Volume 34 Number 1 JANUARY/FEBRUARY 2012

FREE

ContinuingEducation

Redefining and Categorizing Page 3 The Development and The Perceived Value Implementation of a Freestanding Patient Education Resource Center Of the RN in (PERC) Page 6 Ambulatory Care Reform Prevention and Early Detection Robin E. Matutina of “Never Events” within Susan B. Hamner Ambulatory Settings to Enhance Rosemarie Battaglia Quality and Safety and Prevent Financial Losses The role of the RN in the outpatient setting is ever evolving, especially in light of new Page 11 initiatives, including health care reform, the medical home model, and meaningful use Telehealth Trials and standards. Expectations of other health care professionals regarding the role of the RN in Triumphs the ambulatory setting may vary from clinic to clinic and from organization to organiza- Nurse – Care for Thyself! Part II tion. Today’s health care arena demands that RNs utilize their multi-dimensional skill set Page 12 and scope of practice in an efficient and fiscally responsible manner. For Your Health In 2005, the American Academy of Ambulatory Care Nursing (AAACN) explored the Page 14 value of ambulatory care nurses in the workplace (Conway-Phillips, 2006). This study, con- AAACN News ducted among members of the specialty organization, found that the nurses viewed themselves as adding value in the following areas: Page 15 National Office Election • Patient/family education • Financial benefits (for example, by Results • Telephone/clinic triage preventing hospital admissions and • Patient care and coordination of care inappropriate use of emergency Page 16 New Year Resolutions for • Leadership/management departments) 2012 • Collaboration with the medical staff • Continuity of care • Patient advocacy • Access to care • Staff education • Quality initiatives Write for ViewPoint • Compliance with regulatory/accrediting • Research Consider sharing your standards ambulatory care or telehealth Conway-Phillips (2006) also found that the majority of ambulatory care settings nursing expertise by writing an (54%) were not collecting data (other than patient satisfaction) regarding performance article for ViewPoint! Download improvement indicators to evaluate the effectiveness of the RN. author guidelines, copy As a starting point for role clarification in the outpatient clinics, the authors of this deadlines, and writing tips at study wanted to examine the value of the in the current health care cli- www.aaacn.org/ViewPoint or mate at the Medical University of South Carolina as compared to the Conway-Phillips send an email to [email protected] (2006) study. to get started. continued on page 8

Contact hour instructions, objectives, and accreditation information may be found on page 10.

The Official Publication of the American Academy of Ambulatory Care Nursing Four Themes Found in The Future of Nursing In November, I was fortunate to attend the Nursing Organizations Alliance (NOA) Fall Summit. We heard from Michael Bleich, PhD, RN, NEA-BC, FAAN, on the Institute of Medicine (IOM) Future of Nursing Reader Services report (IOM, 2010). Dr. Bleich is the Dr. Carol A. Lindeman AAACN ViewPoint American Academy of Ambulatory Care Distinguished Professor at Oregon Health & Science University, of Nursing. He provided an overview of the key points of the report East Holly Avenue, Box 56 Pitman, NJ 08071-0056 and our progress toward implementing the recommendations, the (800) AMB-NURS challenges we face, and topics we need to address to move forward Fax: (856) 589-7463 as a profession. It was disturbing to hear from Dr. Bleich that only 1 in Email: [email protected] I Web site: www.aaacn.org 10 nurses are familiar with the report. While it is daunting to take on AAACN ViewPoint is a peer-reviewed, bi- the 671-page read of the IOM report, The Future of Nursing, I found Linda Brixey monthly newsletter that is owned and pub- the 18-page summary to be a good read. Both the full report and the summary version are lished by the American Academy of Ambulatory Care Nursing (AAACN). The available online (http://www.nap.edu/catalog/12956.html). I recommend reading the sum- newsletter is distributed to members as a mary and encouraging your nurse colleagues to do the same. direct benefit of membership. Postage paid at Deptford, NJ, and additional mailing offices. There are eight recommendations in the IOM Future of Nursing report. Dr. Bleich grouped them into four key messages that are important to all nurses. Advertising Contact Tom Greene, Advertising Representative, (856) 256-2367. Key message one is to promote the practice of nursing to the Back Issues fullest extent of education training and licensure. To order, call (800) AMB-NURS or (856) 256-2350. • The first recommendation of the IOM report is: “Remove scope of practice barriers.” Each nurse needs to participate at the state level to promote legislation that will allow Editorial Content AAACN encourages the submission of news nurses to work, practice, and be compensated for expertise fully functioning within items and photos of interest to AAACN mem- licensure. The National Council of State Boards of Nursing and State Action Coalitions bers. By virtue of your submission, you agree to the usage and editing of your submission are working to address restriction of the practice on advanced practice registered nurs- for possible publication in AAACN's newslet- es (APRNs). There does not seem to be a good rationale for restricting the practice of ter, Web site, and other promotional and edu- cational materials. the APRN. It is incongruent that an APRN who functions independently and prescribes For manuscript submission information, medication in one state finds that just across the state line he or she must work under copy deadlines, and tips for authors, please the direct supervision of a physician to perform the same task. The nurse’s competen- download the Author Guidelines and Suggestions for Potential Authors available cy has not changed – only the law governing practice. at www.aaacn.org/ViewPoint. Please send On the national level, Medicare programs need to expand coverage to include the comments, questions, and article sugges- tions to Managing Editor Katie Brownlow at APRN in reimbursement plans. Much of the Medicare language is physician centric in [email protected]. nature, leading to reduced or no coverage for services provided by the APRN. Much rhet- AAACN Publications and oric has been heard from physician groups regarding care variation. In a 2000 study, Products “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A To order, visit our Web site: www.aaacn.org. Randomized Trial,” the conclusion was that the care provided by the and Reprints physician group were comparable (Mundinger et al., 2000). The American Nurses For permission to reprint an article, call (800) AMB-NURS or (856) 256-2350. Association (ANA) has responded with recommendations to improve the language for Subscriptions stronger recognition of the value of the APRN in the new proposed Medicare rules. AAACN We offer institutional subscriptions only. The supports these recommendations as an ANA affiliate member. cost per year is $80 U.S., $100 outside U.S. To subscribe, call (800) AMB-NURS or (856) • The second IOM recommendation also fits this key message in that it challenges nurs- 256-2350. es to expand their influence through opportunities to lead and diffuse collaborative Indexing improvement efforts with physicians and other members of the health care team, rec- AAACN ViewPoint is indexed in the ognizing the expertise the nurse brings to conduct research and to redesign practice Cumulative Index to Nursing and Allied Health Literature (CINAHL). environments and health systems (IOM, 2010). © Copyright 2012 by AAACN. All rights reserved. Reproduction in whole or part, elec- The second key message found in the IOM report, The Future of Nursing, was tronic or mechanical without written permission stronger educational standards for nurses. of the publisher is prohibited. The opinions expressed in AAACN ViewPoint are those of the There are four of the IOM recommendations related to this key message. This topic has contributors, authors and/or advertisers, and do not necessarily reflect the views of AAACN, been debated for over fifty years with no real progress. The plans include transitions into AAACN ViewPoint, or its editorial staff. the continual learning and higher degrees. Publication Management is provided by Anthony J. Jannetti, Inc., which is accredited continued on page 13 by the Association Management Company Institute.

