FEATURE Ypacked. The phone rings on your way out...shop online, pay your bills online, take American...

The Official Publication of the American Academy of Ambulatory Care Nursing

SEPTEMBER/OCTOBER 2006

InsideSPECIAL ISSUE:

NURSING INFORMATICSFEATUREPage 3Ambulatory InformaticsNurses – Translating theLanguage of Patient CareA look at the ambulatoryinformatics nurse and howtechnology is impacting patienthealth records.

2Integrating Evidence intothe Electronic HealthRecord: Great Challenges,Great OpportunitiesWith the advent of electronichealth records, ambulatory carenurses will need to know how toaccess an evolving knowledgebase to support the needs oftheir patients.

NEWSPage 10Continuing EducationStandards Changing withANCC’s New CriteriaANCC has implemented a seriesof changes that will affectcontinuing nursing educationbeginning January 1, 2007.

Page 11AAACN Annual Scholarshipand Awards ProgramNominate your colleague today!

Volume 28 Number 5

Karen Colorafi, BScN, RN, CPHIT, CPEHR

tions. Virtually every other industry – finan-cial, telecommunications, transportation,manufacturing – uses information technolo-gy (IT) solutions to help them address work-flow issues, productivity, and safety con-cerns. Despite the lessons learned from theirexperience, only 14% of physician practicesare electronic today, and just 14% morehave any intention of becoming electronicwithin the next year (Morantz, 2005).Clearly, we have a long way to go to meetthe President’s goal of widespread electron-ic health record (EHR) adoption by 2014.

Presidential OrderWhen President Bush signed Executive

Order 13335 on April 27, 2004, he estab-lished the Office of the NationalCoordinator of Health InformationTechnology. Not three months later, Dr.David Brailer, the newly appointed NationalCoordinator for Health InformationTechnology, released his strategic frame-work as a plan of action to ensure that allAmericans have electronic health recordswithin 10 years.

YYou’ve got your coat on and your bag

packed. The phone rings on your way outthe door, and like any good ambulatorycare nurse , you run back and answer it. It’syour two o’clock patient calling. Mrs. Jonescan’t remember if the doctor said to takeher new atenolol prescription in addition tothe hydrochlorothiazide or instead of thehydrochlorothiazide. You take a deepbreath. You were busy splinting littleBobby’s ankle when Mrs. Jones left andhave no idea what the doctor’s medicationorders were. Mrs. Jones’ chart left the clinican hour ago with the doctor. He had toleave to do an admission at the hospitaland planned to finish his documentationtonight at home. You have no choice butto apologize and tell Mrs. Jones you’ll getback to her tomorrow. Sound familiar?

In this day and age where you canshop online, pay your bills online, takeAmerican dollars out of a bank machine inMexico, and print your airline boardingpass on your home computer, it is readilyapparent that the health care industry hasbeen slow to transition to electronic solu-

continued on page 14

“While national adoption rates for health information technology are slowly climbing,we are seeing a widening gap between larger hospitals and physician groups and theirsmaller counterparts. Physicians and providers face many barriers to adopting healthinformation tools. We need to create incentives for providers to adopt electronic medicalrecords and ensure the products they buy will do the job.”

– David Brailer, MD, PhDNational Coordinator for Health Information TechnologyU.S. Department of Health and Human Services

2 V I EWPO I NT S E PTE M B E R/OCTOB E R 2006

From thePRESIDENT

Real Nurses. Real Issues. Real Solutions.

American Academy ofAmbulatory Care Nursing

Reader ServicesAAACN ViewpointThe American Academy of AmbulatoryCare NursingEast Holly Avenue Box 56Pitman, NJ 08071-0056(856) 256-2350 • (800) AMB-NURSFax (856) 589-7463E-mail: [email protected] site: www.aaacn.org

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SBuilding and Sustaining Community

Songwriter Jerry Garcia once joked, “The scariestthing in the world is a blank page.” He was speakingfrom a musician’s perspective, and as a writer who isnow staring at a blank screen trying to figure out whatto write, I have to say those words keep ringing in myears.

In Philadelphia and around the country, we are inthe midst of celebrating Benjamin Franklin’sTercentenary. As national celebrations honor the 300-year anniversary of Franklin’s birth, I am learning a lotabout the enduring legacy of one our most remarkablefounding fathers. When Franklin was 21, he gathered 11 friends to form theJunto, a club that met weekly to discuss the ways of working together for thebenefit of the Philadelphia community. Over several decades of activity,Franklin and his friends enriched community life in Philadelphia by establishinga lending library, a hospital, a school, and a fire brigade to name a few. A num-ber of institutions and initiatives that appear in U.S. communities today can betraced back to Franklin’s passion for building and sustaining community.

The AAACN community had similar humble beginnings 30 years ago. LikeFranklin, a small group gathered to form the American Academy of AmbulatoryNursing Administration (AAANA), a professional organization that met to dis-cuss management styles in ambulatory care, use of nursing staff in ambulatorycare, current developments in the health care system influencing ambulatorycare, patient education in outpatient clinics, and expanded nursing roles. Likethe Junto Club, the group was comprised of passionate and committed volun-teer leaders who chose to perform service, without being paid, for the benefitof the ambulatory care nursing community. Over the past three decades, theAAANA became the AAACN, and it has grown in number and established alegacy as a community of nurses dedicated to building the knowledge base forambulatory care nursing. Consistent with Goal 4 of our Strategic Plan –Community, AAACN has a history of providing ambulatory care nurses with asupportive and collaborative community in which to share professional inter-ests, experience, and practice – real nurses, real issues, real solutions. In addi-tion, the services and member benefit portfolio has grown and diversified.

AAACN celebrated its 30th anniversary during the 2005 annual confer-ence, an annual event that helps build and sustain the community of nursesworking in ambulatory care settings. In this issue, you will read about thedynamic program being planned for the 2007 annual conference. Less than sixmonths away, the 2007 annual conference will be held in Las Vegas, NV, fromMarch 29 to April 1, 2007. The theme for the conference is “Shaping theFuture of Ambulatory Care.”

Close your eyes and remember the last AAACN conference you attended.As you entered the hotel or checked in at the registration desk, do you remem-ber that smile from a colleague you had not seen in a while? As you startedbidding at the silent auction, can you feel the hug from a colleague you met atthe last conference? At the pre-conference and opening ceremony, can youpicture the sea of waves across the room, colleagues and co-workers, connect-ing with each other? Are you still using the quality management tool shared

Beth Ann Swan


Ambulatory Informatics Nurses –Translating the Language of Patient Care

W W W . A A A C N . O R G 3

IJoyce Lofstrom, MS, APRJoyce Sensmeier MS, RN, BC, CPHIMS, FHIMSS

It’s a typical scene in the endocrine clinic: the ambula-tory nurse comes into the examining room, takes thepatient’s vitals, and records the data. But now, this nursesits down to a laptop computer positioned on the desk inthe room. She records any additional new information forthis patient, following the procedures of the clinic. Shedoesn’t have to ask about previous history because it isright in front of her as the patient’s medical chart comesup on the screen.

