadn’t thought much about it – you know, it’s someone else’s problem. She said, “Who’s going to take care of me?” Although I’m in extremely good health, facing 65 this year made her question suddenly very personal.

After returning to my office in Albuquerque, I discussed the issue with my editor and we decided to initiate an effort and do our part to bring this problem to the attention of the public.
We began planning something we have never done before—a special insert in our magazine—one that would focus exclusively on nurses and nursing. We decided to publish the insert in May, which is National Nurses Month.

Our research makes it very clear that the problem in New Mexico is not lack of interest in nursing as a career, but rather a serious shortage of nursing teachers. Many teaching institutions and legislatures are working to address this problem, but it is not easy to solve. The initiative to maintain and increase the number of nurses to care for our aging population requires long-term planning, a lot of special attention, public support and funding.

We are very excited about the participation and support we have received from the healthcare community and hope that our efforts bring additional, positive attention to this critical issue.

Looking Ahead


October 2006

Oct. 31 Deadline to apply for Chapter Advisory Team positions in Regions 4, 5, 6, 10, 13, 15, 17 and 19. If you are interested in serving as a chapter adviser but have
questions regarding the role, contact Chapter Specialist Val Hardwick at (800) 394-5995, ext. 313; Val.Hardwick@aacn.org. To apply, register online at
www.aacn.org.


November 2006

Nov. 9 AACN/JCR audio conference on Effective Decision Making, one of the AACN Standards for Establishing and Sustaining Healthy Work Environments; 12:30 to 2 p.m.
(EST). Price is $249. For more information, call (877) 223-6866; www.jcrinc.com..


December 2006


Dec. 31 Deadline to make up transcripted hours for CCNS exam. For more information, visit the AACN Certification Corporation Web site.

Coming in November in American Journal of Critical Care


• Changing the Work Environment in Intensive Care Units to Achieve Patient-Focused Care

• Using Evidence and Process Improvement Strategies to Enhance Healthcare Outcomes for the Critically Ill

• State of the Heart: Building Science to Improve Women's Cardiovascular Health

• Measuring ICU Nurses’ Perspectives on Family-Centered End-of-Life Care

• Hemodynamic Changes During Discontinuation of Mechanical Ventilation in Medical Intensive Care Unit Patients

• Use of Local Anethesia for Arterial Punctures

• Effect of Continuous Display of Cerebral Perfusion Pressure on Outcomes in Patients With Traumatic Brain Injury

• Surreptitious Baclofen Poisoning

• Brain Natriuretic Peptide, Clinical Reasoning, and Congestive Heart Failure

• Comparison of Anxiety Between Smokers and Nonsmokers With Acute Myocardial Infarction

Subscriptions to Critical Care Nurse and the American Journal of Critical Care are included in AACN membership dues.
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