Excellence in Clinical Practice—Non-Traditional Setting
24 Hospital Units Receive Beacon Award
University of Alabama Hospital, Birmingham
Heart Transplant Intensive Care Unit
Santa Barbara Cottage
Hospital (2 units)
Critical Care Unit (CCU)
Intensive Care Unit
Mission Hospital, Mission Viejo
Surgical-Neuro Trauma ICU
Gwinnett Medical Center, Lawrenceville
Intensive Care Unit
Northwest Community Hospital,
Critical Care Unit
Neuro Critical Care Unit
St. Luke's Hospital, Cedar Rapids
Intensive Care Unit
St. Cloud Hospital, St. Cloud
Intensive Care Unit
Strong Memorial Hospital, Rochester
Cardiovascular Intensive Care Unit
Highland Hospital, Rochester
Intensive Care Unit
Carolinas Medical Center,
Trauma Intensive Care
Grant Medical Center,
Salem Hospital, Salem
EBR: New Name, New Features for AJCC Journal Club
By Ruth Kleinpell, RN, PhD
Evidence-based practice is increasingly advocated to promote best practices in healthcare as well as to improve patients’ outcomes. Many factors have led to the promotion of evidence-based practice as the new standard for healthcare, among them the publication of the Institute of Medicine report titled Crossing the Quality Chasm: A New Health System for the 21st Century (2001), which challenged clinicians to provide healthcare based on available scientific evidence.
As Melynk and Fineout-Over holdt note in their Evidence-Based Practice in Nursing & Healthcare (Williams & Wilkins, 2005), evidence-based practice is linked to incorporating research and considering the strength of the research evidence when making clinical decisions. This is especially important in critical care settings, where new research findings can improve patient care and patient outcomes.
Since September 2002, each issue of the American Journal of Critical Care (AJCC) has designated an article as the journal club feature. The purpose of the journal club feature is to facilitate discussion and review of a research study and to discuss implications of the study for clinical practice. As the focus on evidence-based practice has expanded, this feature has given readers of the journal access to valuable information that is most relevant to clinical practice. Beginning with the May 2007 issue, the journal club feature has a new name, “Evidence-Based Review”—or EBR for short—and it features several improvements to make it more accessible and relevant to AJCC readers.
The purpose of the EBR section is to provide a review and critique of research and evidence-based practices, highlighting implications for nurses in acute and critical care settings. As such, one new component is a discussion with the study’s primary investigator to find out more about how the idea for the research study originated. By including this information, we hope to shed some light on behind-the-scenes planning and analysis that led to the study questions and the research itself, demystifying the research process for those who might like to get involved with research at their own institutions. Readers will find this new feature on the EBR page in the callout box titled “Investigator Spotlight.”
Another enhancement is the presence of eLetters on the AJCC Web site (www.ajcconline.org). This function enables readers of the EBR article (and other new and archived articles) to begin or contribute to an online dialogue about the topic or to pose questions to other readers. After reading either the full-text or .PDF version of the EBR article online, visitors to the Web site simply click “Respond to This Article” from the list of choices on the right side of the page. This will prompt them to share their name and the text of their comments, after which they are permitted to review their remarks before sending them to the journal’s editors. Upon editor approval, their contribution will be added to the Web site and can be viewed by other AJCC readers for up to six months.
Because evidence-based practice includes evaluating research for use in practice, we feel that these enhancements to the AJCC journal club feature should help to promote the use of research in clinical practice—a goal we are all striving to meet as we seek to incorporate the best possible care for acutely and critically ill patients and their families.
March Madness in Member-Get-A-Member Campaign
As men’s and women’s college hoops were “marching” to their dramatic crescendo, AACN members were busy doing some excellent work of their own in the current Member-Get-A-Member campaign.
With a stellar performance of 20 members recruited in March, Ann Brorsen, RN, MSN, CCRN, CEN, of Sun City, Calif. vaulted into the overall campaign lead with 80. Holding in second place with 64 overall was Susan Rogers, RN, DNS, MSN, of Vienna, Va. Tied for third place overall with 49 were Diana Lane, RN, MSN, of Hermitage, Tenn. and Kathleen Richuso, RN, MSN, RN-BC, of Chapel Hill, N.C.
In a great individual performance in the month of March, Nenita Rattanopas, RN, BS, BSN, CCRN, of North Las Vegas, Nev. brought in 29 new members. Her total was good enough to place her in eighth position overall in the campaign to date. Also of note was Ellen Peller, RN, BS, BSN, PCCN, of Spokane, Wash. who had an outstanding recruiting month with 23. She is now fifth overall in the campaign.
In chapter recruiting, the Northwest Chicago Area Chapter had an outstanding month, adding 41 new members to the AACN roster. They are now in fourth place overall in the campaign with 72 to date. The Greater Richmond Chapter also had a great month with 26 new members, boosting their campaign-leading total to 110. The Houston Gulf Coast Chapter also checked in with an impressive monthly result of 22 new members, taking second place overall with 89. In third place overall with 81 new members recruited is the Southeastern Pennsylvania Chapter, which added 11 in March. Also of note: The Greater Cincinnati Chapter added 13 members in March and holds the fifth place slot overall.
They are among the 1,155 individuals and chapters that have recruited 4,874 new members since the campaign began May 1. 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 in the future.
