1. Alexander, Mary MA, RN, CRNI(R), CAE, FAAN

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2018 marks the start of INS' 45th year as a specialty nursing organization. We have made incredible strides since our inception as the National Intravenous Therapy Association (NITA), yet many of the same issues remain at the forefront-defining infusion teams, measuring cost and quality, demonstrating the importance of infection prevention and control, integrating best practices, ensuring patient satisfaction, and validating nurse competency. While our past has defined our specialty, we must embrace our future.

Mary Alexander, MA, ... - Click to enlarge in new windowMary Alexander, MA, RN, CRNI(R), CAE, FAAN INS Chief Executive Officer Editor,

Our profession faces a number of obstacles in the coming years, particularly within the nursing workforce. According to the American Nurses Association (ANA), nurses comprise the largest clinical subgroup in hospitals1; yet with the aging patient population who require a more demanding care regimen, and recent reforms in health care that have given millions of new patients access to the health care system-more nurses and health care professionals are needed. These factors, coupled with the increase in the average age of employed nurses, will create a critical renewed nursing shortage.1


Unfortunately, a potential shortage in registered nurses (RNs) has also coincided with a potential shortage in qualified faculty. Some institutions of higher learning have also been structurally unprepared to meet the enormous demand for prospective nurses after the passage of the Affordable Care Act (ACA).2 ANA is lobbying both houses of Congress, as well as federal agencies, on policies and legislation to bolster the number of RNs and nurse faculty.1 The ACA has also left unanswered questions in regard to reimbursement models, such as unintended overpayment of some services and favorably rewarding specialty disease-based and procedurally based care.3


Other immediate challenges include the escalating opioid and substance abuse crisis in the United States. Since 1999, the Centers for Disease Control and Prevention (CDC) has shown that the number of overdose deaths involving opioids (including prescription opioids and heroin) has quadrupled.4 CDC guidelines for prescribing opioids in outpatient settings have been improved in terms of dosage recommendations and assessing the risks; however, nurses who treat patients after an overdose are susceptible to second-hand exposure and must do what they can to protect themselves.5 In addition, let's not forget that alcohol and substance abuse in nurses is a common reason that disciplinary action is taken against them. Therefore, we must continue to be vigilant in taking care of ourselves and our colleagues.


The recent rash of natural disasters in the United States, Puerto Rico, and Mexico have greatly impacted the supply of parenteral solutions. To manage the shortage, organizations must reevaluate the needs of their patients against the available resources. Can medications be administered via intravenous (IV) push instead of an intermittent infusion? Can syringe pumps be used instead of an electronic infusion pump? Instead of IV delivery and if the oral route is not feasible, can the medications be administered by the intramuscular or subcutaneous route? How is your practice prepared for a natural disaster?


INS will continue to promote clinical expertise, education, and research as we tackle these challenges and more. Advances in technology such as telehealth, robotic nursing, simulation, and virtual meetings can help fill some of the gaps in practice. Networking with colleagues, both new and old, as well as attending meetings and other trainings, will provide the groundwork for new opportunities. And we'll continue to expand our global reach to support our international colleagues as they seek to standardize practice and improve patient care.


While I have more questions than answers, I remain steadfast in INS' commitment to creating and initiating positive improvements within our clinical practices that will raise the level of care for the patients we serve. Your continued feedback and support is an invaluable resource in our pursuit for quality care. Let's make the most of 2018 and the next 45 years.


Mary Alexander




1. American Nurses Association. Nursing shortage. Accessed November 9, 2017. [Context Link]


2. University of Saint Mary. Five factors contributing to the nursing faculty shortage. Accessed November 9, 2017. [Context Link]


3. Goodson JD. Patient Protection and Affordable Care Act: promise and peril for primary Care. Ann Intern Med. 2010;152:742-744. doi: 10.7326/0003-4819-152-11-201006010-00249 [Context Link]


4. Centers for Disease Control and Prevention. Opioid overdose. Last updated October 23, 2017. Accessed November 9, 2017. [Context Link]


5. What 3 nurses in Ohio taught us about the opioid crisis. Published August 14, 2017. Accessed November 9, 2017. [Context Link]