But…WHO manages that patient health informationand ensures that theelectronic medical recordor EMR meets the needsof the clinicians staffingthis setting? Meet theambulatory informaticsnurse, a skilled practi-tioner with clinicalknowledge and experi-ence who has made thetransition from stetho-scope to working withspecifically designed soft-ware and strategic tech-nology to managepatient health informa-tion.

As the benefits of information technology (IT) in healthcare become more evident, ambulatory informatics nursesplay a crucial role in the delivery of patient care.Technology represents immediate access to patient infor-mation, and through the electronic medical record, all cli-nicians can track what’s happening with patients and withthe EMR system itself.

Defining Nursing Informatics In 1994, the American Nurses Association (ANA) first

defined the scope of practice for nursing informatics, andin 2001, ANA defined the specialty of nursing informaticsas one that “integrates nursing science, computer scienceand information science to manage and communicateinformation, data and knowledge” (ANA, 2001).

In addition, the nursing and nursing informatics litera-ture offers several definitions, citing “nursing informatics”:

• Is the vehicle that enables evidence of the effects ofnursing interventions to be linked with the outcomesof care in relation to the problems identified for a spe-

cific patient or groups of patients (Swan, McGinley, &Lang, 2002).

• Addresses the management and processing of data,information, and knowledge to support nursing prac-tice and the delivery of care (Bakken, Cimino, &Hripcsak, 2004; Delaney, 2001).

• Is a combination of computer science, information sci-ence, and nursing science designed to assist in themanagement and processing of nursing data, informa-tion, and knowledge to support the practice of nursingand the delivery of nursing care (Graves & Corcoran,1989)These definitions of nursing informatics demand both

attention and understand-ing based on the jobdescription of a nurse whomanages information tech-nology and managementsystems in health care.Why? Nursing informaticsgoes beyond the basics ofword processing. An ambu-latory informatics nursemust be able to develop,access and manage an EMR,often taking on the role ofboth the data manager andprofessor, in essence, thenursing professional whomust both implement and

explain the technology. “When new clinical IT applications are successful,

many stakeholders take credit,” said Richard D. Lang, EdD,editor of the Journal of Healthcare Information Managementin the spring 2006 edition on nursing informatics (Lang,2006). “Physicians are lauded for their unselfish participa-tion and valuable insight into the process. Administratorsare commended for their vision, foresight and leadership inpromoting clinical system initiatives. IT staff are rewardedfor their technical acumen and long hours of hard work inmaking the many changes to programs, reports, andscreens that ultimately make applications useable in a high-ly complex, process-driven environment. But whether ornot the application is truly successful depends on how wellnursing adopts, advocates, and ultimately integrates theseinitiatives into production.”

As a result, the field of informatics has truly introduceda new and effective dynamic, resulting in significantly

continued on page 4


increased patient care quality, safety, and empowerment.In an ambulatory care setting, information technologyhelps support the immediacy of care and the caseload ofpatients. In fact, IT enables every aspect of the nursingprocess by improving the information flow.

Nursing Informatics – The ProfessionMost nursing informaticists arrived at their current posi-

tion through the traditional nursing path, according to the2004 Nursing Informatics Survey, conducted by theHealthcare Information and Management Systems Society(HIMSS) and sponsored by Omnicell. In just two years,more degree programs have been created for health infor-matics in general. To find a list of some of these programs,visit the directory on the HIMSS Web site(www.himss.org/ASP/academicDirectory.asp).

Yet, as evidenced from the data of this nursing infor-matics Web-based survey, 10% of the total 537 respon-dents indicated that they hold degrees in nursing informat-ics; less than 2% were currently pursuing this type ofdegree. One-third of the respondents had a master’sdegree in nursing, with 14% holding a master’s degreeoutside of nursing, such as an MBA.

Nursing Informatics – TrainingThe HIMSS survey (2004) found that on-the-job train-

ing ranked as the primary way nursing professionals learnthis specialty, with more than half of the respondents citingthis approach. Approximately 50% of the respondents saidthey had at least 16 years, and another 21% with 11 to 15years, of clinical experience before making the informaticstransition. As to what kind of experience, nurses respond-ing to the survey cited critical care (24%) and medical-sur-gical nursing (22%) as the areas most often leading to aposition in nursing informatics.

For the ambulatory informatics nurse, these statisticsare noteworthy because they illustrate both the currentand future position of nursing. Most nurses learn by doing,at least for the current time, when transitioning to nursinginformatics, as supported by the survey results. But for theambulatory informatics nurse working in or thinking aboutmaking the transition into applying the technology topatient care, clinical experience represents the qualifyingrequirement.

“Supporting empowerment of citizens to manage theirhealth care demands a nursing workforce that is educatedas much in ambulatory care hospital-based practice,” saidConnie White Delaney, PhD, RN, FAAN, FACMI, dean andprofessor, School of Nursing, University of Minnesota. “Theintegration of informatics knowledge and education relatedto practice in ambulatory care to support individual, family,and community health trajectories are imperative for alllevels of nursing education.”

Ambulatory Nursing InformaticsConsider the informatics nurse as a translator, a nurs-

ing professional translating the language of nursing forpatient care to computer systems. This description simpli-fies the job description but also represents the strategic

approach that the ambulatory nurse must take in the roleof language translator.

“Ambulatory nurses will be one of the prime users ofenabling technologies as health care becomes patient-centric, and more care will be given, not only in the outpa-tient setting, but also in the home,” said Marion J. Ball,EdD, fellow, IBM Global Business Services. “Ambulatorynurses will become expert in telemedicine applications, theuse of handheld devices, and the use of Internet-ableaccess to personal and electronic health records to accessinformation when and where it is needed.”

Consider the ambulatory care informatics nurse as thebehind-the-scenes expert who ensures that the technologysystem operates and provides value to the team. Here aresome examples of how that happens.

• Systems implementation: The ambulatory infor-matics nurse may train, support, and prepare users touse an EMR system.

Figure 1.Sources with Links

• Alliance for Nursing Informatics (ANI): The Alliance forNursing Informatics is a collaboration of organizations thatrepresents a unified voice for nursing informatics. TheAlliance represents more than 3,000 nurses and bringstogether 20 distinct nursing informatics groups in theUnited States. Visit www.allianceni.org.

• Nursing and Informatics for the 21st Century: An InternationalLook at Practice, Trends and the Future (2006), a book edit-ed by Charlotte A. Weaver, PhD, RN; Connie WhiteDelaney, PhD, RN, FAAN, FACMI; Patrick Weber, MA, RN;and Robyn L. Carr, RGON, published by HIMSS. Visitwww.himss.org/bookstore to read more about the bookand order a copy.

• HIMSS – Nursing Informatics: Learn more about the pro-fession of nursing informatics on the HIMSS Web sitewww.himss.org/asp/topics_nursingInformatics.asp

• Nursing Informatics Background and Research: Visitwww.himss.org/asp/topics_FocusDynamic.asp?faid=115 toaccess current presentations and research on nursing infor-matics. • 2006 NI Roundtable Final Results - Presentation

(3/1/2006).• 2005 The Impact of Health Information Technology on

the Role of Nurses and Interdisciplinary CommunicationFinal Results/Findings - Survey Result (3/1/2006)

• 2005 Impact of HIT on Role Requirements (2/14/2005).• 2004 HIMSS Nursing Informatics Survey, Sponsored by

Omnicell, Inc. Survey Result (2/19/2004).• HIMSS Directory of Academic Programs in HIT: The HIMSS

Educators Special Interest Group developed this Directory ofAcademic Programs in HIMSS-Related Disciplines to promoteawareness of these programs and to provide a useful resourcefor prospective students and other interested parties. The direc-tory includes nursing informatics programs among its 33 aca-demic programs throughout the U.S. To access the directory,visit www.himss.org/ASP/academicDirectory.asp on the HIMSSWeb site. The directory will be updated on a regular basis.


