AACN News—January 2008—Association News

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Vol. 25, No. 1, JANUARY 2008

Beacon Award Recipients for Fall 2007 Announced

Every year since 2003, AACN has recognized the top critical care units across the country with the Beacon Award for Critical Care Excellence. These units have demonstrated a greater use of best practices, stronger teamwork, higher morale, better patient care and improved patient outcomes. The Beacon Award recipients for Fall 2007 included 21 units from 17 hospitals in 13 states.

As Beacon Award recipients, these units have demonstrated quantitative success when measured against evidence-based national criteria in these areas that impact patient care:
• Recruitment and retention
• Education, training and mentoring
• Research and evidence-based practice
• Patient outcomes
• Leadership and organizational ethics
• Healing environment

“The commitment to high-quality standards and dedication to exceptional care of patients and their families have brought clear, valuable recognition to these units and institutions. Earning a Beacon Award sends a clear message that these units are providing exceptional care and that their commitment to evidence-based practice is unwavering,” said AACN President Dave Hanson, RN, MSN, CCRN, CNS. “They have set examples that serve as beacons for other hospitals and healthcare facilities to use in navigating the rough waters of acute and critical care nursing.”

The latest award recipients bring the total number of Beacon units to 101 in 30 states. More than 200 units are in the process of applying at any given time. The award is presented twice a year.

Following are Beacon Award recipients for Fall 2007:

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Online Registration for NTI 2008 Opens This Month

What’s the fastest, easiest way to secure your spot at NTI 2008? Register online! You can sign up for the conference, download the NTI 2008 brochure, print out a poster of this year’s Reclaiming Our Priorities theme art and book your hotel room by visiting the NTI Web page at www.aacn.org/nti. You’ll save money too if you register by the Early Bird deadline, March 18, 2008.

The National Teaching Institute & Critical Care Exposition May 3 through 8 promises to be an exciting event, with plenty of opportunities to learn, share and network. And, for the first time, NTI will be held in Chicago, a popular city with lots to see and do. Please join us in the Windy City.

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AACN/Joint Commission Resources Online Series Begins Next Month

AACN and Joint Commission Resources (JCR) are co-sponsoring a series of online programs that focuses on issues important to acute and critical care nurses and other practitioners.

Healthy Work Environments will lead off the series of three topics, each offering three presentations that can be accessed either live or later from the Web conference library. The other topics are Reducing Medical Errors and Palliative and End-of-Life Care.

Representing AACN to discuss Healthy Work Environments on Thursdays, Feb. 5, 12 and 19, is Kathy McCauley, PhD, RN, BC, FAAN, FAHA, a past AACN president who is associate dean for academic programs and associate professor of cardiovascular nursing at the University of Pennsylvania School of Nursing. McCauley is also a clinical specialist in cardiovascular nursing at the Hospital of the University of Pennsylvania. Representing JCR is consultant Terrance Shea, MPA, BSN. All presentations are scheduled from 11:30 a.m. to 1 p.m. (CST), with time allowed for questions from participants.

The lead-off presentation Feb. 5 will be around the AACN Healthy Work Environment Standards, introduced in 2005 and endorsed by leading healthcare associations. AACN believes that the link between healthy work environments and patient safety, nurse retention and recruitment and, thus, the bottom line, is irrefutable. The Standards – which set out the ingredients for success as skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership – are available online at www.aacn.org/hwe.

The presentation will continue Feb. 12 with Implementing the Healthy Work Environment Standards and Feb. 19, with Healthy Practice Environments for Internationally Recruited Nurses.

You can register for this program now by visiting the JCR Web site at www.jcrinc.com. Cost is $249 per Web conference or $600 for all three topics within a series. The entire nine-session Web conference series will be available for $1,800.

Presentations around Reducing Medical Errors are scheduled for Thursdays, June 10 (2008 Joint Commission National Patient Safety Goals), June 17 (Mistake-proofing Healthcare) and June 24 (Ensuring Reliable Care). Presenting are, on behalf of AACN, Patricia R. Ebright, RN, DNS, associate professor at Indiana University School of Nursing, and on behalf of JCR consultant Roberta Fruth, RN, MS, PhD, FAAN, a past AACN board member.