2 ViewPoint JANUARY/FEBRUARY 2012 The Development and Implementation of a Freestanding Patient Education Linda Northrop Renée Meehan Resource Center (PERC) Barbara Hatfield

Tampa General Hospital (TGH) is a 988-bed, private, not-for-profit hospital The Patient Education Council and the only Level 1 Trauma Center in west-central Florida. Among its services developed and implemented a unique are 6 Ambulatory/Community Health Centers which include two TGH Family PERC without startup financial support Care Centers, Genesis (OB/GYN), Pediatric Clinic, Specialty Center (24 special- from the hospital. The TGH PERC is a ties), and KIDCARE (sick child daycare). freestanding kiosk with computer cubicles on both ends and space for 100 pamphlets in the center. The pamphlets cover TGH’s most preva- lent diagnosis-related groups and pre- ventive medicine topics. The kiosk is located in the main lobby across from the Registration Center, an area of high flow and visibility. Maintenance Medical Library personnel and TGH volunteers provide the kiosk’s minimal maintenance. Library person- nel monitor which pamphlets require restocking and reordering. The librari- ans also keep a running total of pam- phlets taken, which in the beginning enabled the Patient Education Council Patient Education Council members at the Grand Opening of the TGH Patient Education Resource to determine which pamphlets would Center (PERC), including authors Barbara Hatfield (second from left), Linda Northrop (kneeling, benefit consumers the most (see Table right), and Renée Meehan (third from right). 2). The Head Librarian reports to and Health literacy is believed to be a medical library become a patient and continued on page 4 stronger predictor of health outcomes family education resource center than social and economic status, edu- (PERC). Figure 1. cation, gender, and age (Egbert & Voluntary Survey Card Nanna, 2009). The Institute of Design and Implementation Medicine (IOM) (2004) defines health Over the next five years, the TGH literacy as “the degree to which indi- Foundation sought funding for a kiosk viduals have the capacity to obtain, and computers, and after obtaining a process, and understand basic health private grant for $20,000 from Verizon, information and services needed to the PERC plan was implemented. The make appropriate health decisions” process included development of an (p. 32). At Tampa General Hospital administrative policy, designing the (TGH), clinicians strive to incorporate desktop and kiosk, ordering materials patient and family education as an and equipment, and selecting Web- integral part of patient care in both based patient education databases. the inpatient and outpatient settings. The TGH Technology Department was The TGH Patient Education Council consulted for equipment purchases, identified the need for a centralized setup, and providing safe but limited location for patient education materi- Internet access for the PERC. A simple als that would provide access to infor- patient/family survey card (see Figure mation for both patients and their 1) was designed to obtain user feed- families. In 2004, the council pro- back (see Table 1), with English printed posed that a portion of the hospital on one side and Spanish on the other.

WWW.AAACN.ORG 3 is an active member of the Patient Table 1. Education Council. Only a minimal Collected Responses from Voluntary Survey Cards, amount of time is required from TGH February 2009 – December 2009 volunteers. A hospital volunteer desk is located next to the Patient Education Resource Center, which Were you able to find what Yes No No answer you where looking for? permits volunteers to request toner for 81.4% 15.3% 3.4% Yes No No answer the printers when needed and direct Did you use the computer? customers in calling the hospital’s 86.4% 5.1% 8.5% information system department with Yes No No answer Did you take brochures? computer technical difficulties. The 33.9% 42.4% 23.7% PERC is a fixed expense absorbed by How long did you have to No wait 5 minutes 10 minutes 20 minutes No answer the hospital. The budget covering wait to use the computer? 88.1% 1.7% 0.0% 5.1% 5.1% toner, paper, and staff was less than Yes No No answer $200 this past fiscal year. Did you print anything? 47.5% 45.8% 6.8% Education Materials 1 2 3 6 How many topics? The educational materials select- 67.9% 17.9% 10.7% 3.6% ed by the Patient Education Council Patient Visitor Employee Other No answer Are you a… are all current materials from the 32.2% 44.1% 10.2% 3.4% 10.2% National Institutes of Health. All print- Would you recommend Yes No No answer ed materials are bilingual and on a the use of the Center to others? 86.4% 3.4% 10.2% sixth grade (or lower) reading level. The National Institutes of Health not only provides these pamphlets free of Table 2. charge, but they also pay for all ship- PERC Complete Inventory Outcomes, February 2009 – December 2009 ping costs. All pamphlet stocks are stored in TGH’s medical library. Since Topic Number of Used Number the kiosk’s implementation, the librar- Category Pamphlet Topics of Pamphlets ian tech has taken over ordering pam- phlets. Men’s & Women’s Health 12 411 Tests & Procedures 23 1020 Outcomes Nutrition 3 42 Evaluating how the PERC is used Safety & Wellness 16 517 and determining the level of user sat- isfaction occurs in two ways. First, the Infectious Disease 4 215 number and type of professionally Cardiovascular & Stroke 25 886 printed brochures taken are counted Dermatology 4 201 and recorded monthly. Secondly, short voluntary PERC satisfaction sur- Endocrine & Diabetes 18 756 vey cards are collected and results are Eye, Ear, Nose, & Throat 2 108 analyzed. Additionally, TGH partici- Gastrointestinal 4 80 pates in the Press Ganey patient satis- faction surveys. Press Ganey scores Musculoskeletal 13 659 related to patient education increased Nephrology 1 43 since the program was implemented Psychiatry & Mood Disorder 3 67 in 2009. Although this increase can- Palliative Care 2 25 not be solely attributable to the PERC, it may have been influenced by it. In Poison 15 600 an article on promoting health literacy via MedlinePlus® and kiosk availability at the University of Tennessee/Baptist PERC Expansion and Growth Intensive Care Unit (NICU). Each PERC Hospital, it was reported that the kiosk TGH’s grantor has expanded funding is strategically and conveniently created a means for patients to discuss for two additional PERCs in specialty placed to attract the greatest number heath matters with their providers and areas of Tampa General Hospital. The of users. The Patient Education for the providers to stress the impor- second PERC is located in our Council reviews appropriateness of tance of complying with diet, exer- (ED). The materials on a monthly basis at their cise, prescriptions, and follow-up third PERC will be in the Neonatal meetings, ensuring all materials are on (Teolis, 2010). or below a sixth grade reading level,

4 ViewPoint JANUARY/FEBRUARY 2012 have a positive impact on health and Online Journal of Issues in Nursing, 14(3). well-being for users, reduce medical doi:10.3912/OJIN.Vol14No03Man02 Send Us errors, and reduce medical expenses Kounts, D.S. (2009). Strategies for improv- ing low health literacy. Postgraduate by promoting healthy lifestyles and Medicine, 121(5), 171-177. Your News managing chronic diseases. By contin- Ludwick, R. (2009, September 30). AAACN ViewPoint welcomes uing to analyze and report user satis- Overview and summary. Promoting health literacy: Strategies for healthcare news from AAACN members. If you faction, proposals for improvements have a news item, photo, or suc- can be identified and evaluated for providers. OJIN: The Online Journal of Issues in Nursing, 14(3). doi:10.3912/ cess story you would like published, use in future plans as the program OJIN.Vol14No03ManOS send it along with your name, continues to expand. Verson, S.A., Howard, K.B., & Penney, B.K. email address, phone number, and (2008). Impact of internet use on References health-related behaviors and the other comments/suggestions to: Egbert, N., & Nanna, K., (2009, September patient-physician relationship: A survey- Katie Brownlow, AAACN ViewPoint, 30). Health literacy: Challenges and based study and review. The Journal of Managing Editor, East Holly strategies. OJIN: The Online Journal of the American Osteopathic Association, Avenue, Box 56, Pitman, NJ 08071- Issues in Nursing, 14(3). doi:10.3912/ 108(12), 699-711. OJIN.Vol14No03Man01. 0056; Email [email protected] Institute of Medicine (IOM). (2004). Health Linda Northrop, BA, RN, PCRN, is a Issue Deadline literacy: A prescription to end confusion. Clinical Nurse, Tampa General Hospital, May/June 2012 April 1, 2012 Washington, DC: Author. Tampa, FL. Teolis, M.G. (2010). A MedlinePlus® kiosk July/Aug 2012 June 1, 2012 promoting health literacy. Journal of Renée Meehan, RN, BSN, MA, CDE, is Sept/Oct 2012 August 1, 2012 Consumer Health On the Internet, 14(2), a Diabetes Nurse Specialist, Tampa Nov/Dec 2012 October 1, 2012 126-137. General Hospital, Tampa, FL. Suggested Readings Barbara Hatfield, RN, CNS, MSN, is a Cornett, S. (2009, September 30). Assessing Clinical Nurse, Tampa General Hospital, and addressing health literacy. OJIN: The Tampa, FL.

