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Throughout the week we have recognized and celebrated the contributions of infusion nurses around the global community. We have made new friends and had the opportunity to network with colleagues. We have assimilated new knowledge. We have had the opportunity to touch, see, and hear about the latest infusion equipment and technology. We have asked questions. We have shared our knowledge and wisdom. We have renewed hopes and acquired new visions for the future.


The celebration of International Nurses Week also begins on May 6, the birthday of Florence Nightingale. This time provides for us an opportunity to reflect on the nursing community. When nurses meet, we have an implicit understanding that we share a common bond of service to others. We recognize the truly amazing things that nurses do every day without receiving public recognition for their efforts. We share a mutual vision of service to the community.


We remember with a sense of awe the contributions of Florence Nightingale, who is the mother of modern nursing. She was the first nurse to utilize social statistics and to demonstrate their significance by the use of graphs. She consulted with others to persuade governmental leaders to support large-scale reforms in public health practices. She used new technology to improve sanitation measures that controlled the spread of infections across populations, resulting in decreased death rates. She overcame tremendous obstacles and is considered to be the greatest war nurse in history. Nightingale had a compelling vision of service to community.


Today, perhaps we need another Nightingale. This is a time of serious challenges. We are greatly concerned with the health of the entire nursing community because it deeply affects our future. We are experiencing an aging nurse workforce with the average age of a nurse at 46. We are doing more with less in a highly competitive, market-driven healthcare environment. We have a limited personnel pool, in which one third of the nurses in California plan to leave within the next 5 years. However, a 2002 landmark study conducted by the American Organization of Nurse Executives (AONE) and NurseWeek magazine of more than 4000 nurses from all 50 states found that 77% of nurses were satisfied with being a nurse and 60% said they were satisfied with their jobs and would recommend nursing as a professional career choice. However, 7 of 10 nurses working in hospital settings reported that during the past year, they had witnessed a negative impact on the quality of patient care as a result of a greater number of patients per nurse and a higher turnover among experienced registered nurses. Results of the scientific study identify that the nursing shortage is no longer limited to certain geographic regions or nursing practice specialties.


According to a 2002 national poll conducted by Vanderbilt University Medical Center's School of Nursing and Center for Health Services Research in Nashville, Tennessee, the average American is acutely aware of the nation's nursing shortage and believes the problem is serious. Specifically, more than 8 in 10 Americans are aware of the nursing shortage, nearly two thirds believe it is a "major problem" or "crisis," and 93% are concerned that it jeopardizes the quality of healthcare in the United States.


As healthcare providers, we need to prepare for 77 million demanding healthcare consumers born in the post-war period between 1946 and 1964. The first baby boomers will reach age 65 years in the year 2011 and will become the nation's number one healthcare consumers. As they reach age 65, they will consume even greater healthcare services. A report published in 1998 by Press Ganey, the nation's largest satisfaction measurement firm in healthcare, has described this generation as consumer-driven, extremely mobile, distrustful of institutions, and self-centered.


In a national analysis of more than 1 million patient satisfaction ratings across the United States, Press Ganey found that baby boomers had a lower mean satisfaction score than other age groups for hospital and home health services. In fact, younger hospital patients rated their care lower than seniors did on every question in Press Ganey's surveys. Patients younger than age 50 years were more critical of quality, service, and staff in every dimension. Their five biggest complaints were:


1. quality of food,


2. tests and treatment/skill in starting IVs,


3. courtesy of business office,


4. cafeteria/coffee shop rating, and


5. discharge too soon.



A study conducted by Lynn and McMillen 1 of 350 nurses and 448 patients in seven hospitals sought to determine nurses' knowledge of what patients think is important in nursing care. The study compared the ratings of patients and nurses regarding important nurse behaviors. The number one and two ranking of important nurse behaviors by patients were (1) the nurse knows what he or she is doing, and (2) the nurse is skillful, especially with needles. The nurses ranked "the nurse is skillful, especially with needles," as number eight. From both of these rankings, "skill with needles" is a criterion measurement in which the public evaluates the quality of care they received. Overall, the study concluded that "professionalism among nurses is something that patients value more than nurses think they do."


Historically, we have had difficulty proving the value of the nurse in specialty practice. In clinical practice, we see, feel, hear, and know the value of an infusion specialist but the reality is that many healthcare administrators still question the value of a nurse in specialty practice when they look at the financial performance of the organization. In 1998, a national survey by the Press Ganey organization for Trustee magazine, hospital board members put finances at the top of their priority list.


Today, perhaps we need another Nightingale. These serious challenges to the nursing community also represent enormous opportunities. As nurses we have an unlimited potential. As a specialty practice of nursing, we need to be committed to proving the value of infusion nursing. A very important measurement of healthcare quality by the public is the competency of infusion nursing skills. As infusion nurses, we know the value of our work. We share a common vision that all individuals should have access to infusion excellence. As the experts of infusion nursing, we can prove the value of infusion excellence. To further this initiative, I have selected for my presidential theme "A Commitment to Infusion Excellence."