• Systems developer: The ambulatory informaticsnurse can customize, update, or create applications tosupport the EMR system already in place.

• Communication broker: Acting as the clinic orpractice envoy, the ambulatory informatics nurse maycoordinate information and other activities of the prac-tice or clinic.With the EMR as the spoke that can keep the patient

care wheel current and effective, an ambulatory informaticsnurse becomes one of the major and must-have players forthe practice or clinic making the transition to health IT.“The speed with which scientific nursing knowledge cannot only be generated, but used to improve the quality ofhealth care, can be greatly accelerated by linking easilyaccessible computerized evidence to clinical informationsystems, and in turn, capturing and storing the document-ed nursing data for new quality improvement and researchstudies. Informatics is the vehicle to facilitate this linkage”(Swan, Lang, & McGinley, 2004).

However, nurses feel that to truly implement informa-tion technology to its expected performance, they need tobe part of the strategic planning process when the EMR isintroduced. HIMSS conducted its HIMSS NursingInformatics Survey again in 2005 and found that somenurse respondents saw the benefits of health IT but stillworried that computer systems might interrupt their careof patients. But often, as in any setting when new technol-ogy of any kind is introduced, lack of understanding andinformation is the real challenge of acceptance.

“Often, nurses are not involved in the decision processwhen it comes to introducing health IT systems into ahealth care setting,” said Joyce Sensmeier, MS, RN, HIMSSvice president of informatics. “Nurses need to be part of

the strategic planning process when implementing theEMR. In an ambulatory setting, the informatics nurses mustbe a key part of the team working with the physicians,vendor and practice manager to both investigate andimplement the best technology.”

Looking AheadThe demand for ambulatory informatics nurses will

only increase as ambulatory care settings (such as physicianpractices and clinics) and health care in general adopthealth IT. According to the American Nurses Association(n.d.), there are 2.9 million nurses in the U.S.; 83% oralmost 2.4 million registered nurses are now in the work-place, as stated in a 2004 U.S. Department of LaborBureau of Labor Statistics (BLS) report. In addition, accord-ing to the BLS (2006), nursing also represented the largesthealth care job sector in 2005. The 2005 data from theBLS also indicated that employment for RNs in all special-ties is expected to grow much faster than average, or at 18to 26%, through 2014 because of the size of the occupa-tion, a prediction based on projected new jobs in nursingand experienced nurses retiring from or leaving the profes-sion. As for the future, a report released in April 2006 fromthe Health Resources and Services Administration (HRSA)predicted a US shortage of more than one million nursesby 2020 with all 50 states experiencing insufficient num-bers of nurses by 2015.

EMRs in the Ambulatory Care Setting Couple the demand for nurses with the expansion of

health IT in the ambulatory care setting and the demandgrows even more for nurses with this specialty. About 24%

Clinical Documentation

Clinical Information Systems

Nursing Clinical Documentation

Computerized Provider Order Entry

Electronic Medical Record

Electronic Medication Administration Record Management

Clinical Data Repository

Point-of-Care Clinical Decision Support

Wireless

Quality Improvement

74%74%71%71%

68%68%52%52%

48%48%43%43%

35%35%34%34%

32%32%29%29%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Figure 2.Which Applications Do You Currently Participate in Developing or Implementing?

(Data from the 2004 HIMSS Nursing Informatics Survey)

Source: HIMSS (2004)

continued on page 6


of physicians in the U.S. said they used full or partial EMRsin 2005, compared with 21% in 2004, according to aCenters for Disease Control and Prevention (CDC) (2006)report. The survey of 1,281 physicians showed that 46% ofphysicians in practices with 11 or more physicians usedsome type of EHR compared with 16% of physicians insolo practices. And just 9% of physician respondents saidthat they use a complete electronic health record system.

Certified Ambulatory EMR ProductsIn addition, the Certification Commission for

Healthcare Information Technology (CCHIT) (2006)announced in July the first group of certified ambulatoryEMR products. These products meet specific certificationstandards that will provide clinicians in an ambulatory set-ting the assurance that the certified ambulatory EMR sys-tem products they purchase have been tested for perform-ance and meet certain specifications. With this new assur-ance, the number of ambulatory clinicians using the EMR isexpected to grow. Nurses were part of, and will continueto be part of, this certification process, offering their com-ments on how certified ambulatory EMR products shouldperform.

Patient-driven Health CarePatients will help drive this transition as well, and with

information technology, patients become even more visiblein an ambulatory setting. For example, patients alreadysearch for and access health information online, and manycan now make their own appointments or review labresults through a portal offered by their physicians. Nursescan and do monitor patients with chronic disease (such asdiabetes or asthma) using interactive technology systems.Secure and private e-mail systems that are part of the EMRallow clinicians to communicate with patients regardingbasic care or questions.

“The home is becoming more and more a center forcare as we almost revert back to the old-fashioned housecall, only now it will be done virtually in many cases, underthe supervision of good nurses and nurse practitioners whowill spend more time in the field,” said Marion Ball, of IBMGlobal Business Services. “Technology will be one of thebest partners the ambulatory nurse will have in taking careof patients in the 21st century health care delivery system.”Ambulatory informatics nurses are needed now and in thefuture. The role of these nurses will continue to focus onfine tuning patient care from the technology perspective asthey use their skills to ensure that bedside computers pro-vide the information clinicians need…that medicationmanagement systems communicate needed data…andthat nurses and physicians alike have the patient healthinformation readily available through handheld technology.“Instead of nurses viewing the informatics revolution as anintrusion that gets in the way of one’s real work withpatients, it is important to appreciate the extent to whichthe Decade of Information Technology (U.S. Departmentof Health and Human Services [DHHS], 2004) can be atime when nursing fully comes into its own as a disciplineand is perceived that way by others,” said Angela Barron

McBride, PhD, RN, FAAN, in “Informatics and the Future ofNursing Practice,” a chapter in Nursing and Informatics forthe 21st Century (McBride, 2006). “Sure, students, faculty,and staff will have to learn new skills, but that has alwaysbeen true of the field.”

Joyce Lofstrom, MS, APR, is HIMSS Manager, CorporateCommunications. She may be reached at [email protected]

Joyce Sensmeier, MS, RN, BC, CPHIMS, FHIMSS, is HIMSS VicePresident, Informatics. She may be reached at [email protected]

ReferencesAmerican Nurses Association. (ANA). (n.d.). Fact sheet. Retrieved

September 25, 2006, from www.nursingworld.org/pressrel/nnw/nnwfacts.htm

American Nurses Association (ANA). (1994). Scope of practice for nurs-ing informatics. Washington, D.C.: American Nurses Publishing.

