Volume 29 Number 2

MARCH/APRIL 2007 Inside FEATURES Page 3 On the Road: Our Magnet Journey Discover how the Cleveland Clinic achieved and has maintained its Magnet status. Page 7 Using the SBAR Communication Technique To Improve Nurse-Physician Phone Communication: Marianne Sherman, MS, RN,C A Pilot Study Is the SBAR tool an effective communication technique? One pilot study attempts to identify the pros and cons. The University of Colorado Hospital investment in achieving a culture that fos- (UCH) is an academic medical facility ters these traits. It is considered the “GOLD Page 10 located in Denver that includes multiple Standard” for nursing work environments Serving Vulnerable outpatient care areas. It became the 44th and excellence in nursing (Goode et al., Populations: Improving hospital to receive Magnet Recognition® 2005). This translates to professional pride Pediatric Immunization in 2002 and was re-designated in 2005. in performance along with a desire to foster Rates in a Safely-Net Delivery System Historically, Magnet recognition focused clinical advances and excellence in care. Studies by the American Nurses Association Denver Health Community on nursing care of patients in the hospital Health Services targets a high- Tacute care settings. Magnet now looks at (ANA) (1983) and others (Kramer & risk pediatric population and nursing care throughout an organization. Schmalenbey, 2004, 2005), and a review of institutes recommended vaccines With the emphasis on patient care moving the Magnet literature (ANA, 1998; for low-income children in the to the outpatient arena, there is a great American Nurses Credentialing Center Denver area. opportunity for ambulatory care nurses to [ANCC], 2006; American Organization of demonstrate how Magnet organizational Nurse Executives [AONE], 2003; Colorado AAACN News qualities can have a positive impact on Center for Nursing Excellence, 2006) have Page 13 their nursing practice. The Magnet jour- identified consistent positive trends and New Products Released at ney offers ambulatory care nurses the outcomes associated with Magnet organiza- Conference tions. Examples of these positive trends are opportunity to demonstrate how Magnet Page 18 organizational qualities can positively shown in Table 1 (page 14). Real Nurses, Real Issues, impact patient outcomes and their own Real Solutions professional development. The Journey to Magnet Recognition The American Nurses Credentialing What is Magnet Recognition? Center (ANCC) oversees the Magnet desig- NEW spotlighton Organizations that receive Magnet nation process. The ANCC selection criteria Recognition emphasize strong professional are based on 14 quality indicators called the nursing values, quality patient care, and continued on page 14 PracticePractice Lost in a staffing maze? Don’t wander aim- lessly in your search for the best staffing The Official Publication of the American Academy of Ambulatory Care Nursing model. See page 19 to find what you’ve been seeking. From the PRESIDENT Celebrating The Tipping Point Thank you for the opportunity to serve as AAACN President. Last year in my President’s Address, I invited all AAACN members to start a positive epidemic as Reader Services connectors, mavens, and salespeople, and together AAACN Viewpoint we would lead the way in shaping the future of The American Academy of Ambulatory Care Nursing ambulatory care. And together as a team, we did just East Holly Avenue Box 56 that. Our Board of Directors, our management firm, Pitman, NJ 08071-0056 (800) AMB-NURS and each of you, our members, contributed to Fax (856) 589-7463 TAAACN’s Tipping Point. This column, my last, cele- E-mail: [email protected] Web site: www.aaacn.org brates achieving the “tipping point” and is dedicated to all our members who worked together on behalf of Beth Ann Swan AAACN Viewpoint is owned and published bimonthly by the American Academy of AAACN – to be the voice of ambulatory care nursing – real nurses, real issues, Ambulatory Care Nursing (AAACN). The and real solutions. newsletter is distributed to members as a direct benefit of membership. Postage paid at I asked each member to: Bellmawr, NJ, and additional mailing offices. • Be the tipping point for AAACN membership in your organization; recruit Advertising one member this year, and we will double our membership. Through the Contact Tom Greene, Advertising Just 1 Campaign, we recruited many new members, and we finished the Representative, (856) 256-2367. 2006 calendar year with 2,071 members, the 2nd highest in our history. As Back Issues To order, call (800) AMB-NURS or an organization, we worked on new membership marketing and recruit- (856) 256-2350. ment, as well as the development of a group membership. In addition, we Editorial Content focused on member retention strategies. AAACN encourages the submission of news • Start the epidemic in your organization. Attend the 2007 AAACN Annual items and photos of interest to AAACN mem- bers. By virtue of your submission, you agree Conference in Las Vegas with a colleague, and we will double our confer- to the usage and editing of your submission ence attendance. As I write this column, we are projected to have record for possible publication in AAACN's newslet- ter, Web site, and other promotional and edu- attendance in Las Vegas. cational materials. • Contact a new colleague that you met at the conference and share a best To send comments, questions, or article sug- practice, policy, or leadership tool. I heard from many members following gestions, or if you would like to write for us, contact Editor Rebecca Linn Pyle at the 2006 conference who were energized and reached out to contacts [email protected] they made at the conference. Listservs were active as well. AAACN Publications and • Share a AAACN education resource with a colleague. We worked to help Products you do this by updating the education resources flyer, adding a column in To order, visit our Web site: www.aaacn.org. Viewpoint titled “Spotlight on Practice” to highlight a practice setting and Reprints how ambulatory care nurses can benefit from AAACN education resources For permission to reprint an article, call (800) AMB-NURS or (856) 256-2350. in creative and innovative ways. We’ve also included excerpts of education Subscriptions resources on the AAACN Web site. The “AAACN Telehealth Nursing We offer institutional subscriptions only. The Practice Pearl of Wisdom” was another new feature added to Viewpoint. We cost per year is $80 U.S., $100 outside U.S. To subscribe, call (800) AMB-NURS or (856) developed new editions of the following publications: The AAACN Core 256-2350. Curriculum for Ambulatory Care Nursing (2nd Ed.), Ambulatory Care Nursing Indexing Administration and Practice Standards (2007), Telehealth Nursing Practice AAACN Viewpoint is indexed in the Administration and Practice Standards (2007), the Ambulatory Care Nursing Cumulative Index to Nursing and Allied Health Literature (CINAHL). Review Questions (formerly Self-Assessment) (2007), and the Telehealth © Copyright 2007 by AAACN. All rights Nursing Practice Resource Directory. AAACN education resources have been reserved. Reproduction in whole or part, elec- available at many national conferences due to participation of our volun- tronic or mechanical without written permission of the publisher is prohibited. The opinions teer leaders. expressed in AAACN Viewpoint are those of the • Spend time thinking about how to make your messages about AAACN contributors, authors and/or advertisers, and do not necessarily reflect the views of AAACN, membership compelling and more contagious. Reach as many ambulatory AAACN Viewpoint, or its editorial staff. care nurses as possible and tell them about AAACN. In my Publication Management by November/December 2006 President’s Column in Viewpoint, I highlighted Anthony J. Jannetti, Inc. all our volunteer leaders who participated in national advocacy activities on behalf of AAACN and contributed to starting the epidemic. Also from this American Academy of Ambulatory Care Nursing continued on page 12 Real Nurses. Real Issues. Real Solutions.

2 VIEWPOINT MARCH/APRIL 2007 Gloria Gresko, RN • Promote positive outcomes for patients (American Nurses’ Credentialing Center [ANCC], 2007). Refrigerator magnets have been widely used as a mar- As of January 2007, 224 hospitals in the United States keting device for telehealth call centers. Staff at Nurse on have been recognized as ANCC Magnet hospitals, includ- Call (NOC) from the Cleveland Clinic pass out hundreds of ing the Cleveland Clinic (ANCC, 2003). Magnet designa- magnets at health fairs and local community centers to tion is in effect for a 4-year term, and our expiration date is attract consumers to our services. Since November 2005, quickly approaching. The processes for re-designation are our focus has been on a different kind of magnet – The identical to those of the original application and require Magnet Recognition Program®. In collaboration with all the the submission of written documentation and a site visit nursing divisions within our health care organization and (ANCC, 2004). Maintaining our Magnet status is a Rled by our Chief Nursing Officer (CNO), we have started hospital-wide, organizational goal. From our past, we know on the arduous yet exciting journey toward the achieve- that the appraisal process is a valuable and rewarding ment of Magnet designation. experience for the entire hospital. Uniting with the admin- The term “Magnet” in the Magnet Recognition istration and ancillary departments as we go through this Program was initially used to describe hospitals that had process of self-assessment has created an organizational the ability to attract and retain nurses. In 1981, facing a energy that seems to be growing stronger as our journey serious nursing shortage, a task force established by the continues. American Academy of Nursing conducted a study of hospi- At the onset, it was apparent that the foundation was tals across the nation. Forty-six hospitals were identified as laid and the cornerstones were well set. We have the having common characteristics that accounted for their encouragement and support of our Chief Executive Officer, success in recruiting nurses, maintaining a low nursing as well as our Hospital and Regional Health Administrators. turnover and vacancy rate, and high nurse satisfaction We have well-established, operationalized structures and (Havens & Aiken, 1999). Forty-one of the 46 hospitals that processes in place. Standing strong are a dynamic Nursing agreed to participate in the study became known as Research and Innovations Department, an evidence-based “Magnet Hospitals.” The organization characteristics of nursing practice, Shared Governance Councils, Preceptor these Magnet Hospitals laid the foundation for and evolved and Mentoring Programs, and a finely tuned Staff into the 14 key “Forces of Magnetism” utilized in today’s Development Department. designation process. We have two experienced and energetic individuals – Since 1990, the American Nurses’ Credentialing Center our Magnet Coordinator and Assistant Coordinator – to (ANCC), a branch of the American Nurses Association help lead us through this process. Along with our CNO (ANA), has had the task of designating hospitals as and Nurse Executive Committee, they are charged with “Magnet Hospitals.” This is done through what is now sifting through enormous amounts of submitted documen- called the Magnet Recognition Program (Bliss-Holtz, tation, capturing our unique elements, and bringing our Winter, & Scherer, 2004). The program’s purpose is to rec- story to life. Having these pillars already in place before ognize health care institutions that provide excellent nurs- beginning the process has made our journey easier. With ing care based on the evolved 1981 Magnet Hospital find- the desire to be recognized as a health care organization ings. The program’s goals are to: that provides the very best in nursing care, we confidently • Identify excellence in the delivery of nursing services. began the application process. • Promote quality of health care services in an environ- There are four phases to the application process. Bliss- ment that supports nursing practices. Holtz et al. (2004) define them as: • Provide a means for the dissemination of best practices • The application process. in nursing services. continued on page 4