Covering Healthcare Call Centers and the Telehealth Industry

Get your FREE subscription at: www.answerstat.com/subscribe

Also, check out Medical Call Center News at www.medicalcallcenternews.com

WWW.AAACN.ORG 5 View health care reform resources online at: www.aaacn.org/HCReform Prevention and Early Detection of “Never Events” Within Ambulatory Settings to Enhance Quality and Safety and Prevent Financial Losses

In the last ViewPoint “Health Care Reform” column with an opportunity to improve patient safety. Table 1 (Haas, 2011), accountable care organizations (ACOs) that shows the updated NQF never event list. include patient centered medical homes (PCMHs) or Currently, never events or HCACs are publicly report- ambulatory care settings created by the Patient Protection ed, with the goal of increasing accountability and improv- and Affordable Care Act (PPACA) were defined and dis- ing the quality of care. Public reporting began with NQF cussed. Within ACOs and PCMHs there are incentives, the dissemination its original list of never events in 2002; 11 proverbial ‘carrots,’ to increase safety and quality of care. states have mandated reporting of these incidents whenev- However, there are also penalties for not enhancing quali- er they occur, and an additional 16 states mandate report- ty and safety, the proverbial ‘sticks.’ A new, final Centers for ing of serious adverse events (including many of the NQF Medicare and Medicaid Services (CMS) rule required by never events) (AHRQ, 2011). Not only must the health care Section 2702 of PPACA will disallow federal funding under facilities report the events, they are accountable for cor- Medicaid effective July 1, 2012, for certain “never events” recting systematic problems that contributed to the event, that State Medicaid Programs are required to define. The with some states (such as Minnesota) mandating perform- events to be defined are health care-associated conditions ance of a root cause analysis and reporting its results (HCACs) and other provider-preventable conditions (AHRQ, 2011). (OPPCs) (CMS, 2011). So what does this mean for ambulatory care nurse lead- Never events include adverse (sentinel) events that are ers? Ambulatory settings performing surgery, interventional clearly identifiable and measurable, and serious events radiology, or infusion therapy will, in about six months, be (resulting in death or significant disability), which are usual- denied payment for never events that occur. Many of the ly preventable (U.S. Department of Health and Human never events listed in Table 1 are rare (AHRQ, 2011), but in Services, Agency for Healthcare and Research and Quality 2009, data from Minnesota’s public reporting indicated [AHRQ], 2011). Hospital-acquired conditions (HACs), such that falls in hospitals account for 30% and pressure ulcers as wrong site surgery for which Medicare already denies 39% of adverse events (Minnesota Department of Health, payment to hospitals, must be included in the State 2009). Both pressure ulcers and falls of patients and care- Medicaid Program definition of HCACs. The new OPPC des- givers in ambulatory settings are potential never events ignation is intended for conditions more likely to occur in across most patient populations. Never events should not settings outside hospitals such as outpatient or office-based occur because there are evidence-based methods of pre- surgery centers, skilled nursing facilities, and ambulatory venting them and detecting them early. practice settings (specifically office-based practices). OPPCs First and foremost, ambulatory nurse leaders need to must be determined from evidence-based guidelines (CMS, be involved in proactively planning for development and 2011). It is expected that public reporting on incidence of implementation of evidence-based guidelines to prevent never events in settings outside of hospitals will also be pub- potential never events in their settings. If guidelines are not lically reported – another ‘stick’ to enhance accountability. already in place, then work should begin on developing The National Quality Forum (NQF) is a nonprofit guidelines for those high-volume, high-cost events such as organization that strives to improve the quality of falls and pressure ulcers. Please note that pressure ulcers American health care by establishing goals for perform- can begin in as little as four to six hours, so procedure areas ance improvement, endorsing national standards for meas- where patients are immobile for such time frames should uring and reporting on performance, and promoting the have guidelines in place to provide for a full body skin attainment of national safety goals through education assessment at the beginning of a visit as part of early detec- (NQF, 2011a). Using a consensus model, the NQF has tion of current or potential areas of breakdown and should been the organization working with the AHRQ to name address positioning and repositioning as well as appropri- and define the never events specified in CMS rules. The ate support surfaces. Ambulatory care nurses should also NQF Board recently approved a list of 29 serious reportable be at the table when Electronic (EMR) doc- events (SREs) in health care in their 2011 Consensus Report. umentation screens are developed for care provided by Of these 29 events, 25 were updated from 2006 and four nurses in ambulatory settings, so that there is opportunity new events were added to the list (NFQ, 2011b). This for nurses to document assessments, interventions, evalua- newly expanded list of serious reportable events (never tions, and outcomes in the EMR. events) is available and it provides health care professionals continued on page 8

6 ViewPoint JANUARY/FEBRUARY 2012 Table 1. Serious Reportable Events in Health Care – 2011 Update 1. SURGICAL OR INVASIVE PROCEDURE EVENTS • Surgery or other invasive procedure performed on the wrong • Unintended retention of a foreign object in a patient after site surgery or other invasive procedure • Surgery or other invasive procedure performed on the wrong • Intra-operative or immediately post-operative/post-procedure patient death in an ASA Class 1 patient • Wrong surgical or other invasive procedure performed on a patient

2. PRODUCT OR DEVICE EVENTS • Patient death or serious injury associated with the use of • Patient death or serious injury associated with intravascular air contaminated drugs, devices, or biologics provided by the health embolism that occurs while being cared for in a health care care setting setting • Patient death or serious injury associated with the use or function of a device in patient care, in which the device is used or functions other than as intended

3. PATIENT PROTECTION EVENTS • Discharge or release of a patient/resident of any age, who is • Patient suicide, attempted suicide, or self-harm that results in unable to make decisions, to other than an authorized person serious injury, while being cared for in a health care setting • Patient death or serious injury associated with patient elopement (disappearance)

4. CARE MANAGEMENT EVENTS • Patient death or serious injury associated with a medication error • Any Stage 3, Stage 4, and unstageable pressure ulcers acquired (e.g., errors involving the wrong drug, wrong dose, wrong after admission/presentation to a health care setting patient, wrong time, wrong rate, wrong preparation, or wrong • Artificial insemination with the wrong donor sperm or wrong route of administration) egg • Patient death or serious injury associated with unsafe • (NEW) Patient death or serious injury resulting from the administration of blood products irretrievable loss of an irreplaceable biological specimen • Maternal death or serious injury associated with labor or delivery • (NEW) Patient death or serious injury resulting from failure to in a low-risk pregnancy while being cared for in a health care follow up or communicate laboratory, pathology, or radiology setting test results • (NEW) Death or serious injury of a neonate associated with labor or delivery in a low-risk pregnancy • Patient death or serious injury associated with a fall while being cared for in a health care setting

5. ENVIRONMENTAL EVENTS • Patient or staff death or serious injury associated with an electric • Patient or staff death or serious injury associated with a burn shock in the course of a patient care process in a health care incurred from any source in the course of a patient care process setting in a health care setting • Any incident in which systems designated for oxygen or other • Patient death or serious injury associated with the use of physical gas to be delivered to a patient contains no gas, the wrong gas, restraints or bedrails while being cared for in a health care or is contaminated by toxic substances setting

6. RADIOLOGIC EVENTS

• (NEW) Death or serious injury of a patient or staff associated with the introduction of a metallic object into the MRI area 7. POTENTIAL CRIMINAL EVENTS • Any instance of care ordered by or provided by someone • Death or serious injury of a patient or staff member resulting impersonating a physician, nurse, pharmacist, or other licensed from a physical assault (i.e., battery) that occurs within or on the health care provider grounds of a health care setting • Abduction of a patient/resident of any age • Sexual abuse/assault on a patient or staff member within or on the grounds of a health care setting

Source: National Quality Forum, 2011c. Reprinted with permission.