American Nurses Association (ANA). (2001). Scope of practice for nurs-ing informatics. Washington, D.C.: American Nurses Publishing.

Bakken, S., Cimino, J.J., & Hripscak, G. (2004). Promoting patient safe-ty and enabling evidence-based practice through informatics.Medical Care, 42(2 Suppl.), II-49-56.

Centers for Disease Control and Prevention (CDC). (2006). More physi-cians using electrical medical records. Retrieved September 9, 2006,from www.cdc.gov/od/oc/media/pressrel/a060721.htm

Certification Commission for Healthcare Information Technology(CCHIT). (2006). Find CCHIT certified products. RetrievedSeptember 9, 2006, from www.cchit.org

Delaney, C. (2001). Health informatics and oncology nursing.Seminars in Oncology Nursing, 17(1), 2-8.

Graves, J., & Corcoran, S. (1989). The study of nursing informatics.Journal of Nursing Scholarship, 21, 227-231.

Healthcare Information and Management Systems Society (HIMSS).(2004). 2004 HIMSS nursing informatics survey. Retrieved September26, 2006, from http://www.himss.org/content/files/nursing_info_survey2004.pdf

Lang, R.D. (2006). Editor’s introduction – Nursing and IT: An encum-bered strategic resource. The Journal of Healthcare InformationManagement, 20(2).

McBride, A.B. (2006). Informatics and the future of nursing practice.In C.A. Weaver, C. Delaney, P. Weber, & R.L. Carr (Eds.), Nursingand informatics for the 21st century. Chicago: HealthcareInformation and Management Systems Society (HIMSS).

Swan, B.A., Lang, N.M., McGinley, A.M. (2004). Access to qualityhealth care: Links between evidence, nursing language, and infor-matics. Nursing Economics, 22(6), 325-332.

Swan, B.A., McGinely, A.M., & Lang, N.M. (2002). Ambulatory carenursing practice: Developing and contributing to the evidencebase. Nursing Economic$, 20(2), 83-87.

U.S. Department of Health and Human Services (DHHS). (2004).Thompson launches “Decade of Health Information Technology.”Retrieved September 9, 2006, from www.hhs.gov/news/press

Additional ReadingsHealth Resources and Services Administration (HRSA). (n.d.). What is

behind HRSA’s projected supply, demand, and shortage of registerednurses: Section IV: Assessing the adequacy of future supply. RetrievedSeptember 26, 2006, from http://bhpr.hrsa.gov/healthwork-force/reports/behindrnprojections/4.htm

Mandel, M. (2005). The coming nursing shortage? Business WeekOnline. Retrieved September 26, 2006, from www.business-week.com/the_thread/economicsunbound/archives/2005/06/the_coming_nurs.html

U.S. Department of Labor, Women’s Bureau. (n.d.). Quick facts on reg-istered nurses. Retrieved September 26, 2006, fromhttp://www.dol.gov/wb/factsheets/Qf-nursing-05.htm

U.S. Department of Labor Bureau of Labor Statistics (BLS). (2006).Occupational outlook handbook (2006-2007 ed.). RetrievedSeptember 25, 2006, from www.bls.gov/oco/ocos083.htm

New Nursing Economic$Column Editor

Candia Baker Laughlin, MS, RN, C, has beenappointed the incoming editor of thePerspectives in Continuity of Care column inNursing Economic$ effective with the 2007 LasVegas conference. Current Editor Liz Dickey,MPH, RN, FNP, now retired from the health careworld, is surrendering her pen for her pruningshears as she pursues her gardening passions asa xeriscape specialist with the Tucson master gar-dener program. She has agreed to help Candywith the column from time to time as needed.

Candy, who just completed editing the 2ndedition of the Core Curriculum for AmbulatoryCare Nursing, was looking for something to fillthe gap now that the core is completed.Candy’s broad background in ambulatory carenursing and her drive and energy are all qualitiesthat will make her a great column editor.

AAACN extends its special thanks to LizDickey for her ongoing contributions to AAACNand the column. If you have topic suggestionsor would like to write a column, contact Candyat [email protected]. Candy is willing to workwith novice writers to help them become pub-lished authors.

Nurse in WashingtonInternship (NIWI)

Looking for a way to influence health care leg-islation but not sure where to start? Attend theNurse in Washington Internship Meeting March11-14, 2007, in Washington, DC. NIWI providesnurses the opportunity to learn how to influencehealth care through the legislative and regulatoryprocesses. Participants learn from health policyexperts and government officials, network withother nurses, and visit members of Congress. NIWIis open to any RN or nursing student that is inter-ested in learning more about the legislativeprocess. There is no application or acceptanceprocess to attend. Register online athttp://www.amrinc.net/alliance/2007niwi.cfm

Ballots to be Sent in November

Ballots for 2007 elected positions will bemailed in November. Your colleagues running foroffice are willing to give their time to helpAAACN achieve continued success. We ask thatyou please take a few minutes of your time tovote for the members who will represent ambu-latory care nursing and lead the organization for-ward. Deadline for returning ballots isDecember 6, 2006, which means you will onlyhave a short period of time to vote. Please makeit a point to review the candidate statements andcast your vote as soon as you open the enve-lope. Your vote is important – make it count!

The official online job bank of the American Academy ofAmbulatory Care Nursing, the AAACN Career Center, offers the

most targeted resource available for NURSE professionals.Whether you’re looking for the perfect opportunity or the perfect candidate to fill an open position in your facility,

your perfect match is just a click away.

Visit www.aaacn.org and click on Jobs or contact the Customer Care Center at 888-884-8242

You may also send an e-mail to [email protected]

The AAACN Career Centeris a member of

Your next Career or the perfectAmbulatory Care Nurse

candidate is just a click away!

Your next Career or the perfectAmbulatory Care Nurse

candidate is just a click away!

Job Seekers

◗ Search hundreds of local andnational ambulatory care-specific opportunities

◗ Create a customizedprofessional résumé with theeasy Résumé Builder

◗ Upload and store existingrésumés

◗ Post your résumé online(confidentially if preferred)

◗ Build your own personalizedprofessional Career Web site

◗ Reply online to job postingsand send a cover letter withyour résumé

◗ Receive e-mail notification of new job postings in the specialty area and geographiclocations you select.

Employers

◗ Target your search toqualified ambulatory carecandidates

◗ Access the résumé databasewith your job posting

◗ Receive e-mail notification ofnew résumé postings thatmeet your criteria

◗ Take advantage of flexible,competitive pricing withvolume discounts

◗ Receive personalizedcustomer care andconsultation

Visit the AAACN Career Centertoday. It’s quick, convenient

and confidential.


AAACNN E W S32nd Annual Conference –

“Shaping the Future ofAmbulatory Care”

Pre-Conference SessionMarch 29, 2007, 1:30 p.m. – 4:00 p.m., Las Vegas, NV

Leading the Way: Delivering Virtual Patient-Centered Care

Shaping a patient-centered health care delivery systemis one of the many challenges facing ambulatory care nurs-es in the 21st century. This pre-conference will discuss tele-health nursing strategies that focus on issues, problems,and solutions useful to all nurses in the ambulatory carespectrum. Key concepts include:

• The challenges we face in delivering care• Optimizing the role of telehealth nursing in ambulatory

care• Maximizing the care continuum• The virtual workplace.