Participation in the Member-Get-A-Member drive offers the opportunity for recruiters to receive valuable 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 entered in the drawing.
In addition, as individuals recruit new members, they are entered in a drawing for a $100 American Express gift check each month they recruit. Nenita Rattanopas, RN, BS, BSN, CCRN, of North Las Vegas won the gift certificate in March.
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 recruiting the most new members during the campaign will receive a $1,000 honorarium check. The winning chapter is also eligible for Grand Prize drawings for 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 March was the Northwest Chicago Area Chapter.
To view the entire list of recruiters and their totals, visit the AACN Web site at www.aacn.org > Membership.
Members on the Move
Bauler Spencer Bradshaw
Greenlaw Kaplow Tracy
Shirey Hanson Reed
Randi Rollinson, RN, BSN, PCCN, was promoted to RN III on the clinical ladder at Pitt County Memorial Hospital, Greenville, N.C.
Lisa Welk, RN, BSN, has been appointed division director of Intensive Care Services for Greater Lafayette Health Services, Lafayette, Ind.
Maria Connolly, DNSc, CNE, APRN, FCCM, was elected chair of the Illinois Colleges of Nursing. She also received a $2.1 million grant from the HRSA to establish a nurse-managed clinic at the University of St. Francis, Ill.
PJ Winchell, RN, CCRN- CMC, directed an event titled “Dancing for Dreams.” Proceeds benefited Lancaster General College of Nursing, Lancaster, Pa.
Elisa Jang, RN, MS, CNS, was appointed to the National Council of State Boards of Nursing’s (NCSBN) Panel of Judges. The panel recommends and sets standards for the NCLEX-RN.
Rosemary Luquire, RN, PhD, has been named chief nursing officer at Baylor Health Care System, Dallas/Fort Worth, Texas, and will direct the system’s standards of nursing practices, policies and procedures.
Debby Greenlaw, RN, MS, CCRN, NP-C, AACN Certification Corporation board member, was elected chair of the Advanced Practice Committee of the South Carolina State Board of Nursing.
Jean Proehl, RN, MN, CEN, CCRN, FAEN, was named 2007-08 chairperson of the Academy of Emergency Nursing.
Carolyn Martindale, MSN, APRN, ACNP, BC, has been promoted to administrative director for Neuroscience and Bariatric Services and assistant to the COO at Saint Francis Hospital and Medical Center, Hartford, Conn.
Mary Allegra, RN, MSN, was recently named cardiac program manager for Connecticut VNA (Visiting Nurse Association), Wallingford, Conn.
Randy Bauler, CEM, AACN’s corporate relations and exhibits director, was elected to serve as chairman-elect of the International Association of Exhibitions and Events (IAEE) for 2007.
Caroline Beckwith, RN, BSN, CCRN, accepted a position as director of critical care for nursing and respiratory care at Southeastern Ohio Regional Medical Center in Cambridge, Ohio.
Connie Spencer, RN, BSN, CCRN, CSC, was chosen 2005-06 employee of the year at Peninsula Regional Medical Center, Salisbury, Md.
Debra Bradshaw, RN, MSN, CNAA, BC, was recognized as one of “The Great 100” RNs for North Carolina – 2006.
Maria Shirey, RN, MS, MBA, CNAA, BC, FACHE, AACN Certification Corporation board member, wrote an article titled “Innovation and Entrepreneurship: Shaping Your Professional Horizon” for the January 2007 issue of Clinical Nurse Specialist.
Roberta Kaplow, RN, PhD, CCNS, CCRN, AOCNS, AACN and AACN Certification Corporation board member, and Sonya Hardin, RN, ND, PhD, CCRN, RN-BC, wrote a book titled, “Critical Care Nursing: Synergy for Optimal Outcomes.” Mary Fran Tracy, RN, PhD, CCRN, CCNS, FAAN, AACN board president, Dave Hanson, RN, MSN, CCRN, CNS, AACN president-elect, Kevin Reed, RN-BC, MSN, CNA, AACN Certification Corporation chair-elect, and Suzanne Burns, RN, RNP, RRT, MS, MSN, CCRN, ACNP, FCCM, FAAN, former AACN board member, also wrote some of the chapters.
Pat Taylor, RN, MS, CCRN, CRN, was named 2006 Idaho Nurse of the Year for Academic Education by the March of Dimes, Idaho Chapter.
You Nominated Me for an AACN National Board Position?
I remember thinking this nearly two years ago when found out I was nominated for the 2006-07 Nominating Committee. A colleague I met at NTI submitted my name as a potential candidate. Of course, this was contingent upon my agreement to run for the position and serve on the committee. After recovering from my disbelief, I was truly flattered and felt honored to be nominated. I also remember thinking I’d never be elected because, “no one even knows me.”
I quickly found out you don’t need to be “known” to be elected to a board position. The first and most important step is to send in the nomination. Secondly, during the application and interview process, you must be able to demonstrate that you possess the six leadership competencies.
Being a member of the Nominating Committee is a wonderful experience. It requires a commitment of your time, but the rewards are invaluable! I’ve found every volunteer opportunity has enabled me to gain new skills, both personally and professionally. Being a part of the Nominating Committee was no exception. I now have a greater understanding of how we elect our leaders as well as AACN national operations. The best part of this experience was the opportunity to develop new friendships and network with national staff, current board members, other elected Nominating Committee members and our past president, Debbie Brinker.
