1. Balaguras, Jean MSN, MBA, RN, CCRN-CSC
  2. Holly, Vincent MSN, BA, RN, CCRN, CCNS

Article Content


The purpose of this presentation was to highlight the development, implementation, and evaluation of an evidence-based, nurse-driven mobility protocol for critically ill patients. Barriers to mobility are identified, and strategies to overcome these barriers are discussed.



Immobility can lead to pulmonary dysfunction, venous thromboembolism, pressure ulcers, deconditioning, and falls. Early mobility is a key intervention in improving these nurse-sensitive outcomes and decreasing cost to the patient and institution.



When the progressive mobility project was started, the patients in critical care and cardiovascular care were not properly mobilized. Immobility led to deconditioning and an increase in ventilator days, length of stay in the intensive care unit, and hospital stay. Both nursing staff and physical therapy were uncomfortable moving critically ill patients. The staff did not want to mobilize patients out fear of self-injury as well as injury to the patient. Lack of equipment to facilitate mobility was also identified as a barrier.



The clinical nurse specialists (CNSs) from these 2 critical care areas worked together to create a progressive mobility protocol to ensure that patients would be mobilized safely and appropriately. Through interdisciplinary collaboration, barriers to mobility were identified, and strategies were created to increase patient activity and address staff concerns. A change strategy was initiated with a clear vision of improved patient mobility, and staff was provided with needed skills, incentives, and resources for successful implementation of the progressive mobility protocol.



The initial outcome is a change in culture that accepted immobility in this patient population. The patient outcomes from the mobility protocol include a decreased length of critical care stay, ventilator days, pressure ulcers, and falls. A decrease in employee injury is accomplished through acquisition of proper lifting equipment.



The CNS-driven, interdisciplinary approach to this project improved patient outcomes, as well as empowered the nurses as they realize the impact they have on patient outcomes. This project also improved the working relation and collaboration between multiple disciplines.


Implications for Practice:

The CNS role is essential in leading an evidence-based project instituting a nurse-driven protocol to change care at the bedside. This presentation provides the audience with practical methods to incorporating progressive mobility in their institution.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.