Presentations around Palliative and End-of-Life Care are scheduled for Thursdays, Oct. 7 (Palliative Care Isn’t Just End-of-Life Care), Oct. 14 (Family Presence in Critical Care) and Oct. 21 (End-of-Life Care). Presenting are, on behalf of AACN, (Oct. 7) Patsy Treece, RN, MN, a critical care research nurse with the Division of Pulmonary and Critical Care at the University of Washington, and (Oct. 14 and 21) J. Randall Curtis, MD, MPH, FCCP, professor of medicine at the University of Washington and director of the Harborview/UW End-of-life Care Research Program. Presenting on behalf of JCR is consultant Beth Glassford, RN, MS, MHA, CHE, a past member of the AACN Certification Corporation Board of Directors.

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Members on the Move

Kay Clevenger, RN, MSN, wrote “The Role of a Nurse Retention Coordinator: One Perspective” for the October 2007 issue of Nursing Management.

Terry Hobbs, RN, BSN, MSA, Cheryl Wolverton, RN, CCRN, MSN, and Clevenger co-wrote an article titled “Lift Team Technologies Elevate Positive Outcomes,” which appeared in the July 2007 issue of Nursing Management.

Andrea Rigby, RN, BSN, has been named nurse manager for the ventilator assist/special needs unit at Madonna Rehabilitation Hospital, Lincoln, Neb.

Robin McGuinness, RN, MSN, CNA-BC, is chief nursing officer at Venice Regional Medical Center, Venice, Fla.
Robin Dennison, RN, DNP, CCNS, wrote the third edition of “Pass CCRN!” published by Mosby.

John Whitcomb, RN, PhD, CCRN, AACN board member, will serve as the Navy’s critical care nursing specialty leader for two years.

Cathie Guzzetta, RN, PhD, AHN-BC, FAAN, Angela Clark, PhD, RN, CNS, FAAN, FAHA, and Margo Halm, RN, PhD, APRN-BC, CCRN, are the editors of the new third edition of “Presenting the Option for Family Presence,” the Emergency Nurses Association’s guidelines on family presence.

Julie Holt, RN, MSN, has been named vice president of patient services and chief nursing officer at West Chester Medical Center, West Chester, Ohio.

Jovita Solomon-Duarte, MSN, RN, CCRN, wrote an article titled “Minority Nurse Educators in Cyberspace: A Progress Report” for the Summer 2007 issue of Minority Nurse.

Gerald Bryant, RN, MSN, joined the team at Wesley Medical Center, Hattiesburg, Miss., as chief nursing officer.

Janie Heath, PhD, APRN-BC, FAAN, former AACN board member, co-wrote a CE article titled “Breaking the Ties of Nicotine Dependence,” for the November 2007 issue of The Nurse Practitioner.

Marilyn Prasun, RN, PhD, CCNS, APRN, assistant professor of nursing at Milliken University, Decatur, Ill., has been named a fellow for the American Heart Association’s Council on Cardiovascular Nursing.

Beth Glassford, RN, MSHA, FACHE, former AACN Certification Corporation board member, was elected to serve as chair of the Board of Trustees of St. Anne’s Retirement Community in Columbia, Pa. She was also named a fellow of the American College of Healthcare Executives.

Are You a Member on the Move?

Tell us about your recent promotion, honor, accomplishment, volunteer activity or academic achievement.
Please include your name, credentials, address and phone number with your submission. Photos are
welcome (in jpeg format).

E-mail us at aacnnews@aacn.org
or write to us
AACN News, 101 Columbia, Aliso Viejo, CA 926569

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Scene and Heard

Our Voice in the Media
Johns Hopkins School of Nursing News (Aug. 8, 2007) – “Hopkins Nurses Partner With Local Hospitals to Develop Nurse Leaders.” Debbie Dang, PhD, RN, Jo Walrath, PhD, RN, assistant professor, and their partners are “conducting an interventional study of disruptive behavior in the work environment based on the healthy workforce standards set by AACN.” Walrath said, “The data will then be utilized to develop a strategy for hospitals in Maryland; to be evaluated based on effectiveness.”

Dimensions of Critical Care Nursing (Sept./Oct. 2007) – “Should We Allow Children to Visit Ill Parents in Intensive Care Units?” Commander Deborah Roy, Naval Medical Center, Portsmouth, Va., said, “Concerns for our staff centered on infection risk for patients and children, and control of children while in the unit. To address these issues, we utilized the AACN Protocols for Practice: Creating a Healthy Environment.”

