AACN News—May 2001—Practice

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Vol. 18, No. 5, MAY 2001


Congratulations to Research Grant Recipients

Numerous nursing research grants are awarded by AACN each year. The deadlines to apply for these grants vary. Following are brief descriptions of the grants that are available for 2001-02, as well as the current recipients of these grants and their research topics:


Agilent Technologies-AACN Critical Care Nursing Research Grant
This grant, which is cosponsored by Agilent Technologies and AACN, provides research support for a study conducted by a critical care nurse. One $35,000 grant is awarded.
This grant is intended to support a well-defined, well-described project. The preferred topic for this grant is the information technology requirements of patient management in critical care. Because this grant is intended to support research with direct clinical application to critical care nursing practice, proposals for basic science or animal studies are not eligible.

The recipient of the Agilent Technologies-AACN Critical Care Nursing Research Grant for 2001 is:
Susan Frazier, RN, PhD
Gallipolis, Ohio
Cardiovascular function during ventilator weaning

Proposals for the 2002 Agilent Technologies-AACN Critical Care Nursing Research Grant must be received by Sept. 1, 2001.


AACN Critical Care Grant
This grant awards up to $15,000 to support research focused on one or more of AACN’s research priorities.

Grant applications submitted in February 2001 are currently being reviewed.

Proposals for this funding in 2002 must be received by Feb. 1, 2002.


AACN Clinical Practice Grant
This $6,000 grant supports research focused on one or more of AACN’s clinical research priorities.

Receiving the Clinical Practice Grant for 2001 is:
Mary Lou Sole, RN, PhD, FAAN
Winter Park, Fla.
Multi-site survey of closed-system suctioning and airway management practices of intubated patients

Proposals for the 2002 AACN Clinical Practice Grant must be received by Oct. 1, 2001.


AACN Clinical Inquiry Grants
This program provides 10 $500 awards to qualified AACN members who are carrying out clinical research projects that will directly benefit patients or their families. Funds are awarded for projects that address one or more AACN research priority and link with AACN’s vision.

Recipients of Clinical Inquiry Grants submitted in July 2000 are:
Debra Staufer, RN, BSN
Oakwood, Texas
The perception of ICU nurses toward family visitation of critically ill patients

Leigh Hart, RN, MSN, CCRN
Jacksonville, Fla.
Evaluation of the process by which critical care nurses attain hemodynamic monitoring skills

Renee Twbell, RN, DNS
Munice, Ind.
Physiologic and psychosocial predictors of initial ventilator weaning

Sylvia Lenart, RN, MSN, CCRN
Bellevue, Wash.
Comparison of two methods for post-pyloric enteral tube feeding placement

Recipients of Clinical Inquiry Grants submitted in January 2001 are:
Mary Napier, RN, CCRN
New York, N.Y.
Use of guided imagery in the cardiac catheterization labatory

Linda Hoke, RN, MSN, CCRN
Philadelphia, Pa.
Home self-weighing behavior in heart failure patients

Colleen Counsell, RN, MSN, CCRN
Gainesville, Fla.
Prediction of terminal status and presence of advance directives for adult medicine patients

Allison Tuppeny, RN, BSN, CCRN
Oviedo, Fla.
Brain aneurysm/AVM support group

Applications for the 2002 AACN Clinical Inquiry Grants must be received by July 1, 2001, or Jan. 15, 2002.


AACN Mentorship Grant
This $10,000 grant provides research support for a novice researcher with limited or no research experience to work under the direction of a mentor with expertise in the area of proposed investigation.

Applications for this grant for 2001 are currently being reviewed.

Proposals for this grant for 2002 must be received by Feb. 1, 2002.


Sigma Theta Tau-AACN Critical Care Grant

This $10,000 grant is cosponsored by AACN and Sigma Theta Tau International. The grant may be used to fund research for an academic degree.

Receiving the grant for 2000 is:
Hilaire J. Thompson
RN, MS, CNRN, CS, ACNP
Philadelphia, Pa.
Thermoregulatory sequela of traumatic brain injury

Proposals for this grant must be received by Oct. 1, 2001.


Evidence-Based Clinical Practice Grant
This program provides six $1,000 awards to stimulate the use of patient-focused data or previously generated research findings to develop, implement and evaluate changes in acute and critical care nursing practice.

