AACN News—December 2007—Practice

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Vol. 24, No. 12, DECEMBER 2007

Practice Resource Network

Staffing is both a process and an outcome and often difficult to define. It can be expressed as the number of staff members required to provide care to a set number of patients, or it can describe the process in which human resources are used in an individual unit.
In this time of steadily escalating demand for critical care services, optimal use of registered nurses’ time and expertise is an important strategy in delivering high-quality care to patients and families. Optimal use of RN time and expertise involves many variables, including:

• Defining the patients and their care needs
• Allocating acute and critical care beds based on patient need
• Providing adequate numbers of qualified, educated and competent staff
• Establishing efficient support systems
• Following and adhering to legal and regulatory requirements
• Evaluation of the delivery of services through outcomes identification and
quality measures

AACN does not subscribe to the concept of staffing ratios, but rather recommends that staffing be based on patient acuity. Unfortunately, there is no national benchmark for patient staffing. California is currently the only state that has legislated minimum nurse-to-patient ratios. To our knowledge, guidelines on determining ratios or recommendations for specific patients do not exist. In current practice the determination is based on the patient's acuity.
Here are several resources to guide you in building your staffing plan:

Staffing Blueprint: Constructing Your Staffing Solutions
Product # 300117

AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence
Product #130600
(Also available as a downloadable PDF at

NIHMBL (Nurses in Healthcare Management and Business Leadership) listserv- By definition, being nimble means being agile in mind and body, having the ability to move quickly, lightly and easily, and exhibiting or possessing skill and ease in performance—all descriptive of an acute and/or critical care nurse manager’s everyday role. Sometimes, these adept, fast-moving leaders want to share their on-the-job challenges and triumphs with others in the same field. The listserv, which has nearly 600 members, can be accessed at http://health.groups.yahoo.com/group/NIHMBL.L

Essentials of Nurse Manager Orientation Program Live on Learn.com
The Essentials of Nurse Manager Orientation, the first comprehensive e-learning program for new frontline managers, assistant managers, charge nurses and aspiring managers, is now available at www.learn.com. The program is also an excellent tool for experienced managers to refresh their understanding or fill knowledge gaps. This course is the result of a landmark national partnership between AACN and the American Organization of Nurse Executives (AONE) and is modeled after the Nurse Manager Leadership Collaborative’s Domain Framework.
The interactive program offers 40 contact hours of CE credit and can be accessed anytime, anyplace, offering an affordable training solution addressing the real issues nurse managers face.
Additional information about the Essentials of Nurse Manager Orientation e-learning program is available at http://www.aacn.org/AACN/conteduc.nsf/vwdoc/ENMOHome.

Jan. 1 Is the Deadline to Apply for These AACN Nursing Research Grants

Unless otherwise specified, all research grant proposals must meet the following criteria: 1) Relevant to acute and/or critical care nursing practice, 2) Addresses one or more of AACN’s research priorities, and 3) principal investigator is a current AACN member and remains a member throughout the life of the grant funding.
Jan. 1, 2008 is the deadline to apply for the following research grants.

Small Grants
AACN Clinical Inquiry Grant
Five awards up to $500 each are available for projects that directly benefit patients and/or families. Interdisciplinary projects are especially invited. The principal investigator must be currently employed in a clinical setting and directly involved in patient care.

AACN End-of-Life/Palliative Care Small Projects Grant
One award up to $500 is available for a project that focuses on patients of all ages, 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.

AACN Evidence-Based Clinical Practice Grant
Three awards up to $1,000 each for projects focusing on research utilization studies, CQI projects or outcome evaluation studies. Collaborative projects are encouraged and may involve interdisciplinary teams, multiple nursing units, home health, sub-acute and transitional care, other institutions and community agencies.

Large Grants AACN Mentorship Grant
One award up to $10,000 to provide research support for a novice researcher, with limited or no research experience, who will act as the principal investigator for the study. The study must be directed by a mentor with strong research experience in the area of proposed investigation. The mentor can be an AACN member; however, it is not a requirement for funding. The mentor may not be a mentor on an AACN Mentorship Grant in two consecutive years.

AACN Critical Care Grant
One award up to $15,000 for a study relative to acute and critical care nursing and focused on one or more of AACN’s research priorities.

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

Nurses Share Their Insights From Mega Weekend

Members of the Staff Nurse Advisory Group include, from left, (front row) Angie Andrzrejewski, Paula Lusardi, Amy Ferenz, Dora Frank, Michelle Legg, (back row) Wanda Johanson, Amy Hanley, Kim Hoepner, Gwen Dransfield, Dave Hanson, Caryl Goodyear-Bruch and Stephanie Hodges.