No matter what the location of your practice setting –the clinic, the call center, the hospital, or the doctor’s office –this session will provide you with valuable, practical, and judi-cious information. Learn from knowledgeable expert leaders.

2007 Annual ConferenceSilent Auction

If you are planning to attend the 2007 AnnualConference, “Shaping the Future of Ambulatory Care,” becertain to mark your calendars for the Opening Receptionand Silent Auction on Thursday, March 29th. This eventhas been immensely popular at past conferences.

It’s never too early to begin thinking and planning forthe Silent Auction, either as a donor or consumer or both!Items included in previous auctions have included gift bas-kets, nursing memorabilia, cookbooks, pictures, and crafts.Jewelry and vintage nursing books are always popular andhotly contested and bid on. Items should be portable andeasy to carry in a suitcase.

The Silent Auction raises monies for the AAACNScholarship Program. The scholarship program providesfunding for academic and research activities. All AAACNmembers who are pursuing additional information about thescholarship program can obtain it from the AAACN NationalOffice at www.aaacn.org, and follow the links to AboutAAACN then Awards.

For more information about the Silent Auction, pleasecontact Pam Del Monte at [email protected]

AAACN‘s scholarship, grants, and awards program offersmembers an opportunity to advance their education or conductresearch, and be recognized for excellence in administrative,clinical, and ambulatory nursing through the following awards:

Research Grant*Funded through Silent Auction fund raising, personal, and corporatedonations.

Nurses who have been members for a minimum of 2 years,who submit a research abstract and proof of acceptance of theresearch study, and agree to present the research findings at theAAACN Annual Conference and/or publish an article in Viewpoint,may be awarded funding for a research project.

Excellence AwardsSponsored by the Anthony J. Jannetti, Inc. Nursing Economic$Foundation

Two nurse members will be recognized by AAACN as posi-tive role models for mentoring, sharing expertise, effective man-agement of rapidly changing situations, and improving patientcare outcomes. Two awards of $500 will be given, one forExcellence in Administrative Ambulatory Nursing and one forExcellence in Clinical Ambulatory Nursing Practice.

Scholarships*Funded through Silent Auction fund raising, personal, and corporatedonations.

Nurses who have been members for a minimum of 2 yearsmay receive an award for payment of tuition, books, or academ-ic supplies. Eligibility includes current enrollment in an accredit-ed school of nursing or a program to advance the profession ofnursing.

All applications receive a blind review and are scored on anobjective point system.

• You can download award applications from the AAACNWeb site. Click on “About AAACN/Awards.”

• Candidates for the Excellence awards may be nominatedby a colleague, supervisor, or may be self-nominated.

• Deadline date for all awards: January 15, 2007.• All awards will be presented at the AAACN Annual

Conference, March 29–April 1, 2007, in Las Vegas, NV.Please consider supporting the AAACN Scholarship/Awards

program. Honor a colleague, family member, or support yourspecialty. Donations are tax deductible and may be sent to:AAACN Scholarship Fund, P.O. Box 56, Pitman, NJ 08071-0056.*Number of awards given and amount ($100-$1000) based on number of appli-cations and funds available in scholarship account.

AAACN Annual Scholarship,Grants, and Awards Program

Application deadline: January 15

If you missed the 2006 conference, you can still obtain the education. Individual audio CDs of sessions from the 2006 Atlanta conference, or a full CD-ROM of the entire conference containing all PowerPoint® handouts and offering

CE credit are available from DCP at 630-985-1182 or dcporder.com/aaacn


Kaiser PermanenteOne Kaiser Plaza, 24 Lakeside

Oakland, CA 94612Phone: 510.271.5700

Web site: www.kaiserpermanente.org

CorporateMembers

LVM Systems, Inc.1818 East Southern AvenueSuite 15A, Mesa, AZ 85204

(480) 633-8200 • www.lvmsystems.com

For more information about LVM Systems and its products, call480-633-8200, ext. 232, e-mail [email protected], or visitthe LVM Web site at www. lvmsystems.com

The story of Kaiser Permanente is a history of excel-lence, a legacy of each generation’s contribution to under-standing health and meeting the needs of members. Byfocusing on members’ needs, the people of KaiserPermanente built the largest nonprofit health care organi-zation in American history.

Kaiser Permanente is an organization that continuallyworks to elevate the state of health care with progressiveproducts, services, and advancements. Our vision of thefuture remains focused on improving the health of ourmembers and the communities we serve.

Kaiser Permanente also focuses on creating a positiveenvironment for our health care, business, and IT profes-sionals. Our employees enjoy a collaborative work culturethat welcomes diversity and innovation. We also offer sub-stantial compensation and benefits, work/life balance, andexcellent opportunities for advancement.

Whether you are a recent graduate or an experiencedprofessional looking for your next challenge, we offerrewarding opportunities with an organization that is work-ing to define the future of health care.

TNP Resource Directory –Revision in Progress

The 2006 AAACN TelehealthNursing Practice (TNP) ResourceDirectory is currently under revisionfor 2007 release. The TNP ResourceDirectory contains a current and rel-evant listing of resource informa-tion for use by health careproviders to help improve thequality, efficiency, and effective-ness of their telehealth practice.Resources included are:Professional Standards, DecisionSupport and Practice SupportTools, Textbooks, Articles,

Standard Reference Works, Web sites, Newsletters,Continuing Education, Associations and Organization,Consultants, and Outsourced Call Center Services. Thisyear, we would like to add a section on “Local NetworkingGroups (LNG).” If you provide a service or are a memberof a LNG, and would like to be listed in the directory,please email Traci Haynes at [email protected]

AAACN Welcomes Kaiser Permanente as a

Corporate MemberTake the Ambulatory Certification Exam

at the Las Vegas Conference at the Las Vegas Conference at the Las Vegas Conference

Tri-Service SIG Pre-Conferencea Huge Success

This year’s presentations at the 2006 AAACN AnnualConference focused heavily on foreign deployments andhumanitarian disaster relief, both at home and abroad.Underlying themes included Role Flexibility, ProgramDevelopment and Implementation, Joint Interoperability,and New Initiatives. Inspiring poster presentations show-cased a variety of topics covering Health Promotion,Telehealth, Disease Management, and a heartwarmingpet therapy presentation “Paws for Healing.”

In spite of budget constraints and heavy deploy-ments, over one hundred Army, Navy, Air Force, andDepartment of Defense nurses attended the conference.As usual, this conference proved to be an excellentopportunity for sister services to network, collaborate, andbrainstorm similar practice challenges. Of course, thehighlight of any conference is the joy of reconnectingwith past acquaintances and making new friends. The Tri-Service SIG Pre-Conference will be held on Wednesday,March 28, 2007 from 8:00 a.m. to 5:00 p.m.

Hope to see you at the 2007 Annual Conference inLas Vegas to hear new ways to enhance military nursingpractice!

see back pagefor details


TContinuing Education Standards Changing

With ANCC’s New Criteria

The American Nurses Credentialing Center’s (ANCC)Commission on Accreditation has implemented a series ofchanges to their criteria for awarding contact hour creditand allowing corporate sponsorship of education activities.These changes will affect nurses who complete and providecontinuing nursing education activities.