IT Solutions (Sept. 2007) – “E-Learning Answers: Real-time Nurse Manager Orientation” was written by Pamela Shellner, RN, BSN, MAOM, AACN clinical practice specialist. She noted that “in early 2002, the chief executive officers of AACN, American Organization of Nurse Executives (AONE) and the Association of periOperative Registered Nurses (AORN) identified that all three organizations shared a critical need to address the development of nurse managers … The three organizations’ combined efforts resulted in the Nurse Manager Leadership Collaborative (NMLC) and the creation of the Learning Domain Framework.”

Biotech Business Week (Aug. 27, 2007) – “American Association of Critical-Care Nurses Presents Its Most Recent News and Research Developments.” This article presented AACN’s latest news including unlimited free CE credits for members, NTI’s focus on healthy work environments and the results of the critical care survey AACN conducted with Bernard Hodes and Nursing Spectrum.

American Journal of Nursing (Aug. 2007) – “The NTI Report: The Real Power of Nurses.” Ramón Lavandero, RN, MSN, MA, FAAN, AACN’s director of development and strategic alliances, said, “If you work in a hospital, you’re a critical care nurse. Most hospital nurses think that only ICU or ED nurses qualify for that description and therefore miss out on the myriad opportunities for education, networking and professional guidance and support that AACN provides to its members.” He added, “Ask the bedside nurses what they’re doing. They’re providing a level of care that years ago only existed in ICUs.”

Atlanta Journal-Constitution (Aug. 26, 2007) – “CHOA Nurse Leads the Way in Critical Care Education.” Heather Maude, RN, CCRN, Children’s Healthcare of Atlanta Sibley Heart Center, attended NTI and “learned how to create a certification culture in her unit and took the information back to her manager. She reported that certification would increase nurses’ knowledge and confidence, raise standards, improve patient care and help the hospital recruit and retain nurses.”

Advance for Nurses (Aug. 6, 2007) – “Guiding Light: Carrying the Torch of Nursing Excellence.” This article described the Beacon Journey of the coronary ICU at Aurora St. Luke’s Medical Center in Milwaukee, Wis. Karin Schmeling, MSN, RN, CCRN, clinical nurse specialist in the CICU, said, “We’re pleased and proud of what we’ve accomplished. But we’d also like to encourage ICUs everywhere to look at their practice. It takes a team effort, but excellence is achievable.”

MedSurg Nursing (Aug. 1, 2007) – “Are You Certified in Your Specialty?” noted that “according to a 2002 report by the American Association of Critical-Care Nurses, more than 67 certifying organizations represent more than 134 specialties.” The article concluded that “certification in your clinical specialty is a wise investment in your career.”

Our Voice at the Table
Kevin Reed, RN, MSN, CNA-BC, CPHQ, AACN Certification Corporation chair, Carol Hartigan, RN, MA, AACN certification programs strategist, and Tracy LoBono, RN, BSN, AACN certification specialist, represented AACN Certification Corporation at the American Board of Nursing Specialties Fall Assembly in Washington, D.C. The meeting was a stakeholder forum for the discussion of certification issues.

Reed and Hartigan attended the Alliance for Accreditation (now called the APRN Alliance) in Chicago. This was also a stakeholder forum to discuss important issues related to certification.

Janice Wojcik, RN, MSN, CCRN, APRN-BC, AACN board member, represented AACN at Priorities in Acute and Critical Care, a conference sponsored by AACN’s South Central Alaska Chapter in Anchorage. She presented a keynote address on “Reclaiming Our Priorities and Healthy Work Environments” and also gave a lecture on “Preventing Ventilator-Associated Pneumonia.”

Marti Reiser, RN, MSN, CNP, CNS, CCRN, CDE, a member of AACN’s Lake Erie Chapter, presented “Mysteries of the Thyroid Revealed” at the national convention of the American Association of Diabetes Educators (AADE) in St. Louis.

Lavandero presented “Elements of Best Practices” at the Internationally Recruited Nurses: Creating Positive Practice Environments conference in Chicago. He said, “Healthy work environments don’t just happen. Setting standards will enhance safety, recruitment and retention, and maintain hospital financial viability … Patient safety and work environment are linked. If you’re not addressing the work environment, you’re not addressing safety.”