WWW.AAACN.ORG 7 References 1. Describe the value that you provide to your employer/ Centers for Medicare & Medicaid Services (CMS). (2011, February workplace as an ambulatory care nurse. 17). Medicaid program; Payment adjustment for provider- 2. Is your workplace collecting data regarding perform- preventable conditions including health care-acquired condi- tions. Federal Register: The Daily Journal of the United States ance improvement indicators to evaluate the effective- Government. Retrieved from http://www.federalregister.gov/ ness of the registered nurse role in ambulatory care articles/2011/02/17/2011-3548/medicaid-program-payment- settings? adjustment-for-provider-preventable-conditions 3. If yes, what performance indicators are being used? Haas, S. (2011). Understanding “value driving elements” of ACOs and PCMHs. ViewPoint, 33(6), 8-9. Data was analyzed both quantitatively and qualitative- Minnesota Department of Health. (2009). Adverse health events in ly. Quantitative analysis included measuring a percentage Minnesota: Fifth annual public report. Retrieved from response for the dichotomous question. Qualitative analy- http://www.health.state.mn.us/patientsafety/ae/09 ahereport.pdf sis was conducted by classifying responses into categories National Quality Forum (NQF). (2011a). About NQF. Retrieved from established by the research team. The authors used the http://www.qualityforum.org/About_NQF/About_NQF.aspx AAACN standards as the basis for categorizing the respons- National Quality Forum (NQF). (2011b). NQF releases updated es (AAACN, 2010). In order to code the responses, the serious reportable events. Retrieved from http://www.quality authors met together and reviewed each individual forum.org/News_And_Resources/Press_Releases/2011/NQF_ Releases_Updated_Serious_Reportable_Events.aspx response. The main points from each response were then National Quality Forum (NQF). (2011c). Serious reportable events in recorded, and agreement was reached among the three healthcare 2011 update. Washington, DC: Author. Retrieved authors as to which category the response matched. For from http://www.qualityforum.org/Publications/2011/12/ example, responses in one of the categories, Nursing Serious_Reportable_Events_in_Healthcare_2011.aspx Process, elicited the following responses: Direct Patient U.S. Department of Health and Human Services, Agency for Healthcare and Research and Quality (AHRQ). (2011). Patient Care (8 responses), Patient Assessment (5), Critical safety primers: Background. Retrieved from http://psnet.ahrq.gov/ Thinking (4), Medication Administration (4), Providing primer.aspx?primerID=3 Quality Care (3), Support (3), Implementing Plan of Care (2), Triage of Patients/Problems (2), Clinical Skills (2), and Sheila A. Haas, PhD, RN, FAAN, is a Professor, Niehoff School of Problem-Solving (1). Nursing, Loyola University of Chicago, Chicago, IL. She can be con- Some RNs responded with compound sentences or tacted at [email protected] sentences with multiple adjectives, nouns, and verbs that needed to be broken down into segments that were then Redefining the Value of the RN filed into different categories. Nevertheless, a single phrase, continued from page 1 adjective, noun, or verb within a sentence was assigned a In addition to the initiatives outlined above, the outpa- single category and not placed into more than category. tient clinics at this organization are in the process of imple- The three authors made the decision regarding the best fit menting three other major changes: (a) the hiring of for the single phrase, adjective, noun, or verb. Certified Medical Assistants for the first time, (b) the imple- Categorization required consensus among all three mentation of a new electronic medical record system, and authors, including: a staff nurse who is also a PhD candi- (c) changes in the workflow processes. These changes in date, a , and a nurse manager. Descriptors the care delivery model increase the need for role clarifica- of the standards were used to categorize the response. tion across all health care disciplines. Results Method The responses to the statement, “Describe the value In 2010, a convenience sample was made up of ambu- that you provide to your employer/workplace as an ambu- latory care registered nurses employed in adult and pedi- latory care nurse,” are summarized in Table 1. atric primary care and specialty clinics (including family In answering the second question, “Is your workplace medicine, pulmonary, urology, internal medicine, derma- collecting data regarding performance improvement indi- tology, transplant, rheumatology, and more) at a teaching cators to evaluate the effectiveness of the registered nurse hospital located in Charleston, South Carolina. Permission in ambulatory care settings?” 49% responded, “Yes,” and to conduct the study was obtained from the Institutional 51% responded, “No,” which was similar to the earlier sur- Review Board. Staff nurses were asked to participate by vey. In response to the third question, “If yes, what per- email response to an online survey created on formance indicators are being used?” there were a total of SurveyMonkey®. Participation was voluntary. Forty-four 27 indicators listed with the most frequent response being surveys were returned (return rate of 28%). “Patient Satisfaction Surveys” (26%). This was also the most frequent response in the 2005 survey. Procedure Some indicators were very general (central line infec- The instrument selected was the “Value of an tions, medication reconciliation), but were only listed once. Ambulatory Care Nurse” survey used in the Conway-Phillips Other indicators were clinic-specific, such as indicators for (2006) study. Permission to use the survey was received patients with baclofen pumps. It was evident from some from Cynthia Hnatiuk, Executive Director of AAACN. The comments that not all nurses were clear on what is meant survey was comprised of the following three items: by “performance indicators” with regard to RN effective-

