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

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Good morning, and welcome to Nashville and the 2009 INS Annual Meeting and Industrial Exhibition. I am pleased to deliver my report of the past year's activities and achievements. We hope that you are as delighted with the format for this session as we are. With so many exciting events to report from 2008, we could think of no better venue than Opening Session to share it with everyone.

Figure. Mary Alexand... - Click to enlarge in new windowFigure. Mary Alexander

It is with much pleasure that I report on the extremely successful year INS enjoyed in 2008. Our successes were spread across all facets of the organization and helped strengthen our leadership position within the infusion nursing specialty. I would like to start with membership, which remains the focus of all we do.



2008 marked the fifth consecutive year of triple-digit increases in INS' membership. We finished the year with the membership rolls topping off at 5951, despite one corporate member not renewing 200 memberships. Since the beginning of 2004, our membership has increased by 872, or 17%. Better retention efforts and effective marketing plans using broadcast e-mail programs, plus an increasing awareness of who we are and what we offer, have contributed to the positive membership numbers. In addition, the implementation of INS' new database, internet4associations (i4a), has helped considerably improve the speed in which memberships and renewals are handled.


A decision was made to hold the line on the cost of membership dues for the 12th consecutive year. Our ability to generate nondues revenue, while increasing the value of INS membership to our members, has enabled us to keep dues at the current $90 rate. Membership revenue for the organization increased by approximately $6000 in 2008.


Equally as important as the actual increase in membership numbers and the financial impact this had for the organization is the increase in member participation. Our ability to attract hundreds of potential volunteers to serve on committees and task forces can be directly attributed to the influence we have on the specialty and the respect we have earned from clinicians practicing within the specialty.



In May 2008, the Flushing Protocols card set was introduced, and by year's end, 7500 sets had been sold. During the summer of 2008, existing products repurposed and sold as the "Competencies Validation Bundle" and the "Infusion Team Implementation Bundle" generated $20,000 for the organization.


In keeping with a 5-year cycle, INS will begin the revision process for the Infusion Nursing Standards of Practice this year. Once again, BD Medical has provided a grant to fund this project. The Standards Committee, chaired by Lisa Gorski, has been seated and will begin work this summer. The projected publication date is the first quarter of 2011. At the same time, the Policies and Procedures for Infusion Nursing will also be updated and revised.



Infusion education is one of INS' core business units. Year after year, we offer top-notch educational programs that address the latest issues in infusion therapy. The consistently high grades we receive from our attendees owe much to the work of the National Council on Education (NCOE).


The 2008 Fall National Academy of Infusion Therapy, held in St Louis, was well attended. The special 1-day program, "Healthcare-Associated Infections: New Regulations and Treatments," was fully funded by Bard Medical. We are looking forward to the 2009 Fall National Academy, to be held November 13-15 in Jacksonville, Florida. This year's National Academy will also be preceded by a special 1-day program, sponsored by B Braun Medical, titled "Developing an Infusion Alliance: A Benchmark for Success."



As a way to broaden INS recognition as the global authority in infusion therapy, increase our visibility and scope of services, and create and expand business development opportunities, a separate business segment was created. Infusion Education Services, or IES, focuses on building relationships with industry and third-party continuing education companies to provide educational opportunities for our members and the infusion nursing community. This business segment has allowed INS to develop such diverse programs as webinars, the Counseling Points and Nursing Practice Management publications, and online CE programs, and it was responsible for increased nondues revenue and multiple offerings in 2008.


The webinar programs were expanded in 2008. Six webinars were offered at no charge to INS members through sponsorships from B Braun Medical and Baxter. All programs are archived on INS' Web site and available for viewing at no charge to INS members. INS also collaborated with the Massachusetts Hospital Association (MHA) on a 2-part webinar series addressing the new Centers for Medicare & Medicaid Services (CMS) rules related to healthcare-acquired infections (HAIs) and reimbursement. To expand our reach, INS exhibited at the HAI Action Workgroup Meeting in November, hosted by the Massachusetts Coalition for the Prevention of Medical Errors. To enhance our webinar library, there are preliminary discussions with 2 other sponsors for additional webinar series in 2009.