Mary Stahl, RN, MSN, APRN-BC, CCRN, CCNS, and Julie Miller, RN, BSN, CCRN, AACN board members, attended the Healthy Work Environment Summit in Tyler, Texas. Stahl presented “A Journey Toward Excellence: Creating a Healthy Work Environment,” which was sponsored by AACN’s Greater East Texas Chapter. The discussion on how to apply HWE standards was attended by about 60 representatives from area hospitals and the local Sigma Theta Tau chapter.

Maria Shirey, RN, MS, MBA, CNAA, BC, FACHE, AACN Certification Corporation board member, spoke at the International Nursing Administration Research Conference (INARC) in Indianapolis. Her topic was “Stress and Coping in Nurse Managers: Translating Research Findings Into Practice.” She addressed the influence of nursing leadership in creating and sustaining healthy work environments and presented her research findings on the work of nurse managers.

Denise Buonocore, RN, MSN, CCRN, APRN-BC, immediate past AACN board member, presented “Inpatient Management of Diabetes Mellitus” at the American College of Nurse Practitioners’ 2007 National Clinical Conference in San Antonio, Texas.

J. “Ski” Lower, RN, MSN, CCRN, CNRN, AACN board member, presented “Making Patient Satisfaction Fun (You’re Kidding, Right?)” at Nursing Management Congress 2007 in Chicago.

Julie Miller, RN, BSN, CCRN, AACN board member, presented a two-day “High Acuity Medical Surgical Review” course at Trinity Mother Frances Health System in Tyler, Texas. She highlighted PCCN certification, membership in AACN, healthy work environments and AACN’s free CE benefit. Seleria Fletcher, RN, MSN, president of AACN’s Greater East Texas Chapter, also attended.

Miller presented “Code Stroke: What Are All Those New Guidelines?” “Ventilator Care: Beyond SIMV” and “Flip a Coin? Better Ways to Titrate Vasoactive Medications” at Specialty Educations’ 7th Annual Critical Care: Opportunities & Challenges in Las Vegas, Nev.

Susan Helms, RN, MSN, CCRN, PCCN, AACN Certification Corporation board member, presented an update on certification at the AACN Region 4 Meeting and Leadership Development Workshop at Germanna Community College in Fredericksburg, Va.

Kristine Peterson, RN, MS, CCRN, CCNS, AACN board member, presented a National Update and “AACN’s Mission, Vision and Values: What It Means to Us” at the Region 13/16 Collaborative in Minneapolis, Minn.

Stahl attended Region 14’s Annual Chapter Collaborative and Education Program, in Osage Beach, Mo. She presented a “National Update,” “Promoting Healthy Work Environments” and “Certification - A Benchmark for Excellence.” Kay Luft, RN, MN, MS, CCRN, Region 14 chapter adviser, presented a “Region Update” and “Applying for AACN Awards.” Luft and Stahl closed the meeting with “Volunteering While Having Fun.”

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AACN Is Thankful for Recruitment Efforts in November

The I Can Make a Difference Member-Get-A-Member campaign continued to make strong gains in membership in November, with 248 individuals and chapters recruiting 521 new members. This brings the campaign total after three months to 1,480 new members recruited by 480 individuals and chapters. Keep up the good work!

November Totals:
274 new members recruited by 126 individuals
247 new members recruited by 122 chapters

In individual recruiting for the month, Teresa Crite, RN, BSN, TNCC, of McLeansville, N.C. added 16 new members in her first recruitment effort. This strong, first-time performance puts her into third place overall in the campaign. Mary Maskell-Amirault, APRN, MS, CCRN, CRN, of Glenmont, N.Y. also had a double-digit month with 10. Leading in the overall campaign with 21 new members recruited is Myra Sanders, RN, ADN, CCRN, of Bowling Green, Ky. Following close behind in second place is Morella Breckenridge, RN, BSN, PCCN, FCCM, FAHA, FAACVPR, of Englewood, Tenn. with 18. Tied for third place with 16 is Kathleen Richuso, RN, MSN, RN-BC, of Chapel Hill, N.C.

In chapter recruiting, the Southern Maine Chapter led the way in November with 16 new members recruited, while the Greater Richmond Area Chapter came in with 10. After the first three months of the campaign, there is a three-way tie for the lead. The Carolina Dogwood Chapter, the Greater Birmingham Chapter and the Greater Washington Area Chapter each have 22 members recruited. In second place with 21 is the San Diego Area Chapter, and in third place is the Southern Maine Chapter with 20.