WWW.AAACN.ORG 3 • Submission of documentation and document review phase. • The site visit phase. • The decision phase. We are between phase one and two. It is during this time of appraisal that nurses at NOC and throughout the hospital are taking an inventory of our best nursing prac- tices, performing a self-assessment, and determining who we are as one nursing entity within the organization. We are formulating goals and deciding what we want to be in the future. Forces of Magnetism To begin with, nurses were asked to volunteer to rep- resent their coworkers by becoming Magnet Ambassadors. Along with our nurse managers, ambassadors attend com- mittee meetings, provide a communication link between our respective departments and the Magnet Committee, Bulletin boards are a creative means of education and a collective and assist in the ongoing education of staff members as expression of individual departments. well as new employees. At the first committee meeting, the Magnet Coordinator provided an overview of the our peer review Quality Management System (QMS) with Magnet Recognition Program, a timeline for designation, a call monitoring forms and criteria for evaluation. All calls plan of action, and homework. The homework involved into our center are recorded. Four calls per quarter for each reviewing the Components, Sources of Evidence, and Best nurse are reviewed by a senior staff nurse and scored on a Practices for Forces 1 through 7. After reviewing them, 100-point system. This process gives an objective measure brainstorming, and obtaining input from nurses within the of how well the nurse is performing and allows for the for- department, the ambassadors were asked to answer these mation of personal improvement goals. As one of our tech- three questions. niques, this performance appraisal ensures that nurses are • What is currently present in my work environment that following the same call process guidelines. It has proven to reflects the sources of evidence? increase our productivity, decrease our call abandonment • What is needed in my work environment that reflects rate, and improve patient and physician satisfaction. the sources of evidence? The third question we responded to was “How do nurs- • What recommendations do you have to improve in es in your clinical area exercise judgment to resolve patient this area? care issues?” (Force 9: Autonomy). All symptom-based calls This homework was repeated for Forces 8 through 14. received at NOC require that we use the nursing process. In subsequent meetings, the answers were discussed by Within the parameters of Cleveland Clinic physician- the group and compiled. To further refine the answers, approved protocols and a standardized call-flow process, each of the ambassadors focused on a specific Source of we prioritize the urgency of the patient’s condition and Evidence and submitted formal written documentation needs. We systematically assess the patient’s symptoms and along with tangible supporting evidence of our best prac- extend our assessment to determine whether a particular tice examples. guideline fits that specific patient. We utilize nursing knowl- Many of the 164 sources of evidence, subsumed under edge obtained from our education, experience, critical the 14 Forces of Magnetism, focus on hospital nursing. thinking, and judgment to develop a plan of care and Our first challenge at NOC was to interpret and identify determine how soon a patient should see a physician. With how as a sub-specialty within ambulatory care we comply any call, we can upgrade a recommendation and advise with the forces. the patient to be seen sooner than the protocol states. For NOC provided formal documentation for four of the any Cleveland Clinic patient we triage, if we determine sources of evidence. Our first submission addressed was that his or her condition does not warrant an emergent “How is staffing adjusted in response to patient workload and recommendation, we can collaborate with the physician acuity?” (Force 4: Personnel Policies and Programs). We on call. If appropriate, a new plan of care is devised, and reported our staggering start times with additional staff to the physician would approve the downgrading of the pro- meet anticipated high call volume. Based on the Deming tocol recommendation. Improvement Model, we presented evidence that our The final documents we submitted were in response to abandonment rate for calls went from 27% to 14% “List some of the community programs in which nurses in because of process improvements and changes in staffing your area are involved where they represent nursing as a pro- patterns. fession” (Force 10: Community and the Healthcare In response to “How has your performance appraisal Organization). Along with a picture of the nurse and expla- improved your practice?” (Force 4: Personnel Policies and nation of his or her involvement in the community, we Programs), we highlighted one specific way and provided submitted:

4 VIEWPOINT MARCH/APRIL 2007 • A camp brochure for the nurse that has provided med- Continuing Nursing Education ical advice and treatment at a children’s summer camp In our continuous learning environment, the Division for the past 12 years. of Nursing has begun conducting a series of educational • A thank you note from the teacher given to the nurse courses on Nursing Practice and the Magnet Recognition that has taught an AIDS/HIV information class to high Program. The series consists of four sessions and includes school students for the past 13 years. the following topics: • A Board of Trustees’ roster, which lists the nurse who • An Introduction to the Cleveland Clinic Professional volunteers her time at a non-profit community center Nursing Practice and the American Nurses that provides medical and dental care to indigent Credentialing Center. patients. • The Cleveland Clinic Nursing Practice integration of Our ambassadors continue to submit miscellaneous Magnet Forces 1-7. sources of evidence to the Magnet Committee. • The Cleveland Clinic Nursing Practice integration of Interpreting and identifying how we at NOC comply with Magnet Forces 9-14. the Forces requires us to take the time to closely look at • Sustaining the Magnet Culture within the Cleveland ourselves, recognize what we do and who we are, and Nursing Practice Structure. define it. This has proven to be a positive, team-building experience. Communication Is Key Communicating frequently and informing In upcoming Magnet Committee others about “the status of the process” meetings, we are having open discussions of Frequently Asked Questions at the Site are essential elements in successfully Visit. Ambassadors for each site are responsible for communicating the pursuing designation. Magnet meeting content and any desig- nation initiatives to their co-workers. This is accomplished The educational series is mandatory for all nurses, and through various methods, such as e-mail communication, ANA Continuing Nursing Education contact hours are distribution of the meeting minutes, informal presentations granted. For nurses who are unable to attend these ses- at staff meetings, and unit-based newsletters. sions, videotapes are available for independent study. The Communicating frequently and informing others about courses have been offered quarterly, and so far, we have “the status of the process” are essential elements in suc- completed two of the sessions. They have received positive cessfully pursuing designation (Havens & Johnston, 2004). responses from the nurses and have proven to be very There are multiple avenues of communication within the informative. By spreading out the educational sessions Cleveland Clinic system. Through our nursing publications throughout the year, it has helped to keep nurses engaged (News in Nursing, Destinations in Nursing, Notable Nursing), and the momentum going. divisional publications (Regional Health “Affairs,” President of Nursing newsletters) and hospital-wide publications Conclusion (Innerpulse Extra, Innerpulse Weekly), we are able to keep Keeping the Magnet energy and spirit alive is vital dur- everyone up-to-date. Our award-winning Division of ing the entire designation process. In doing so, it is foster- Nursing Web site and Magnet home page offers the ing a spirit of teamwork and strengthening our culture of opportunity for anyone to tell his or her story and share collaboration. Some examples of our efforts include: examples of ways that we excel at meeting Magnet stan- • All nurses have received a Shared Governance pin and dards. a Magnet calendar. Another means of communication that also serves to • Our bulletin boards hang proudly along with multiple help educate employees are bulletin boards. Most of the banners throughout the hospital. clinical areas have a bulletin board making it a convenient • A diverse group of executive, managerial, and staff vehicle for communicating important events. Bulletin nurses attended the 2006 Magnet Conference in boards have been used to hang flyers regarding upcoming Denver, CO. Shared Governance Forums, Nursing Grand Rounds, Town • In the future, we will be having a “mock visit” experi- Hall Meetings with our Chief Nursing Operator, and ence. Continuing Education opportunities. The Magnet With genuine enthusiasm, we prepare for and eagerly Committee recommended that the ambassadors focus on await our real site visit. It will be greatly rewarding to be one Force of Magnetism per month. Many ambassadors acknowledged by our peers for our excellence in nursing care. chose to use bulletin boards to illustrate to their clinical Effective communication, frequent educational offer- area what the Forces of Magnetism meant to all of them. ings, and a positive energy have helped to propel us on The bulletin boards have been a creative means of educa- this Magnet journey. By taking the time to look closely at tion and a collective expression of individual departments. ourselves at NOC, we have been able to interpret the Forces of Magnetism and identify how we are acculturated continued on page 6