8 ViewPoint JANUARY/FEBRUARY 2012 Table 1. knowledge to help address medical conditions, establish 2010 Survey Responses plans of care, assess current conditions, and formulate pre- Describe the value that you provide to your ventive care.” Other values that were illuminated in the employer/workplace as an ambulatory care nurse. nurses’ responses included the concept of wellness care. By teaching patients value in self-care, exercise, nutrition, safe- AAACN Number of Percentage ty, and disease management, nurses place a measure of Category Standard Responses of Responses control back in the lives of their patients and enhance their sense of well-being, comfort, and quality of life. Additional 1, 2, 3, 4, 6 34 20% important values cited included “making a difference, Experience/ delivering compassionate care, and establishing a trusting 8 28 16% Education relationship with patients and families.” Some nurses also mentioned their role in preventing Coordination of Care 5a 21 12% hospitalizations. One nurse stated that, “We are able to prevent patient admissions due to our vigilance in identify- Leadership 16 16 9% ing problems early and taking appropriate preventive nurs- ing interventions.” In addition to preventing costly hospi- Collaboration 11 15 9% talizations, outpatient nurses also “provide cost Health Teaching/ 5b 14 8% containment, cost and time efficiency in regards to nursing Health Promotion practice, prevention of wasted resources, prevention of Resource Utilization 15 13 8% ‘mistakes’ or adverse patient related events.” These state- ments compare with findings in another study by Performance 7 10 6% Chinaglia and colleagues (2002). That study found a nurse- Improvement managed outpatient clinic decreased hospitalizations by Ethics 12 9 5% 70%, improved the functional status and quality of life of the patients, and decreased medical costs (Chinaglia et al., Professional Practice 9 7 4% 2002). Environment/ It is clear that RNs recognize their value and are able to 14 3 2% Safety articulate the role they play in the care of the ambulatory patient. Further investigation needs to address the link Research 13 1 0.5% between the actual nursing care activities as defined by the AAACN Scope and Standards of Practice (2010) and the ness. Others were not sure if performance indicators were achievement of improved patient outcomes. being measured in their area. Although much of the focus and research related to the RN’s impact on outcomes is based on the inpatient Summary experience, it is the authors’ belief that additional financial In the 2005 survey, 31% of nurses identified benefit to the health care system is achieved with patient/family education as value added. In contrast, in the improved health outcomes in the ambulatory setting as 2010 survey, nurses identified health teaching/health pro- well. There is demonstrated evidence in inpatient settings motion in only 8% of responses. However, these nurses list- that indicators, such as bloodstream infections with central ed the work they do in the areas of assessment, phone lines, ventilator-associated pneumonia, and urinary tract triage, or care coordination, which can involve patient infections, are decreased and patient outcomes are teaching. The number one response (20% of total respons- improved when RNs are providing care (Earsing, Hobson, es) included activities associated with the nursing process: & White, 2005; Elpern et al., 2009; Goulette, 2001; Mark, assessment, planning, implementation, outcomes, and Harless, & Berman, 2007). There is currently a lack of evaluation. With the new emphasis on achieving outcomes research and literature examining the role of the ambula- in care, it is possible that nurses are recognizing the value tory RN in health promotion, health maintenance, and of the nursing process as the key foundation for decision- chronic care and the benefits derived from this care. In making and evaluation to achieve patient goals. Nurses fact, a literature search of the years 1993 through the pres- also responded that their experience and education were ent resulted in only 20 publications (approximately one valuable attributes to the organization and to quality publication per year), and of those 20 publications, only patient care (16% of responses) (as shown in Table 1). four may be considered research studies: a qualitative More specifically, “Experience/Education” responses study (Baghi, Panniers, & Smolenski, 2007), a four-part revealed that in addition to initial education, personal com- survey study (Haas & Hackbarth, 1995a, 1995b; Haas, mitment to ongoing professional development through Hackbarth, Kavanagh, & Vlasses, 1995; Hackbarth, Haas, continuing education and certification was an important Kavanagh, & Vlasses, 1995), and two other survey studies component. (Conway-Phillips, 2006; Quirk, 1998) including the origi- One nurse stated that she provides value through “crit- nal survey study (Conway-Phillips, 2006) that we modeled. ical thinking skills, triage, communication, and education to patients and families” and that RNs “possess a body of continued on page 10

WWW.AAACN.ORG 9 The recent changes in health care delivery with increased focus on fiscal accountability, achievement of Instructions for Continuing Nursing outcomes, and appropriate resource utilization present an opportunity to translate the assessment, planning, and Education Contact Hours interventions of the outpatient RN into measurable patient Redefining and Categorizing the Perceived care outcomes and economic benefits. The information Value of the RN in Ambulatory Care gained will assist organizations to better understand and Deadline for Submission: February 28, 2014 utilize the professional registered nurse. It is expected that To Obtain CNE Contact Hours improvements in patient safety and patient outcomes will 1. For those wishing to obtain CNE contact hours, you must also be achieved. read the article and complete the evaluation online in the AAACN Online Library. ViewPoint contact hours are free to References AAACN members. American Academy of Ambulatory Care Nursing (AAACN). (2010). • Visit www.aaacn.org/library and log in using your Scope and standards of practice for professional ambulatory care AAACN email address and password. (Use the same log nursing (8th ed.). Pitman, NJ: Author. Baghi, H., Panniers, T.L., & Smolenski, M.C. (2007). Description of in and password for your AAACN Web site account and practice as an ambulatory care nurse: Psychometric properties Online Library account.) of a practice-analysis survey. Journal of Nursing Measurement, • Click "ViewPoint Articles" in the left hand navigation bar. 15(1), 62-76. • Read the ViewPoint article of your choosing, complete Chinaglia, A., Gaschino, G., Asteggiano, R., Titta, G., Gullstrand, R., the online evaluation for that article, and print your CNE Bobbio, M., & Trinchero, R. (2002). Impact of a nurse-based certificate immediately. heart failure management program on hospitalization rate, 2. Upon completion of the evaluation, a certificate for 1.0 functional status, quality of life, and medical costs. Italian Heart contact hour may be printed. Journal Supplement, 3(5), 532-538. Conway-Phillips, R. (2006). Ambulatory nurses speak out: The value of Fees ambulatory care nurses in the workplace. Viewpoint, 28(4), 3-4. AAACN members: FREE Regular price: $20 Earsing, K.A., Hobson, D.B., & White, K.M. (2005). Preventing cen- Objectives tral line infection. , 36(10), 18-24. The purpose of this continuing nursing education article is to Elpern, E.H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, increase the awareness of the perceived value of the RN in O. (2009). Reducing use of indwelling urinary catheters and ambulatory care in nurses and other health care professionals. associated urinary tract infections. American Journal of Critical After studying the information presented in this article, you will Care, 18(6), 535-541. be able to: Goulette, C. (2011). Skin care vigilance in the ICU. Retrieved from 1. Explain the 2006 study of members of the American http://nursing.advanceweb.com/Features/Articles/Skin-Care- Academy of Ambulatory Care Nursing (AAACN) and its Vigilance-in-the-ICU.aspx results. Haas, S., & Hackbarth, D.P. (1995a). Dimensions of the staff nurse 2. Discuss the importance of a revised survey in 2010 and its role in ambulatory care: Part III – Using research data to design components. new models of nursing care delivery. Nursing Economic$, 13(4), 230-241. 3. Describe how results of these studies varied and how these Haas, S., & Hackbarth, D.P. (1995b). Dimensions of the staff nurse results can be applied to practice. role in ambulatory care: Part IV – Developing nursing intensity 4. Identify ways in which the current health care arena will measures, standards, clinical ladders, and QI programs. Nursing impact the perception of ambulatory care nurses in years to Economic$, 13(5), 285-294. come. Haas, S., Hackbarth, D.P., Kavanagh, J.A., & Vlasses, F. (1995). The authors have not disclosed any affiliation or financial interest in Dimensions of the staff nurse role in ambulatory care: Part II – relation to this educational activity. Comparison of role dimensions in four ambulatory settings. This educational activity has been co-provided by AAACN and Nursing Economic$, 13(3), 152-165. Anthony J. Jannetti, Inc. Hackbarth, D.P., Haas, S., Kavanagh, J.A., & Vlasses, F. (1995). Anthony J. Jannetti, Inc. is accredited as a provider of continuing nurs- Dimensions of the staff nurse role in ambulatory care: Part I – ing education by the American Nurses' Credentialing Center's Methodology and analysis of data on current staff nurse prac- Commission on Accreditation (ANCC-COA). tice. Nursing Economic$, 13(2), 89-98. Mark, B.A., Harless, D.W., & Berman, W.F. (2007). Nurse staffing AAACN is an approved provider of continuing nursing education by the California Board of Registered Nursing, provider number CEP5366. and adverse events in hospitalized children. Policy, Politics, & California licensees must retain this document for four years. Nursing Practice, 8(2), 83-92. This article was reviewed and formatted for contact hour credit by Quirk, B.P. (1998). Primary patient care in a chronic outpatient Rosemarie Marmion, MSN, RN-BC, NE-BC, Education Director. hemodialysis unit. ANNA Journal, 25(3), 301-306, 319.