ANCC’s Commission on Accreditation instituted thesechanges to more closely align the continuing nursing edu-cation processes with continuing education criteria of thephysicians’ regulatory group, the Accreditation Council forContinuing Medical Education (ACCME). The contact hourchange was implemented, in part, due to the growingnumber of Nurse Practitioners asking to use ACCME con-tact hours for their continuing nursing education, a difficulttask because the groups use two different standards for cal-culating those contact hours.

Changes to ANCC’s corporate sponsorship guidelinesare a direct result of the work done by the Office of theInspector General, which gave rise to the PharmaceuticalResearch and Manufacturers of America (PhRMA) guide-lines, a set of rules established to guide the pharmaceuticalindustry in improving the educational value of direct-to-consumer advertising. The introduction to these guidelinesstates that “We are committed to following the highestethical standards as well as all legal requirements. We arealso concerned that our interactions with healthcare pro-fessionals not be perceived as inappropriate by patients orthe public at large” (PhRMA Code, 2004, p. 3).

ANCC has mandated that the changes take effect nolater than January 1, 2007, however, some organizations,including Anthony J. Jannetti, Inc., are beginning the tran-sition earlier than that mandatory deadline. There are sev-eral criteria changes, but only the following affect howproviders of continuing nursing education activities willfunction.

Contact Hour ChangePreviously, the standard used for calculating contact

hours was based on a 50-minute time period. A 50-minuteperiod provided 1 contact hour of continuing nursing edu-cation, and a 60-minute time period provided 1.2 contacthours of continuing nursing education. ANCC’s new guide-lines are based on a 60-minute time period, so the sameactivity that provided 1.2 contact hours will now provide 1contact hour.

Although this may seem a minimal change, it willbecome much more significant when someone attendsactivities that last for longer periods of time or when sever-al one-hour activities are combined as a cumulativeamount of hours. Using the old standard of 50 minutes = 1contact hour, if an all-day activity had five 60-minute ses-sions, the participant would have earned 6 contact hours.However, with the new calculations, those same five ses-sions will provide 5 contact hours.

The accumulation of contact hours from reading nurs-ing journals will also be affected. Journal articles typicallyoffer between 1 and 2.5 contact hours. With the new stan-dard, gathering enough contact hours for re-certification orlicensure could require reading a greater number of arti-cles.

Contact hours earned prior to this change remain thesame. Education resources currently in libraries or pur-chased prior to the change will be “grandfathered” andwill still award the number of contact hours originally indi-cated.

Nurses who live in states with mandatory continuingeducation and those who are certified will need to stayalert for information about how this will affect theirrequirements. State boards of nursing and certificationboards are discussing whether to decrease the number ofcontact hours or keep the same standards required forrenewing a license, becoming certified, and re-certifying.Early discussions indicate that state boards are consideringadjusting their requirements while many certificationboards are deciding against this. These decisions will bemade by each state and accrediting body within the nextseveral months.

Corporate Sponsorship IssuesIt has always been required that corporate sponsorship

be supplied in the form of unrestricted educational grants,with the provider determining the content, the objectives,the speaker, and the form of evaluation. However, severalregulatory agencies are mandating that there be a greaterdistance between corporate entities and educational con-tent. Teaching done by pharmaceutical agents, forinstance, which used to occur frequently, is now notaccepted. Speakers and educational event planners mustdisclose any conflicts of interest they may hold, as well asany conflicts of their family members. This disclosure alsoapplies to anyone who could affect the continuing nursingeducation content of the activity, including advisors or con-tent experts. These conflicts, such as being on the payrollor having stock in a pharmaceutical company within thepast 12 months, must be disclosed to the learners in writ-ing prior to the activity.

ANCC also requires providers to assure that the con-tent is balanced and unbiased. When an education activityis presented, participants must trust that unbiased, soundinformation has been provided. Promoting a particularproduct may not occur and branding of the handouts withproduct logos and/or trade name information also may notoccur.

Those responsible for the education that specialty nurs-ing associations provide have networked extensively toshare ideas on the effect ANCC’s changes will have on theiractivities as well as how to operationalize these criteria.This collaboration will continue with the use of a list serve

W W W . A A A C N . O R G 1 1

during one of the concurrent sessions? How many tele-phone calls and e-mails have you shared with colleaguesyou networked with during the conference?

Whether you have attended a conference or if youhave not had the opportunity to experience a AAACN con-ference, I invite and encourage each of you to attend thisyear’s conference and bring a blank page (and smiles,waves, or hugs) – meet new colleagues, connect with ane-mail or discussion board buddy, be inspired by outstand-ing speakers, get motivated by the initiatives of AAACN’sspecial interest groups, donate an item to the silent auc-tion, reconnect with the AAACN community, and discoverwhat our lively and informative conference has to offer.

If you are not able to attend the conference in person,you can still experience the knowledge, expertise, andenergy of the conference speakers and fellow members(and gain continuing education hours) by purchasing con-ference audio CDs, participating in the live audio seminars,or completing a printed self-study learning module. If youcannot attend the conference, be an active member byjoining a special interest group (SIG), volunteering for ashort-term charter work group, participating in a discus-sion board, and responding to a listserve with a best prac-tice. If you and your colleagues cannot come to the con-ference, have AAACN bring one of our On the Road cours-es to your organization. We offer an ambulatory care nurs-ing certification review course, as well as a telehealth nurs-ing practice core course.

If you are new to ambulatory care and telehealth nurs-ing practice, take advantage of AAACN’s many excellentresources, such as the Core Curriculum for Ambulatory Care(2nd ed.), the Guide to Ambulatory Care Nursing Orientationand Competency Assessment, the Telehealth Nursing PracticeResource Directory, the Ambulatory Care NursingAdministration and Practice Standards, the TelehealthNursing Practice Administration and Practice Standards, andthe Ambulatory Care Nurse Staffing: An AnnotatedBibliography. AAACN also offers multimedia CDs on manyambulatory care topics, visit our Web site for a completelisting at www.aaacn.org

Be on the lookout for the 2007 Annual Conferencebrochure and share it with your colleagues. If you needextra brochures for your organization, please contact us. Ilook forward to seeing you in Las Vegas! Remember that asmile, a hug, or a wave is something special we have tooffer each other to build and sustain community.

Thank you to everyone who responded to the Just Onecampaign and recruited one new member. Although thecampaign officially ended October 1, 2006, please contin-ue recruiting. As always, thank you for your active partici-pation and volunteer leadership. I am interested in yourviews, please contact me at [email protected]

Beth Ann Swan, PhD, CRNP, FAAN, is AAACN President andAssociate Dean of Graduate Programs, Jefferson School of Nursing,College of Health Professions, Thomas Jefferson University,Philadelphia, PA. She may be reached at [email protected]

President’s Messagecontinued from page 2

hosted by Anthony J. Jannetti, Inc. Web services. The goalis to assure that the highest quality education is providedand members are informed about changes that will havean impact on their professional lives.