WWW.AAACN.ORG 5 within our nursing environment, our health care organization, and our com- The 14 Forces of Magnetism munity. When we attain Magnet desig- nation, of course, we will celebrate. For Force I: Quality of Nursing Leadership Force VIII: Consultation and Resources right now, we are enjoying the process. Nursing leaders are perceived as knowledge- Adequate consultation and other human able, strong risk takers who follow an articu- resources are available. Knowledgeable Gloria Gresko, RN, is the Magnet lated philosophy in the day-to-day operations experts, particularly advanced practice nurses, Ambassador for Nurse on Call at The of the nursing department. Nursing leaders are available and used. In addition, peer sup- Cleveland Clinic, Cleveland, OH. She may be reached via e-mail at [email protected] also convey a strong sense of advocacy and port is given within and outside the nursing support on behalf of the staff. division. References Force II: Organizational Structure Force IX: Autonomy American Nurses Credentialing Center Organizations are characterized as flat, rather Nurses are permitted and expected to prac- (ANCC). (2003). Magnet designated facil- than tall, structures in which unit-based deci- tice autonomously, consistent with profes- ity information: Cleveland Cinic. Retrieved sion making prevails. Nursing departments sional standards. Independent judgment is January 15, 2007, from http://www.nur- secredentialing.org/magnet/getdetail.cf are decentralized, with strong nursing repre- expected to be exercised within the context m?magnetid=1200 sentation evident in the organizational com- of a multidisciplinary approach to patient American Nurses Credentialing Center mittee structure. The nursing leader serves at care. (ANCC). (2004). Magnet Recognition the executive level of the organization, and Force X: Community and the Health Program [brochure]. Silver Spring, MD: the Chief Nursing Officer reports to the exec- Care Organization Author. utive level. American Nurses Credentialing Center Organizations that are best able to recruit (ANCC). (2007). What is the Magnet Force III: Management Style and retain nurses also maintain a strong com- Recognition Program? Retrieved February Organization and nursing administrators use munity presence. A community presence is 9, 2007, from http://www.nursing- a participative management style, incorpo- seen in a variety of ongoing, long-term out- world.org/ancc/magnet/index.html Bliss-Holtz, J., Winter, N., & Scherer, E.M. rating feedback from staff at all levels of the reach programs. These outreach programs (2004). An invitation to Magnet accredi- organization. Feedback is characterized as result in the organization being perceived as tation. Nursing Management, 35(9), 36- encouraged and valued. Nurses serving in a strong, positive, and productive corporate 42. leadership positions are visible, accessible, citizen. Havens, D.S., & Aiken, L.H. (1999). Shaping and committed to communicating effectively Force XI: Nurses as Teachers systems to promote desired outcomes: with staff. The Magnet hospital’s model. Journal of Nurses are permitted and expected to incor- Nursing Administration, 29(2), 14-20. Force IV: Personnel Policies and porate teaching in all aspects of their prac- Havens, D.S., & Johnston, M.A. (2004). Programs tice. Teaching is one activity that reportedly Achieving Magnet hospital recognition: Salaries and benefits are characterized as gives nurses a great deal of professional satis- Chief nurse executives and Magnet coor- competitive. Rotating shifts are minimized, faction. dinators tell their stories. Journal of and creative and flexible staffing models are Nursing Administration, 34(12), 579-588. Force XII: Image of Nursing used. Personnel policies are created with staff Nurses are viewed as integral to the organi- involvement, and significant administrative zation’s ability to provide patient care and clinical promotional opportunities exist. services. The services provided by nurses are Force V: Professional Models of Care characterized as essential by other members Models of care are used that give nurses the of the health care team. responsibility and authority for the provision Force XIII: Interdisciplinary Ambulatory of patient care. Nurses are accountable for Relationships their own practice and are the coordinators Interdisciplinary relationships are character- Certification of care. ized as positive. A sense of mutual respect is Fall Date Force VI: Quality of Care exhibited among all disciplines. Nurses perceive that they are providing high- Force XIV: Professional Development quality care to their patients. Providing quali- Exam: October 20, 2007 Significant emphasis is placed on orientation, ty care is seen as an organizational priority as Application deadline: in-service education, continuing education, well, and nurses serving in leadership posi- formal education, and career development. July 6, 2007 tions are viewed as responsible for develop- Personal and professional growth and devel- August 3, 2007, with $35 late fee ing the environment in which high-quality opment are valued. In addition, opportuni- care can be provided. Go to ties for competency-based clinical advance- www.nursecredentialing.org Force VII: Quality Improvement ment exist, along with the resources to for more information or call Quality improvement activities are viewed as maintain competency. 800-284-2378 educational. Staff nurses participate in the Go to www.aaacn.org quality improvement process and perceive Source: Reprinted with permission from the the process as one that improves the quality American Nurses Association, Magnet for more information on test Recognition Program®. preparation resources. of care delivered within the organization.

6 VIEWPOINT MARCH/APRIL 2007 Using the SBAR Communication Technique To Improve Nurse-Physician Phone Communication: A Pilot Study Karen L. Rodgers, MSN, CCRN

Voice mail, e-mail, text messaging, faxing, and paging: (SBARR) in which the listener “repeats back” what he or she despite the plethora of means available, concise and accu- has heard. This simple format, which mirrors the scientific and rate communication remains an elusive goal. According to nursing process, can be used to organize both verbal and writ- the Joint Commission on Accreditation of Healthcare ten communication. Although the format remains the same, Organizations (JCAHO), communication errors are the root content may be situation specific. cause of almost 70% of sentinel events, and 75% of the Dr. Michael Leonard of Kaiser Permanente, Colorado, patients involved died (Leonard, Graham, & Bonacum, has done extensive work with the SBAR tool. He believes 2004). Both JCAHO and the Institute for Healthcare that nurses and physicians have been educated differently, VImprovement (IHI) are espousing the use of a communica- and thus, communicate as if they are speaking different lan- tion tool known as Situation, Background, Assessment, and guages (Groff & Augello, 2003). According to Dr. Leonard, Recommendation (SBAR). Unfortunately, even a cursory liter- nurses are trained to be very descriptive since they are gen- ature review reveals not only the massive scope of health erally taught that diagnosis is the physician’s prerogative. care’s communication problem, but also the lack of evidence Physicians on the other hand are taught to be concise. supporting the use of SBAR. The IHI maintains an SBAR dis- While the nurse is speaking on the phone, the physician is cussion group where professionals seek information about impatiently waiting for him or her to get to the point. Dr. how to implement and measure its effectiveness (Institute Leonard believes that nurses and physicians need to recon- for Healthcare Improvement [IHI], 2006). Should SBAR be cile their differences in order to communicate effectively. taught as a format to facilitate oral communication, or SBAR provides a predictable structure for communication should nurses be required to complete forms with every and promotes critical thinking. It makes use of critical lan- phone call? Does SBAR improve communication, or are guage, such as “I am concerned,” in order to focus the lis- improvements secondary to other factors? What outcomes tener’s attention. Although the recommendation may not be should be measured and how? Prior to implementing an the correct answer, the value lies within clearly defining the institution-wide training program on the use of SBAR to situation (Leonard et al., 2004). facilitate nurse-physician telephone communication, a pilot A Solution in Transition study was conducted in an attempt to identify problems SBAR is one piece of a patient safety program imple- before money and time were invested. Although the study mented within Kaiser Permanente, which draws upon princi- did not produce statistically significant data supporting the ples of team management and training first studied within use of SBAR, it did smooth the implementation process. the aviation industry. Following the implementation of for- The SBAR Model malized briefings within the perioperative environment, A Shared Format for Communication wrong site surgeries fell to zero, and nursing turnover rates decreased by 16% (Leonard et al., 2004). However, how SBAR is a communication format, which was initially devel- much of this improvement can be attributed to SBAR and oped by the military and refined by the aviation industry to how much is due to the effect of team training? reduce the risks associated with the transmission of inaccurate and incomplete information. As previously mentioned, the Choosing and Measuring Outcomes acronym SBAR stands for Situation, Background, Assessment, Measuring the Nonexistent and Recommendation. In other words, the person doing the Part of the problem with measuring the effectiveness of communicating starts by stating what is happening right now, any safety procedure is that it is difficult to measure what does moves on to the context, provides a problem assessment, and not happen. For example, plane crashes are fortunately infre- suggests a solution. Some organizations add an additional R quent. Therefore, the aviation industry cannot realistically look Contact hour instructions, objectives, and accreditation information may be found on page 9.

WWW.AAACN.ORG 7 at reductions in the number of crashes in order to evaluate its Results safety programs. Instead, safety experts have evaluated Statistically insignificant results. Although 31 surveys were improvement in employee attitudes toward safety. Sometimes, returned, only 9 sets of pre-and post-training scores were they have simply investigated whether or not employees per- available for analysis. Unfortunately, one of the nursing units ceive a tool to be helpful (Pizzi, Goldfarb, & Nash, 2001). closed prior to post-training data collection. As a result, no Similar attitude surveys may prove useful in measuring the significant difference was found between pre- and post- impact of SBAR, at least in the initial stages of implementation. training mean anxiety and skill scores. However, analysis of Choosing Appropriate Dependent Variables the total data set did yield some interesting findings. Rosenstein’s research on disruptive behavior provided Tool reliability. After deleting one item purporting to some interesting responses about nurse-physician telephone measure skill and one to measure anxiety, the tool was communication. Nurse respondents indicated that disruptive found to be internally consistent. Total-item analysis yielded behavior commonly occurred after placing calls to physicians. p values of 0.000 and 0.002. Cronbach’s Alpha scores were Physicians cited ill-timed calls and calls that were placed 0.873 and 0.731. Although the survey tool certainly needs before the nurses had gathered all necessary information as additional testing, it may prove useful in further evaluation factors in disruptive behavior (Rosenstein, 2002). Additional of SBAR training. research by Rosenstein documented multiple responses Correlations between anxiety, skill, and experience. A moder- about the deleterious effect poor telephone communication ately strong inverse relationship existed between mean anxi- has on patients. Some nurses indicated that they were afraid ety and mean skill scores (p = 0.000). In addition, One Way to call certain physicians, therefore delaying care (Rosenstein ANOVA values showed significant differences between the & O’Daniel, 2005). Considering Rosenstein’s research, it is mean anxiety scores from different nursing units (p = 0.002). valid to measure variables, such as nurses’ perceptions of The Telemetry Unit’s mean anxiety score (3.2143) was signifi- anxiety and skill related to calling physicians. cantly higher than that of the Rehabilitation Unit (2.0536) (p = 0.001). Was this secondary to patient acuity or other fac- The Pilot Study tors? The Telemetry Unit’s demographics differed from that of Purpose and Hypotheses the Rehabilitation Unit in that 47.6% of the respondents from The study was designed to pilot a means of implement- Telemetry had been registered nurses less than 5 years, and ing SBAR and measuring its effectiveness. The results were 42.9% had been employed on the unit less than 1 year. used to make training revisions. Two hypotheses were tested. However, 50% of the respondents from the Rehabilitation The first hypothesis was that nurses who were trained to use Unit had been on the unit for more than 5 years. the SBAR tool when calling physicians would demonstrate decreases in mean anxiety scores as measured by a Likert- Discussion style attitude survey. The second hypothesis was that nurses Although the data failed to support the hypotheses, this would demonstrate an increase in mean scores measuring does not mean that SBAR training was useless. Rather, the their perceptions of skill as related to calling physicians. results were impacted by small sample sizes and extraneous variables, such as unit closure. Indeed, results seem to indicate Variables that training should be concentrated on less-experienced As noted, the dependent variables were nurses’ percep- practitioners. In addition, responses to the open-ended survey tions of anxiety and skill related to calling physicians. The questions and informal conversations during unit rounds indi- independent variable was actually the training program and cate that some less-experienced nurses feel more comfortable tools used to implement SBAR. The SBAR tool from the IHI making calls using SBAR as a guide As one nurse stated, Web site was given some minor revisions and printed in “Sometimes it’s still hard for me to know how all the pieces fit tablet form as a worksheet (IHI, 2005). The training consist- ® together.” ed of a PowerPoint presentation and role-play. Nurses were A one-size-fits-all approach to communication will not also provided with pocket cards outlining SBAR. Posters and work. Nurses from all areas of practice should learn how to copies of the SBAR tool were placed around the units. In communicate using the basic SBAR format. Using their addition, phone stickers were utilized to remind nurses to expertise, they should then adapt the format to their prac- gather all necessary materials prior to making calls. tice environment and mentor less-experienced colleagues. Methods As with any worthwhile pursuit, improvement in communi- The research design was quasi-experimental, consisting cation will take time. of a treatment group without a control group. A conven- ience sample of registered nurses was drawn from 3 in- Karen L. Rodgers, MSN, CCRN, is a Critical Care Educator, Organizational Education, Humility of Mary Health Partners (HMHP), patient units. Although various valid tools for measuring Youngstown, OH. She may be contacted via e-mail at anxiety are available, none of these tools specifically meas- [email protected] ures anxiety secondary to communication, nor do they measure perceptions of communication skill. The nurses References completed a pre- and post-training survey tool designed for Groff, H., & Augello, T. (2003, July). From theory to practice: An inter- view with Dr. Michael Leonard. Retrieved December 29, 2006, the study. The tool consisted of 16 Likert-style scaled items from http://www.rmf.harvard.edu/files/documents/Forum_V23N3_a5.pdf as well as two open-ended items, providing both quantita- Institute for Healthcare Improvement (IHI). (2005). SBAR technique for com- tive and qualitative data. munication: A situational briefing model. Retrieved December 29,