The mission statement of INS states we "exist to promote excellence in infusion nursing through standards, education, advocacy, and outcomes research." This theme reflects the values that support the mission statement: integrity, excellence, and commitment.


Honesty, openness, consistency, and respect in all that we do demonstrate integrity. We invite you to be an active member and to share your knowledge and expertise. As members of the Board of Directors, we would like the opportunity to get to know you. We welcome your input, ideas, and suggestions. We are your elected representatives. Invite us to your local chapter meetings. Publish any innovative ideas or creative initiatives that you have implemented as an individual, department, or organization to support infusion excellence. Present a poster, abstract, or educational presentation for the local INS chapter in your area or at a national INS meeting.


As an organization, a commitment to infusion excellence begins with the local INS chapter. I have implemented an initiative to support new chapter development. An individual will serve as a chapter development liaison by offering support and ideas to individuals who are working to establish new chapters. Our foundation is the local INS chapters who are comprised of many talented and dedicated leaders. If your local INS chapter needs invigorating, be that person who gets in there and makes great things happen. For the majority of us, the local chapter is our first introduction to INS. The local chapter is a wonderful opportunity for leadership development. It is important that we mentor the infusion nurses of the future. When we share our expertise and knowledge with one another, we demonstrate a commitment to infusion excellence. Ultimately, we are improving infusion care provided within the community.


A commitment to infusion excellence requires shared values. Increased energy and motivation results when the shared values are learning, creating, and participating. A shared value enables us to stay focused, clarifies our mission, and directs us in the management of our resources. A commitment is a "matter of the heart" compared to compliance, which is a "matter of the mind."


To have a commitment to excellence requires a passion for infusion nursing. We are deeply passionate about ensuring excellence for all individuals who require infusion care. We believe that an infusion nurse makes a tremendous difference in the quality of patient care. An infusion nurse has expert eyes and ears to help manage the patient's care.


A core infusion nursing value is that every patient has a right to early venous assessment and will have the appropriate infusion device selected for the prescribed treatment. We know that we are the best in the world at providing and ensuring infusion excellence. Excellence in infusion nursing means that we are dedicated to continually improving ourselves, our programs, and our services. We must never consider ourselves to be "finished" as nurses; we must be committed to learning throughout our lives.


To further develop our commitment to infusion excellence, a Clinical Practice Committee has been implemented. Their first assignment is to develop a blueprint for the implementation and justification for an infusion specialist or an infusion therapy team. This initiative will include information about how to develop a revenue center for infusion nursing. The development of a revenue center is essential for the financial justification of infusion services.


The commitment to infusion excellence will be furthered by the development of a basic infusion therapy curriculum. This initiative will provide an educational resource that can be used by educators in all healthcare settings. A standardized infusion curriculum will provide information that is based upon established infusion nursing standards of practice.


A commitment to infusion excellence will be enhanced by the development of criteria measurement tools to validate the clinical competency of all nurses who are involved in the delivery of infusion care. The criteria measurement tools will model the Infusion Nursing Standards of Practice and the recommended practices established in the INS Policies and Procedures of Infusion Nursing manual. The generalist nurse, as well as the infusion expert, may use the criteria checklists to validate procedures.


A commitment to infusion nursing will be demonstrated by the development of outcome measurement tools. It is important that infusion nurses have quality measurement outcomes to justify their contribution to infusion excellence. We must be able to prove our value by demonstrating the impact that an infusion specialist has on achieving quality measurement outcomes.


As an organization, we will continue to further our commitment to infusion excellence by establishing partnerships with other affiliated healthcare organizations. Our affiliation with other healthcare organizations such as the American Nurses Association (ANA), National Student Nurses Association (NSNA), National Home Infusion Association (NHIA), Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Nursing Organization Alliance (The Alliance), to name just as few, provide for us a venue to demonstrate professional partnership and unity. Our affiliation with other professional organizations provides a forum to tell the world what infusion nurses do.


We continue to define best practices within infusion care. A commitment to infusion excellence is demonstrated by a standards-based practice that continually ensures patient safety and focuses upon the achievement of outcomes. Our work as infusion nurses adds value to the health of a community. Our work is an essential component of quality healthcare. Each one of us has an important role in the commitment to infusion excellence. As individuals, we must never underestimate the difference that each of us can make in ensuring infusion excellence. We are proud of our commitment to infusion excellence. We are proud to be infusion nurses.



Figure. Roxanne Peru... - Click to enlarge in new windowFigure.



1. Lynn MR, McMillen BJ. Do nurses know what patients think is important in nursing care? J Nurs Care Quality. 1999; 13( 5):65-74. [Context Link]