INS also worked with Centocor and its third-party CE medical education company to confirm a series of "dine-and-dialogue" programs that took place in 2008. The groundwork for this series began in 2007, with INS receiving a stipend in 2008. A collaborative effort with Novartis and ONSEdge also generated a small profit for the organization.



INS' flagship publication, the Journal of Infusion Nursing (JIN), continues to be the #1 member benefit. In 2008, JIN converted to a 4-color publication with an enhanced format and design. A major value-added component for our membership is the ability to access JIN online at no charge. In addition to accessing current issues, members are able to access all issues dating back to 2001. With sponsorship from B Braun Medical, a special supplement, the "Annual Meeting Reporter," was published. Advertising revenue in 2008 was $312,000 versus $269,000 in 2007. Revenue from OVID/licensing subscriptions increased by $16,000.


A major change to INS' membership newsletter, Newsline, was its new color design. In addition, it is now available on the INS Web site with a "page-turning" feature and direct live links to any Web site address in both text and classified ads. Throughout the year, additional electronic communications, INS Connection and INS Newsbrief, were sent to members to provide the most current infusion nursing news.


I am pleased to announce the debut of INS' textbook, Infusion Nursing: An Evidence-Based Approach, third edition. As editor-in-chief of this version, I want to recognize the editors, Ann Corrigan, Lisa Gorski, Judy Hankins, and Roxanne Perucca, for their commitment and dedication to this project. Their knowledge and expertise was critical in completing this revision. My thanks also go to the 35 content-expert authors who contributed to the 30 chapters of the text. The major focus of the book highlights the importance of evidence-based practice and research as it applies to infusion nursing. Focus on Evidence boxes, Patient Outcomes boxes, and Procedure boxes are added features designed to make the text user-friendly. New chapters that have been included are "Evidence-Based Practice," "Clinician and Patient Safety," "Financial Considerations," and "Biologic Therapy." As an authoritative resource, this text will guide clinicians in continuing to provide the best and safest care to patients.



Much of our recent success can be attributed to the many collaborations we have formed with industry, medical education companies, professional associations, and academia. Our ability to work with each of these groups affords us the opportunity to increase our visibility and exposure and work toward meeting the needs of our ever-growing membership.


As we look to continue our work in identifying INS' research priorities, INS has been collaborating with the Wayne State University College of Nursing (WSU CON). With input and guidance from the WSU faculty, INS conducted a Delphi study to identify practice issues and research priorities. Lisa Gorski and I presented the model for this collaborative work between a specialty nursing organization and an academic institution as a poster at the 2008 American Academy of Nursing (AAN) Conference last November. Along with Mary Zugcic, Lisa and I presented the poster at WSU CON's Research Day in March. This poster, along with a second one describing the survey results, will be available for viewing in the Exhibit Hall. In addition, I invite you to attend the presentation on Wednesday where Mary and Lisa will describe this research work and discuss the results of the survey. To add to the richness of the data, we are seeking additional input from our members. You will note in the Exhibit Hall a board with flip charts where you can provide information on the practice issues that you believe need to be addressed. Please take a moment and give us your thoughts.


INS is pleased to have joined the American Nurses Association (ANA) as an Organizational Affiliate (OA). In this capacity, Organizational Affiliates have voting seats in the ANA House of Delegates and the Congress of Nursing Practice and Economics. In December, ANA's official journal, American Nurse Today, featured INS on their Web site's career highlights section. We also offered feedback that was included in a letter to the National Quality Forum (NQF) sent on behalf of the OAs in response to their Quality Enterprise document: "Building a Foundation for Better Care: An Infrastructure to Support Performance Measurement and Improvement." This document was sent to Congress and the new administration with recommendations for improving quality of care. In our ongoing efforts to support infusion nursing research, INS will be funding an ANF (American Nurses Foundation) Research Grant in the amount of $3500. Not only will the ANF grant give us visibility in the larger nursing community, but it will also enable us to build our research capacity.