Recipients of Evidenced-Based Clinical Practice Grants submitted in October 2000 are:
Corrine Miller RN, BSN
Raleigh, N.C.
Web-based data collection: Linking international nursing research efforts to improve patient care for heart failure

Rebecca Johnson, RN
Apex, N.C.
Choices: creating holistic options in end-of-life strategies

Grants applications submitted in March 2001 are currently being reviewed.

Proposals for 2002 must be received by Oct. 1, 2001.


AACN Certification Corporation Research Grants

This program provides four $10,000 awards to support research related to certified practice.

Applications for the 2001 AACN Certification Corporation Research Grant for 2001 are currently being reviewed.

Applications for 2002 AACN Certification Corporation Research Grants must be received by Feb. 1, 2002.


American Nurses Foundation Research Grant

Up to $5,000 is awarded by the American Nurses Foundation for this AACN-sponsored grant.
Additional information about this grant and applications can be obtained from the American Nurses Foundation, (202) 651-7298, or by visiting the ANF Web site at www.nursingworld.org.

The recipient of this grant for 2000 is:
Rhonda Board, RN, PhD, CCRN
Londonderry, N.H.
School-age children perceptions of PICU hospitalization

The proposal deadline is May 1, 2002


Medtronic Physio-Control AACN Small Grants Program

This program awards up to $1,500 to qualified individuals carrying out projects that focus on aspects of acute myocardial infarction resuscitation, such as the use of defibrillation, synchronized cardioversion, or noninvasive pacing or interpretative 12-lead electrocardiogram.

Recipient of this grant for 2000 is:
Kathleen Stone, RN. PhD,FAAN
Columbus, Ohio
Autonomic nervous system tone in genetically inherited sudden cardiac death

Proposals for the next round of grants must be received by July 1, 2001.


AACN-Datex-Ohmeda Grant

Funded by Datex-Ohmeda, this $5,000 grant supports research related to nutritional assessment in the critically ill patient.

Applications for the 2001 grant are currently being reviewed.

Proposals for this grant for 2002 must be received by Feb. 1, 2001.


‘Substituted Judgment’ Requires Knowing the Patient


By Barbara Krumbach, RN, MS, CCRN
Member, Ethics Work Group

Many of the difficult decisions that critical care nurses and physicians face every day entail conflict. Following is just one example.

B.T, a 46-year-old African-American female with a history of asthma, was admitted to the hospital following respiratory and cardiac arrest. Resuscitation efforts, which had been started by her family, continued in the hospital’s emergency department (ED). The staff was able to resuscitate her to a normal rhythm.

Because of the time that had elapsed during the resuscitation effort, the ED physician informed the family that B.T. would likely not regain normal neurological function. After being admitted to the ICU, B.T. arrested again. Again, she was resuscitated to a normal rhythm. However, she had only minimal neurological response. Although the nursing and medical staff tried to include B.T.’s family members in the care plan, her family had difficulty dealing with the prognosis.

The nursing staff was attentive to the family, which included B.T.’s mother, niece and two children, allowing them as much visitation time as possible. They created a very caring environment, answering questions and listening to the family as they talked to her and about her.

Over the next three days, B.T. showed signs of multisystem failure. Despite attempts at education, the family continued to cling to the hope she would recover. In response, the team continued an aggressive course of treatment, with full resuscitation orders for B.T. When her kidneys began to fail, the renal team was consulted and dialysis was considered. The neurological team felt that the likelihood of a meaningful recovery was extremely low and that B.T would probably end up in a nursing home in a vegetative state.

The team questioned whether adding dialysis would constitute futile care, only adding to B.T.’s suffering and prolonging the dying process. An ethics consult with the physicians, the social worker and the case manager was requested.

The first part of the process was to clarify B.T.’s medical condition. Everyone still felt that the likelihood of her recovering was very poor, and that dialysis was futile care and would not change the outcome. They did not want to prolong her suffering and questioned whether dialysis needed to be offered.

B.T.’s mother was the decision-maker in this case. She had indicated to the staff several times that her daughter was a fighter and that, regardless of how her daughter would end up, she would prepare to take her home and take care of her. This presented the type of conflict that we often see in our patients in the ICU.

It is generally agreed that, if care is futile, it does not need to be offered as part of the treatment plan. However, in this case we asked the team to delve into the question further. We encouraged them to ask: What is B.T. like? What are her values? If she could speak for herself, what would she want to have happen?