The I Can Make a Difference campaign began Sept. 1, 2007 and will continue through Aug. 31, 2008. Participation in the Member-Get-A-Member drive offers the opportunity for recruiters to receive valuable rewards, including a $1,500 American Express gift check that will be awarded to the top individual recruiter. Members who recruit more than 20 new members by campaign end will be entered into a random drawing for a $1,000 American Express gift check, those who recruit 10-19 new members by campaign end will be entered into a random drawing for a $750 American Express gift check, and anyone who recruits 1-9 new members by campaign end will be entered into a random drawing for a $500 American Express gift check.

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.

In addition, individuals who recruit at least one new member in a campaign month will be entered into a drawing for a $100 American Express gift check. Lisa Mae Williams, RN, BS, BSN, CCRN, from Homestead, Fla. won the gift check in November.

The overall top-recruiting chapter by campaign end will be awarded a $1,500 honorarium check toward the chapter treasury. Recruiting chapters will also be entered into a random drawing at campaign end for an honorarium check toward their chapter treasury: If they recruit more than 20 new members by campaign end, chapters are eligible for a $1,000 honorarium check, 10-19 new members recruited by campaign end, they are eligible for a $750 honorarium check, and with 1-9 new members recruited by campaign end, chapters are eligible for a $500 honorarium check.

In addition, chapters are eligible for monthly drawings for a free NTI registration any month they recruit a new member. The winner for November was the Greater Louisville Chapter.

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Monthly Super Savers

Start the year off right with these study tools to help you get that certification you want. These Super Saver prices are valid through Feb. 28, 2008. All orders must be received or postmarked by Feb. 28 to be eligible for the Super Saver price.

CMC Review Course on DVD (#300916)
This 12-hour program is designed for nurses preparing for the cardiac medicine subspecialty certification (CMC) or those who provide care for cardiovascular patients and want to increase their level of cardiac nursing knowledge and skill. The clinical content for this course is based on key components of the CMC exam test plan. Cardiovascular pathophysiology, dysrhythmia interpretation, hemodynamics, patient assessment and monitoring, and related patient problems will be covered in depth. The teaching approach will include a focus on physiological understanding of the cardiovascular and other body systems with an emphasis on critical thinking and clinical application. In addition to certification preparation, an emphasis will be placed on linking knowledge to current clinical practice. Experience in cardiac nursing is advantageous in achieving optimal benefit from the course. Includes comprehensive syllabus and 12 contact hours of CE credit.
Regular Price
Member $179, Nonmember $209
Super Saver Price
Member $155, Nonmember $189

PCCN Adult Review Course on DVD (#300900)
This comprehensive review program was produced from the 2007 NTI preconference and is based on the PCCN blueprint. Experts present an overview of cardiovascular, endocrine, gastrointestinal, hematology/immunology, multisystem, neurologic, pulmonary and renal topics, and share some test-taking strategies. The Synergy Model is included in the content. This is an excellent review course for progressive care nurses preparing for the PCCN exam. Included are three DVDs, a substantial study guide and 12 hours of CE credit. Note: This product will play on a computer with a DVD drive installed.
Regular Price
Member $200, Nonmember $275
Super Saver Price
Member $176, Nonmember $255

Adult CCRN Review Course on DVD (#301965)
This digital review program was produced from the 2007 NTI preconference and is based on the Adult CCRN blueprint. Experts present an overview of cardiovascular, endocrine, gastrointestinal, hematology/immunology, multisystem, neurologic, pulmonary and renal topics, and share some test-taking strategies. A review of the content of the CCRN exam is provided, and the Synergy Model is included in the content. An excellent review course for critical care nurses preparing for the CCRN exam, this product includes three DVDs, a comprehensive study guide and 12 hours of CE credit.
Regular Price
Member $200, Nonmember $275
Super Saver Price
Member $176, Nonmember $255

This Month’s Featured Products

'Boomers, Xers, & Nexters: How to Retain, Manage, and Educate Them (#190025)
This presentation offers insight into segments of the multigenerational workplace (Baby Boomers, Generation Xers and Nexters). The session is directed specifically toward the education of the multigenerational staff.
Member $22, Nonmember $25