In addition to sponsoring a speaker at the National Student Nurses Association's (NSNA's) Midyear Conference for the eighth consecutive year, INS was a sponsor of NSNA's DVD, "Nursing-The Career for a Lifetime." The purpose of the video is to reach registered nurses (RNs) to encourage them to advance their education within the nursing profession. In addition, INS will be funding a $1000 scholarship for a student nurse through the Foundation of NSNA.


INS has begun an active relationship with the Society for Healthcare Epidemiology of America (SHEA). INS endorsed SHEA's Compendium of Strategies to PreventHealthcare-Associated Infections in Acute Care Hospitals. Also, at SHEA's 2009 Annual Scientific Meeting in San Diego, INS sponsored one of the Meet-the-Consultant sessions, Bloodstream Infections, presented by Leonard Mermel, DO, and Robert Sherertz, MD.


INS has continued its partnership with the Hartford Institute for Geriatric Nursing. We have submitted a proposal to participate in the Specialty Nurses Impacting Aging initiative through the development of a webinar program highlighting infusion needs of the older adult. The goal of the initiative is to deepen the involvement of specialty nurse associations in improving nursing competencies for providing care to older adults. INS is one of several specialty nursing organizations that have endorsed the "Global Vision Statement on Care of the Older Adult."


We continue to collaborate with the National Home Infusion Association on public policy issues. This year, INS signed on to a coalition letter urging Congress to pass legislation to add a meaningful home infusion therapy benefit to Medicare.


Last year INS joined the Alliance for Plasma Therapies, an organization committed to working for better access to intravenous immune globulin (IVIG) products. The Alliance is continuing its work to educate legislators and government agencies on the patient care issues related to access to IVIG. In March, I was appointed to the Board of Directors of the Alliance.


In 2002, INS was a member of the committee that revised the Centers for Disease Control and Prevention (CDC) Guidelines for the Prevention of Intravascular Catheter-Related Infections. We were once again invited to participate in the latest revision of the guidelines. We were honored to take part and were further honored to be the only nursing organization represented on the committee. The revised draft is currently out for review and will be published in the near future.


The Institute for Safe Medication Practices (ISMP) regularly seeks comments from INS on articles related to infusion nursing. In turn, ISMP contributes a regular medication safety column for INS Newsline.



Interest from our nurse colleagues in countries outside the United States continues to grow. We have 193 international members from 28 different nations. To create a formal relationship with the nurses in these countries, an international affiliate program has been established to enable groups of nurses to be more connected with INS. We look forward to welcoming these nurses as part of our organization. At this meeting, we are pleased to have representatives from Brazil, Canada, China, Italy, the Philippines, Singapore, Taiwan, Thailand, Uganda, and the United Kingdom.


This past year I traveled to Brazil, Colombia, Mexico, and China to present infusion-related education programs with an emphasis on standards and the implications for clinical practice to nurses, other healthcare professionals, and pharmaceutical and device companies. There is great interest in INS' Standards of Practice and Policies and Procedures for Infusion Nursing and how they can effectively be integrated into clinical practice. Other topics of interest for foreign-educated nurses include medication delivery, patient safety, and the implementation of infusion teams. I have been presenting these programs for over 10 years, and I am encouraged by the changes I have seen in the nurses' practice. Although there are differences in language and culture, regardless of the country, as nurses we all have the same common goal and that is to provide the best and safest care for our patients.



As a member of the ANSR Alliance (Americans for Nursing Shortage Relief), INS was a signatory on the consensus document, "Assuring Quality Health Care for the United States: Building and Sustaining an Infrastructure of Qualified Nurses for the Nation." This document was sent to congressional leaders with recommendations for addressing the nurse and nursing faculty shortages.


As a member of the NQF, we continue to work with 16 other nursing organizations to support nursing candidates for NQF Council positions and provide input on consensus standards.



In 2008, internet4associations (i4a), a Web-based association management software system, was implemented to give INS the capabilities to increase operational efficiency and improve member services. Its interactive features allow members to update their individual information. Enhancements have been added with the Membership Exclusive and Public Policy sections. A major benefit to converting to this system is that cash flow is improved as transactions are posted in real time.