It is important not only to discuss with family members what their goals are, but also to let them know the values of the treatment team and what the team feels would have an impact on the outcome. Although the treatment team did not want to offer care that was futile and that would prolong suffering, B.T.’s mother wanted her daughter to remain alive.

We encouraged the team members to acknowledge that, though they may each hold certain values, they must concentrate on what B.T. would want. There were neither advance directives nor discussions that had taken place to indicate what B.T. would have wanted done. Thus, in advocating for her, the team members needed to use

“substituted” judgment with respect to what they thought her wishes would be. Often, simply discussing what a person was like and how he or she viewed life helps to make the decision.

The principle of “substituted judgment” uses a surrogate decision-maker to decide what a formerly competent person would want. This is different from the “best interest” standard, which is used in making decisions for a person who was never been competent, such as an infant or a severely mentally disabled person.

The team of physicians and nurses met with the family the next day and proceeded with the discussion as outlined. When the process of resolving the dilemma shifted to understanding the family’s and patient’s values and beliefs, the dilemma was resolved. Although the decision was difficult, the family members appreciated where the team was coming from. They agreed that B.T. should be on a do-not-resuscitate order if an acute event occurred. However, they were not ready to have ventilator support withdrawn. Supportive care was to be given, but nothing withdrawn.

The wishes of the family were acknowledged. Over the next couple of days, the nursing staff was very supportive, listening to the family members as they described B.T.’s life. The chaplain also spent time with the family to offer spiritual support. Three days later, B.T. died peacefully, with her family at her side.

As part of the healthcare team, the patient and family must be involved in the decision making and plan of care. Recognizing and responding to the diverse needs of all involved helps to establish true caring practices.

This case represents that, even when conflict occurs or a difficult decision needs to be made, a collaborative effort on the part of physicians, nurses and the family to consider the whole picture and provide support in a caring and understanding way can meet the needs of not only the patient, but also the family.

Barbara Krumbach is a clinical nurse specialist and educator for the day surgery and postanesthesia unit, cardiac Catheter lab, electrophysiology lab and GI lab at the University of Colorado Hospital, Denver, Colo. She is also a member of the hospital ethics committee and the on-call ethics group.
 

Research Corner: Confused About Clinical Practice Guidelines?

By Charlene A. Winters, RN, DNSc, CS
Chair, Research Work Group

Clinical practice guidelines, technology assessments and evidence reports provide practitioners with state-of-the-science information that is easy to use in clinical decision making and patient counseling. Although the development and use of these guidelines has increased substantially, there is still confusion about their purpose, intended audience and where they can be located. Following is information that can help to clarify these questions:

What Are Clinical Practice Guidelines?
Clinical practice guidelines are statements developed to assist physicians, nurses, other practitioners and patients make decisions about appropriate healthcare.1 Guidelines are produced under the direction of medical specialty associations, professional societies, public or private organizations, government agencies and healthcare organizations. Each guideline is based on the latest scientific evidence available to the writers during the development period and includes recommendations, strategies or information for specific clinical circumstances.

Who Should Use Clinical Practice Guidelines?
Physicians, nurses, other healthcare professionals, researchers and health policy makers are the intended audience for clinical practice guidelines.2 In addition, educators can incorporate information from these guidelines into their curricula and continuing education offerings. Government agencies can use clinical practice guidelines in their quality assurance and program oversight efforts.

There is a strong movement to have all healthcare providers base their care on evidence from research and, whenever possible, to use clinical practice guidelines to direct their choices for treatment and therapy. However, before applying any recommendations to their practices, practitioners must evaluate them according to scientific evidence and technological advances that have occurred since the guidelines were published.3

Where Are Guidelines Found?
A primary force behind the development of clinical practice guidelines is the Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research. AHRQ’s mission is to support research designed to improve the outcomes and quality of healthcare, reduce costs, address patient safety and medical errors and broaden access to effective services. The research sponsored, conducted and disseminated by the agency provides information that helps patients, clinicians, policy makers and health system leaders make better decisions about healthcare.2