Chaotic Inflammatory Response to Trauma (#190026)
This session provides explanations of the multiple inflammatory processes following trauma. In addition, the session covers a review of the inflammatory responses seen with burn injuries. Case studies are used to illustrate key points of the presentation.
Member $22, Nonmember $25

Confronting Difficult Situations and Bad Behaviors (#190031)
This presentation offers case studies in confronting difficult situations and behaviors. Learners will be exposed to communication tools and personality preferences that provide insights into self-understanding.
Member $22, Nonmember $25

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In Memory of Jessica Palmer

One of AACN’s committed leaders, Jessica P. Palmer, died Nov. 4. She suffered a heart attack after doing one of the activities she loved most, riding her horses.

Palmer’s dedication to her profession was evident on many levels, including as a member of AACN since 1992. She was on the national board from 1999 to 2002, serving as board treasurer for two of her terms. She also served on a number of work groups and presented at NTI. Palmer was one of the subject matter experts who developed content for Essentials of Nurse Manager Orientation, the new e-learning course produced by AACN and the American Organization of Nurse Executives.

After 20 years as a bedside clinician in a variety of critical care units, Palmer served in nurse manager and director positions, including as nurse manager of the medical-surgical and critical care business unit at Duke. At the time of her passing, she was a clinical operations director for all inpatient medical units at Duke University Medical Center, Durham, N.C.

AACN named scholarships for nurse manager development will be awarded using contributions made in Palmer’s memory. Gifts should be sent to Development Office, AACN, 101 Columbia, Aliso Viejo, CA 92656. To make a gift by phone, call (800) 899-2226.

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Marsh AACN Excellent Nurse Practitioner Awards

Rachel K. Vanek, RN, MSN, CNP
University Hospitals Case Medical Center, Cleveland, Ohio

Our medical ICU and the mechanical ventilator were very familiar to M.E. She was familiar with the group of nurses and, most importantly, our unit’s acute care nurse practitioner, Rachel Vanek. Rachel had assumed primary responsibility for M.E.’s care during each MICU admission and had coordinated her recent transfer to a ventilator weaning facility.

She noted that M.E. had been slowly weaned off the ventilator at the facility, but was again suffering from hypercapnea. After readmission and workup, it became clear that her symptoms were a result of an exacerbation of her COPD. After four days on the ventilator, Rachel and the team were able to wean and extubate the patient. However, M.E.’s clinical status remained tenuous, and noninvasive ventilation (NIV) was instituted. Unfortunately, M.E. could only tolerate short intervals off NIV.

Finally, it became clear that M.E. had reached the end of her effective treatment options. Once again, Rachel initiated a patient and family meeting to review M.E.’s clinical status and prognosis, and to address treatment limitations. Although she could only speak in short, broken phrases, M.E. was adamant in her preference for no further intubation. The patient confirmed her understanding, stating, “I want nothing to do with the ventilator ever again!” After presenting M.E.’s clear preferences to her family, who unanimously agreed, Rachel re-entered M.E.’s room. As the bedside nurse, I watched with deep respect as Rachel connected with M.E., taking her hand, looking into her eyes and saying, “I will not let you suffer.” Rachel instituted comfort measures, including a fan, the patient’s favorite water fountain with nature sounds, a well-loved and well-worn quilt from home, open family visitation, hourly sublingual morphine titrated to dyspnea and finally a morphine drip. M.E. died peacefully in the MICU two days later with her family at the bedside.

Laura Kierol-Andrews, PhD, APRN, ACNP
The Hospital of Central Connecticut
New Britain General Campus, New Britain, Conn.

Mrs. C, a 90-year-old patient, was admitted to the ICU with end-stage heart failure and was dying. I called her family. Her oldest daughter Nancy arrived at the hospital first. The ICU intern wanted to listen to how I talked with families about end-of-life care. I told Nancy that her mom was dying and that her wishes were to not have life supportive therapies continued. She agreed, but was concerned that her sister Patty “won’t be unable to let Mom go.” This became obvious to me, as we had to call Patty several times to get her to come to the hospital. I talked with Nancy about Patty’s personality and relationship with her mom. I needed to understand the family dynamics to be able to talk with Patty. When she arrived I spoke with them, but focused on helping Patty understand her mother’s wishes. I chose my words carefully so that she knew the decision to withdraw support was not hers, but her mother’s. I reiterated that our goal would be to respect her mom’s life and provide her with comfort and caring. With tear-filled eyes she agreed to comfort measures only.