AACN is a strong and reputable organization representing the interests of nearly 100,000 acute and critical care nurses. We are one of the largest associations in healthcare. To remain at the forefront of healthcare, you and I need to continue to nominate and elect dedicated, passionate, visionary leaders. This is why I strongly urge you to consider nominating yourself or a colleague for a board position.
Circle of Excellence Awards Applaud Those Who Make a Difference
Spotlight the art and science of acute and critical care nursing by nominating yourself or a colleague for an AACN Circle of Excellence Award.
The nominating process opened March 15, with nominations due July 15, 2007.
All recipients are presented a plaque, announced in AACN News and on the AACN Web site and honored at the National Teaching Institute & Critical Care Exposition.TM Most also receive honorariums and complimentary NTI registration. For specifics, check the Circle of Excellence Awards Guide (www.aacn.org > Awards, Grants & Scholarships).
Following are brief descriptions of the award criteria:
These awards recognize local and regional leadership that furthers AACN’s mission and vision and represents the contributions of individuals and groups.
Excellent Nurse Manager Award
Recognizes nurse managers who demonstrate excellence in coordination of available resources to efficiently and effectively care for acutely or critically ill patients and their families. Successful applicants will address how they promote the following: an environment of professional involvement, development and accountability, collaborative problem solving, empowerment, leadership to transform thinking, structures and processes to address opportunities and challenges, communication, and how they serve as a catalyst for successful change.
Eli Lilly and Company-AACN Excellent Preceptor Award
Recognizes preceptors who demonstrate the key components of the preceptor role, including teacher, clinical role model, consultant and friend or advocate. Successful applicants will address how they demonstrate the following: the utilization of positive teaching strategies, effective communication skills, creating a positive practice setting, sensitivity to the learning needs of preceptees, clinical competence, effective feedback and problem-solving skills.
Recognizes individuals or patient care unit staff who develop and enhance another’s intellectual and technical skills, acculturating them to the professional community and modeling a way of life and professional achievement. Nominators will address how their mentor served in the mentoring role by providing for upward career mobility; boosting self-esteem; sharing a dream; giving vision; providing advice, counsel and support; introducing corporate and organizational structure; teaching by example; imparting valuable information and giving feedback on progress.
Excellence in Leadership Award
Recognizes nurses who demonstrate the key leadership competencies of empowerment, effective communication, continuous learning and the effective management of change. Successful applicants will address how they demonstrate lifelong learning strategies; encourage risk taking; see change as a process and not an end; identify ways to support and enhance others’ strengths; demonstrate creativity in problem analysis and generation of solutions; demonstrate congruence in words and actions; challenge traditional assumptions and rules; and champion the perspective of the consumer.
Elsevier-AACN Excellence in Education Award
Recognizes nurse educators who facilitate the acquisition and advancement of the knowledge and skills required for competent practice and positive patient outcomes in the care of acutely and critically ill patients and their families. Successful applicants will address how they promote critical thinking, consider individual learner needs, create a learning environment and positively affect a learner or group of learners.
Community Service Award
Recognizes significant service by acute and critical care nurses, either individuals or groups, who make a contribution to their community. Successful applicants describe a service that demonstrates responsiveness to their community’s concerns and issues. The awarded community service projects a positive image of critical care nursing.
Recognizes print, broadcast and Web-based media excellence in the portrayal of healthcare providers, especially acute and critical care nurses, contributing to a healthcare system driven by the needs of patients and their families. Successful entries will present relevant nursing and healthcare topics to large audiences of consumers – the general public, patients and families. Accuracy, realism and technical qualities are important factors in the selection of entries.
AACN Certification Corporation – Value of
Recognizes contributions that support and foster the advancement of certified nursing practice in critical care. Successful applicants will show how they have accomplished some or all of the following: increased the number of certified nurses; increased the renewal and retention of certified nurses; influenced the preparation or ability of nurses to qualify for certification; increased public awareness and promotion of the value of certified nursing practice; and contributed to research validating the impact of certified nursing practice. Applications will be evaluated for innovation; scope of impact in relation to the nominee’s sphere of influence; quality of work; and rate and/or indicators of success.
Datascope-AACN Excellence in Collaboration Awards
Honor innovative contributions to collaborative practice by nurses caring for acutely and critically ill patients and their families. Successful applicants will show how they have accomplished some or all of the following:
• Contributed to optimal patient outcomes
• Advanced the use of nursing knowledge and expertise to influence patient care decisions
• Implemented innovative evidence-based strategies for patient care
• Cultivated an environment of respect for the unique contribution of each healthcare team member
• Increased family participation in patient care and decisions
• Developed shared governance practices and policies
• Improved communication and conflict management
• Improved team satisfaction
• Increased nurse recruitment and retention
• Increased patient satisfaction
• Impacted organizational success
Applicants may apply in the following collaboration categories:
• Nurse-Physician Collaboration Award
• Nurse-Administration Collaboration Award
• Nurse-Family Collaboration Award
• Multidisciplinary Team Collaboration Award
Excellence in specific roles and focus areas within nursing is recognized by these awards that honor local and regional impact along with those who reach beyond.
Baxter-AACN Excellence in Patient Safety Award
Recognizes patient-care teams that have made significant contributions toward patient and caregiver safety in acute and critical care. Recipients will describe innovative approaches used to develop new and revised processes that encompass safety and improve the quality of care at the unit hospital or health system level. They will show clear evidence of active collaboration among team members validating their success by presenting evidence-based outcomes of their safety initiatives.