8 VIEWPOINT MARCH/APRIL 2007 2006, from http://www.ihi.org/IHI/Topics/PatientSafety/Safety General/Tools/SBARTechniqueforCommunicatonASituationalBriefin gModel.htm Institute for Healthcare Improvement (IHI). (2006). Web and action: Using SBAR to improve communication. Retrieved December 29, 2006, from http://www.ihi.org/ihi/forums/ShowForum.aspx?ForumID: 97 Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: Announcing The critical importance of effective teamwork and communica- tion in providing safe care. Quality Safe Health Care, 13, 185-190. 4th Annual Viewpoint Pizzi, L., Goldfarb, N.I., & Nash, D.B. (2001). Crew resource manage- Writer’s Award Call for Manuscripts ment and its applications in medicine. In K.G. Shojania, B.W. Duncan, & K.M. McDonald (Eds.), A critical analysis of patient safety practices (pp. 505-513). Rockville, MD: Agency for Health Research and Quality. Rosenstein, A.H. (2002). Nurse-physician relationships: Impact on Viewpoint, the official publication of the American nurse satisfaction and retention. American Journal of Nursing, Academy of Ambulatory Care Nursing, announces 102(6), 26-34. a call for manuscripts for the 4th Annual Rosenstein, A.H., & O’Daniel, M. (2005). Disruptive behavior & clini- cal outcomes: Perceptions of nurses and physicians. American Viewpoint Writer’s Awards. Journal of Nursing, 105(1), 54-64. The purpose of this annual award is to encourage and recognize excellence in ambulatory care nursing. Manuscripts published in the newsletter on topics in To Obtain CNE Credit ambulatory care nursing practice, clinical research, and professional development and leadership are eli- 1. For those wishing to obtain CNE credit, please use the gible for consideration. Articles published in 2007 are evaluation form inserted in this newsletter, or visit the AAACN Web site (www.aaacn.org). Read the article, eligible for consideration. An awards committee will “Using the SBAR Communication Technique to Improve select the winning manuscripts. The awards, consist- Nurse-Physician Phone Communication: A Pilot Study,” ing of a plaque and one complimentary registration to and complete the answer/evaluation form. the 2008 AAACN Convention, will be presented at 2. Photocopy and send the answer/evaluation form along the 33rd Annual AAACN Convention in Chicago, IL. with your credit card payment or check ($15 mem- The winners will be notified by mail and announced bers/$20 non-members) payable to AAACN, East Holly in Viewpoint. Avenue Box 56, Pitman, NJ 08071–0056. 3. Evaluation forms must be postmarked by February 28, Guidelines 2009. Upon completion of the answer/evaluation form, 1. Manuscripts must be approximately 4-7 typed, a certificate for 1.1 contact hour(s) will be awarded and double-spaced pages (1,000 to 2,000 words). sent to you. Style should follow the Publication Manual of the American Psychological Association (5th Objectives ed.). The purpose of this continuing nursing education series is to increase the awareness of nursing management issues in 2. The manuscript and a cover letter must be sub- nurses and other health care professionals. After studying mitted to the editor. The author(s) must indi- the information presented in this series, you will be able to: cate in a cover letter that the manuscript is not 1. Define SBAR and identify its components. currently under review or being published by 2. Cite some of the difficulties involved in designing stud- another publication. ies to measure the effectiveness of using the SBAR tech- 3. Color or black & white photographs (5”x 7” or nique. 3”x 4”) and/or 35 mm slides that will help 3. Identify two implications for further research. enhance the article are welcome and encour- Note: The author and editor reported no actual or potential aged. Please submit digital photographs that conflict of interest in relation to these continuing education are high-resolution (300 dpi). nursing articles. Please contact the AAACN National Office for Sally S. Russell, MN, CMSRN, disclosed that she is on the author guidelines and more information: Advisory Board for Roche/Abbott Labs. This educational activity has been co-provided by AAACN and Anthony J. Jannetti, Inc. Carol Ford, Managing Editor Anthony J. Jannetti, Inc. is accredited as a provider of continuing nurs- Viewpoint ing education by the American Nurses’ Credentialing Center’s East Holly Avenue Box 56 Commission on Accreditation (ANCC-COA). Pitman, NJ 08071-0056 AAACN is a provider approved by the California Board of Registered (856) 256-2433 Nurses, provider number CEP 5336. Licenses in the state of CA must retain this certificate for four years after the CE activity is completed. FAX (856) 589-7463 These articles were reviewed and formatted for contact hour credit by e-mail: [email protected] Sally S. Russell, MN, CMSRN, AAACN Education Director; and Rebecca Linn Pyle, MS, RN, Editor.

WWW.AAACN.ORG 9 Serving Vulnerable Populations: Improving Pediatric Immunization Rates in a Safety-Net Delivery System A 2006 Codman Quality Award-Winning Project in Ambulatory Care

Vickie J. Leger, MS, RNC physician’s offices and public health Mumps Rubella (MMR), 3 Anne L. Hammer, BSN, RN clinics. Haemophilus influenzae type b (Hib), Denver Health Community Health and 3 Hepatitis B (Hep B) vaccines (4- Note: The Joint Commission on Services identified the need to increase 3-1-3-3 series). Accreditation of Healthcare Organizations childhood immunization rates in the Denver Health began assessing announced the 2006 organization and high-risk pediatric population served childhood immunization rates in their individual winners of the 10th Annual through their safety-net delivery sys- primary care sites in 1993 by chart Ernest Amory Codman Award to recog- tem. Denver Health is a comprehen- audit. Given the low immunization nize excellence in the use of outcomes sive, integrated health care organiza- rates realized in these clinics and measurement to achieve improvements in tion with multiple components, knowing these rates put our communi- the quality and safety of health care. The including a network of 9 Family Health ty at risk for outbreaks of vaccine-pre- Codman Award is the first national health Centers (primary care clinics) in the ventable diseases, we developed an care award that recognizes excellence in low-income communities of Denver, initiative that included multiple strate- performance measurement. In the ambu- latory care category, Denver Health and CO. Denver Health is the primary gies known to improve pediatric Hospitals Authority Community Health provider of care to the low-income immunization rates. The key method Services was the award recipient. Vickie populations in the city and county of to improve our vaccine rates was the Leger, a member of AAACN, is the Director Denver, and serves approximately 35% development of an immunization reg- of Nursing Services for Denver Health of Denver’s children. istry to accurately track our patients, Community Health Services The specific goal of the initiative regularly assess immunization levels, was to ensure that targeted children and improve the on-time delivery of A successful initiative includes a received all recommended vaccines by vaccines in our primary care clinics. well-defined and executed process, 24 months of age. At the time the ini- This initiative required the alloca- along with the support of those tiative began, those vaccines recom- tion of financial resources for the reg- involved with day-to-day operations. mended for delivery by 24 months of istry development and human Nursing plays a critical role in assuring age were 4 Diphtheria, Tetanus, resources for both registry develop- that processes are developed with Pertussis (DTaP)-3Polio (IPV)-1 Measles, ment and the site-based quality input from stakeholders. From the first steps of problem identification and Athroughout the design, implementa- tion, and review of outcomes, nursing involvement assures a user-friendly project, which leads to improved patient outcomes. Immunizations provide protection against vaccine-preventable diseases, thus promoting patient health, public health, and decreasing costs associated with illness. The majority of pediatric immunizations are provided in ambu- latory primary care clinics. The estimat- ed savings associated with pediatric vaccines are $6.30 of direct savings and $18.42 indirect for each $1.00 spent on vaccine delivery. Universal vaccination is a critical component of quality health care and is best accom- Pictured (L-R): Terence Shea, Director of Regulatory Compliance at Denver Health; Lon Berkley, plished through routine and intensive JCAHO; Vickie Leger, Nursing Director of Community Health Services at Denver Health; Anne Hammer, Coordinator of Denver Health Immunization Program; Paul Melinkovich, MD; Director of vaccination programs implemented in DH Community Health Services; and Dean Brown, President of Community Health Services Board.