Each year at the end of August, AACN hosts Mega Weekend, an event that brings the organization’s work groups together for face-to-face meetings with the members, the board and the national office staff. At this year’s event, the first Staff Nurse Advisory Group met to provide AACN with a deeper understanding of the perspectives of staff nurses regarding the challenges in their work environments and practice. Specifically, AACN hoped the staff nurses would:

• Identify needs generated by these challenges
• Help to generate possible solutions (which could be resources or services) where AACN could take the lead
• Learn things they didn’t know about AACN
• Come away feeling very connected to AACN and a part of the AACN community
• Feel celebrated by AACN for their contributions—both day-to-day and at this meeting

Four of the staff nurses who participated in Mega Weekend wanted to share their thoughts and experiences. They are Michelle Legg, from the CCU at Virginia Commonwealth University Health Systems in Richmond, Va.; Stephanie Hodges, from the CCU at Duke University Health Systems in Durham, N.C.; Gwen Dransfield, from the SICU at St. Joseph’s Regional Medical Center in Paterson, N.J.; and Amy Ferenz, from the ICU at Baystate Hospital in Springfield, Mass.

AACN: What were your initial thoughts when you were approached about participating in the Staff Nurse Advisory Group? What did you anticipate being able to contribute?

SH: I received an e-mail from AACN and thought it was either a mistake or too good to be true. All expenses paid to California? What could I contribute that would be worth that? What did they want from me? I had no idea but decided it was worth finding out. Fortunately, my employer was supportive and worked with my schedule so I could attend. What did I, a nurse of only one year, have to contribute to a conversation about work environment? I’ve been a member of AACN since early in nursing school when I decided I wanted to be a critical care nurse. But all I had ever really done with AACN was to attend a chapter conference and read the magazines. Little did I know that limited participation with AACN was one of the requirements of the Staff Nurse Advisory Group. To reduce my nervousness I tried to convince myself that my lack of experience was an asset – after all, couldn’t I contribute a fresh perspective?

AF: My initial feeling was that it was an honor to be asked to participate in a national organization and wondered how my little opinion could help. Who am I? Why would anyone listen to my opinion and my experience? There are so many more experienced nurses who could bring more information to the team than I could possibly bring.

GD: I have to say that I came into the experience of Mega Weekend thinking that it was primarily a marketing strategy to increase the number of members. I knew that the idea was to see how we can help staff RNs at the bedside, but I didn’t expect it to be so true. I believed that big organizations are really all about business and making money.

ML: I first learned about the Staff Nurse Advisory Group from Marian Altman, clinical nurse specialist for my unit [and AACN board member]. I had no idea what I was volunteering to do, but a weekend trip to California seemed nice and to do something for an organization that might benefit my co-workers and me was worthwhile. As a fairly new nurse, with not quite two years under my belt, I believed I could offer a fresh look at nursing from someone who had no prior healthcare experience but had knowledge of how things work outside a medical setting. In the nearly three years I’ve worked in the CCU, I’ve observed the challenges nurses, managers and doctors face on a daily basis and thought it would be interesting to see if other hospitals across the U.S. faced those same challenges. I also thought it would be great to learn if there are ways to make our jobs more productive by eliminating some of those challenges.

AACN: What was the experience like for you? What did you learn from the two-day event? What was your biggest “ah-ha” moment?

GD: I was deeply touched by the sincerity of the folks I met, like the AACN staff, Board of Directors and President Dave Hanson. Every staff RN should have the opportunity to experience having her or his opinion so valued and respected, and to understand that AACN really does care and wants to help every nurse. The energizing activity of working together was awesome.

ML: The experience was awesome. Hearing that the eight of us faced many of the same challenges on any given day was a relief. Brainstorming and getting ideas from the others was helpful. Focusing on what nurses face on a daily basis and putting it into perspective with what our priorities are supposed to be, turned on the light for action. I came away from the meeting eager to facilitate change and have since encouraged all of my colleagues and former classmates to volunteer and become a member of AACN if they are not already members. I believe we, as a group, made suggestions and created possible solutions to assist AACN in its process to help nurses “Reclaim their Priorities.”

SH: The experience of the group was unbelievably uplifting. From the moment we got together and started talking, we shared differences and similarities in our backgrounds and ourselves. The group came from various parts of the country and different types of hospitals. Almost from the start, the group clicked. From that point it was nonstop talking and laughing the whole weekend. Our facilitators from AACN made us feel welcome and valuable. We spent two days brainstorming, fleshing out problems and coming up with ideas. Our ultimate goal was to identify common issues in the nursing work environment and start developing some solutions AACN could contribute. It was really validating that so many of us shared concerns in our daily work experience. We realized that we not only have shared concerns, we could share in the solutions. I left feeling that I was not alone and that change could take place.