Robin E. Matutina, PhD(c), RN-BC, CPN™, CPON®, is an RN III, Medical University of South Carolina, Charleston, SC. Susan B. Hamner, MSN, RN, is a Clinical Education Specialist, Medical University of South Carolina, Charleston, SC. Rosemarie Battaglia, MSN, RN, is a Nurse Manager, Children’s Hospital, Medical University of South Carolina, Charleston, SC. Acknowledgement: The authors would like to acknowledge all the outpatient nurses who participated in the survey and Shannon Richards-Slaughter, PhD, for her editorial contributions.

10 ViewPoint JANUARY/FEBRUARY 2012 described in Part I (Koehne, 2011), you still can prevent injuries. For example, you can make adjustments to your Nurse – Care for Thyself! chair, computer screen, lighting, telephone, and desk. It is important to take micro-breaks. These include adjusting Part II your posture, stretching your back and shoulders, and rest- Delivering patient care via the telephone can negative- ing your hands. These breaks, when done consistently ly affect a nurse’s physical health. While research has dis- throughout the day, can reduce the incidence of overuse covered these sobering problems, there are things you can injury. It may be helpful to post pictures of workstation do to keep healthy and prevent premature death. Part I of stretches in your view to serve as a reminder. Then engage this article series (Koehne, 2011) described the impact of in activity during your breaks – take a walk, lift some hand stationary nursing jobs that keep them primarily in front of weights, or do a little yoga. And don’t forget to fidget. a computer or on the phone. This installment will supply Scientists have proved that fidgeting, which is defined as additional information, including tips for maintaining life- non-exercise activity, burns calories and increases blood cir- long healthy habits. culation (Levine et al., 2005). Fidgeting includes foot tap- ping, head bobbing, and pacing. You make look restless, The Basics but it is for your health! Establish a consistent exercise routine and incorporate activity during your workday; plan movement at least Your Eyes Matter Too every two hours. According to recent studies (Katzmarzyk, Even if you are not suffering from a metabolic or mus- Church, Craig, & Bouchard, 2009), an exercise program culoskeletal disorder, you may be experiencing other alone will not counteract the risk of a sedentary job, but computer-related symptoms. The American Optometric moving throughout the day is beneficial. It is important to Association (2011) identified Computer Vision Syndrome, have a 5-minute movement break every hour. Do not work symptoms of which may include eyestrain, headache, dry through your breaks. To maintain good health, you should eyes, and neck and shoulder pain. Over 50% of computer leave your workstation and move – go outside for a brisk users report one or several of these symptoms. Reducing walk or go up and down stairs. Simply standing up and glare and adjusting screen brightness may prevent eye- doing a quick run in place or a few jumping jacks may look strain. It is also helpful to raise or lower the screen so it is unusual, but will have a powerful benefit. These movement positioned 4-5 inches below eye level. Additionally, it is ‘bursts’ will reduce the impact of prolonged sitting. important to look away from the screen for 20 seconds As stated in Part I (Koehne, 2011), there is a metabol- every 20 minutes, and to avoid computer use while on ic effect caused by long-term sitting. As a telephone triage break. Remember to blink frequently to retain eye mois- nurse, you may be managing many calls every day, but you ture. By implementing these practices, you will reduce the are not moving as calls are processed. Your mouth moves impact of the computer on your eyes. Typically, any visual as you talk and your upper body will be used to document changes are temporary and only occur when the comput- the calls by writing or typing, but this expends minimal er is in use. Once the user is no longer visualizing the physical energy. According to most calorie burn calcula- screen, the symptoms resolve. However, it is important to tors, sitting at a desk burns 60-110 calories (depending on report any visual concerns to your health care provider and variables such as gender, age, and weight). The longer you have regular eye exams. According to a survey completed engage in this type of work, the amount decreases to one by over 1,000 optometrists, approximately 10 million eye calorie per minute. There is great potential for weight gain examinations are performed annually because of visual dis- when you transition from an active nursing job to a more turbances caused by computer use (Sheedy, 1992). stationary telephone triage position. We all have heard of AAACN Takes a Stand the ‘freshmen fifteen.’ Have you experienced the ‘tele- Although OSHA has become increasingly involved in phone nurse twenty?’ promoting computer workstation safety in recent years, Many nurses who spend the majority of their time man- there are no federal or state level standards that enforce aging patients by phone report a weight gain. Often they workstation wellness for employees. However, the report that when they were “running around the hospital” American Academy of Ambulatory Care Nursing (AAACN) they burned off more calories and now they do not have has taken a bold step to establish a standard that promotes this opportunity. If you have experienced this phenomenon a “safe, efficient, hazard-free, and ergonomically correct common to telephone triage nurses, evaluate your diet. As environment” for telehealth nursing staff (AAACN, 2011, nurses, you know the basics of proper nutrition. Awareness p. 37). The Scope and Standards of Practice of Professional of the change in your caloric needs and making adjust- Telehealth Nursing (Standard 16 – Environment) has ments is the first step. A nutritionist may be a great resource defined criteria which include proper ergonomic seating if you are finding that this is a constant struggle. and equipment, and proper lighting and sound. AAACN is Self-Care is Your Responsibility advocating for the health of telephone triage nurses Even if your employer does not provide a formalized through this standard. ergonomic assessment and workstation evaluation as continued on page 12

WWW.AAACN.ORG 11 Conclusion As discussed throughout this series, telephone triage nurses are highly valued and in great demand. It takes experienced nurses with excellent communication skills, critical thinking ability, confidence in decision-making, and common sense to manage patient care via telephone. Even ● Yes, even older Americans can exercise to maintain body with life and professional experience, telephone triage mass, strengthen muscles, and promote cardiovascular nursing is highly sophisticated and takes time to develop health. Check many resources at the National Institute of and refine itself. However, the longer we spend on the Health, National Institute on Aging, for free brochures that phones in a physically static state, the more we risk our you can share with your elderly patients: chance to remain healthy. But by engaging in workstation http://www.nia.nih.gov/health/publication wellness activities, we can maintain and improve our ● health and well-being. If we implement ergonomic princi- Love your heart this Valentine’s Day! Check out various eth- ples, we will be able to help patients for years to come! nic options for eating more healthfully, including the Asian, Latin American, and Mediterranean food pyramids from References Mayo Clinic: http://www.mayoclinic.com/health/healthy- American Academy of Ambulatory Care Nursing (AAACN). (2011). diet/NU00190 Scope and standards of practice for professional telehealth nursing (5th ed.). Pitman, NJ: Author. ● Ever consider becoming an organ donor? Check out informa- American Optometric Association. (2011). Computer vision syn- tion on live organ donations from the United Network for Organ drome. Retrieved from http://www.aoa.org/x5374.xml Sharing: http://www.unos.org/docs/Living_Donation.pdf Katzmarzyk, P.T., Church, T.S., Craig, C.L., & Bouchard, C. (2009). ● Sitting time and mortality from all causes, cardiovascular dis- Did you forget about adult immunizations and what should ease, and cancer. Medicine and Science in Sports and Exercise, be updated at each visit? Print and share this poster on what 41(5), 998-1005. is required and when from the Centers for Disease Control Koehne, K. (2011). Nurse – Care for thyself! Part I. ViewPoint, 33(6), and Prevention: http://www.cdc.gov/vaccines/recs/ 4-5. schedules/downloads/adult/adult-schedule-11x17.pdf Levine, J.A., Lanningham-Foster, L.M., McCrady, S.K., Krizan, A.C., Olson, L.R., Kane, P.H., … Clark, M.M. (2005). Interindividual variation in posture allocation: Possible role in human obesity. Carol Ann Attwood, MLS, AHIP, MPH, RN,C, is a Medical Science, 307(5709), 584-586. doi:10.1126/science.1106561 Librarian, Patient Health and Education Library, Mayo Clinic Sheedy, J.E. (1992). Vision problems at video display terminals: A Arizona, Scottsdale, AZ, and a ViewPoint Editorial Board member. survey of optometrists. Journal of American Optometric She can be contacted at [email protected] Association, 63(10), 687-692. Suggested Readings Patel, A., Bernstein, L., Deka, A., Feigelson, H., Campbell, P., Gapstur, S., … Thun, M. (2010). Leisure time spent sitting in We took everything you relation to total mortality in a prospective cohort of us adults. need for your job search American Journal of Epidemiology, 172(4), 419-429. doi:10.1093/aje/kwq155 and put it all in one place. U.S. Department of Labor. (2011). Occupational and safety adminis- tration: Computer workstations. Retrieved from http:// www.osha.gov/SLTC/computerworkstation/index.html Welcome to the AAACN Career Center – your leading resource for an ideal position Kathryn Koehne, RNC-TNP, is a Nursing Systems Specialist, or effective recruitment. Job seekers can: Department of Nursing, Gundersen Lutheran Health Systems, and t Find the right nursing jobs. Quicker. a Professional Educator for Telephone Triage Consulting, Inc. She t Get job alerts. can be contacted at [email protected] t Receive targeted e-mails, e-newsletter, and career advice. And if you’re hiring, there’s something Coming soon in for you too. Because we’re connected to other disciplines’, your career centers job posting is seen by more people Educational offerings: every day. • Think Zebra: Promote Awareness of PIDD • Lyme Disease: The Great Imitator Plus these favorite columns: • Telehealth Trials and Triumphs • Health Care Reform • For Your Health Connect today! • Member Spotlight www.healthecareers.com/AAACN  tJOGP!IFBMUIFDBSFFSTDPN