Mrs. C died a few minutes after we withdrew therapies and her family had the chance to say their goodbyes. Her family hugged me and thanked me for caring so much. Later that day, I got a hug from my intern. He said, “They don’t teach us this stuff in medical school.” When people talk of the successes in intensive care units, they talk of saved lives. As an acute care nurse practitioner, I know this is not always the case. It is recognizing that patients’ outcomes are not always measured in lives saved. Success is often measured by lives touched.

Megan E. Carr-Lettieri, MSN, CRNP, BC, CCRN
Hospital of the University of Pennsylvania, Philadelphia, Pa.

Kia, a 28-year-old single mother of two young children, had developed significant pulmonary emboli, progressive pulmonary hypertension and right heart failure requiring evaluation for transplant on our unit. As time passed, her condition worsened, and she appeared to be seeking medication for pain that was disproportionate to her physical exams.

During this period, Kia asked me for a favor. Because her children’s father was in prison, she wanted to make certain that her mother would become their legal guardian if she should die. I collaborated with our legal consultants and social worker, who helped her to draft both a living will and power of attorney.

I also offered her my tape recorder so that she could leave messages for her family. When approached about this, she was tearful, but agreed that she would do so. During this same conversation, I had a valuable discussion regarding her pain medication use. She revealed that she was simply trying to hide from the reality of her situation. Together we determined a reasonable weaning strategy so that she could have meaningful interactions with her family during the precious days to come.

Soon after, Kia died peacefully with her mother at her bedside. It was then that I gave the tape to her mother. I don’t think I’ll ever forget the power of that moment. Her mother has since told me that she listens to the tape daily and is grateful for the words her daughter shared with her and her children, who were now in her custody as Kia had wanted.

The lesson I learned from Kia is that our role as clinicians is not merely to provide patients with physical care or technical support, but also to be cognizant of their emotional, social and spiritual needs, even when they may not be vocalized.

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AACN Excellent Nursing Student Award

Laura Jenson, RN, BA
Oregon Health and Science University School of Nursing, Portland, Ore.

As a senior nursing student, I sat in leadership class listening to faculty discuss AACN’s Healthy Work Environment Standards. The standards rang true with me; I want to do my life’s work where there is authentic leadership, meaningful recognition, appropriate staffing, effective decision making and skilled communication that is truly collaborative. But if this is supposed to occur in the workplace after graduation, why aren’t the students in various disciplines collaborating now? The students from the School of Medicine and School of Nursing take many of the same courses, but they do so in isolation. I voiced these concerns over dinner one night to two medical students and an MD/PhD student when the conversation turned toward how little education medical students receive about multidisciplinary teamwork. My three dinner companions and I wondered if we could impact collaboration between the two disciplines. So, we decided to bring medical and nursing students together to discuss authentic multidisciplinary collaboration and planned a Medical/Nursing Student Forum. We invited speakers, including a fourth-year nursing student, a nursing school faculty member who is known for consistently integrating collaboration into our simulation labs and a pediatric medical resident who had spent a rotation being precepted by pediatric ICU nurses. Medical students, undergraduate and graduate nursing students, and faculty attended the forum; it appeared the forum topic struck a nerve. Feedback following the forum was positive, and the students were excited that they had an opportunity to interact.

I’ve learned that, through attempts to authentically collaborate, we can be “Bold Voices” by identifying the most pressing challenges in our school environment, initiating discussions with colleagues to find solutions and remaining actively involved until solutions are working. If we don’t have these crucial conversations now, patient safety could be jeopardized later.

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Dale Medical Products AACN Excellent Clinical Nurse Specialist Awards

Michael A. Frakes, APRN, MS, CCNS, CFRN, CCRN, EMTP
LIFE STAR Hartford Hospital, Hartford, Conn.

While Michael is a leader caring for patients during critical care transport, CNS practice differs from expert clinical practice away from the bedside.On a recent afternoon, two of our new staff cared for patients with an aortic dissection, an expanding subdural hematoma, a pediatric seizure and cardiogenic shock. This high-intensity, high-acuity experience was completely safe, as the encounters took place in a very realistic, high-fidelity human patient simulator program that Michael has helped to develop and operate. More important than the scenarios are the debriefings, which always begin with the team “talk(ing) about three things that went really well” before discussing improvement opportunities. Experienced staff benefit from an equally thorough program of “high-risk, low-frequency” cases for recurrent education.