AHQR initially sponsored the development of 19 clinical practice guidelines, which are available online at www.ahrq.gov/ clinic/cpgnline.htm. An independent, multidisciplinary panel of clinicians and other experts developed each guideline. Topics include acute pain management, Alzheimer’s disease, benign prostate hyperplasia, cancer pain, cardiac rehabilitation, cataract, depression, heart failure, low back problems, mammography, otitis media, poststroke rehabilitation, pressure ulcer prevention and treatment, sickle cell disease, HIV infection, smoking cessation, unstable angina and urinary incontinence. For more information, contact the AHRQ Publications Clearinghouse, PO Box 8547, Silver Spring, MD 20907; phone, (800) 358-9295.
Additional clinical practice guidelines are available from the National Guidelines Clearinghouse. This comprehensive database of clinical practice guidelines is available online at www.guideline.gov. AHRQ, in partnership with the American Association of Health Plans and the American Medical Association, sponsored the development of these guidelines to promote access to evidence-based clinical practice guidelines and related abstract, summary and comparison materials. This site, which is updated with new content on a weekly basis, allows practitioners to keep abreast of the large number of clinical practice guidelines now available.2 The AHRQ invites organizations, professional societies and other developers to submit completed guidelines for inclusion. To be considered, clinical practice guidelines must meet the following criteria:
• Be systematically developed and contain recommendations, strategies or information that assist physicians and other healthcare practitioners and patients make decisions about appropriate healthcare for specific clinical circumstances.
• Be developed under the auspices of medical specialty associations, relevant professional societies, public or private organizations, government agencies at the federal, state or local level or healthcare organizations or plans. A clinical practice guideline developed and issued by an individual not officially sponsored or supported by one of the these types of organizations does not meet the inclusion criteria.
• Be based on existing scientific evidence published in peer-reviewed journals and document that a systematic literature search and literature review was performed during the guideline development period.
• Be written in the English language and produced in the most recent version. The guidelines must be either developed, reviewed or revised within the last five years.2
Additional information about the National Guideline Clearinghouse can be obtained from Jean Slutsky, NGC Project Officer, Center for Practice and Technology Assessment/AHRQ, 6010 Executive Blvd., Suite 300, Rockville, MD 20852; phone, (301) 594-4042; fax, (301) 594-4027; e-mail, Jslutsky@ahrq.gov; Web site, www.guideline.gov or www.ahrq.gov.

AHRQ continues to support the development of clinical practice guidelines through its Evidence-based Practice Program.4 Under this program, 12 five-year contracts were awarded to institutions in the United States and Canada to serve as Evidence-based Practice Centers (EPCs). These centers review all relevant scientific literature on assigned clinical care topics and produce evidence reports and technology assessments and conduct research. Organizations may use the reports and assessments as the basis for their own clinical guidelines and other quality improvement activities. The EPCs focus on clinical topics that are common, expensive or significant for the Medicare and Medicaid populations. Some of the topics assigned to EPCs are part of AHRQ’s response to congressional requests for specific information. Additional information about EPCs is available from Jacqueline Besteman, EPC Project Officer, Center for Practice and Technology Assessment, Agency for Health Care Policy and Research, 6010 Executive Blvd.,
Suite 300, Rockville, MD 20852; phone, (301) 594-4017;
Although guidelines are readily available on the Internet and by writing or calling AHRQ, some clinical practice guidelines contain copyrighted materials and further reproduction is prohibited without the specific permission of copyright holders. Information about copyright materials is also available on the Web sites previously listed in this article.

References
1. Field MJ, Lohr, KN (eds). Clinical practice guidelines: directions for a new program. Institute of Medicine. Washington, DC. National Academy Press. 1990;39.
2. The National Guideline Clearinghouse. Fact Sheet. Rockville, Md. Agency for Healthcare Research and Quality. Publication No. 00-0047. July 2000. Available at: www.ahrq.gov/clinic/ngcfact.htm.
3. Fonteyn M. The Agency for Health Care Policy and Research Guidelines: implications for home health care providers. AACN Clinical Issues: Advanced Practice in Acute and Critical Care. (9),3. Available at: http://www.aacn.org.
4. Evidence-based Practice Centers. Overview. Rockville, Md. AHRQ Publication No. 00-P013, March 2000. Available at: .


June 22 Is Deadline to Apply for New Class of AACN Wyeth-Ayerst Fellows

June 22, 2001, is the postmark deadline to submit applications for the 2001-02 AACN Wyeth-Ayerst Nursing Fellows Program class. This nine-month fellowship is sponsored by Wyeth-Ayerst Laboratories in collaboration with AACN and the American Journal of Nursing (AJN).