Excellence in Caring Practices Award—
In Honor of John Wilson Rodgers
Recognizes nurses whose caring practices embody AACN’s vision of creating a healthcare system driven by the needs of patients and their families. Successful applicants empower patients and their families by addressing the following: helping patients or families understand and cope with illness; offering avenues or possibilities of understanding, increasing control and acceptance of a difficult experience; or demonstrating vigilance, persistence and commitment to the patient and family’s life or well-being. Successful applicants also make the patient’s problem approachable and manageable through the patient’s own ability to face and cope with the problem. These applicants will demonstrate how they have encompassed the AACN values and ethic of care in their work.
Note: This award was established in 1984 in the name of Marguerite Rodgers Kinney’s late father, John Wilson Rodgers. It was the care of the nurses during Rodgers’ illness and at the end of his life that inspired Kinney, a former AACN president, to recognize the artistry of nursing as well as honor her father’s memory.
3M Health Care-AACN Excellence in Clinical Practice Award
Recognizes acute and critical care nurses who embody, exemplify and excel at the clinical skills and principles that are required in their practice. Successful applicants will address how they have successfully integrated the following into their practice: standards of care, patient advocacy, holistic care, collaboration and coordination of care, leadership, inquiry and critical thinking, values and ethics.
Excellence in Clinical Practice—
Designed to recognize excellence in the care of acutely and critically ill patients that takes place in environments outside the traditional ICU/CCU setting. Successful applicants will demonstrate that their patients were acutely or critically ill and address how they have successfully integrated the following into their practice: standards of care, patient advocacy, holistic care, collaboration and coordination of care, leadership, inquiry and critical thinking, ethics and values. Eligible applicants include, but are not limited to, home healthcare nurses, progressive care nurses, telemetry nurses, catheter lab and emergency nurses.
Dale Medical Products-AACN Excellent Clinical Nurse Specialist Award
Recognizes acute and critical care nurses who function as clinical nurse specialists. Successful applicants will demonstrate the key components of advanced practice nursing including: leadership, advanced practice clinical skills, research application, evidence-based practice, outcome-focused practice, cost containment, quality assurance, mentoring, problem solving and communication with patients, families, staff and systems. Additionally, they will illustrate how they have served as a catalyst for successful change.
Marsh-AACN Excellent Nurse Practitioner Award
Recognizes acute and critical care nurses who function as nurse practitioners. Successful applicants will demonstrate the key components of advanced practice nursing including: leadership, advanced practice clinical skills, research application, evidence-based practice, outcome-focused practice, cost containment, quality assurance, mentoring, problem solving and communication with patients, families, staff and systems. Additionally, they will illustrate how they have served as a catalyst for successful change.
Excellent Nursing Student Award
Recognizes nursing students whose activities during nursing school have promoted the value of nursing and reflect the AACN vision of creating a healthcare system driven by the needs of patients and their families where critical care nurses make their optimal contribution. Successful applicants will show how their leadership has transformed thinking, structures and/or processes to address opportunities and challenges as well as how they collaborated with key stakeholders to create synergistic relationships to promote common interests and shared values.
Excellence in Research Award
Recognizes nurse researchers or nurse-led collaborative research teams that are furthering the mission, vision, values and research priorities of AACN in the acute and/or critical care setting. Successful applicants will describe the research project(s), original or replicated, the outcome of the project(s) on patients and families, and/or the change in practice that occurred as a result of the project(s).
AACN, SCCM and AIA ICU Design Award
The ICU Design Award for adult and pediatric ICUs is cosponsored by AACN, Society of Critical Care Medicine and American Insitute of Architects. The award was conceived to identify and recognize a critical care unit already in operation whose design demonstrates attention to both functional and humanitarian issues. With a focus on planning and design characteristics rather than process or administrative features, recipients demonstrate: a commitment to creating a healing environment, a commitment to promoting safety and security, a commitment to efficiency and attention to innovative, unique aesthetic and creative design features
To obtain an application, contact Carol Prendergast at the Society of Critical Care Medicine at (847) 827-6826; firstname.lastname@example.org.
Mentoring Award: In the Circle
Editor’s note: The Mentoring Award recognizes individuals or groups who develop and enhance another’s intellectual and technical skills, acculturating them to the professional nursing community, and modeling a way of life and professional achievement. Following are excerpts submitted in connection with this award for 2006.
Helene M. Anderson, RN, CCRN
Lake Oswego, Ore.
Providence St. Vincent Medical Center
I admire Helene for her enthusiasm for the nursing profession, her expert bedside skills and her ability to get others interested in choosing nursing as a profession. She has a vision that makes you feel you can achieve anything. She has more energy and ideas than anyone. Her ability to bring things to fruition is infectious. I look up to her for the energy and commitment she has for her projects.
Under her leadership as chairperson for the Clinical Ladder Review Board, the program has grown more than 60% in the last three years. She continues her commitment to promote the professional ladder by organizing staff workshops.
Helene is an inspiration to me and many other co-workers, both personally and professionally. She has a talent for identifying your strengths and giving you a boost to better yourself. In the true spirit of mentoring, Helene helps direct and inspire staff.