10 VIEWPOINT MARCH/APRIL 2007 Figure 1. Denver Community Health Pediatric Immunization Rate

Community Health Pediatric Patients Percent UTD @ 12 mos (3:2:2:2) & 24 mos (4:3:1:3:3) 100%

90%

80%

70% 12 mo UTD DTaP Shortage: Recommendation to suspend 4th & 5th 60% DTaP doses, 4/21/01

24 mo UTD 50% Reminder / Recall System implemented syste-wide, 4/98 Percent UTD Percent

40%

Immunization Registry started in Newborn Nursery, 12/19/96, 30% and implemented across our Immunization Registry system gradually over 8 weeks; initiated in Immunization Consistently recording data as of Clinic, 4/95 4/1/97 20%

DTaP Shortage 10% lifted, 10/23/02 Also occuring system-wide during this time: *Quarterly A FIX Assessments to improve immunization rates in each clinic * Flag of WIC program patients not UTD on immunizations 0% May-95 May-96 May-97 May-98 May-99 May-00 May-01 May-02 May-03 May-04 May-05 Sep-95 Sep-96 Sep-97 Sep-98 Sep-99 Sep-00 Sep-01 Sep-02 Sep-03 Sep-04 Sep-05 Jan-95 Jan-96 Jan-97 Jan-98 Jan-99 Jan-00 Jan-01 Jan-02 Jan-03 Jan-04 Jan-05

Quarter/Year improvement work. Financial resources training and ongoing support, distrib- in site-specific QI meetings to review were made available through funding ute the monthly reminder/recall lists this data and plan and implement from the state health department for and postcards, communicate updated improvement projects as necessary. immunization improvement activities. immunization information to staff, and Immunization records for all active A multi-disciplinary team was assem- assist with team immunization quality patients in our target population are bled to oversee the initiative. Leaders improvement projects. All primary care analyzed on a quarterly basis. On aver- from throughout the Denver Health sites also have an immunization age, we review quarterly the vaccine and Hospital Authority Agency, includ- “champion.” The immunization cham- history for a cohort of over 3,000 1- ing Community Health, Public Health, pion is a member of the nursing staff year olds and an equal number of 2- Inpatient Newborn Nursery, and who is the registry super user, is year olds. After the data are down- Information Services divisions were responsible for maintaining the clinic’s loaded, trend line graphs, involved in the planning of the initia- vaccine inventory, is a local resource immunization rate assessment diag- tive and commitment of resources. A for staff members regarding immuniza- nostic reports, and micro-system full-time RN and full-time Data Entry tions and the recommended schedule, report cards are generated and dis- Clerk were allocated to work on moni- and is responsible for the clinic’s seminated to each team. toring performance, developing the reminder/recall activities. All sites also Site-based process improvement registry, and conducting improvement have an immunization team dedicated activities included: activities at all of our primary care to this initiative. The teams vary in • Quarterly immunization rate sites. In 1995, a partnership with the makeup. In some clinics, they consist assessments. state Primary Care Association was of a selected group of staff members; • Semiannual immunization team developed to assist staff with audits in other clinics, the entire pediatric meetings. and site-specific QI activities. staff also functions as the immuniza- • Reminder/recall activities. The Immunization Program RN tion team; in other clinics the Physician • Development and sharing of and Data Entry Clerk served, and con- Team Leader and Nursing Program immunization “best practices.” tinue to serve, as immunization Manager comprise the team. The team • Celebrating successes and team resources to our agency’s clinical and is involved in receiving immunization incentives. clerical staff. They provide registry rate assessment data and participating

WWW.AAACN.ORG 11 Over the past 10 years, our immu- need for direct provider involvement. Health Promotion. (n.d.). Healthy People nization rates have improved dramati- Initial and on-going nurse commitment 2010. Retrieved January 26, 2006, from cally. In 1995, only 38% of our 2-year- to this initiative has proven to be a key http://www.health.gov/healthypeople/ U.S. Department of Health and Human old patients had received the entire factor. Nursing involvement continues Services Centers for Disease Control and 4-3-1-3-3 series compared to 84% at to assure success in the sustainability of Prevention. (1998). Measles, mumps, the time of our most recent report. For improved pediatric immunization rates. and rubella – Vaccine use and strategies the 1-year old 3-2-2-2 assessment (3 for elimination of measles, rubella, and DTaP, 2 IPV, 2 Hib, 2 HepB vaccines by Vickie J. Leger, MS, RNC, is the Director of congenital rubella syndrome and control of mumps: Recommendations of the the time the child is 12 months of Nursing Services, Denver Health Community Health Services, Denver, CO. She may be con- Advisory Committee on Immunization age), 66% of 1-year olds were up to tacted via e-mail at [email protected] Practices (ACIP). Morbidity and Mortality date (UTD) in 1996, and now 92% of Report, 47(RR-8), 1-57. 1-year olds are UTD (see Figure 1). The Anne L. Hammer, BSN, RN, is the Nursing U.S. Department of Health and Human Clinical Coordinator, Denver Health most compelling confirmation of sus- Services Centers for Disease Control and Immunization Program, Denver, CO. She may be Prevention. (2002a). General recommen- tainability was evident directly after an contacted via e-mail at [email protected] dations on immunization. Morbidity and 18-month DTaP immunization shortage Mortality Report, 51(RR02). 1-36. occurred. During this time our rate for Additional Readings U.S. Department of Health and Human Services the 4-3-1-3-3 series dropped to 28% Davidson, A.J., Melinkovich, P., Beaty, B.L., Centers for Disease Control and Prevention. Chandramouli, V., Hambidge, S.J., Phibbs, due to a mandatory suspension of the (2002b). How to read a CASA summary S.L., et al. (2003). Immunization registry report. Retrieved January 25, 2006, from fourth dose of DTaP vaccine. Once the accuracy: Improvement with progressive http://www.cdc.gov/nip/publications/pink/ shortage resolved, rates rebounded clinical application. American Journal of appendices/B/casa_sum_rpt.pdf back to previous performance levels. Preventive Medicine, 25(3), 276-280. U.S. Department of Health and Human We found that use of our immu- Every Child by Two. (2007). Closing the vaccina- Services Centers for Disease Control and tion gap: A shot in the arm for childhood nization registry allows us to maximize Prevention. (2005). In W. Atkinson, J. immunizations programs. Retrieved February Hamborsky, L. McIntyre, & S. Wolfe (Eds.) the utilization of nursing support staff 10, 2006 from http://www.ecbt.org/ (8th ed.), Epidemiology and prevention of by generating standing orders and execsum.pdf vaccine-preventable diseases. Washington streamlining the process of vaccine U.S. Department of Health and Human DC: Public Health Foundation. delivery, dramatically reducing the Services. Office of Disease Prevention and

President’s Message for nominations of outstanding candidates for the clini- continued from page 2 cal and administrative excellence awards. challenge, an on-going column in Viewpoint was born – • Host an AAACN “On-the-Road Course” for ambulatory “Real Nurses, Real Issues, Real Solutions.” Our inaugural care certification review and/or the telehealth nursing column in this issue was written by Nancy Spahr and fea- practice core course. AAACN members presented eight tures two AAACN members from Indiana. Many thanks “On-the-Road Courses” from April 2006 through to Nancy for making this a reality! We will be looking to December 2006 – another AAACN record. all our AAACN members to contribute and be featured in Wow! Congratulations to all of us. Just look at what we’ve this column. AAACN’s message about certification accomplished as a team in one year – Together Everyone reached record numbers of ambulatory care nurses – Achieved More. over 62 nurses will take the Ambulatory Care Nursing It has been a privilege and honor to serve this awesome Certification Exam at the annual conference in Las Vegas! organization. My predecessors and “girlfriends” – Regina • Volunteer for a task force when you receive the broad- Phillips, Kathy Krone, Catherine Futch, Candy Laughlin, and cast e-mail or telephone call; AAACN offered many vol- E. Mary Johnson – welcomed me to the Board and showed unteer opportunities, and our members responded. For me the way. I will always value the professional and person- example, members volunteered for the following task al relationships I formed along the way and the work we force/charter groups: marketing and promoting prod- accomplished together. I am proud to be an ambulatory ucts externally, developing and implementing a leader- care nurse, and I am proud to be a member of AAACN. I ship audio seminar series, updating the Ambulatory Care want to thank all our volunteer leaders, the Board of Nursing Review Questions (2nd Ed.), membership reten- Directors, the entire staff of Anthony J. Jannetti, Inc., and tion, and advanced topics in telehealth. you, the members, for making this experience priceless and • Participate actively in a Special Interest Group (SIG). We for shaping the future of ambulatory care. AAACN will grow had record attendance at the SIG meetings in Atlanta, and continue to be a strong voice for ambulatory care nurs- and I encourage all SIGs to sustain a high level of par- ing – real nurses, with real issues, and real solutions. ticipation throughout the year. Thank you for your active participation and volunteer • Apply for AAACN Scholarship Funds. We set a record leadership. Please keep in touch ([email protected]). for submissions of research and scholarship applications Beth Ann Swan, PhD, CRNP, FAAN, is AAACN President and this year. Our successful Silent Auction, held at each Associate Dean of Graduate Programs, Jefferson School of Nursing, annual conference, increased the pool of funds avail- College of Health Professions, Thomas Jefferson University, able for this scholarship program. Philadelphia, PA. She may be reached at [email protected] • Nominate a colleague or ask a colleague to nominate you for one of the Excellence Awards. We set a record

