1. Alexander, Mary BS, CRNI(R), CAE, INS Chief Executive Officer, Editor

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Since the Institute of Medicine (IOM) released its noteworthy report, To Err Is Human, in 1999, healthcare organizations and practitioners have faced growing scrutiny over the safety and quality of care. At the same time, the ability of current education and training programs to adequately prepare healthcare professionals for patient care responsibilities is also being closely examined.

Figure. Mary Alexand... - Click to enlarge in new windowFigure. Mary Alexander BS, CRNI(R), CAE, INS Chief Executive Officer

I recently attended a conference, sponsored by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), that addressed these issues and developed recommendations for transforming healthcare professional education. As a starting point, our discussions centered on a recent IOM report, Health Professions Education: A Bridge to Quality. The report focused on integrating a core set of competencies into health professions education and concluded that "all health professionals be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics." This vision embodies the core competencies the IOM sees as the basis for future reform of health professional education across disciplines.


It was very clear that among the professionals at the conference-primarily nurses, physicians, and pharmacists-that we have major obstacles to overcome before we can reach the goal of an outcome-based education system that better prepares clinicians to meet patient needs. We face difficulties in coordinating multidisciplinary teams, matching educational offerings with the needs of various healthcare service environments, and rounding up sufficient resources. We found that we often don't even speak the same language, because there is no consensus about language and terms related to core competencies.


Although there are individual models that have addressed the IOM's vision, there remain a number of issues that need to be realized:


* IOM competencies should be possessed by all clinicians regardless of discipline.


* The competencies are defined as the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, value, and reflection in daily practice.


* Patient-centered care includes identifying, respecting, and caring about patients' differences, values, preferences, and expressed needs; relieving pain and suffering; coordinating continuous care; listening to, clearly informing, communicating with, and educating patients; sharing decision-making and management; and continuously advocating disease prevention, wellness, and the promotion of healthy lifestyles.


* Healthcare professionals should cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable.


* Integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities.


* In order to improve quality of care, identify errors and hazards; understand and implement basic safety design principles; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care with the objective of improving quality.


* Use informatics. Communicate, manage knowledge, mitigate errors, and support decision-making using information technologies.



As professional education is transformed to better address the complexities of the healthcare environment, organizational oversight bodies, such as licensure, credentialing, and accreditation, will need to integrate the core competencies into their education and training requirements. From a credentialing standpoint, certification bodies should require their certificate holders to maintain their competence throughout the course of their careers, and to periodically demonstrate their ability to deliver patient care that reflects the 5 competencies, among other requirements. INCC will examine to what extent the competencies are already reflected in Certified Registered Nurse Infusion (CRNI(R)) requirements.


As infusion nurses, we provide patient care in a wide variety of settings. Our complex specialty involves the administration of many critical and potentially dangerous medications, so it is vital to our profession-and our patients' well-being-that we continually upgrade our skills and keep up with the latest in technology. It is imperative that we embrace life-long learning and be open to the proposed formats for evaluating and demonstrating continued competence. Our active involvement in the multidisciplinary discussions will contribute to the drive for continuous educational improvement that is sure to enhance patient safety and health outcomes.


Mary Alexander