Helene’s guidance, encouragement and mentoring made me believe that I can be even more than I put forth. I use her guidance not only for my own growth and development, but also in mentoring others myself. Because of Helene’s mentoring, I will continue promoting nursing as a profession at the bedside and in the community.
Mary Jane Bowles, RN, MSN
Dale City, Va.
Mary Washington Hospital
I have been a critical care nurse for all but one of my 23 years as a nurse. Several patients have reaffirmed my decision to become a nurse and made an indelible impression. Caring for them, I have learned about the human spirit and sincere communication, as well as pathophysiology.
M. was a 45-year-old female, admitted with respiratory distress from a severe case of Guillain Barre with ascending paralysis progressing to the level of her respiratory muscles, requiring immediate intubation. We anticipated the usual seven-to-10-day course, but she continued with paralysis despite aggressive treatment and required long-term care. As the primary nurse, each day I explained the plan of care to her sister, her only family. I encouraged her participation in hopes of easing some of the anger and frustration of an uncertain, prolonged illness.
M.’s length of stay progressed, and in two months we weaned her from the ventilator and transferred her to a rehabilitation unit. Months later, I saw M. leaving after outpatient therapy. It was exciting to hear her voice, because she was not able to speak while I was caring for her. M. said she loved having me as her nurse and that I was always so kind and gentle. Her statement validated my belief in nursing as an art and a science.
As an experienced nurse, educator and mentor, I share these lifelong lessons about the body and spirit with new nurses to equip them with the knowledge and compassion to achieve the best patient outcomes.
Amy S. Brower, RN, BSN, CNA, BC, CNRN
Clarian Health Partners
As I expressed my apprehension about caring for a high-acuity patient on my first night after orientation, Amy replied that I was a devoted and detail-oriented nurse, which would be beneficial to the patient. Amy’s approach gave me the confidence I needed. I believe that if she had coddled me, I would not have had the self-assurance to care for this challenging patient.
Amy has profoundly influenced and fostered my growth as a well-rounded, dedicated leader, while helping me achieve my goal of becoming an expert critical care nurse. I believed we shared similar beliefs and values regarding patient care. Amy relayed her confidence in my leadership abilities by encouraging me to become a charge nurse and preceptor, and later a shift coordinator. Amy taught me that my strong points included communicating with nurses, families and physicians to resolve outstanding issues.
By serving as an outstanding role model, Amy also taught me how to identify and conquer my weaknesses. She remained calm in stressful situations, which allowed her to think critically and resolve problems quickly. I have learned to coach rather than criticize staff members. She has demonstrated how to take a non-punitive approach when addressing mistakes. She counsels in private and praises in public.
Amy has changed the environment on our unit to reflect self-governance, autonomy and empowerment. Through her dedication, compassion and commitment to teamwork and patient care, Amy has taught me how to be an influential leader. I am proud to call her my mentor.
Debbie Hansen, RN, MS
St. Luke’s Medical Center
I met Debbie through an innovative program initiated by our chief nurse executive to develop nurse leaders. Debbie was the first mentor chosen for this program, and I was privileged to be paired with her. It was the beginning of our friendship, as well as our professional relationship.
Throughout the next year and a half, Debbie and I met each week. We discussed managerial duties and philosophy and made the distinction between leadership and managing. I attended meetings at many different levels with Debbie. As I became more comfortable, she encouraged my participation. Because of her support and confidence in my abilities, I was acknowledged as a valuable participant.
When I met Debbie, I was a staff nurse content in my role. I never imagined I would have what it takes to be a nurse manager. Debbie encouraged me to interview for a managerial position, and she counseled me on what to expect during the interview process. I was offered and accepted the position. It is because of the self-confidence and poise Debbie helped me develop that I am moving forward in my career. She saw potential and management qualities in me.
This was the first time I was involved in a mentoring relationship. Having Debbie available for my questions, to obtain advice, explore options and vent in private has been invaluable. Confidentiality was vital to the success of the mentoring program. Debbie has shared her vision of nursing management and helped me achieve my dream. I am indebted to her, and I know she will continue to guide me in my new role.
Tara L. Hardinge, RN, MSN, CCRN, CNRN
Morristown Memorial Hospital
As Tara’s manager, I know that new nursing staff are especially grateful for her nonthreatening communication style. She has consistently mentored new graduates from their first steps as professionals to their development as sophisticated critical thinkers. It is rare that we find one nurse versatile enough to accommodate this broad range of education and learning. Tara exemplifies vision, consistent teamwork, customer focus and a drive for success.
Following are thoughts from two mentees.
• Tara was my third preceptor after starting my first job in the United States after four years of critical care experience in the Philippines. I needed time to adjust to the language, new equipment and different medical techniques. Tara was soft-spoken and reassuring. She gave me a sense of trust while always supporting me. Tara never hesitated to give me opportunities to learn and helped me attain the career ladder this year. Once my orientation to the neuro special care unit was completed, Tara extended her personal friendship and included me in her holiday plans that December.
• Tara was never rushed or upset, even when she had to repeat herself several times before I grasped something new. At the end of my formal orientation to NSCU, she accompanied me on the night shift to help bridge my leap to independence. Tara helped me see my career as an ongoing learning experience and to apply for the highest level of the career ladder this year, as well as return to graduate school, and study for a national certification exam.