12 VIEWPOINT MARCH/APRIL 2007 AAACN NEWS NEW Educational Resources Released at Conference Attendees of the 32nd Annual AAACN Conference in Las Vegas, March 29-April 1, will Your next Career or the perfect be the first to see and purchase “hot off the press” revisions to several educational Ambulatory Care Nurse resources. They are: • The Ambulatory Care Nursing candidate is just a click away! Administration and Practice Standards, 7th edition The official online job bank of the American Academy of • The Telephone Nursing Practice Ambulatory Care Nursing, the AAACN Career Center, offers the Administration and Practice Standards, most targeted resource available for NURSE professionals. 4th edition The standards have been updated to reflect Whether you’re looking for the perfect opportunity or the current practice. Some standard titles have perfect candidate to fill an open position in your facility, changed, a leadership standard has been added, your perfect match is just a click away. and measurement criteria has expanded. • The Telehealth Nursing Practice Resource Directory Job Seekers Employers Updated with the most up-to-date informa- tion on telephone triage software, consultants, ◗ Search hundreds of local and ◗ Target your search to articles, and speakers. A new section containing national ambulatory care- qualified ambulatory care sample position descriptions has been added. specific opportunities candidates • Ambulatory Care Nursing Review Questions The previously named Self-Assessment ◗ Create a customized ◗ Access the résumé database Manual has been revised to reflect current professional résumé with the with your job posting practice. There are 200 all-new questions that easy Résumé Builder ◗ Receive e-mail notification of will assist nurses in preparing for the ambulato- ◗ ry certification exam and can be used by facili- Upload and store existing new résumé postings that ties to educate/test their nursing staff. résumés meet your criteria get ◗ Post your résumé online ◗ Take advantage of flexible, ber aMemb (confidentially if preferred) competitive pricing with m e volume discounts e r ◗ Build your own personalized M professional Career Web site ◗ Receive personalized customer care and ◗ Reply online to job postings consultation and send a cover letter with your résumé Visit the AAACN Career Center Accept the Challenge… ◗ Receive e-mail notification today at www.aaacn.org, click on “Jobs.” It’s quick, Recruit the most new members between of new job postings in the April 1, 2007-December 31, 2007, and specialty area and geographic convenient and confidential. win a trip to AAACN’s 33rd Annual locations you select. Conference in Chicago, IL! Be the AAACN member who recruits the most new members (6 or more) and receive paid registration, airfare (maximum of $400), and 3 nights lodging at the headquarters hotel (double Visit www.aaacn.org and click on Jobs occupancy). Any member recruiting 3 or more or contact the Customer Care Center at 888-884-8242 new members will receive a certificate worth $100 You may also send an e-mail to [email protected] off future AAACN programs or products. To quali- The AAACN Career Center fy, enter your name on the “Who referred you to AAACN?” line on the membership application. is a member of Ambulatory Nursing Experience practice scenarios and enthusiastic communicators of the continued from page 1 Magnet message. To illustrate nursing professional devel- Forces of Magnetism (ANCC, 2006). Evaluation and selec- opment, a list was compiled of the number of nurses who tion is also based on how the organization’s nursing prac- belonged to a professional nursing organization and the tice incorporates ANA’s Scope and Standards for Nurse number of nurses with certification in a nursing specialty. Administrators and compliance with regulatory standards Nurses who had received recognition, such as a nurse and the National Patient Safety Goals (ANCC, 2006). The excellence award, were highlighted. Educational opportu- path to becoming a Magnet-recognized organization has nities were outlined in a report. several steps. Information on nursing publications was collected that • Letter of intent to the ANCC Magnet Recognition provided an opportunity to showcase a number of ambula- Program. tory care nurses who have conducted research and pub- • Organizational assessment and collection of evidence lished innovative quality projects (Schober-Flores, 2003; of meeting the 14 Forces of Magnetism. Sherman & Romfh, 2003). Examples of nursing best prac- • Submission of evidence for review by the ANCC tices were gathered. Evidence-based process improvement Magnet appraisers. projects were discussed to illustrate positive patient out- • ANCC Magnet appraisers review evidence. If accepted, comes. Explanation of the shared governance model used a site visit is scheduled at the organization. If declined, at UCH demonstrated compliance with the Magnet stan- the organization must begin the process over. dard on management style. This model demonstrated that • Site visit by Magnet appraisers from ANCC to validate ambulatory care nursing has a voice in clinical decision- submitted evidence. making. The Ambulatory Nurse Leadership Committee is • Review of findings by the ANCC Magnet Commission included in this council, and ambulatory care nurses serve on Magnet. Decision is made by ANCC and communi- as representatives on many other committees. All evidence cated to the organization. was summarized and submitted to ANCC. • Designation decision to the organization – If designa- During the survey process, nursing care is evaluated in tion isn’t achieved, the organization may choose to all areas of the organization. The Magnet standards call for appeal or begin the process again. a nursing structure within the organization that has “one • Celebrate at the National Magnet Conference. individual serving as the Chief Nursing Officer who typical- • Determine plan for Sustaining the Magnet Culture. ly is responsible for sustaining the standards of nursing • Yearly reports to the ANCC Magnet program office. practice in all areas” (ANCC, 2006). Thus, nursing care in • Re-apply for Magnet Designation every 4 years. the ambulatory setting is included during the survey process. Surveyors interviewed ambulatory care nurses dur- The Journey at the University of Colorado ing visits to clinics and during a dinner event. They also Hospital interviewed ambulatory care nurses who were members of At UCH, a Magnet Steering Committee was formed to the committees. Ambulatory care nurses were able to share oversee the assessment and application process. This pro- their evidence-based process improvement projects and vided the ambulatory care nursing leadership and staff their opportunities for professional growth. Through the nurses the opportunity to actively participate in the collec- assessment and survey process, nurses were able to high- tion of data for the submission packet. These ambulatory light their contributions in influencing nursing practice in representatives served as clinical experts identifying best ambulatory care.

Table 1. Positive Trends and Outcomes Recognized in Magnet Organizations

Positive Nursing Work Excellence in Quality Strong Support for Nursing Environment Nursing Care Professional Development

Increase ability to recruit and retain Investment in continuing education Nursing care built on EBP nursing staff opportunities Collaborative team effort with mutual Decrease in mortality and morbidity Nurse involvement in professional multidisciplinary respect rates organizations High levels of nurse autonomy and Recognition and support for professional Clinically competent nurses control over nursing practice achievements (such as certification)

Increased nurse satisfaction Positive patient outcomes Career advancement opportunities

Organizational nursing education Balanced patient/staff ratios programs available

14 VIEWPOINT MARCH/APRIL 2007 The hard work paid off, and UCH made the grade for • Classes are available for nurses on Introduction to Magnet Designation. Upon hearing the words, “You have Research and EBP. been designated as a Magnet Organization,” the celebration • Nurse researchers consult and mentor nurses in research began. The sense of pride expressed by nurses was palpable. and EBP. University of Colorado Hospital as a Magnet Hospital has had the opportunity to participate in two amazing experi- Professional Development ences. In 2004, UCH won the prestigious Magnet prize for • The Ambulatory Care Nursing Administration and Practice innovation in evidence-based practice (EBP). Standards (AAACN, 2004) are used to guide professional In 2006, UCH partnered with 3 other Magnet-desig- practice in ambulatory care settings. nated organizations in Colorado to host the 10th annual • Defined career ladder with opportunity for clinical Magnet Conference in Denver. The value of nursing was advancement. celebrated using an “Olympic theme,” with nurses from all • Nursing achievements are honored during Nurses Week. organizations contributing to the celebration. The positive • Professional nursing development is financially support- atmosphere made an impression on the entire organization ed for joining a professional organization, attending as nurses spread their personal Magnet experience and conferences, and obtaining specialty certification. enthusiasm. Personal accounts by two ambulatory care • A nursing education department serves the entire system. nurses follows: • Dedicated ambulatory nurse clinical educator. “When I helped at the Magnet How has Magnet designation changed practice at Conference, I thought it was the most UCH? Joy Mulder, the Charge Nurse uplifting nursing experience I have from the Senior’s clinic, states, “The had in a long time. Everyone was so quality of nursing leadership in our enthused about nursing and where it Magnet hospital is visible, inspiring, is going. It was enlightening to hear accessible, and sincere. Support for all positions of the nursing profession professional development extends far having one goal – to make nursing beyond the manager’s walls. In addi- better.” – Peg Randall; staff nurse from tion, the continued daily research into Peg Randall the Ambulatory Internal Medicine advancements in health care provides Clinic Joy Mulder endless opportunities for personal “Volunteering at the Magnet conference was an expe- growth.” rience I won’t soon forget. I came back to work energized The 14 Forces of Magnetism provide a framework for and excited about nursing again. I took some information nurses to continue the Magnet journey. Participating in the and used it in staff meetings to get the nurses more Magnet survey process and working in a Magnet-designat- engaged and involved in changes in our unit.” – Lynne ed organization offers the ambulatory care nurse at the Wyatt, RN Clinical Nurse Coordinator, Endoscopy Lab University of Colorado Hospital in Denver a rewarding opportunity to demonstrate excellence in nursing care, The Magnet Culture at UCH identify best practices, and highlight his or her professional The journey does not end with Magnet designation. achievements. Sustaining the Magnet culture takes dedication and work. The Magnet Culture at UCH supports ambulatory nurses in a Marianne Sherman, MS, RN, C, is the Ambulatory Clinical variety of ways. Examples of some of the support includes Standards Coordinator, the University of Colorado Hospital, Denver, CO, and a Director, the AAACN Board of Directors. She may be con- the following. tacted via e-mail at [email protected] Work Environment Acknowledgment: The author thanks Rene Katial, MS, RN, NP, • Dedicated chief nursing officer (CNO) who oversees all Ambulatory Project Coordinator, and Mary Krugman, PhD. RN, FAAN, Director of Professional Resources, for their assistance and guidance; and nursing within the organization. Colleen Goode, PhD, RN, FAAN, Chief Nursing Officer, and members of the • Dedicated ambulatory nursing directors who oversee Magnet Committee for their knowledge, dedication, and ongoing support clinical practice. of the Magnet journey. • Shared governance model includes ambulatory care nurse leadership council. References American Academy of Ambulatory Care Nursing (AAACN). (2004). • Ambulatory care nurses participate on multiple com- The ambulatory care nursing administration and practice standards. mittees and task groups. Pitman, NJ: Author. • Opportunities exist for nurses to contribute on multi- American Nurses Association (ANA). (1983). Magnet hospitals: Attraction and retention of professional nurses. Kansas City, MO: disciplinary teams. Author. American Nurses Association (ANA). (1998). Looking for quality Quality Patient Care patient outcomes: The American Nurses Credentialing Center’s • Ambulatory nurses participate in developing, writing, and Magnet Program recognizes excellence. Nursing Trends and Issues, 3(4). Retrieved February 15, 2007, from http://nursing- implementing UCH policies and guidelines based on EBP. world.org/readroom/nti/9804nti.htm • Nursing standards of practice serve as the bases for all nursing evaluations. continued on page 16