Through the program each fellow is guided by a mentor in preparing a personal fellowship plan, which includes completing an individualized project, attending AACN’s National Teaching Institute™ and Critical Care Exposition and developing a manuscript that is published in a supplement to the AJN.

Each pair of mentors and fellows will work together to produce a manuscript on a current cardiopulmonary topic, which will be published in a supplement to the May 2002 issue of AJN and showcased at the NTI in May 2002 in Atlanta, Ga.

Fellows will receive registration, travel and lodging for the 2002 NTI. Mentors attending the 2002 NTI will receive complimentary registration and a $500 educational grant.

To obtain an application, call AACN Fax on Demand at (800) 222-6329 and request Document #2005. Applications are also available online at www.aacn.org.


New CD-ROM Education Programs Offer Interactive Clinical Simulations


New clinical education CD-Rom programs geared toward critical care nurses are now available from Lippincott Williams & Wilkins. Each program contains four realistic, highly interactive clinical simulations related to critical care nursing topics. The case simulations present core and advanced information associated with the care of patients, including assessment techniques, diagnostic tests and nursing care related to pharmacologic and medical treatment. In addition, the programs offer continuing education credits.

Complex Problems
Clinical Simulations: Complex Problems was published in October 2000 by AACN and Lippincott Williams & Wilkins. This program is geared toward situations where the patient has more than one pathophysiological problem that requires medical and nursing management. The user interface incorporates narration, color photographs and medical illustrations. Users may print scores to obtain CE credit. Included in this program are four units—multiple trauma, multiple organ dysfunction, acute pancreatitis and acute myocardial infarction with cardio-embolic stroke.

Shock Management
Clinical Simulations: Shock Management was published in November 2000 in conjunction with AACN and the Emergency Nurses Association. This program is based on critical care and emergency nursing topics involving the assessment, management and care of shock patients. Users can earn up to 4 hours of CE credit. The four units included in this program are neurogenic shock, septic shock, cardiogenic shock and hypovolemic shock.

Updated programs on the cardiovascular system and the endocrine system are also available.

For more information on ordering or previewing these new products, call (800) 326-1685 or e-mail medisim@lww.com.


Deadlines Near to Apply for Research Grants

The deadlines to submit proposals for two AACN nursing research grants are approaching. Following is brief information about each of these grants:

Medtronic Physio-Control AACN Small Grants Program

Cosponsored by Medtronic Physio-Control, this program awards up to $1,500 to qualified individuals carrying out projects that focus on aspects of acute myocardial infarction management. Proposals must be received by July 1, 2001.

AACN Clinical Inquiry Grants
These grants provide awards of up to $250 to qualified AACN members who are carrying out clinical research projects that will directly benefit patients or their families. Applications must be received by July 1, 2001.

To obtain an application for either of these grants, call AACN Fax on Demand at (800) 222-6329 and request Document #1013, or visit the AACN Web site at www.aacn.org. Click on “Clinical Practice,” then “Research,” then “Grants.”


Useful Tools Support Practice: Document Outcomes for Advanced Practice Nurses

By Kathleen H. Miller, RN, EdD, CS-ACNP
Member, Advanced Practice Work Group

As the roles of clinical nurse specialists (CNSs) and acute care nurse practitioners (ACNPs) continue to evolve, further studies are needed to examine the care they provide. Because the current healthcare system is focused on quality, cost-effective care, these advanced practice nurses must be involved in monitoring and reporting their outcomes to substantiate the integral roles they have as members of the healthcare team delivering care to patients.

Advanced practice nurses, including also nurse anesthetists and nurse midwives, may be master’s or doctorally prepared and often have achieved certifications in their areas of specializations. In addition, their state licensing boards may recognize them as practicing in this expanded role, though the responsibilities of these nurses, including prescriptive privileges, vary from state to state. These differences may impact how outcomes are measured for the different types of advanced practice roles.

CNS and ACNP Roles
CNSs and ACNPs usually practice in acute and critical care settings. Traditionally, CNSs have been involved with the indirect roles of education, consultation, research and administration. ACNPs have managed patients using direct role or care responsibilities.

However, in some instances changes in state regulations and practice guidelines may have blurred this distinction between the indirect and direct roles. Nevertheless, there are still differences in the performance of specific role activities, the value placed on these tasks and the time spent in these roles by CNSs and ACNPs.1,2

Quality Indicators
Documentation of care is important, particularly at a time when the practice of healthcare providers, including advanced practice nurses, is being analyzed for positive outcomes and cost-effectiveness. Outcomes for healthcare providers are also coming under increasing scrutiny by healthcare consumers. Patients are becoming increasingly sophisticated and may explore healthcare provider outcomes prior to seeking care.

