Translating Research Into Practice
The members of the conference planning committee have been working on the plan for the next conference to be held in Phoenix, Ariz, Feb 28-March 3, 2007, and I am excited by the plans they are making! The themes of the conference will be extremely relevant and important topics: patient safety and quality. The part that a clinical nurse specialist (CNS) plays in those two very important topics is pivotal, and I am very pleased that we will be showcasing much of that work at the next conference.
The work is not easily accomplished, and there are many facets to it that are often intangible. Recently, there has been a lot of talk about the Institute for Healthcare Improvement (IHI) initiatives. These initiatives fall clearly with in the purview of CNSs and actually serve as a conduit for displaying the best of what a CNS can do. Through the collaborative and interactive multidisciplinary team coordination that is the strength of the CNS, the Institute for Healthcare Improvement initiatives become real. This is research in action. It is research "on the fly" if you will, and CNSs are at the forefront of the movement.
Between the 100K lives campaign, the SBAR process to improve communication between caregivers, and the numerous patient safety initiatives for all age groupings, I see CNSs driving the awareness of the programs and making the programs work in the participating facilities. The Institute for Healthcare Improvement initiatives have done much to increase awareness of the needs and, very importantly, provide a format where CNSs can and do shine.
What I do not see, however, is the CNS stepping up and taking credit where credit is due. Everyday, I see hardworking CNSs who take a lead role in the implementation of a new process or procedure and teach the nursing staff about new content or changed content so that the staff they work with can ensure that the patient's safety is a number one priority. I see it everyday in the facility where I work, and I am proud of those CNSs and the energy they share to make our patient's world a better place. I am humbled by their work.
When considering the topic of this message, I looked at the Agency for Healthcare Research and Quality (AHRQ) Web site and saw the content area of quality and patient safety. While searching the site and the Translating Research Into Practice-II initiatives, I was dismayed to see that the programs that were being funded were driven by physicians. I am not dismayed that physicians are doing research on quality and safety[horizontal ellipsis]far from it. I am very pleased that the focus has been turned in that direction. What dismayed me is that we have so few publications by CNSs that focus on quality and safety (relative to the number of us who are out there working on these initiatives) and, furthermore, that I could not clearly identify any CNSs who had funded research in these areas.
We are the masters of translating research into practice. We work with staff to help them understand the research. We work to create the policies and procedures that other staff will follow using the evidence base to support the changing practice. We are the experts in translation at the direct interface of the staff with the patients. We are where the rubber meets the road.
However, for all that work, we have little to show for it. The body of literature and applied research in the form of evidence-based practice for nursing is scant. Oh, we have documentation of a sort. We have the tools that we have created in our workplace to address the specifics of the various initiatives and how we will implement them in our environment. We have the policies to prove it. We have been doing a lot of work in the trenches, but we have not been telling anyone about it outside of our own workplace environment. What was the old adage that we learned in nursing school? If it is not documented, it was not done.
The AHRQ identified that "translation of research into sustainable improvements in clinical outcomes remains a substantial obstacle to improving the quality of care" (AHRQ Translating Research Into Practice-II Web site). They provided funding for some very worthwhile projects that they hoped would "close the gap between knowledge and practice" (AHRQ Translating Research Into Practice-II). The only problem is that the Translating Research Into Practice-II initiative was last funded in 2000. Does that mean that the research yielded little? Does that mean that we do not need to continue to do what we do? Far from it!
The Joint Commission on Accreditation of Healthcare Organizations has been addressing issues of patient safety and quality of care for a number of years. The national patient safety goals are updated and distributed each year and focus on slightly different topics each year in an effort to drive healthcare organizations to reduce errors and improve patient outcomes (Joint Commission on Accreditation of Healthcare Organizations Web site). Patient safety and the quality of care continue to be primary drivers for the Joint Commission on Accreditation of Healthcare Organizations and for the facilities that are accredited by them. As a result, the CNSs in many different roles are addressing those needs. However, again, I see little evidence of those creative ideas and evidence-based processes that are developed being shared in the literature.
What is needed is the publication and presentation of information that we know, live, and breathe everyday. Share your thoughts, your work, and your processes. Use the framework of patient safety and quality not only because they are relevant to the broader audiences of AHRQ, Joint Commission on Accreditation of Healthcare Organizations, and Institute for Healthcare Improvement but also because they are relevant to us and our patients.
Come to the National Association of Clinical Nurse Specialists conference on Feb 28-March 3, 2007. Plan to attend the sessions and learn how you too can participate in translating research into practice in a formal way with your peers. Come and get excited about what you do and be humbled by those who work by your side. Lift your head from the trenches long enough to see and admire their work or show off your own. Publish your work in the National Association of Clinical Nurse Specialists journal[horizontal ellipsis]or other journals[horizontal ellipsis]but publish! And most importantly, take credit where credit is due. You worked hard to earn the CNS credential. Show it off and help us all by bolstering the recognition of who we are and what we do for the healthcare system. It is time.