WWW.AAACN.ORG 15 American Nurses Credentialing Center (ANCC). (2006). What is the Magnet Recognition Program®? Retrieved February 15, 2007, from http://www.nursecredentialing.org/magnet/index.html Corporate American Organization of Nurse Executives (AONE). (2003). Healthy work environments, volume 2: Striving for excellence. Retrieved February 15, 2007, from http://www.hospitalcon- Members nect.com/aone/keyissues/hwe_excellence.html Colorado Center for Nursing Excellence. (2006). Advancing Nursing Excellence, 1(2). Goode, C., Krugman, M., Smith, K., Diaz, J., Edmonds, S., & Mulder, J. (2005). The pull of magnetism: A look at standards and the experience of a western academic medical center hospital in Kaiser Permanente achieving and sustaining Magnet status. Nursing Administration One Kaiser Plaza, 24 Lakeside Quarterly. 29(3), 202-213. Oakland, CA 94612 Kramer, M., & Schmalenbey, C. (2004). Developing and evaluation of essentials of Magnetism tool. Journal of Nursing Administration. Phone: 510.271.5700 34(7-8), 365-378. Web site: www.kaiserpermanente.org Kramer, M., & Schmalenbey, C. (2005). Revising the essentials of Magnetism tool: There is more to adequate staffing than num- bers. Journal of Nursing Administration, 35(4), 188-1998. Schober-Flores, C. (2001). The sun’s damaging effects. Dermatology Nursing, 13(4), 279-286. Sherman, M., & Romfh, P. (2003). Improving clinical emergency response in an outpatient setting. AAACN Viewpoint. 25(5). LVM Systems, Inc. 1818 East Southern Avenue Suite 15A, Mesa, AZ 85204 (480) 633-8200 • www.lvmsystems.com For more information about LVM Systems and its products, call 480-633-8200, ext. 232, e-mail [email protected], or visit the LVM Web site at www. lvmsystems.com

TELEHEALTH cell phones/handhelds cannot be guaranteed as confi- dential by cell phone providers, allowing callers to con- of tinue or terminate the call. This can be done efficiently on the front end of the call for those organizations uti- lizing call recording and can be handled within the Cell Phone Triage Calls “notification of all calls being recorded” statement. • Regarding safety, if the call is from a cell phone, the Recently, a question was posed to the Telehealth triage staff member should quickly remind the caller Nursing Practice (TNP) Special Interest Group (SIG) con- that for safety sake, he or she might want to pull over cerning how to handle callers phoning in for nursing assis- so that undivided attention can be given to the call. tance using cell phones. Comments ranged anywhere from, This statement should be inclusive in the guideline as “We take the calls,” to “We won’t take calls from cell phone well as allowing for a simple check box demonstrating users.” What’s a nurse to do? that the nurse made the request. We have become a virtual society, and any type of tech- • Obtaining the cell phone/handheld device number should nology tool is available to those who can successfully use it, become a critical piece of information because these have access to it, or who can afford it. Many households no devices are prone to dropping signal, and a triage staff per- longer have hard lines since utilization of cell phones in son would not want to lose a call due to signal failure. homes eliminates many of the surcharges added on to As with all “Pearls of Wisdom,” information is provided monthly bills. It has been said that 1 in 8 homes no longer with the best intentions of everyone and with the under- have hard line telephone lines. Technology experts expect standing that both individuals assume his or her responsibili- that number to continue to rise! ty in any given situation. As nurses, we must perform within The triage industry continues to evolve with technology the standard of care, document care and service provided, advancements as well. It is becoming more and more diffi- and ask for confirmation of understanding and compliance cult to actually discern a cell phone call from a hard line call from the patient. The rest is up to the patient for follow- due to sophistication and advancement of technology. through! Several procedural tasks should be considered when taking cell phone type/hand held device triage calls. Maureen T. Power, RN, MPH, is a senior legal nurse consultant • Modification of guidelines to support a confidentiality with the defense firm of Power & Cronin, Ltd. She conducts workshops clause within the initial moments of the interaction tak- for clients on areas involving risk identification and risk reduction in health care and ambulatory care settings, including triage and call ing place. Guidelines that instruct callers that calls from center environments. She is a AAACN TNP SIG Committee Member.

16 VIEWPOINT MARCH/APRIL 2007 Professional

Development knowledge using the Ambulatory Care Nursing Review Questions tool (AAACN, 2007c). Ambulatory Care Nursing Develop telephone triage skills. Schedule a AAACN Telehealth Nursing Practice Core Course to present at your Professional Development organization. Use the AAACN Telephone Nursing Practice Nursing professional development is described by Core Course (AAACN, 2004) and incorporate into nursing Benner (1984) as a journey building on knowledge and orientation. skill beginning with a novice nurse and progressing to an Attend the AAACN Annual Conference. Learn from expert nurse. A variety of educational and professional experts from across the United States. opportunities is needed to support a nurses’ acquisition of Participate in continuing nursing education. An excel- knowledge requisite skills. Based on predictions by the lent option is learning via live audio seminars within your Bureau of Labor Statistics, U.S. Department of Labor own organization. Visit the AAACN Web site (2004), the demand for nurses in ambulatory care settings (www.aaacn.org) for times and offerings. will rapidly grow due to a combination of factors shifting Build a library of resources. Read AAACN’s Viewpoint patient care to ambulatory care settings. This shift will cre- and stay current on nursing practice. ate the need for nurses to provide care to more complex Strengthen nursing orientation by using the Guide to patients. To meet the increasing demands for patient care, Ambulatory Care Nursing Orientation and Competency and address the future skill sets needed by an ambulatory Assessment (AAACN, 2005). nurse, professional development must be supported by Support quality patient care based on evidence. The organizations and individuals. links and resources on the AAACN Web site provide quick The American Academy of Ambulatory Care Nursing and easy access for locating evidence. (AAACN) is a professional organization that supports the Ambulatory nurses are in a position to promote quality ongoing professional development of ambulatory care care and positive patient outcomes. Supporting the ongo- nurses, and its mission is to “Advance the art and science ing professional development of ambulatory nurses is of ambulatory care nursing.” It provides a variety of essential to preparing a competent workforce. This creates resources to support nurses in their professional develop- a win-win situation for organizations, nurses, and patients. ment, from a novice ambulatory care nurse to an expert in Marianne Sherman, MS, RN, C ambulatory care. Ambulatory care nursing is multifaceted, AAACN Board of Directors and these resources can be utilized to support the profes- Ambulatory Clinical Standards Coordinator University of Colorado Hospital sional growth of nurses practicing in a variety of settings. Denver, Colorado 80210 Resources range from the collegial support of belong- ing to a national organization, to cutting-edge continuing References education opportunities, to preparation for specialty certifi- American Academy of Ambulatory Care Nursing (AAACN). (2004). cation. This all contributes to an ambulatory care nurse’s Telephone nursing practice core course (TNPCC) manual (2nd ed.). Pitman, NJ: Author. professional growth and pride in his or her profession. American Academy of Ambulatory Care Nursing (AAACN). (2005). A guide to ambulatory care nursing and orientation and competency How Can You Promote Your Professional assessment. Pitman, NJ: Author. Growth? American Academy of Ambulatory Care Nursing (AAACN). (2006). Join a national nursing organization, such as AAACN. Ambulatory care certification review course. Pitman, NJ: Author. American Academy of Ambulatory Care Nursing (AAACN). (2007a). Develop collegial relationships with ambulatory nursing Ambulatory care nursing administration and practice standards (7th leaders from across the United States. ed.). Pitman, NJ: Author. Define your role and develop performance expecta- American Academy of Ambulatory Care Nursing (AAACN). (2007b). tions. Use the Ambulatory Care Nursing Administration and Telephone nursing practice administration and practice standards Practice Standards (AAACN, 2007a) and/or the Telephone (4th ed.). Pitman, NJ: Author. American Academy of Ambulatory Care Nursing (AAACN). (2007c). Nursing Practice Administration and Practice Standards Ambulatory care nursing review questions. Pitman, NJ: Author. (AAACN, 2007b) as a guide. Benner, P. (1984). From novice to expert: Excellence and power in clini- Obtain nursing specialty certification. Substantiate cal nursing practice (pp 13-34). Menlo Park: Addison-Wesley. your expertise with a certification in Ambulatory Nursing Bureau of Labor Statistics, U.S. Department of Labor. (2006). or telehealth nursing. Prepare for the exams by reviewing Occupational outlook handbook: Nursing, psychiatric, and home health aides. Retrieved February 14, 2007, from http:// the Core Curriculum for Ambulatory Care Nursing (Laughlin, www.bls.gov/oco/ocos165.htm 2006), attending the AAACN Ambulatory Care Certification Laughlin, C. (2006). AAACN core curriculum for ambulatory care nurs- Review Course (2006), or purchasing the CD-ROM and ing (2nd ed.). Pitman, NJ: American Academy of Ambulatory reviewing from the comfort of your home. Test your Care Nursing.