Monthly Super Savers From AACN’s Catalog Products
Celebrate critical care nursing with one of this month’s super savers. The following prices are good through June 30. All orders must be received or postmarked by June 30 to be eligible for the Super Saver price.
A Daybook for Nurses: Making a Difference Each Day (#330103)
Be inspired every day with quotations, stories, poems and inspirational thoughts especially for nurses. These daily motivational vignettes will provide inspiration and encouragement to nurses as they work each day to make a difference in the lives of the patients, families and communities they serve.
Member $15.15; Nonmember $15.95
Super Saver Price
Member $14.25; Nonmember $14.95
Daily Miracles: Stories and Practices of Humanity and Excellence in Healthcare (#330104)
Daily Miracles is anchored in vivid clinical practice experiences. These experiences open the door to profound insights about the unique synergy that nurses, patients and families can achieve. The book is a compilation of short stories and photography highlighting the exceptional work that is nursing.
Member $13.25; Nonmember $13.95
Super Saver Price
Member $12.50; Nonmember $12.95
AACN Procedure Manual for Critical Care, 5th Ed. (#128150)
The manual provides comprehensive coverage of procedures unique to the critical care environment. This edition is thoroughly revised, updated and expanded to reflect the current state of critical care nursing practice. Information is presented in a highly illustrated step-by-step format with supporting rationales for each step of every procedure. This resource also emphasizes evidence-based practice and provides complete coverage of the latest clinical studies.
Member $92.95; Nonmember $96.95
Super Saver Price
Member $88.50; Nonmember $91.50
Browse our selection of new products at www.aacn.org/bookstorespecial
Marsh Affinity Group Services Excellent Nurse Practitioner Award: In the Circle
Editor’s note: Sponsored by Marsh Affinity Group Services, this award recognizes acute and critical care nurses who function as nurse practitioners. Following are excerpts from exemplars submitted in connection with this award for 2006:
Mary M. Deivert, RN, MSN, CCRN, ACNP
Oak Park, Va.
University of Virginia Health System
J.C., an 84-year-old blind African-American, was hospitalized after he had fallen at home. J.C.'s injuries were facial fractures not requiring further intervention. The physician staff requested that J.C. be “discharged today,” so the resident and I assessed J.C. to formulate a safe discharge plan. My evaluation began immediately. The patient was sitting upright in bed with an ecchymotic and edematous face, swollen eyelids and a protruding massively edematous lower lip. He was being fed by staff and attempting to swallow. He appeared to tolerate the first two swallows, but began coughing with the third bite. I made the patient NPO and consulted Speech Therapy for a swallow study. J.C. lived alone. Despite the injuries, his cognitive thought processes were intact. Although he had family, home support was not available. I explored with J.C. the possibility of his going to a skilled nursing facility (SNF) while he was healing. He agreed. I placed a Physical Therapy consult to determine his gait and balance needs. While being evaluated, the patient said his hand hurt. I had it X-rayed, which revealed an injury requiring orthopedic consultation. I next consulted Social Work to assist with placement. Because I advocated for the patient by clearly defining his needs, including aspiration risk, safe mobility and adequate nutrition, the proposed SNF plan was expediently developed. I coached the junior physician through the process. As an ACNP, my advanced practice experience is used to manage and advocate for patients. My comprehensive assessment and detailed care planning in collaboration with the patient and multidisciplinary team resulted in a safe and appropriate discharge.
Peggy L. Kirkwood, RN, MSN, APRN, BC
Laguna Hills, Calif.
My position as an ACNP for heart failure patients allows me to make a difference in both inpatient and outpatient settings. I had been working with DS, a 38-year-old woman, for three years as she struggled with a 20% ejection fraction and severe heart failure symptoms. Serious co-morbidities precluded her from receiving a transplant. The best we could offer her were evidence-based medications and support. We talked almost daily to titrate her drugs, activity and diet so she could enjoy some quality of life. We developed a strong bond. Near the end of her life, she surprised us by going to Hawaii with her husband. She could barely walk without being out of breath and all she could do was sit on the beach, but she spent this “last hurrah” with her husband. Shortly after her return, she was hospitalized with severe decompensation. When we discussed quality vs. quantity of life, she opted for quality and dobutamine was started. Although we had several difficult discussions, one day she said, “When my heart stops, just make me comfortable and help my husband understand.” As I was calling to get the DNR order, she arrested. Her cardiologist answered the code, and together we honored her last wishes. As healthcare providers, we want to help people. With heart failure patients sometimes that means helping them and their families make and accept difficult decisions. It took many years of nursing for me to realize that our contributions go beyond physical healing. As an ACNP, I bring all aspects of body, mind and spirit into the healing process, and hopefully role model along the way.
Patti A. McCluskey-Andre, RN, MSN, CCNS, ACNP-C
Chino Hills, Calif.