References:
Agency for Healthcare Research and Quality (AHRQ) Web site. Available at: http://www.ahrq.gov.
Institute for Healthcare Improvement (IHI) Web site. Available at: http://ihi.org/ihi.
Joint Commission on Accreditation of Healthcare Organizations National Patient Safety Goals. Available at: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/.
Translating Research Into Practice (TRIP)-II. Fact sheet. March 2001. AHRQ Publication No. 01-P017. Available at: http://www.ahrq.gov/RESEARCH/trip2fac.htm.
National Association of Clinical Nurse Specialists Updates
Alternative Link/ABC Coding Solutions
As part of an ongoing project to enhance reimbursement for clinical nurse specialist services, the National Association of Clinical Nurse Specialists (NACNS) is collaborating with Alternative Link/ABC Coding Solutions and Relative Value Systems Inc to develop codes describing clinical nurse specialist practice and relative values of those codes for reimbursement.
Please follow the development of this project on the NACNS Web site. We will be posting an online survey to establish the database for relative value codes. If you are asked to participate, please do so! This is an important project to describe the economic value of clinical nurse specialist practice!
Every Woman Magazine
The NACNS is happy to inform you about a new collaborative arrangement with the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). Recently, AWHONN approached NACNS about the feasibility of providing complimentary copies of Every Woman magazine to NACNS members for use in their clinical settings. Every Woman is published quarterly and is targeted to women aged 40 years and older. The magazine covers the main health issues of this population. If you are interested in ordering your free copies, visit the AWHONN Web site at http://www.awhonn.org/, click on the picture of the magazine, and follow the registration and ordering instructions.
News From Our Affiliates
California-The California CNS Network annual conference will be held in Palm Springs on November 4. This year, we will be in Southern California, and we have booked the beautiful Rancho Las Palmas Resort and Spa for the meeting. Our theme, Safety and Quality, is in alignment with the conference of the National Association of Clinical Nurse Specialists, which will be held in March in Phoenix.
Thanks to American Nurses Association, California (ANA/C) lobbyist, former State Assembly member, and clinical nurse specialist (CNS) Trish Hunter, California CNSs have been addressing state bills AB 2120 and 1591. Trish Hunter is lobbying to have CNSs included in language permitting nurses to bill Medicare/Medical for services and write for Department of Motor Vehicles (DMV)> disability placards. Many individual CNSs have been struggling with antiquated legislation and barriers to reimbursement for years.
In response to a member query, California CNS Network's member stance is universal. Clinical nurse specialists who provide the same services as other reimbursed health providers should be reimbursed at the same rate if they function in the patient sphere. Trish has solicited member letters and will be calling on individual CNSs to testify before the committee.
Trish will be presenting at the California CNS Network's fall conference on November 4. California CNS Network hopes to forge a solid working relationship with ANA/C and other organizations to improve legislation affecting public access to CNS healthcare providers.
Submitted by Margaret Talley, RN, CNS; Chair, California CNS Network.
News From the Clinical Nurse Specialist Foundation
The Clinical Nurse Specialist Foundation would like to acknowledge all the generous donors who have helped to establish the foundation. We are in our third year and are working to fulfill the mission that we have established to promote clinical nurse specialists and to support the education of clinical nurse specialist students throughout the country. Your donations will help provide scholarships and to establish an endowment to support research in practice and education for clinical nurse specialists.