WWW.AAACN.ORG 17 Also from Indiana, Sheryl A. Health, RN, has been a AAACN member since 2002. Sheryl started her nursing career as an LPN and later earned her ADN degree. She is

REAL currently continuing her education, working on a Bachelor of Science Editor’s Note: This column will highlight some of our AAACN degree in Health Professions. members by looking at the types of ambulatory roles they fill, Like most ambulatory nurses, their day-to-day challenges, their reasons for joining AAACN, Sheryl Health Sheryl started her career in the acute and how AAACN membership has helped them as professional care setting, later accepting a posi- ambulatory nurses. tion at the Welborn Clinic in Evansville, IN. Sheryl has appar- ently found her home in ambulatory care nursing because Kathy Knox, BSN, RN,C, she has been with the Welborn Clinic for 25 years. She start- works as a “Shift Clinical ed as a staff nurse, advanced to Nursing Supervisor, Director Coordinator” at Cardinal Health of Satellite Clinic Operations, Operations Administrator, and System in Muncie, IN. Kathy is now the Director of Nursing. From LPN to the Director of explains that this title means she Nursing for the Welborn Clinic is a career path of which manages the day-to-day operations Sheryl can be proud! of the Outpatient Residency Clinic Sheryl decided to join AAACN in 2004 because she with 17 interns and residents. realized that AAACN was the organization that best repre- However, like many of our AAACN sented her many ambulatory nursing roles. Since joining, members who work in or manage Kathy Knox Sheryl has made excellent use of her membership. She clinics, Kathy is a “working supervi- explains, “I have just completed the development of a sor” and a “Jack of all trades.” She frequently fills in for the Nursing Competency Validation Program for all the RNs, telephone triage nurses, reviews lab and radiology reports, LPNs, and MAs at Welborn Clinic. I used the AAACN Guide serves as the clinical resource for clinical staff and resi- to Ambulatory Care Nursing Orientation and Competency dents, and even helps with registration and check-out. Assessment as one of the primary references for this pro- Approximately 2 years ago, the clinic converted to an elec- gram.” Sheryl has also recently purchased the Telehealth tronic medical record, so the role of nurse informatics was Nursing CD from a previous AAACN conference and plans also added to Kathy’s repertoire of skills. to use it to develop telehealth nursing competencies. Kathy attended her first AAACN conference in Phoenix Sheryl admits that she has yet to attend a AAACN national in 2004. Her manager brought her to the conference, and conference because of work commitments, but she is hop- as Kathy explains, “I was amazed at the amount of knowl- ing to correct that situation in the near future. edge I gained in two and a half days. I joined AAACN Those AAACN members who are responsible for shortly after that conference.” Kathy values the AAACN implementing flu clinics should take note of Sheryl’s cre- publications and uses them regularly. She relates, “Before I ative and innovative approach. She relates, “This year we started receiving AAACN material, I felt like I was in the created the very first ‘drive-through’ Flu Clinic in dark about many issues. The journals and Viewpoint always Evansville, IN. We erected a large tent in our municipal sta- contain information about something I haven’t heard dium parking lot, developed a flow of traffic, registered about or something I need an answer to.” Kathy took the patients on wireless computers, and administered flu shots AAACN Ambulatory Nursing Certification Review Course without patients ever leaving their car. We administered and is proud to wear her certification pin. more than 1,000 flu shots within 3 days. The weather was Kathy started her nursing career as a pediatric nurse cold and rainy, but the patients stayed warm and dry in and later worked on a medical-surgical unit at Ball their cars.” Sheryl reported that patient satisfaction was Memorial Hospital in Muncie, IN. After many years in the very high, and she is already working on plans to repeat acute care setting, Kathy saw an opening and transferred the process next year. to her current position. She feels that she has found a What has kept Sheryl in ambulatory nursing for 25 home in ambulatory care nursing. Kathy writes, “The best years? Sheryl states, “I enjoy all aspects of ambulatory nurs- part of being an ambulatory nurse is feeling like you can ing and feel I have been rewarded ten-fold by caring for truly help improve the quality of life for each patient. I these patients. The needs of the ambulatory patient cover enjoy teaching patients how to manage their chronic dis- the spectrum from minor to immense, and being a nurse ease, how to take their medications, and how to make who can fulfill these needs is what nursing is all about.” better lifestyle choices. It is the best of all parts of nursing If you would like to highlight a AAACN member in all rolled into one. I am never bored because I learn some- your organization, please contact Nancy Spahr at thing new every day.” Will we be seeing Kathy in Las [email protected]. Vegas? You bet! Nancy Spahr, MS, RN, MBA, is a Clinical Nurse Specialist, the Mayo Clinic Hospital, Phoenix, AZ.

18 VIEWPOINT MARCH/APRIL 2007 spotlighton A Tale of Nurse Staffing: The Best, the Brightest, PracticePractice and the Bibliography

Once upon a time, there were many • Plan for new nursing positions. ambulatory care nurses who managed • Support staffing changes to management. nurse staffing. They did not have the • Prepare reports. luxury of excess time, so they realized • Design evidence-based research studies. they had to work smarter, not harder. As they build and refine their staffing models, nurses, They turned to AAACN, whose brave patients, and facilities reap the rewards. The nurses are grate- knights in the form of Editors Beth Ann ful that Swan, Griffin, and colleagues included key areas perti- Swan, PhD, CRNP, FAAN, and Karen nent to practice: scope and dimension of ambulatory care Griffin, MSN, RN, CNAA; Search Librarian nursing practice; nursing workload, nursing intensity, and Extraordinaire Lenore Wilkas, MLS; and a Beth Ann Swan patient classification; and ambulatory care nursing staffing. panel of the country’s leading ambulatory Although this story has a happy ending, the editors note care experts, rescued them in their often that there is no magic spell – adequate nurse staffing is critical to frustrating search for staffing solutions. delivering safe, cost-effective, quality patient care and requires Swan, Griffin, and colleagues found continual effort. Reaching this goal is an ongoing quest, and a treasure trove of published information calls for ongoing evaluation of the work environment. – rich with relevant research – on ambu- The editors and AAACN wish you well on your staffing latory care nurse staffing that surpassed journey and hope you will arm yourself with the bibliography their expectations. They then proceeded to guide you on your way. to build a hands-on tool to help the nurses find the best staffing model for For More Information ambulatory care settings. Their master- Karen Griffin To learn more about the Ambulatory Care Nurse Staffing: work, Ambulatory Care Nurse Staffing: An Annotated An Annotated Bibliography and to order, visit the AAACN Web Bibliography, is a comprehensive summary of over 100 land- site, www.aaacn.org; e-mail [email protected]; or call 800-AMB- mark articles (classic to current) on nurse staffing. NURS (800-262-6877). And those ambulatory care nurses who managed staffing were pleased. They now had the perfect guide for finding the most pertinent articles for their specific staffing challenges. Today, they are using the bibliography with great success to: • Assess and plan their staffing needs. • Evaluate staff’s workload. • Adjust their staffing mix.

Nursing Economic$ Names New Column Editor Candia Baker Laughlin, MS, RN, C, has been appointed the incoming editor of the “Perspectives in Continuity of Care” column in Nursing Economic$ effective with the March/April 2007 issue. Current Editor Liz Dickey, MPH, RN, FNP, is stepping down as she retires Candia Baker Laughlin from the health care world. Laughlin just completed editing the 2nd edition of the Core Curriculum for Ambulatory Care Nursing. Laughlin’s broad background in ambulatory care nursing will serve her well as column editor.

WWW.AAACN.ORG 19 American Academy of Ambulatory Care Nursing Presorted Standard Real Nurses. Real Issues. Real Solutions. U.S. Postage PAID Volume 29 Number 2 Bellmawr, NJ Permit #58

Viewpoint is published by the American Academy of Ambulatory Care Nursing (AAACN) AAACN Board of Directors President Beth Ann Swan, PhD, CRNP, FAAN Associate Dean of Graduate Programs Thomas Jefferson University 215-503-8057 (w) [email protected]

President-Elect Charlene Williams, MBA, BSN, RNC, BC Manager, Cleveland Clinic Nurse on Call Cleveland Clinic 216-738-4888 (w) [email protected] AAACN is the association of professional nurses and associates who identify ambulatory care practice as Immediate Past President essential to the continuum of accessible, high quality, and cost-effective health care. Its mission is to advance the Regina C. Phillips, MSN, RN Process Manager art and science of ambulatory care nursing. Humana, Inc. 312-627-8748 (w) [email protected]

Secretary Karen Griffin, MSN, RN, CNAA Associate Chief Nursing Service, Ambulatory Care South Texas Veterans Healthcare Systems 210-617-5300 x4152 (w) National Nurses Week: [email protected] Treasurer May 6-12, 2007 Kitty Shulman, MSN, RN, C Director of the Children’s Specialty Center St. Lukes Regional Medical Center 208-381-7010 (w) [email protected] The work of America’s 2.9 million registered and lobbying Congress and the regulatory nurses to save lives and to maintain the health agencies on health care issues affecting nurses Directors MAJ Belinda A. Doherty, USAF, NC of millions of individuals is the focus of this and the public. Flight Commander, Education and Training United States Air Force year’s National Nurses Week, celebrated annual- In addition, nurses are encouraged to 520-228-1547 (w) [email protected] ly May 6-12 throughout the United States. observe and participate in Cover the Uninsured “Nurses: Strength, Commitment, Week, May 1-7, 2007. Nurses see firsthand the Marianne Sherman, RN, C, MS Clinical Standards Coordinator, Ambulatory Compassion” is the theme for 2006. Annually, consequences that stem from a lack of health University of Colorado Hospital 720-848-2397 (w) National Nurses Week begins on May 6, marked insurance coverage: sicker patients who have [email protected] as RN Recognition Day, and ends on May 12, postponed needed health care. More than 1,000 AAACN Viewpoint the birthday of Florence Nightingale, founder of events will take place during Cover the East Holly Avenue, Box 56 Pitman, NJ 08071-0056 nursing as a modern profession. During this Uninsured Week, involving nurses, doctors, (856) 256-2350 (800) AMB-NURS week, registered nurses across the country will union members, business owners, hospitals, (856) 589-7463 FAX be honored by activities, such as rallies, commu- members of religious groups, students, grand- [email protected] www.aaacn.org nity health screenings, childhood immunization parents, and people from all walks of life and Rebecca Linn Pyle, MS, RN efforts, dinners, receptions, hospital events, etc. every point of view. For more information, go to Editor Cynthia Nowicki Hnatiuk, EdD, RN, CAE In honor of National Nurses Week and RN www.CovertheUninsuredWeek.org Executive Director Recognition Day, registered nurses around the Traditionally, National Nurses Week is Sally S. Russell, MN, CMSRN Education Director country are encouraged to wear the official “RN devoted to highlighting the diverse ways in Patricia Reichart Pin.” The pin can be purchased by calling 1- which registered nurses, the largest health care Association Services Manager Carol Ford 800-445-0445. In addition to wearing the RN profession, are working to improve health care. Managing Editor Pin, nurses will be asked to dress in uniform on From bedside nursing in hospitals and long- Bob Taylor Layout Designer that day. term care facilities to the halls of research insti- Tom Greene ANA, through its 54 constituent member tutions, state legislatures, and Congress, the Director of Marketing Robert McIlvaine associations advances the nursing profession by depth and breadth of the nursing profession is Circulation Manager fostering high standards of nursing practice, meeting the expanding health care needs of promoting economic and general welfare, pro- American society. moting a positive and realistic view of nursing,

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