Hoag Memorial Hospital Presbyterian
As a nurse practitioner/clinical nurse specialist, I bring 25 years of experience to the bedside caring for cardiac surgery patients. Getting to know my patients and following them through surgery is my favorite part of being a cardiac surgery nurse practitioner. TL was a 75-year-old patient with an evolving MI that required emergency surgery. He was worried about his wife, so I assured him I would care for her. I did what teaching I could, then took Mrs. TL to a waiting room. I promised to visit or call her every few hours. TL was extubated and looked good except for being hypoxic. His X-ray revealed atelectasis, so my orders focused on pulmonary toilet and hygiene with mild diuresis. By the end of the day, his condition was stable and he was moved to the telemetry unit where Mrs. TL could stay with him. He progressed well and was nearing discharge when he had a cardiac arrest. I was walking by when I heard the commotion and saw the look on his wife’s face. As I gave ACLS orders, we placed a monitor and realized he was in ventricular tachycardia, which deteriorated to ventricular fibrillation. He was awake so I told him to hold on. After two shocks, he returned to sinus rhythm and full mental capacity. Later, I asked him where he had gone. He laughed and replied, “I knew I could not go anywhere when I saw that look on your face!” I told him I couldn’t let him go because of the look on his wife’s face! Mr. and Mrs. TL are now hospital volunteers stationed near my office. When I walk by, I can hear in the background that I am their hero. I did not do anything extraordinary, but they remind me of what important work we do and the miracles we witness every day.
Baxter Excellence in Patient Safety Award
Editor’s note: Sponsored by Baxter Healthcare, this award recognizes patient-care teams that have made significant contributions toward patient and caregiver safety in acute and critical care. Following are excerpts from exemplars submitted in connection with this award for 2006:
MICU Nursing Research Team
University of Virginia Health System
In 2001, our MICU nursing team developed a procedure to prevent the inadvertent placement of gastric tubes into the lung using ETCO2 (capnograph) monitoring (Burns, et al. Critical Care Medicine, 2001). The procedure clearly prevented airway cannulation. We discovered it was not adopted as a hospital standard due to some inherent problems, including breakage of equipment, equipment loss and the need for decontamination when used with an isolation patient. To address these issues, our MICU nursing team designed a study to determine if a disposable colormetric CO2 detector might perform as accurately as the ETCO2 monitor. The team included nurses, mostly bedside clinicians, and the MICU medical director. The completed study (American Journal of Critical Care, March 2006) demonstrated equivalent performance of the colormetric device and the capnograph. Our MICU nursing team presented the information to the institutional multidisciplinary Patient Care Committee, which ruled that use of the colormetric device would become a hospital standard. The MICU nursing team is now involved in hospital-wide introduction and subsequent application of this technology, and also directly educates physicians on the use of the device. Our MICU nursing team’s application of evidence-based nursing research related to safe practice demonstrates our commitment to patient safety—both at the university level and beyond. Our team is confident that direct involvement with changing practice will result in fewer iatrogenic complications associated with the placement of gastric tubes.
Keystone ICU Team
The ICU Team has come a long way since the 1980s. The current Keystone ICU Team is a multidisciplinary team that was formed in 2004, in conjunction with the Keystone Project from Johns Hopkins and the Michigan Hospital Association. The purpose of the team is to improve patient safety through process improvements, mainly communication. The team’s accomplishments are phenomenal. In little over a year, this team has impacted every discipline that has patients in the ICU. The ICU now has a pharmacist, respiratory therapist, dietitian, social worker and internal medicine physician assigned to it. To improve communication, each of them was given a Spectra Link phone instead of a pager; response time is now immediate. Daily goal sheets were established to address patient problems. Goals question the need for continued ICU care and ventilator weaning, and each sheet specifically asks what the patient’s greatest safety risk is and the two priority goals for the day. The sheets are then used as the basis for multidisciplinary rounds. As a result of the team’s work, ventilated patients are reviewed daily. Identifiers include head of bed elevation, peptic ulcer prevention therapy, DVT prophylaxis, mouth care with chlorhexadine, glucose control, weaning tolerance and sedation requirements. The most important patient safety improvement is the reduction in the number of ventilator-associated pneumonias, urinary tract infections and bloodstream infections. As of July 6, 2005, ICU patients had been free from VAP for 12 months and bloodstream infections for six months, and there was only one UTI.
Strong Memorial Hospital
Creating a culture of patient safety is a priority in today’s healthcare setting. The MICU team implemented a ventilator bundle in October 2002 to reduce ventilator-associated pneumonia (VAP). With the utilization of evidence-based research and a best practice model from the Institute for Healthcare Improvement, the team changed standards of practice, promoted a culture of safety for ventilator patients and dramatically reduced the incidence of VAP. The ventilator bundle consists of five key elements in the daily care plan of every ventilator patient. These elements are 30-degree head of the bed elevation, DVT prophylaxis, peptic ulcer disease prophylaxis, daily sedation interruption and daily assessment for readiness to wean from the ventilator. The most challenging aspect to the success of the “vent bundle” initiative was daily sedation interruption. The nursing staff met this challenge by developing a nurse-driven sedation protocol. After the first year, the VAP rate decreased 67%, average ventilator days decreased 16%, mortality was reduced 25% and ICU length of stay decreased 16%. Structured oral care and mobility elements were added as adjunct therapy to enhance vent bundle effectiveness. The combined bundle interventions produced dramatic results that were improved upon and sustained in the ensuing three years. This successful collaboration is consistent with the MICU’s approach of empowering nurses to impact patient outcomes by involving the staff in all aspects of patient care. The MICU team are true critical care champions who take pride in their accomplishments. They understand that change takes dedication, determination and a willingness to be innovative and creative in their practice.
Excellence in Clinical Practice—Non-Traditional Setting: In the Circle
Editor’s note: This award is designed to recognize excellence in the care of critically ill patients in environments outside the traditional ICU/CCU setting. Following are excerpts from exemplars submitted in connection with this award for 2006:
Margaret A. Morley, RN, BC, MSN, CCNS, ANP-C
Newport Coast, Calif.
