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Fellow board members, members of INS, colleagues, friends and guests: it is a great honor to accept the INS Presidential Gavel today. My term comes at an exciting time of change and opportunity, and I am here to tell you that we are in a position to make a difference. With increased roles for our specialty, advanced technology, and new approaches to practice in an evolving healthcare system, we are ready to expand our horizons beyond all our expectations. Together, we will create a global community in the new century.


We are all aware of what a revolutionary time we live in. Our world is being transformed, to say nothing of our specialty. Nursing has changed. IV nursing has changed. The changes are not always easy to accept, nor are they all beneficial or desirable. Still, in our time, the potential exists for worldwide communication and connection, for innovative use of resources, for invigorated research and sharing of expertise.


I believe that the heart of nursing is still the same as it was when we chose nursing as our profession. We want to have the knowledge necessary to give excellent care. We want to give of ourselves and of our talents so that our patients can attain the best health possible for their age and condition. We want to care for the whole person-physically, mentally, and emotionally. I believe that, despite financial pressures and nursing shortages, we will find a way to provide excellent infusion therapy for our patients. We can do this, not just for ourselves, not just for our specialty organization, not just or our specialty practice, but for everyone involved in the delivery of infusion therapy. I propose to you today that in order to thrive in the new century, we need to reach out beyond the traditional confines of our specialty and enfold a wider community of healthcare providers. When we create this global community, we will bring infusion therapy to a new level of excellence.


The phrase "global community" may evoke in our minds the far-reaching community of our colleagues the world over. We may also think of the "global village," that buzzword of the late 20th century that signifies the shrinking of time and distance as information technology brings the whole world, literally, to our fingertips. It is indeed important for us to use technology to the fullest in reaching out to nurses all over the globe. INS has already begun, and will continue, to establish partnerships with nurses in Asia, Europe, and Australia. In a few months, I will travel to Japan, where I plan to share information about our standards and knowledge regarding intravenous complications and infection control. Thanks to the Internet and e-mail, INS' resources and services are benefiting infusion nurses in these places and in many more.


Still, the idea of reaching beyond borders is not just about the borders of North America. INS has always been the premier organization for the infusion nurse specialist, supporting and promoting the infusion specialty and the CRNI credential. Infusion nurse specialists remain at the heart of quality infusion therapy. But the ideal situation of having an IV team in every care setting is far from a reality. The number of specialists is shrinking, and the number of settings in which complex infusion treatments are performed is growing. This is a time of staffing shortages and decreasing nursing school enrollment. Fewer healthcare organizations can support IV teams, and generalist nurses, as well as nurses of other specialties, are asked to perform infusion therapy in acute and nonacute settings. INS needs to shift its focus to all nurses who are responsible for making decisions about infusion therapy in all healthcare settings. It may be the infection control nurse who gathers and reports infection data. It may be the critical care nurse who has been encouraged to insert peripherally inserted central catheter lines. It may be the long-term care facility nurse who administers intravenous antibiotics and pain management. Every institution and company needs to designate someone to be the expert or resource nurse for infusion therapy. And INS needs to be there to support that person with educational opportunities, resources, research, and a network of expertise. We must broaden our focus beyond the certified infusion nurse specialist to embrace all modalities of infusion nursing, in all care settings, for all registered nurses, serving all patient populations. INS has the resources and knowledge base to support this expanded community, and we are in a position to make an impact wherever infusion therapy is performed.


The changing focus of INS is already audible in our language. You will hear many more references to infusion, rather than intravenous, nursing in the coming months because infusion encompasses many crucial modalities of therapy that the IV nurse specialist may need to perform: not only the intravenous delivery of medication, blood transfusions, pain management, chemotherapy, and parenteral nutrition, but also epidural administration, intraosseous administration, intrathecal administration-the many other routes of therapy that are crucial in some instances to the best possible care for the patient. We want to reflect in our language the inclusion of all of these modalities, for they need to be embraced by the infusion nurse if we are to keep up with the demands of healthcare.


Just as importantly, we need to understand the unique needs of the nurse who performs infusion therapy in alternate settings. Let us consider the nursing home whose residents require parenteral nutrition or pain management, yet its nursing staff has limited experience in complex intravenous administration. The homecare nurse who faces unique concerns related to infection control and patient education. The ambulatory infusion center, where complex procedures are performed in a nonhospital setting. And even the traditional hospital setting, where infusion therapy is a vital component of care in the oncology department, the critical care department, the emergency department. Let us keep in mind between 80% and 90% of patients entering the healthcare system each year require some form of infusion therapy as part of their treatment-27 million patients annually! And their treatment is seldom confined to the acute setting. Our educational opportunities, reference guides, and outreach must go out to every corner of the infusion healthcare market so that we support excellence in infusion care wherever it is performed.