Gold: $10,000-100,000
Janet Bingle
Silver: $5,000-9,999
Sue Davidson
Theresa Murray
Bronze: $1,000-4,999
Joanne Alderman
Jill Anderson
Constance Baker
Peggy Barksdale
Lorie Blythe
Janel Borkes
Jo Ann Burns
Margie Campbell
Angela Clark
Kathryn Davies
Susan Davis
Nancy Dayhoff
Robin Dennison
Kathleen Dunn
Jennifer Dunscomb
Patricia Ebright
Debra Ferguson
Christine Filipovich
Yvonne Fonsworth
Janet Fulton
Paddy Garvin
Peggy Gerard
Cathy Gettis
Mary Gniady
Jo Ann Green
Hue Handy
Barbara Hasbargen
Barbara Hazard
Mary Heye
Tim Heyse
Barbara Hickman
Vince Holly
Kathleen Hubner
Donald Kautz
Juanita Keck
Karen Knight-Frank
Cathy Lewis
Brenda Lyon
Michelle Madison
Lenora Maze
Rachel Moody
Terri Murphy
Kimberly Nagy
Michelle Peck
JoAnne Phillips
Ginger Pierson
Catherine Prinzing
Jill Roccaro
Jo Ellen Rust
Julia Senn-Reeves
Donald Shuck
Sue Surane
Margaret Talley
Linda Urden
Valerie Vitale
Kathleen Vollman
Robin Waggoner
Mary Waldo
Jane Walker
Weslee Wells
Benefactor: $500-999
2005 Education Committee and Sue Davidson
Sherri Atherton
Kathleen Baldwin
Patricia Bielecki
Michael Bingle
Winifred Carson-Smith
Randall Hudspeth
Anne Muller
Beth Vandenberg
Cathryn Vogeley
Patron: $100-499
Maureen Asper
Jane Backer
Cynthia Balkstra
Jan Buelow
Ann Herbage Busch
Mary Date
Shannon Dowell
Susan Dresser
Sarah Ferrari
Susan Fox
Phyllis Gaspar
Terri Girt
Kelly Goudreau
Catherine Griffith
Sioban Haldeman
Carol Hansen
Angela Hill
Mallori Hooker
Lisa Hopp
Dorothy Jones
Melanie Kalman
Mary Jo Keith
Onna Koeneman
Jane Lacovara
Rena Lawrence-in memory by the National Association of Clinical Nurse Specialists Board
Nadine Lendzion
Ann Martin
Dorothy Mayer
Ann Mayo
National Association of Clinical Nurse Specialists Board
Catherine Ryan
Debra Siela
Monica Simpson
Brenda Snyder
Paula Spoonmore
Judith Spross
Nancy Taylor
Uta Tichawa
Liz Torrence
Bert Vrijhoef
Cindy Weidner
Jeannine White
Susan White
Donor: Less than $100
Ruth Berns
Rose Brauht
Mark Chamberlain
Mary Fedewa
Brenda Forrest
Cynthia French
Colleen Gonzalez
Amanda Hansell
Melissa Hodges
Marjorie Hooper
Francesca Levitt
Lorissa Plis
Connie Randolph
Maurine Shambarger
Member Recognition
Cindy R. Balkstra, MS, APRN, BC, was recently elected president-elect of the Georgia Nurses Association. Ms Balkstra is a pulmonary clinical nurse specialist (CNS) at St Joseph's/Candler in Savannah, Ga. At St Joseph's/Candler, she was a standard/force leader for the Magnet Core Team, thus helping the organization achieve Magnet status. In addition to being a recognized leader in her employment setting, she is a leader in the nursing profession. Ms Balkstra is a current member of the Georgia Nurses Association Commission on Nursing Practice and has held the offices of president, treasurer, and director for district 1 of the Georgia Nurses Association. In addition, she is immediate past president of the Respiratory Nursing Society and is a regional representative of the Asthma and Allergy Foundation of America. She has also been a recipient of several leadership awards in the past. In her future role as president of the Georgia Nurses Association, she plans to use her extensive legislative experience to communicate nursing outcomes to legislators and plans to work through the professional association to promote the unique contributions of Georgia's nurses. She credits her role as a CNS in providing her with unique insights into the rewards of nursing and a frontline perspective on the challenges that nurses face in their daily practice.
Jan M. Bingle, MS, RN, CNS, Chief Nursing Officer and Vice President of Clinical Standards for Community Health Network, was presented with the Emily Holmquist Lifetime Achievement in Nursing Award during the "Celebration of Nursing" luncheon presented by the Indiana University School of Nursing on April 28.
The award is presented to an individual with a distinguished career as a registered nurse who has served the nursing profession with excellence and achieved recognition from peers and others through awards and honors for service to the community.
Ms Bingle is a founding member and past president of the National Association of Clinical Nurse Specialists, the first organization to represent the specialty at the national level. With dual expertise as a CNS and nursing administrator, she is a pioneer in her field. She serves as a nurse consultant ona wide range of topics, including patient care redesign, professional nursing practice and leadership, the scope and value of the CNS role, evidence-based practice, and advanced nursing practice.
Melanie Duffy,MSN, RN,CCRN, CCNS, is the CNS for the unit. The Medical Surgical Intensive Care Unit at Harrisburg Hospital, Pinnacle Health System, Harrisburg, Pa, proud recipient of the 2006 Beacon Award for Critical Care Excellence. The award was developed by the American Association of Critical Care Nurses and was conferred upon 9 critical care units at this year's National Teaching Institute in Anaheim, Calif. Characteristics of a Beacon Unit include recognized excellence in the critical care environment, recognized excellence in processes and evidence-based outcomes, and recognized excellence in collaboration and communication.
According to Ms Duffy, the staff nurses were instrumental in the Beacon application process. The CNS and the nurse manager mentored the staff and were supportive during the process; however, the staff deserves the credit-as it should be in a critical care unit recognized for excellence in critical care.
