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In this era of cost containment, advanced practice nurses (APNs) must articulate their role to consumers, colleagues, and other health professionals. Musclow, Sawhney, and Watt-Watson's article in this section highlights the importance of this need. These authors discuss the emerging role for APNs as members of Canadian acute pain service teams. Poorly controlled acute pain is an important clinical problem with both short (eg, post-operative complications) 1 and long-term consequences (eg, development of posttraumatic stress disorder in injured children). 2 Rawal 3 argues that the acute pain service teams are effective and have universal applicability in the management of acute pain; clearly, Musclow et al's article has relevance well beyond Canada's borders.


According the literature, APNs have much to offer concerning management of acute pain. For example, their academic preparation equips them to (1) conduct and evaluate teaching rounds for developing staff nurses' critical thinking, assessment, and interpersonal skills concerning pain management 4 and (2) lead acute pain service teams. 3 Carlson, Clement, and Nash 5 argue that APNs play an instrumental role in the recognition and treatment of neonatal pain. Hence, it is not surprising that the role responsibilities articulated by the nurse members of acute pain service teams in Musclow et al's sample are consonant with those identified by the Canadian Nurses Association for APNs. 6 What is surprising is that only 46% of their sample were APNs. Perhaps some of the role challenges reported by the participants (eg, role definition issues, mixed support from other professionals) reflect, in part, problems associated with educational preparation below the master's level in nursing. These role challenges, along with the authors' other findings and those in the existing literature, clearly argue the need for APNs to be a part of acute pain service teams.


The role of APNs in acute pain management is complicated by the current scarcity of APNs with specialization in anesthesia. 7 Nevertheless, Musclow et al's findings illustrate the need for nurses to clearly articulate their role, especially with respect to level of academic preparation and in terms of the unique skill sets that APNs bring to the clinical arena.


In addition to calling our attention to the role of APNs in acute pain service teams, Musclow et al call our attention to two new strategies that APNs can use to enhance quality of care, regardless of their specialty. First, the authors discuss the use of the World Wide Web to create networks of APNs who share a common specialization and can discuss with each another topics concerning clinical practice and professional issues, providing support, and sharing resources. These networks also lay the foundation for collaborative research projects, allowing APNs to work together to evaluate their practice needs and outcomes.


Second, the authors used Microsoft Excel, 8 a spreadsheet software program, to collect and describe their study data. Spreadsheet programs (eg, Excel, 8 Lotus Notes 9) offer today's APNs the opportunity to create patient care-related databases and research databases such as the one used by Musclow et al. These spreadsheet programs are easy to use for entering data, computing descriptive statistics (eg, means, standard deviations), and creating visual displays of data (eg, graphs and pie charts). As such, these programs are an invaluable resource for the APN interested in tracking the characteristics of his or her patient population and the outcomes of his or her practice. Further, these spreadsheet programs can be used to create files easily read by more sophisticated data analysis programs (eg, SPSS, 10 SAS 11) for APNs when they want to use inferential statistics to further analyze their data. In addition, add-in software can be purchased for Excel (Analyse-it General Statistics 12) to calculate many of these inferential statistics.


What makes APNs special? Clearly, there is much to be said about the unique contribution APNs make and the unique skill set they bring to the organizations in which they work. Today's technology offers new strategies for enhancing our practice and expanding our contributions. Let's get the word out!




1. Rawal N, Berggren L. Organization of acute pain services: a low-cost model. Pain. 1994; 57 (1):117-123. [Context Link]


2. Saxe G, Stoddard F, Courtney D, et al. Relationship between acute morphine and the course of PTSD in children with burns. J Am Acad Child Adolesc Psychiatry. 2001; 40 (8):915-921. [Context Link]


3. Rawal N. Ten years of acute pain services-achievements and challenges. Reg Anesth Pain Med. 1999; 24 (1):68-73. [Context Link]


4. Segal S, Mason DJ. The art and science of teaching rounds. A strategy for staff development. J Nurses Staff Dev. 1998; 14 (3):127-136. [Context Link]


5. Carlson KL, Clement BA, Nash P. Neonatal pain: from concept to research questions and a role for the advanced practice nurse. J Perinat Neonatal Nurs. 1996; 10 (1):64-71. [Context Link]


6. Canadian Nurse Association. Advanced Nursing Practice: A National Framework. Ottawa: Canadian Nurse Association; 2000. [Context Link]


7. Rosenbach ML, Cromwell J, Pope GC, Butrica B, Pitcher JD. Report of the National Commission on Nurse Anesthesia Education. Study of nurse anesthesia manpower needs. Am Assoc Nurse Anest J. 1991; 59 (3):233-240. [Context Link]


8. Microsoft Corporation. Available at: Accessed February 1, 2002. [Context Link]


9. IBM Software Group. Available at: Accessed February 1, 2002. [Context Link]


10. SPSS, Inc. Available at: Accessed February 1, 2002. [Context Link]


11. SAS Institute. Available at: Accessed February 1, 2002. [Context Link]


12. Analyse-it Software, Ltd. Available at: Accessed February 1, 2002. [Context Link]


Ms Moloney-Harmon is a clinical nurse specialist (CNS) for Children's Services at the Sinai Hospital of Baltimore, Md, where she provides clinical oversight for the pediatric and neonatal intensive care units, the general pediatric unit, and the pediatric emergency department.


As a clinical leader, she chairs and participates in a variety of committees, task forces, and new program committees with clinical implications and provides for the professional growth of nursing staff-facilitating independent problem solving and decision making among staff so that they are empowered in their practice. In addition, her role includes increased accountability for practice and its impact on patient care outcomes-variances, length of stays, complications, satisfaction, and research. She works closely with nursing and physician colleagues to ensure that complex patients are progressing along a continuum and that resources are used appropriately.


Along with her work experiences, Ms Moloney-Harmon's professional publishing give her a strong background for the position of associate editor. She has served on several editorial boards, has been a guest editor for a number of journal issues, has edited a pediatric critical care nursing textbook, and worked closely with the American Association of Critical-Care Nurses in the development of the CNS in critical care certification examination. It is a pleasure to welcome Ms Moloney-Harmon to the editorial board.