12 ViewPoint JANUARY/FEBRUARY 2012 President’s Message began collecting data on the high death rate of sol- continued from page 2 diers. When the military surgeons did not embrace her suggestion for improvements in environmental condi- • The third recommendation is to implement nurse resi- tions, she used her connection with a reporter to alert dency programs. These programs would help transi- the British people of the conditions. This sparked pub- tion new nurses into practice, support advanced prac- lic outrage, and she received the needed supplies, tice degree programs, or facilitate nurses transitioning equipment, and support to implement the changes into a new clinical area of practice. The goal of the pro- (Mason, 2011). grams would be to promote retention of nurses, As ambulatory care nurses, we can advocate for expanded competencies, and improved patient out- National Compact Licensure. This initiative allows nurses to comes. practice in any compact state, the goal being all states • The fourth recommendation is to increase the propor- become part of the compact. Licensure impacts us all tion of nurses with a baccalaureate degree to 80% by because of the telehealth connection to our patients. 2020. Fifty percent of RNs currently have a baccalaure- The Future of Nursing report provides us with more oppor- ate degree. This recommendation also seeks funding tunities to stand as equals at the ‘table’ to devise a stronger for education and encourages nurses with associate or and better health care system through collaboration. diploma degrees to enter baccalaureate nursing pro- Ambulatory care nurses need to arm themselves with grams within 5 years of graduation. the knowledge and tools to articulate our value in improv- • The fifth recommendation of the IOM is to double the ing patient outcomes. We continue to expand our inde- number of nurses with a doctorate by 2020. This pendent and collaborative practice using our broad knowl- requires an increase in accredited programs to support edge base of nursing and health sciences, clinical student enrollment. The goal is that 10% of baccalau- judgment, and critical thinking skills to manage the com- reate graduates will enter a master’s or doctorate pro- plex problems of our patients. We work with our patients gram within 5 years of graduation. to promote optimal wellness, provide leadership, and coor- • The sixth recommendation is to ensure that nurses dinate care through the continuum of life in a variety of engage in lifelong learning. Nurses must continually settings and methods of communication. participate in learning to gain and maintain competen- cies needed to provide care for diverse patient popula- References tions. Educational programs should be adaptable, flex- Bleich, M. (2011, November 18). What’s happened in a year? A ible, accessible, and have a positive impact on clinical follow-up to the IOM Future of Nursing report. Presented at the Nursing Organizations Alliance (NOA) Fall Summit, Miami, FL. outcomes. Institute of Medicine (IOM). (2010). The future of nursing: Leading change, AAACN and many employers offer scholarships or advancing health. Retrieved from http://www.iom.edu/nursing financial assistance for the continuing education of their Mason, D.J. (2011). The nursing profession: Development, challenges, members or staff. and opportunities. San Francisco, CA: Jossey-Bass. Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.Y., The third key message is that nursing must be a full Cleary, P.D., … Shelansku, M.L. (2000). Primary care outcomes partner with physicians and other health care in patients treated by nurse practitioners or physicians: A ran- professionals in redesigning health care systems. domized trial. Journal of the American Medical Association, 283(1), 59-68. • In their seventh recommendation, the IOM states nurs- es need to be prepared and enabled to lead change to Linda Brixey, RN, is Program Manager, Clinical Education, Kelsey- advance health initiatives. Nurses should be education- Seybold Clinic, Houston, TX. She can be contacted at linda. ally prepared to assume leadership positions. There [email protected] needs to be a grassroots nursing involvement to effect this change. • We need nursing representation at every level of health care decision-making to advocate for our patients and define the impact of nursing on improving outcomes.

The fourth key message relates to the eighth recommendation. There needs to be effective workforce planning and policy-making. • The IOM recommends an infrastructure be built that supports the collection and analysis of inter- LVM Systems, Inc. professional health care workforce data. The Workforce 4262 E. Florian Avenue, Mesa, AZ 85206 Commission and Health Resources and Service www.lvmsystems.com Administration should lead collaborative efforts to Corporate members receive recognition in ViewPoint, on AAACN's Web site, improve research, collection, and analysis of data on and in various conference-related publications, as well as priority booth place- effective workforce planning and policy-making. ment at AAACN's Annual Conference. For more information about Corporate • Political activism for nursing has been around since the Member benefits and fees, please contact Marketing Director Tom Greene at Crimean War in 1853 when Florence Nightingale [email protected] or 856-256-2367.