Ann Earhart, MSN, RN, CRNI, and Jeannie Meyer, MSN, RN, CCRN, CCNS, PCCN, will be presenting at the "2006 Summer Institute on Evidence-Based Practice" in San Antonio, Tex, in June. Their abstract, "Decreasing Central Line Infections with Evidence Based Practice," was accepted as a poster presentation at the event.
In their abstract, Earhart and Meyer describe how Banner Desert Hospital's intensive care units were able to assemble a multidisciplinary team to review central line infections and implement tools based on the Institute for Healthcare Improvement's Central Line Bundle. The implementation of the bundle resulted in 7 months without a central line infection.
Linda MacKenna Ikuta, MN, RN, CCNS, PHN, a neonatal CNS at Packard Children's Hospital, Stanford University Medical Center, was selected to give a oral >presentation entitled "Posttraumatic Stress Disorder in Families of NICU Patients," for Sigma Theta Tau International's 17th International Nursing Research Congress, "Focusing on Evidence-Based Practice."
Provena Saint Joseph's Medical Center in Joliet, Ill, recently awarded Mary Gniady, MS, APRN, CCNS, NP-C, an emergency department CNS, with the 2006 Nursing Excellence Award. To be selected, recipients are nominated by coworkers or physicians and decided upon by a committee of Provena Saint Joseph Medical Center employees. Ms Gniady was recognized for being an excellent role model who is enthusiastic about nursing, focused on improving patient care, for working continuously to educate nurses and bring nursing care to the next level. She is viewed as a truly outstanding nurse at the organization. Ms Gniady is a member of the Illiana Lakeshore National Association of Clinical Nurse Specialists Affiliate.
Nancy M. Richards, MSN, RN, CCNS, CCRN, is a CNS in surgical cardiology at Saint Luke's Hospital of Kansas City. She provided 3 presentations at the "Trends in Cardiovascular Nursing" Conference at the Washoe Health System in Reno, Nev, on March 20. Her presentations were entitled "Best Evidence-Based Practices in the Care of the Cardiac Surgery Patient," "Glycemic Control in the Cardiac Surgery Patient," and "Congenital and Acquired Long QT Syndromes."
In addition, she presented "Best Evidence-Based Practices in the Care of the Cardiac Surgery Patient" at the National Teaching Institute (sponsored by the American Association of Critical Care Nurse) in Anaheim this May.
This summer, Mary A. Stahl, MSN, RN, APRN,BC, CCNS, CCRN, will begin a 3-year term as a member of the board of directors for the American Association of Critical Care Nurses, the world's largest specialty nursing organization. Ms Stahl is a CNS in medical cardiology at Saint Luke's Hospital of Kansas City. The hospital is a recipient of the Malcolm Baldrige National Quality Award and has achieved Magnet designation. Ms Stahl is a member of the Greater Kansas City Clinical Nurse Specialists Group.
News Briefs
APN Multi State Reimbursement Alliance Created
Advanced practice nursing leadership from Ohio, Pennsylvania, West Virginia, Indiana, Illinois, Kentucky, Michigan, Virginia, Washington, DC, and Delaware held a summit in Cleveland on March 24 and 25, 2006, to address the growing challenges on fair reimbursement for nurse midwives, certified nurse practitioners, certified clinical nurse specialists, and certified nurse anesthetists.
As commercial health insurers, Medicaid and Medicare frequently reimburse these healthcare providers at substandard rates or even refuse to recognize them, thus denying reimbursement altogether. When commercial insurers refuse to reimburse advanced practice nurses (APNs), patients are often denied access to quality care.
Advanced practice nurses provide medical care in community clinics, hospitals, and private practices in rural, urban, and suburban settings. They commonly serve the neediest patients, including the uninsured or underinsured.
This newly formed APN Multi State Reimbursement Alliance is united in its commitment to discuss these payment inequities with commercial insurers, Medicaid and Medicare and to persuade them to fairly reimburse APNs for their services. The alliance seeks to build support for its cause across the multistate region. Melanie Duffy and Jeff Jones represented NACNS at the first meeting. For further information, you may send an e-mail to [email protected], attention APN, Multi State Reimbursement Alliance.
Section Description
NACNS Statement on Clinical Nurse Specialist Practice and Education,Second Edition
This document articulates the core competencies requisite to CNS practice, outlines the outcomes of CNS practice, and provides direction to schools of nursing regarding the preparation of CNSs. Endorsed by the National League for Nursing and American Organization of Nurse Executives (AONE) as "a comprehensive reflection of the contemporary role that Clinical Nurse Specialists play in the delivery of quality nursing care," this updated version contains information for contemporary clinical nurse specialist practice and education. You can purchase your copy through the NACNS Office at a cost of $25 per copy for members of NACNS and $45 per copy for nonmembers. Discounts are offered on purchases of 15 copies or more. Contact the NACNS Office today to order your copy of the Statement.