Hoag Memorial Hospital
One late evening in April 2004, C.R. presented to the emergency room with an acute inferior myocardial infarction. His presentation was not unlike others; chest pain 8/10, diaphoretic with 2 mm ST elevations on his 12 lead. The patient was quickly taken to the cath lab where he had a balloon angioplasty and stent placement. His cath lab nurse was Peggy Morley, who is also the cardiology CNS/NP. The following day, Peggy reviewed the events with C.R. and his wife. In December 2004, C.R. suffered another AMI and a cardiac arrest. Paramedics brought him to a different, noninterventional, facility, so Peggy quickly coordinated C.R.’s transfer and cared for him in the cath lab once again. Seven months after his second myocardial infarction, C.R. suffered a third. Alone at home, C.R. called his neighbor instead of paramedics. His neighbor did call the paramedics, but unfortunately she did not know CPR. Upon C.R.’s arrival in the emergency room, he was in NSR but neurologically he had only brainstem function. Peggy helped Mrs. R. to understand the severity of C.R.’s brain injury and his grave prognosis. Peggy’s warm relationship with Mrs. R. helped both of them get through these difficult times. Nine months after C.R.’s death, Peggy and Mrs. R developed a community CPR class. The positive impact of their educational endeavors has helped Mrs. R. deal with her grief and given her hope that perhaps the life of someone in her community may be saved.
Marva D. Pharis, RN, BSN, PhD, PCCN, RNBC
La Belle, Fla.
Lee Memorial Health System
It seemed like a routine day in the Progressive Care Unit, but Mr. T. was anything but routine. He was a very demanding patient who had an abdominal aortic aneurysm repair with a complicated recovery. He was on TPN and intravenous antibiotics, and had a large abdominal incision. When I walked into the room, Mr. T. demanded that I remove his staples. I checked the incision; six staples were intact but with redness, swelling and increased heat in the area. I said I would check with the surgeon. He started yelling, so I looked at him and said, “You can yell all you want; I am looking out for your best interests, and I will do nothing that is unsafe.” He immediately calmed down and apologized. Later, Mr. T. called me to his room complaining of diarrhea. I discovered there was drainage from the incision. I called the surgeon, told him what I had seen and that the patient was now having pain after being pain-free for days. When the surgeon arrived he opened the incision with his gloved fingers and stool flew everywhere, as Mr. T. groaned in pain. As the surgeon left the room yelling orders, I asked him for an order for IV pain medication and asked another nurse to help me. The patient’s scan revealed a perforated bowel and he was taken back to surgery. As he left he whispered that he was scared and asked me to pray for him. As I held his hand I realized that my demanding patient was gone, replaced with a scared man who needed a nurse’s touch.
LCDR Thomas Pryor, RN, BS, BSN, CPAN
Jicarilla Apache Health Care Facility
On December 26, 2004, the world witnessed one of the greatest natural disasters in history, described to me by a survivor as “a hand that reached out of the ocean bringing death and chaos to whatever it touched.” My involvement in tsunami relief was as a United States Public Health Service (USPHS) nurse officer assigned to the USNS Mercy. We were deployed off the shores of Banda Aceh, Indonesia as part of Operation Unified Assistance: a coalition of U.S. Navy, Civilian Mariners, USPHS and Project Hope medical volunteers. Because of my pediatric critical care experience, my primary role was the care of an 11-year-old, whom I refer to in my online journal as “Harapan,” which is Indonesian for hope (www.surgeongeneral.gov/journal). Suffering from “tsunami lung” (a severe lung infection caused by swallowing muddy, bacteria-laden water), Harapan required aggressive respiratory and ventilator management, blood transfusions, antibiotics and other medical support. As his primary care nurse, I worked with the medical team 12 to 14 hours a day, managing his care. Our culturally sensitive and holistic care also empowered Harapan’s uncle to participate in his nephew’s care. After four weeks of caring for the patient, I had the unforgettable experience of escorting Harapan back to Banda Aceh, where he was reunited with his aunt and uncle, the only surviving members of his family. As we embraced and said goodbye, Harapan and his family held my hands and said, “Terima kasih, menyetujui cinta dan kelaurga kami,” which means “thank you and accept our love and family.” They will be forever in my heart and remembered as a family who found hope in the midst of despair.
Apply for the Circle of Excellence Awards
Spotlight the art and science of acute and critical care nursing by nominating yourself or a colleague for an AACN Circle of Excellence Award. The nominations deadline is July 15, 2007.
For more information, check the Circle of Excellence Awards Guide (www.aacn.org>Awards, Grants & Scholarships).
Is Your Unit a Beacon of Excellence?
The AACN Beacon Award for Critical Care Excellence shines national recognition on units that attain high standards for quality, exceptional care of patients, and healthy, humane and healing work environments.
The Web-based application process asks you to evaluate your critical care unit in six areas:
• Recruitment and retention
• Education, training and mentoring
• Evidence-based practices
• Patient outcomes
• Healing environments
• Leadership and organizational ethics
Applications, which may be submitted at any time, are evaluated on a quarterly basis. Awards are granted twice a year. The application fee is $1,000 per unit.
For more information, visit the AACN Web site at www.aacn.org.