AF: I was nervous at first but once I arrived and met everyone it was incredible. Everyone was so excited to be there. The support for each person was something that I had never experienced before. There are co-workers and I that support each other, but I have never had the experience of absolutely everyone being supportive of each other with respect for each other. I also was so impressed that everyone still worked as a staff nurse no matter what credentials were behind the name. I realized that one of the reasons everyone was so supportive and respectful was because everyone never lost touch with the work of bedside nursing. Knowing that all the members who attended the Mega Weekend work groups could relate to me because they are still involved in the day-to-day experiences I encounter every day made me feel like I was part of the group and organization.

AACN: Since returning home, has anything changed for you as a result of this experience? What have you been able to share with others since you returned?

SH: When I arrived home I was still flying high from our enthusiasm. I talked with several of my co-workers about my experience. I found it very difficult to fully explain the sense of empowerment the weekend gave me. More strongly than ever I feel nurses can band together to solve our common struggles. I look forward to becoming more active in AACN both with my chapter and hopefully at a national level someday. Recently I started back to school to complete my BSN. Our advisory group and my contact with the other representatives from AACN has inspired me more than ever to further my education and get involved in our profession. Staff nurses are the largest constituency of AACN. It was an honor to represent staff nurses on the advisory group. We gave AACN an honest and frank look at what impacts us, and now AACN will seek to turn our solutions into action.

ML: People were very excited to hear about my experience and some were motivated to sign up as volunteers as a result of my experience. Being a part of the Staff Nurse Advisory Group made me want to do more and to get involved in the local chapter, as well as become a member of ANA. I feel like AACN was really interested in what we had to say and there might actually be progress made from our participation. And, I hope to be able to participate more. Participating also enhanced my desire to submit poster abstracts for NTI and to attend NTI to learn more.

AF: I must tell you that my experience at this meeting has given me the courage to voice my opinion and not be afraid to speak my mind, especially when it comes to patient safety and doing what is right for my patients, since I have been home. I am also more confident in letting others know what my standards of care are for my patients and holding others accountable for poor care.

GD: Our unit has had a problem managing the visitors. I worked with a couple of staff nurses to develop a welcome letter that is to be distributed when the visitors first arrive. The letter describes the unit’s visiting guidelines.The discussions during the weekend helped me understand that communication is the responsibility of the person wishing to communicate, so if the receiver is not receiving, try another method.

AACN: Is there anything you would like to share with others to encourage them to become involved with AACN?

AF: What I would like to share with other RNs is that AACN is a superior organization that cares a great deal about nurses, that supports them and values their opinions. AACN supports us in finding our way back to the basic priorities that made each of us become a nurse in the first place. I plan to become more active in the local chapter and national organization in the future.

GD: Every staff nurse should have the opportunity to experience having his or her opinion valued and respected. AACN really does care and wants to help every nurse.

ML: My perception of AACN as an organization changed in that I saw how committed they are to our profession and to learning what the needs are of their membership and consumers.

SH: Nurses have so many demands made on their time and energy. It’s easy to see why we would make the time to participate in a professional organization like AACN. But we are AACN. The organization exists to aid nurses to practice safely and provide the best evidence-based care. After meeting our current and future AACN presidents, as well as other board members, I was struck by how sincere and approachable they are. I would not hesitate to contact one of them if I had a suggestion or a concern. AACN connects 68,000 nurses and gives us access to each other. And if that isn’t reason enough to join, one day you may get an all-expense-paid trip to California.

The other members of the Staff Nurse Advisory Group were Angie Andrzejewski, Zablocki VA Hospital, Milwaukee, Wis.; Dora Frank, University of Maryland Medical Center, Baltimore, Md.; Kim Hoepner, Park-Nicolett Hospital, Minneapolis, Minn.; and Amy Hanley, Trinity Mother Frances Health System, Tyler, Texas.

Since Mega Weekend, the information AACN received from the Staff Nurse Advisory Group has been shared with AACN’s Board of Directors. Many of the ideas and suggested solutions have become a catalyst for action for AACN. In the spring, AACN will host a second Staff Nurse Advisory Group to continue the great work that Hodges, Legg, Dransfield and the rest of the group started. If you are interested in volunteering, please complete a Volunteer Profile at www.aacn.org > Volunteers.

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