Sally Russell, MN, CMSRNEducation Director

ReferencePharmaceutical Research and Manufacturers of America. (2004).

PhRMA Code on Interactions with Healthcare Professionals.Washington, DC: Author.

Instructions for CE CreditNursing Informatics Activity

AssignmentColorafi, K. (2006). The ABCs of EHR for the ambulatory care nurse.

Viewpoint, 28(5), 1, 14-19.Loftstrom, J., & Sensmeier, J. (2006). Ambulatory informatics nurses –

Translating the language of patient care. Viewpoint, 28(5), 3-6.Androwich, I.M., & Haas, S. (2006). Integrating evidence into the

electronic health record: Great challenges, great opportunities.Viewpoint, 28(5), 12-14.

Note: The authors reported no actual or potential conflict of interest inrelation to this continuing education article.

ObjectivesThe purpose of this continuing education series is to increase

the awareness of nursing informatics in nurses and other healthcare professionals. For those wishing to obtain CE credit, please usethe evaluation form inserted in this newsletter, or visit the AAACNWeb site (www.aaacn.org). After studying the information present-ed in this series, you will be able to:

1. Summarize the value of evidence-based clinical content in elec-tronic records for ambulatory care nurses.

2. Relate the tangible and intangible benefits believed to be pres-ent with adoption of an electronic health record.

3. Describe the importance of the role filled by ambulatory infor-matics nurses.

To Obtain CE Credit1. To receive continuing education credit for individual study after

reading all three articles, complete the answer/evaluation form.2. Photocopy and send the answer/evaluation form along with

your credit card payment or check ($15 members/$20 non-members) payable to AAACN, East Holly Avenue Box 56,Pitman, NJ 08071–0056.

3. Evaluation forms must be postmarked by October 31, 2008.Upon completion of the answer/evaluation form, a certificatefor 1.3 contact hour(s) will be awarded and sent to you.

This educational activity has been co-provided by AAACN andAnthony J. Jannetti, Inc.

Anthony J. Jannetti, Inc. is accredited as a provider of continu-ing nursing education by the American Nurses’ CredentialingCenter’s Commission on Accreditation (ANCC-COA).

AAACN is a provider approved by the California Board ofRegistered Nurses, provider number CEP 5336. Licenses in the stateof CA must retain this certificate for four years after the CE activityis completed.

These articles were reviewed and formatted for contact hourcredit by Sally S. Russell, MN, CMSRN, SUNA Education Director;and Rebecca Linn Pyle, MS, RN, Editor.


in the appropriate form. This requiresa data model that allows concepts ofinterest in the content (such as nurs-ing problems, expected outcomes,orders, and activities to be incorporat-ed). A terminology is then selected toprovide the values for all the data ele-ments in the model. In an electronichealth record, it is important to usestandardized and logically interrelatedterminology.

Automated systems require clinicaldata that is recorded at the appropri-ate level of detail (neither too generalnor too specific), remains consistentover time and across settings, can betransmitted without loss of meaning,can be aggregated at more generallevels and from multiple perspectives,and can be interpreted by automatedsystems. Standardized terminologiesare necessary for clear, accurate,unambiguous data about patients; toallow for coded data for analysis andstorage; and to promote interoperabil-ity within information systems.

Standardized terminologies alsohelp to summarize medical informa-tion and allow manipulation of datafor aggregation and analysis (forexample, “How many new cases ofdiabetes have we seen this month?”“Is this person’s blood sugar improv-ing?”). Standardized terminologies

ity of information that allows for moni-toring and management of publichealth threats that result from episodicor unexpected events that affect wholepopulations (such as emergency infor-mation networks, bio-surveillance, andpandemic surveillance [syndromic sur-veillance]). Systems for adverse drugreporting and notification have thepotential to further enhance safety.

The challenge for ambulatory carenursing with the emerging electronichealth records is to be able to inte-grate evidence-based content thataffects nursing practice decisions at thepoint of care. Current, relevant, sys-tematically synthesized, rigorous evi-dence can inform and strengthen deci-sion making and will allow for evi-dence-based practice. The term bestpractice, while frequently used, is notconsidered equal to evidence-basedpractice because often, best practicestend to be what has always beendone. Yet, evidence alone is rarelyenough. Clinician skill and expertise, aswell as patient values and preferences,need to be incorporated in clinicaldecision making.

For clinical knowledge to be con-sidered good, it must be clinicallyaccurate, current, and come from thehighest levels of evidence available. Italso must be “delivered” to the nurse

TIda M. Androwich, PhD, RN, FAANSheila Haas, PhD, RN, FAAN

The journey to evidence-basedhealth care requires information ageskills and a shift from knowing a staticbody of information to knowing how toaccess an evolving knowledge base tosupport the needs of patients (Haase-Herrick, 2004). This is importantbecause according to the Institute ofMedicine (IOM) studies, nearly 100people die each day because currently,a paper-based health care systemintroduces errors, delays in treatments,and by its nature, limits what healthcare professionals know because cur-rent evidence is not available. Yettoday, with the increased use of com-puters in health care, many opportuni-ties exist. Consumers will be empow-ered to help manage their own healthwith the availability of personal healthrecords that include medication histo-ries and links to information about dis-eases. Health may be improvedbecause providers and hospitals will beenabled to deliver safe and timely ther-apy and keep up with medicaladvances and innovations (such aselectronic health records, E-prescrib-ing, quality monitoring and reporting,chronic disease management, child-hood immunization records, andemployee empowerment tools).Another area of opportunity is in pub-lic health protection, with the availabil-

W W W . A A A C N . O R G 1 3

also allow automated reasoning tosupport evidence-based practice anddecision making. In other words, thecontent in electronic systems must beuseable to the provider.

Ambulatory care nurses spend amajority of their time managing infor-mation. When they have access to avail-able evidence-based content, they canmake better decisions. Having poorlyorganized or too much information isno better than having insufficient infor-mation. Consequently, content must beefficient to access and use. Contentneeds to provide linkages betweenproblems, interventions, and outcomes,and support clinical workflow and deci-sion making. Figures 1 and 2 depict therole of knowledge and care process ininformation systems.

Figure 1 demonstrates an informa-tion system without clinical content. Asystem without clinical content pro-vides limited support to the provider.In Figure 2, where clinical content isactually incorporated into the system,the impact is powerful. The nurse hasclinical content/knowledge available toassist in decision making during his orher encounters with patients. In addi-tion, the documentation that occurs asa result of each individual patientencounter can then be incorporatedinto the data base, aggregated withthe data from other similar encounters,and used to generate nursing knowl-edge and to support future encoun-ters. Important clinical content can beavailable to the provider in the form ofreferential knowledge available to thenurse at the point of care and can alsobe “pushed” to the nurse in the formof alerts for optimal impact on patientcare.

Challenges for AmbulatoryCare Nurses

Some of the challenges facingambulatory care nurses in realizing thisvision of integrating evidence-basedcontent at the point of care includethe following:

• RN information-seeking behavior(Pravikoff, Tanner, & Pierce, 2005).In a recent study of over 2,000nurses from all areas of education,

Data and Informatics aboutProfessional Nursing Practice

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Figure 1.

Figure 2.