We can be the ultimate resource for infusion nursing, not just for infusion nurse specialists but for all healthcare workers involved in the provision of infusion therapy. It is time to reach out to the generalist nurse whose routine duties include catheter insertion, care and maintenance of access devices, intravenous or nonintravenous administration of medications, and phlebotomies. What about oncology nurses, infection control specialists, physicians and medical students, nutrition specialists, critical and intensive care nurses, emergency personnel? Their practice demands skill and knowledge related to infusion procedures. We, as a specialty organization, can help them enhance their delivery of care. With INS publications such as the Standards of Practice and Policies and Procedures, we can work toward universal terminology and techniques designed to provide the best possible outcomes for our patients.


And speaking of which, let us not forget that our patients are part of this global community. In expanding the scope of our practice, let us not leave out any patient population who requires our expertise: newborns who require umbilical catheters; pediatric patients needing special consideration for their level of physical and psychological development; and older patients with their fragile veins and changing physiologies. The more we consider the unique needs of each population, the better care we can provide for everyone. The more we support specialist nurses who work closely with each population, the better infusion therapy outcomes we will see, from neonatal to geriatric care.


We must place renewed emphasis on education and the value of expertise (including credentialing) in infusion therapy-not just for the infusion nurse specialist, but for all nurses. We must engage generalist nurses and student nurses in infusion education alongside those who specialize. We must advocate the importance of having infusion resource nurses in all settings, whose expertise and experience will continuously spread to their colleagues. We can be a resource not just for other nurses but for physicians, pharmacists, other healthcare workers, for administrators and managers, and for our patients. As we create this global community, it will be increasingly important to recognize accomplishments in all settings: to applaud all those who conduct or support infusion therapy-related research, those who share their expertise, those who seek new ways to improve the quality of care.


We have the opportunity to claim our role in all settings. We have the opportunity to advocate for the importance of infusion management, safety, infection control, pain management, bloodborne disease prevention, and antineoplastic therapy. By creating a community in which resources and expertise are actively shared, where standard procedures for each infusion therapy modality are followed by every nurse in every care setting, we will decrease the incidence of complications associated with infusion therapy. Education will focus on process improvement: finding the practical and policy changes that will make care safer, more effective, more cost-efficient, less painful or frightening for the patient, and simpler for the nurse. We will increase our research efforts so we can share with all healthcare workers our data on which new therapies show promise and which products or techniques produce the best outcomes.


Creating a global community is about expanding our horizons. It is about reaching out further than we have before, not just because we want to, but because, in this century, we must.


I was fortunate to have visited Italy about 5 years ago. The artwork was incredible, and the churches were beautiful. The most impressive church, though far from elegant, was at Assisi. The theme of the prayer of St. Francis was change. I would like to borrow some of his credo: "God grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference."


It is sobering to hear that:


* More than 95% of hospitalized patients have IV access, yet infiltration and phlebitis develop frequently because RNs do not have the time or the expertise to recognize problems early and prevent complications.


* Many patients have the wrong type of IV access and are stuck needlessly or too frequently because the nurse did not place a midline, peripherally inserted central catheter, or central venous catheter.


* Between 44,000 and 98,000 patients die each year from medication errors made because of lack of knowledge about drug interactions, dosages, or because of poor communications. Many patients and healthcare providers don't know about potential drug interactions with herbal remedies or over-the-counter medications, such as ginseng interfering with anticoagulant medications.


* There is a nursing shortage that will not improve in the near future. The average age of RNs in the United States is 44 years. Nursing school enrollment is down by 30%. Generation X-ers are looking for balanced lives in which they do not have to work on weekends or holidays.


* Most healthcare facilities do not have a designated IV resource nurse to help educate staff and physicians about IV therapy.


* IV practices are not the same in other countries. Some countries do not use closed systems, do not observe standard precautions, do not wear gloves, and use steel needles for peripheral IVs.


* Thirty percent of terminally ill patients die in pain. Fifty percent of patients in nursing homes are in pain but are not medicated.


Although there are many things we cannot change, there are so many more that we can. The creation of a global community begins here, in Minneapolis. Please join me in accepting the challenges of our changing world in order to turn them into shining opportunity.


I look forward to a wonderful year. I have a fantastic board, a supportive INS staff, and an organization of intelligent, talented, and dedicated members. I am so proud to be your President. I look forward to getting to know you better individually. I am eager to work with you and ask for your help to make our organization even stronger.