WWW.AAACN.ORG 13 AAACN Marketing Opportunities Advertise with AAACN and reach more than 2,000 nurse managers and supervisors, nurse administrators Members to Serve on The Joint and directors, staff nurses, educators, consultants, NPs, and researchers – the ideal audience for your sales and Commission Professional and marketing message! Technical Advisory Committee Marketing opportunities include: Two AAACN members were recently • Exhibiting at the AAACN Annual Conference appointed to serve on the Joint • Corporate sponsorships Commission Ambulatory Care Professional • Premium advertising and Technical Advisory Committee • ViewPoint, the AAACN official newsletter (PTAC). Margarita Gore, RN-BC, BSN, • AAACN Web site MBA, from the Mayo Clinic in Scottsdale, • AAACN monthly Enewsletter AZ, had served as the alternate to this Margarita Gore committee and will now serve as the offi- • Online Library cial representative to the PTAC. Stephen E. Anderson, MBA, • Conference program book RN, FACHE, from VHA Pacific Northwest, in Seattle, WA, was For more information, contact Marketing Director Tom appointed to serve as the alternate to this committee. Both Greene at [email protected] or 856-256-2367. members will serve 2-year terms. PTAC representatives assist The Joint Commission in the development and refinement of standards and elements of Online Library Tip performance. They also provide observa- An easy way to check if you are logged in as a mem- tions regarding environmental trends, ber in the Online Library (www.prolibraries.com/aaacn) is educational needs, and other important to look in the upper left corner of the screen (below the issues facing each of the fields in which PROLibraries Home text) for this image: Stephen E. Anderson The Joint Commission offers accreditation Because members receive discounted pricing on all services. PTAC representatives are expected to be propo- Online Library education, and nents of their respective bodies of knowledge to The Joint you can only access any free Commission, and proponents of The Joint Commission to CNE offerings by logging in their constituents. as a member, this is an important thing to check. Also, an easy way to access the Online Library is to ViewPoint Article “Wish List” login to the AAACN Web ViewPoint features articles on a variety of topics of site (www.aaacn.org) first, interest to ambulatory care and telehealth nurses. The then click on the Online following “wish list” includes topics members have told Library button on the left us they’d like to read more about, and now we’re hop- side of the home page. When ing you can share your experience and knowledge with you do this, the Online Library other members! will recognize you as a member and will automatically show you • Ambulatory care staffing • Magnet® process for member pricing. ratios ambulatory care • Ambulatory pediatrics • Medical home model New Webinars Added to • Bariatrics • Metrics for ambulatory Online Library • Case management care nursing These November and December webinars have been • Disease management • Patient safety added to the Online Library (www.prolibraries.com/aaacn): • Immunizations • RN leadership • Medical Home Model and Review of the NCQA • Leadership in nursing • Staff education Certification presented by M. Colette Carver, APRN-BC, education • Staffing/competencies in ADM, FNP • Legal nurse consulting specialty clinics •The Transitional Care Model presented by Christine • Travel medicine Bradway, PhD, CRNP, FAAN If you or someone you know might be able to write an arti- These webinars each offer 1.0 contact hour and will cle on a “wish list” topic, complete the Author Interest Form at enhance your knowledge on these current topics in ambu- www.aaacn.org (click Publications > ViewPoint). latory care. Member Price: $29 14 ViewPoint JANUARY/FEBRUARY 2012 HOT OFF THE PRESS Scope and Standards of Practice for Professional Telehealth Nursing, 5th Edition Put on Your Mouse Ears and A team of our telehealth experts Meet us at Lake Buena Vista! has updated this valuable resource for Nurses across the country may not all put on current practice. This expanded fifth mouse ears, but they will gather at the Hilton Walt edition defines clear responsibilities Disney World® to network, learn, and squeeze in a and accountabilities for clinical practi- little fun at the 37th Annual Conference, May 2-5, tioners and administrators in the mul- 2012, in Lake Buena Vista, FL. The weather in May titude of practice settings delivering will be between 62 and 85 degrees. We encourage telehealth nursing care. Each stan- you to consider coming a few days early or staying dard contains a statement and com- a few extra days to make the most of your trip to petencies. The 16 standards define: the Sunshine State. The hotel is located across the • Assessment • Research and Evidence- street from Downtown Disney, which offers an • Nursing Diagnoses Based Practice array of restaurants, shopping, and attractions. • Outcomes Identification • Performance The conference will offer cutting-edge sessions • Planning Improvement on ambulatory care and telehealth nursing. A Pre- • Implementation/ • Communication Conference workshop will help you “Guard your Coordination of • Leadership Ambulatory Practice” by reducing your liability and Care/Health Teaching • Collaboration practicing safely. Military nurses will network and and Health Promotion, • Professional Practice learn at the new, 2-day Tri-Service Military Pre- Consultation Evaluation Conference. Once the conference gets started, • Evaluation • Resource Utilization you’ll enjoy Opening Ceremonies and Barbee •Ethics • Environment Bancroft, MSN, RN, PNP, as the Keynote. Barb will • Education take you on a hilarious trip down memory lane The publication also contains our new Scope of through the last 30 years of nursing and medicine. Practice that includes the Definition of Professional An array of groundbreaking sessions, an Opening Ambulatory Care Nursing, describes the Conceptual Reception, Networking Luncheon, Exhibit Framework, analyzes the Evolution of Modern Ambulatory Hall/Poster Display, interactive Town Hall, and more Care and Nursing Practice, defines the Practice will offer you educational opportunities you will not Environment, and explains Ambulatory Care Nursing forget. Roles. Visit www.aaacn.org/conference for more Member Price: $29 Non-Member Price: $44 information and to register online. Order this must-have resource online at www.aaacn.org/store today!

National Office Election Results Results of the 2012 AAACN National Office election are in. A record-breaking number of members took a few min- utes to cast their votes online for the future leaders of the association and approve Bylaws changes. Newly elected offi- cers will begin their terms at the close of the 37th Annual Conference. The Nominating Committee will also begin its work recruiting candidates for the next election during the conference. Congratulations to these members who have volunteered to serve AAACN and you, our members:

President-Elect Director Director Nominating Committee Susan M. Paschke, MSN, Col. Carol Andrews, RN-BC, NE- Judy Dawson-Jones, MPH, BSN, Carol Zeek, BSN, MSBA, RNC RN-BC, NEA-BC BC, CCP (second 3-year term) RN (second 3-year term)

WWW.AAACN.ORG 15 Presorted Standard U.S. Postage CHANGE SERVICE REQUESTED PAID East Holly Avenue, Box 56 Deptford, NJ Pitman, NJ 08071-0056 Permit #142 Volume 34, Number 1

ViewPoint is published by the American Academy of Ambulatory Care Nursing (AAACN) AAACN Board of Directors President Linda Brixey, RN President-Elect Suzanne (Suzi) N. Wells, BSN, RN Immediate Past President Traci Haynes, MSN, RN, BA, CEN Director/Secretary Mary Vinson, MS, RN-BC, CMPE Director/Treasurer Susan M. Paschke, MSN, RN-BC, NEA-BC Directors Col. Carol Andrews, RN-BC, NE-BC, CCP Judy Dawson-Jones, MPH, BSN, RN Barbara Pacca, BSN, RN, CPN AAACN is a welcoming, unifying community for registered nurses in all ambulatory care settings. Executive Director Our mission is to advance the art and science of ambulatory care nursing. Cynthia Nowicki Hnatiuk, EdD, RN, CAE Director, Association Services Patricia Reichart AAACN ViewPoint www.aaacn.org Issue Editor Virginia Forbes, MSN, RN, NE-C, BC Editorial Board Carol Ann Attwood, MLS, AHIP, MPH, RN,C Patricia (Tricia) Chambers, BHScN, DC, RN Liz Greenberg, PhD, RNC New Year Resolutions for 2012 Laura Morano, RN, CPN, MA Susan M. Paschke, MSN, RN-BC, NEA-BC Ginger H. Whitlock, RN, MSN, CNA Here are some resolutions we hope you will consider adding to your list: Manuscript Review Panel Irene Berg, MSN, RN-BC • Get certified in ambulatory care nursing to validate your knowledge; Patricia Jensen, BSN, RN Vannesia Morgan-Smith, MGA, RN, NE-BC • Attend the annual conference to learn the latest in ambulatory care Becky Pyle, MS, RN practice; Janice Tuxbury, DNP, FNP-BC Managing Editor • Encourage a colleague to join AAACN; Katie R. Brownlow, ELS Editorial Coordinator • Purchase the NEW Scope and Standards of Practice for Professional Joe Tonzelli Telehealth Nursing; Layout Designer Bob Taylor • Join one of the 7 Special Interest Group email discussion lists to network Education Director with other members; Rosemarie Marmion, MSN, RN-BC, NE-BC Marketing Director • Get involved in AAACN – volunteer to serve on a task force, write an Tom Greene article for ViewPoint, or serve on a committee; • Contact the National Office if you have any questions about your membership or our products and services; and most importantly • Take care of yourself. Your family and patients need you! AAACN wishes all of our members a happy, healthy, and prosperous New Year.

www.facebook.com/AAACN

www.twitter.com/AmbCareNursing AJJ-0212-V-17C © Copyright 2012 by AAACN