Clinical education and consultation are not limited to the sophistication of the simulation center. We often turn to Michael for answers to clinical questions, to which he invariably answers either “a recent paper says …” or “great question, let me look around,” followed soon by an e-mail summarizing the current literature. This evidence-based approach extends to ensuring that our practice standards consistently reflect best practices and to nonclinical features of team performance, such as patient safety, documentation and transport operations.
Michael is also a contributor to the medical literature. In the past year, he has edited a book, written three chapters, published seven clinical articles and four abstracts, and made seven national presentations. More importantly, he has helped us to develop skills in clinical inquiry. Michael either helps us to develop an idea into a workable project (“any idea can be a great project:”) or asks for “a little help with something” to get us involved in research. Currently, 14 members of our multidisciplinary team are involved in projects, along with a college student seeking research experience.

Mary Jane Fleener, MSN, RN, CCRN, CCNS
Bloomington Hospital, Bloomington, Ind.

As the first clinical nurse specialist in a 300-bed community hospital, my mission has been to empower nurses to identify nursing-sensitive outcomes and quantify their contributions to the patient, other staff and the system. This journey has been long, but very satisfying.
As I expanded my practice from staff nurse to educator and later manager of the ICU, opportunities arose, and I could demonstrate the key components of advanced practice nursing. First, at the bedside, I seized opportunities to discuss evidence-based practice as I worked with and coached other nurses while caring for the ICU patient.

Second, about six years ago, I was given the opportunity to move into the first clinical nurse specialist role at my facility. In this role, I was able to engage others to participate in the Critical Care Nursing Practice Council, building evidence-based procedures, protocols and standing orders. These activities soon expanded outside the ICU and with 25 years of critical care experience, I was now being asked for advice on patient issues in other areas of the hospital.

The Education Department that I was charged with forming a couple of years ago has totally changed. The name has changed to the Clinical Education & Practice Department to reflect what we actually do. We influence patient outcomes through best practice, which occurs through education. CNS-led teams have contributed to the reduction of falls by 54% and the reduction of hospital-acquired pressure ulcers by 88%, and phlebitis rates have decreased by 67%. The Clinical Education & Practice Department has also expanded to include additional clinical educators, centralized educators, an infusion team, wound ostomy nurses and three other clinical nurse specialists.

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AACN Excellence in Research

Judith Gedney Baggs, PhD, RN, FAAN
Oregon Health and Science University School of Nursing, Portland, Ore.

As an ICU staff nurse, I have observed that decisions and their interactions are better when nurses and physicians work together. As a beginning researcher, I studied collaboration between MICU nurses and physicians in making decisions to transfer patients from the ICU, remembering that Kathy Dracup had said physicians should make ICU admission decisions, nurses should decide about transfers out. The more collaboration nurses reported, the less likely patients were to die or be readmitted to the ICU, and both nurses and residents were more satisfied with their work. Satisfaction influenced nurse retention.

With AACN funding, I studied nurse-physician collaboration in making decisions about the level of aggressiveness of care for MICU patients. Although both believed patients should be involved in decision making, they also believed that patients often were not involved.
I studied the transfer decision in three ICUs (MICU, SICU, combined medical-surgical ICU). Nurses’ reports of collaboration predicted better patient outcomes in the MICU, where the patients were more complex and sicker. Units’ rank on structures supporting collaboration corresponded to their rank in better outcomes.

I combined an interest in end-of-life decision making (EOLDM) with my focus on collaboration, expanding collaboration to include patients and families. I conducted a four-year study of culture related to EOLDM in four adult ICUs. Each unit was distinctive in aspects such as timing of involvement of families in EOLDM during a patient’s illness, use of technology and roles and relationships of healthcare providers.
In the current healthcare climate, where care is integrated, improving implementation of collaborative care is crucial. Collaboration improves quality of care for the most complex critically ill. Preventing readmissions can save costs related to premature transfers. Findings from the ethnographic study will identify barriers and facilitators for good EOLDM and encourage intervention researchers to individualize interventions for each unit.

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