Outcomes are viewed as indicators of the quality of healthcare provided by a specific provider, service or institution. This information can be used to evaluate the impact a provider or type of provider, specific procedures and different treatments have on patient outcomes. It can also be used to determine if the care offered by a provider is cost-effective. The indirect nature of the CNS role and issues related to reimbursement have made quantifying patient outcomes for CNSs more challenging.

Successful Measures
Advanced practice nursing outcomes may be examined as either part of a quality improvement program or as scientifically based research. Outcome measures used to evaluate the care of advanced practice nurses have usually focused on patient and provider indicators.

Patient outcome measures that have been successfully used in studies related to advanced practice nurses have included hospital and intensive care length of stay, number of complications, acuity level, mortality, cost and readmission rates. Provider outcome measures have examined provider retention rates, family and patient satisfaction, provider satisfaction and employer satisfaction regarding the care provided by advanced practice nurses and other healthcare personnel.

Improved Outcomes
Several investigators have reported improved outcomes for patients cared for by an ACNP or a CNS in tertiary settings. Information on the impact of ACNPs continues to be somewhat limited, because the role is relatively new. A study by Rudy, et al, found that ACNP and physician assistant outcomes were similar to those of resident physicians, based on measures such as length of stay, in-hospital mortality and readmissions rates.3 The patients cared for by resident physicians were older and sicker than those managed by the other providers. Other investigators have reported that lower hospital costs and lengths of stay have resulted for heart failure inpatients who are cared for by ACNPs.4

Mitchell-Dicenso, et al, compared the outcomes for an ACNP-CNS team with a resident physician team in the neonatal ICU. The care provided by these two groups was similar for measures such as length of stay, number of complications, mortality rate, quality of care and costs.5

There are a number of useful tools that can help you decide what outcomes to measure to support your practice. Many can be found by conducting a literature search online. AACN’s Practice Resource Network at (800) 394-5995, ext. 217, can also direct you to available resources.

References
1. Lincoln P. Comparing CNS and NP role activities: A replication. Clin Nurs Spec. 2000;14:269-27.
2. Mick D, Ackerman M. Advanced practice nursing role delineation in acute and critical care. Heart & Lung. 2000;29:210-221.
3. Rudy EB, Davidson LJ, Daly B, Clochesy JM, Seereika S, Baldisseri M, Hravnak M. Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: A comparison. Am Jour Crit Care. 1998;7:267-281.
4. Dahle KL, Smith JS, Ingersoll GL, Wilson JR. Impact of a nurse practitioner on the cost of managing inpatients with heart failure. Am Jour Card. 1998;82:686-688.
5. Mitchell-DiCenso A, Guyatt G, Marrin M, Goeree R, William A, Soutwell D, Hewson S, Paes B, Rosenbaum P, Hunsberger M, Baumann A. A controlled trial of nurse practitioners in neonatal intensive care. Pediatrics. 1996;98:1143-1148.


Practice Resource Network

QI am a staff nurse in a critical care unit, and my fellow nurses and I have been frustrated because of what we consider to be unsafe staffing ratios and patient assignments. Does AACN have written guidelines or recommendations for staffing ratios and requirements for critical care units?

ABecause of the nurse’s critical role as a patient advocate, the responsibility for ensuring safe, quality care for the patient is a real and valid concern. AACN strongly advocates that the delivery of care be driven by the patient’s needs. AACN does not advocate specific nurse-to-patient ratios. Instead, AACN “believes that resolving staffing dilemmas requires a thorough understanding of the interrelated factors that impact the quality of care delivered, such as acuity, skill mix and available resources.” (Refer to the AACN Position Statement titled “Maintaining Patient-Focused Care in an Environment of Nursing Staff Shortages and Financial Constraints,” which can be accessed through the “Practice” area of the AACN Web site at www.aacn.org.)
In evaluating staffing issues, nurses should be aware of and have knowledge about federal and state regulations and the Nurse Practice Act in their states.

Most acute-care hospitals receive government funding for Medicare and Medicaid patients, binding them to conditions of participation, which include staffing and quality of care guidelines. The Nurse Practice Act defines the legal scope of nursing practice. If you believe a violation has occurred, you are responsible for notifying your nursing supervisor first, then the State Board of Nursing.