The Gardner Foundation continues to provide grants and scholarships to INS members wishing to pursue careers in infusion therapy and to promote infusion nursing research and educational programs. The number of submissions continues to increase from year to year. This year the Foundation added a new award, the INS Presidential Leadership Scholarship. The purpose of this scholarship is to honor the commitment and contributions of INS past presidents by recognizing exceptional leadership qualities among nurses within the infusion nursing specialty.


In January, I attended the Nursing Organizations Alliance Foundations Meeting held at the Oncology Nursing Society (ONS) headquarters in Pittsburgh. At this meeting, I had the opportunity to meet with individuals from other specialty nursing organization foundations to discuss and share best practices and lessons learned about fundraising programs, planned giving, and philanthropic perspectives.



The Infusion Nurses Certification Corporation (INCC) continues to receive positive comments on the computer-based testing (CBT) format for the CRNI(R) Examination. In 2008, 2 administrations of the CRNI(R) Examination were offered-in March and September. A total of 409 candidates sat for the examination, with an additional 9 foreign candidates taking a paper-and-pencil version of the test. The pass rate for the 2008 candidates was 71.3%, compared to 72.51% in 2007. The 2008 CRNI(R) recertification rate was 72.7%, compared to a 71.6% rate in 2006 and a 75% rate in 2007. This is consistent with the industry average of 70% to 75%.


A critically important component of any certification program is a job analysis. This process ensures that the items on the examination reflect current nursing practice. In 2008, the results from the 2007 Job Analysis were used to develop a revised test blueprint that was then used to develop items for the CRNI(R) Examination.


Members of the INCC Board of Directors play an important role as stewards of the organization. Their commitment to certification in general and infusion certification in particular is unsurpassed. As their terms of office will end at the board meeting in June, I want to thank Chair Roxanne Perucca and Director Mary Hagle for the contributions they've made as members of the INCC board. Their knowledge, expertise, and dedication to infusion nursing certification have enabled INCC to continue to provide a strong, reputable certification program. Pamela Jacobs will assume the chair position at the conclusion of the INCC board meeting.


An issue that INCC continues to address is the difference between a certification program and a certificate program. Often, the terms certification and certificate are used interchangeably; however, there are distinct differences between them. It is important that examination candidates, certificants, and other healthcare professionals understand the separate programs and the implications they have with relation to public protection. Articles clarifying the differences have been published in Chronicle and Newsline, and copies are also available in the INCC booth. INCC feels very strongly about this topic and will continue our awareness campaign to educate nurses and other healthcare professionals.


INCC continues to play an active role in the American Board of Nursing Specialties (ABNS). My 2-year term as nominations chair will be complete in July. Roxanne Perucca has completed her term as a member of the Awards and Recognition Committee. INS/INCC Executive Vice President Chris Hunt and I also presented at the ABNS Assembly Meetings to discuss the topics of misrepresentation of credentials and organizational autonomy.


As a way to increase the recognition of certified nurses, the American Nurses Credentialing Center (ANCC) has designated March 19 Certified Nurses Day(TM). Certified Nurses Day(TM) is a special day of recognition to celebrate the contribution of board-certified nurses to the advancement of nursing professionalism and to higher standards and better outcomes in patient health. INCC was one of many organizations that signed on in support of the campaign.


ABNS and the Competency and Credentialing Institute (CCI) are convening a Nursing Certification and Competency Summit to be held in Baltimore in October 2009. The purpose of the summit is collectively to create a unified research agenda on nursing certification and continuing competency and to establish strategies for study. INCC will be a participant.


The INCC Web site,, has a new look and incorporates many of the same technological advances and ease of navigation as the INS site.



I want to thank the INS Board of Directors for their commitment to excellence and their passion for the specialty practice that continues to drive the Society forward as the global authority on infusion nursing. I would also like to extend a special thanks to all our members. As INS continues its work on behalf of you, your patients, and the entire infusion community, we do so with the knowledge that our success is a direct result of your active participation and our commonality of purpose.


Your dedication to your patients and our specialty practice is unsurpassed, and for that we are extremely grateful. Thank you for all that you do to help set the standard for infusion care.