To provide safe nursing care, the following activities must be carried out:1
• Accurate administration of medications and implementation of critical medical treatment regimens
• Protection of patients at risk of harming themselves
• Monitoring patients’ responses to medical and nursing interventions, consistent with each patient’s healthcare problem
• Notification of the physician of deteriorating or unexpected change in a patient’s status
• Accurate documentation of the care delivered to the patients

In today’s environment of healthcare staff shortages and cost constraints, the frequent lack of nursing staff is, unfortunately, common. If you feel that you have been placed in an unsafe situation, you are ethically and legally obligated to protect the patients. Ideally, you should identify and report the situation immediately, preferably before you accept the assignment.
Begin by reporting your concern to the charge nurse, nursing supervisor or nurse manager. Document your concerns in an objective way, providing specifics to back up your concerns. To protect yourself from legal liability, always keep copies of this documentation. Some state nurses associations have “Assignment Despite Objection” (ADO) forms. You may want to contact your state nurses association to obtain this form.

AACN’s Staffing Blueprint is a useful tool for evaluating and strategizing staffing needs and solutions for the staff nurse as well as the nurse manager. Included is a comprehensive reference list of sources where you can find more information on acuity and staffing needs. To order the AACN Staffing Blueprint: Constructing Your Staffing Solutions, call (800) 899-AACN (2226) or visit the AACN Web site at www.aacn.org and click on “Bookstore.” The price for this item (#300117) is $26 for members and $35 for nonmembers.

Referrence
Staffing Blueprint: Constructing Your Staffing Solutions. Aliso Viejo, Calif. American Association of Critical-Care Nurses. 1999;49.


Quarterly Clinical Publication Targets Advanced Practice Nurses


Are you looking for the most current information available for the advanced practice nurse in acute and critical care? AACN Clinical Issues publishes a range of topics that will help you stay up-to-date.

Each issue of this quarterly publication includes 10 to 12 articles on one to two current topics. In addition, at least three contact hours of continuing education credit are available with each issue. Among the topics covered in recent issues of this quarterly publication are nutrition; complementary and alternative therapies; pathophysiology; managing clinical and economic outcomes; and gastrointestinal disorders. Patricia Gonce Morton, RN, PhD, ACNP, FAAN, is the editor in chief.

To subscribe to AACN Clinical Issues, call Lippincott Williams & Wilkins at (800) 638-3030. The price is $72.55 per year for AACN members and $85 for others. A special student rate of $44 is also available. The subscription price for institutions is $200. Back issues can also be ordered.
 

Submit Research and Creative Solutions Abstracts for NTI 2002


Sept. 1, 2001, is the deadline to submit research and creative solutions abstracts for AACN’s National Teaching Institute™ and Critical Care Exposition, scheduled for May 4 through 9, 2002, in Atlanta, Ga.

Presenters of selected abstracts receive a $75 reduction in NTI registration fees. All other expenses are the responsibility of the presenter, who can be either the first author or a designate of the author.

Following is information about these abstracts:

Research
Abstracts can focus on any aspect of critical care nursing research, including reports of research studies or reports of research utilization. Only abstracts of completed projects will be accepted.

Abstracts reporting research studies must address the purpose; background and significance; methods; results; and conclusions.

Creative Solutions
Abstracts should focus on specific strategies and practice innovations that are used by nurses to solve difficult, unique or interesting problems in patient care, nursing practice, nursing management or nursing education. The creative solution must have been implemented, with outcomes evaluated.

Abstracts must address the purpose of the project and include a description of the creative solution, as well as evaluation and outcomes.

Accepted abstracts will be designated either as an oral presentation or as a poster presentation.

To obtain abstract forms, call (800) 899-AACN (2226), and request Item #6007, or visit the “Clinical Practice” area of the AACN Web site at www.aacn.org. Click on “Research.”


AACN Online Quick Poll

How long should orientation be for a new graduate nurse?

3-6 months 53%
3 months 28%
More than 6 months 14%
2 months or less 5%

Number of Responses: 1,180

The AACN Online Quick Poll is a voluntary, nonscientific survey on a variety of topics. AACN presents these surveys to give our users an opportunity to share their opinions on particular topics. Participate by visiting the AACN Web site at www.aacn.org.