14 V I EWPO I NT S E PTE M B E R/OCTOB E R 200614 V I EWPO I NT S E PTE M B E R/OCTOB E R 2006

The framework for strategic action has a four-prongedapproached. First, inform clinical practice. This is all aboutgetting clinicians to use EHR technology. Strategies toimprove widespread use include reducing the risk of invest-ment, incentivizing early adopters, and promoting adop-tion in underserved and rural areas.

Second, nurses must interconnect clinicians. This strate-gy addresses the need to foster regional collaboration,develop national health information networks, and coordi-nate the federal health information systems.

Next, technology must be used to personalize care. Farfrom concerns about technology encouraging “cookie-cut-ter medicine,” technology can allow the use of personalhealth records (PHRs) that patients themselves can main-tain, can allow and promote telehealth systems, and canactually enhance consumer choice.

Finally, EHRs will undoubtedly improve populationhealth by unifying public health surveillance systems, accel-erating the dissemination of evidence-based research, andstreamlining quality monitoring and reporting (Brailer,2005).

The National PlayersNationally, there is tremendous support for what is

known as the “HIT Movement,” or health information tech-nology movement. The Certification Commission forHealthcare Information Technology (CCHIT) has just releasedstandards for certifying EHR products, which should make iteasier for clinicians to know what they’re getting when theymake the decision to purchase an EHR. Multiple professionalgroups produce reports on the quality and ease of use ofvarious EHR products that are available to ambulatory carepractices (sometimes for a fee). In addition, professionalassociations like the American Academy of Family Physicians(www.centerforhit.org), the American College of Physicians(www.acponline.org), and the Health InformationManagement Systems Society (www.himss.org) are promot-ing the adoption of EHRs in ambulatory care through Web-based strategies and classroom-based sessions.

The Centers for Medicare & Medicaid Services (CMS)has recently embarked on a three-year project with thestate Quality Improvement Organizations to promote theadoption of electronic health records in ambulatory pri-mary care settings (www.doqit.org). The program, calledDOQ-IT (which stands for Doctor’s Office QualityInformation Technology), aims to provide consulting serv-ices at no charge to primary care practices as they progressthrough the roadmap to fully implementing an EHR (seeFigures 1-3).

Identifying Barriers to EHR AdoptionWith all the national support for the adoption of EHRs,

you might wonder why there is resistance to using thistechnology. In fact, the barriers to EHR adoption are sub-stantial (Ash & Bates, 2004). First, there are financial barri-ers. Current cost estimates run between $35,000 and$85,000 per physician to purchase and implement an EHR.

ABCs of EHRcontinued from page 1

clinical practice, and administration, 64.5% of nursesreported needing information weekly or several timesper week, but only 26.7% reported having receivedtraining in using tools to access evidence. Only 11%cite searching information from evidence weekly ormore often, and nearly half (48.5%) are not familiarwith the term “evidence-based practice.”

• In another study, Hutchinson and Johnston (2006)cited several barriers RNs face in trying to utilize evi-dence-based research including lack of time, lack ofconfidence in critical appraisal skills, lack of authority,organization infrastructure, lack of support, lack ofaccess, and lack of evidence.

• In the past, organizations were able to select their ownareas for measuring quality, now national organizationssuch as JCAHO, NCQA, National Quality Forum, CMS,and the Leapfrog Group are beginning to identify coremeasures of quality for which organizations will beresponsible. Within nursing, institutions seeking mag-net status will be collecting data on the NationalDataset on Nursing Quality Indicators (NDNQI).

ConclusionConsequently, each nurse practicing in ambulatory

care must develop an understanding of the value of havingevidence-based clinical content available in the electronicrecord and an informed view of the current state of con-tent and terminologies used to support and promote evi-dence-based decision making. Nurses will also need todevelop individualized strategies for using evidence in theirown settings and identifying key indicators to measure.

Ida M. Androwich, PhD, RN, FAAN, is Professor and ProgramDirector, Loyola University Chicago Niehoff School of Nursing,Chicago, IL. She may be reached at [email protected]

Sheila Haas, PhD, RN, FAAN, is Dean and Professor, LoyolaUniversity Chicago Niehoff School of Nursing, Chicago, IL. She maybe reached at [email protected]

ReferencesHaase-Herrick, K. The nurse of the future. Modern Healthcare, 34(16),

18.Hutchinson, A,M. & Johnston, L. (2006). Beyond the BARRIERS Scale:

Commonly reported barriers to research use. Journal of NursingAdministration, 36(4), 189-199.

Pravikoff, D.S., Tanner, A.B., & Pierce, S.T. (2005). Readiness of U.S.nurses for evidence-based practice: Many don’t understand orvalue research and have had little or no training to help themfind evidence on which to base their practice. American Journal ofNursing, 105(9), 40-51.

Viewpoint Call for ManuscriptsFor more information or to request

author guidelines, contact:Carol Ford, Managing Editor, [email protected]

W W W . A A A C N . O R G 1 5

That’s a lot of money for a small ambulatory practice, espe-cially when reimbursement rates are declining and payerscontinue to put the squeeze on providers.

The business case for EHR in primary care ambulatorysettings tends to be underdeveloped. There is a sense thatpayers and large hospital groups reap most of the financialrewards but fail to contribute to the cost burden of imple-menting these systems in ambulatory care. Many physi-cians take a “wait and see” approach, pushing off EHRadoption plans until a time when a more equitable cost-of-ownership arrangement can be made. In addition to thecash purchases that are required, there are high initial coststo implementation, including training time for staff andphysicians, consulting fees (contract attorneys and the ITsquad), and a period of reduced productivity while theoffice becomes accustomed to different operating proce-dures.

There are technical issues to address as well. Most nurs-es don’t learn about servers, interfaces, modems, and HL7standards in nursing school. Highly competent clinical staffmay be reluctant to wade into the sea of information tech-nology language and generally feel ill equipped to haveintelligent conversations about things they don’t under-stand. Small ambulatory practices may not have adequateIT support. Small offices may not have a main server for e-mail or even computers that are networked. Small offices,especially rural offices, may not even have access to high-speed Internet connections. There are concerns about the

Figure 1.Personal Health Records

Did you know that many Americans already maintainsome form of personal health record (PHR)? A PHR is arecord that the individual patient maintains. It is differentand separate than the traditional medical-legal note cre-ated by a clinician, and allows patients to write their ownstories in their own words. The PHR is electronic so that itcan be easily distributed and readily available in the caseof an emergency.

Patients can collect and record the following types ofinformation in a standard PHR:

• Personal and demographic information.• Emergency contacts.• Insurance information.• Problem lists.• Medications and allergies.• Immunizations.• Labs and tests.• Hospitalizations and surgeries.• Advance directives.• Spiritual affiliation.• Care plan.

For more information on PHRs, visit www.myphr.com.

Figure 2.EHR Product Reports

Selecting the right EHR product for your office is animportant task. Here are some of the EHR reports cur-rently available to consumers that rate and rank EHRproducts:

• AC Group Annual Report (www.acgroup.org).• KLAS Report (www.healthcomputing.com).• Electronic Medical Records: A Buyer’s Guide for

Small Physician Practices (www.chcf.org).• Family Practice Management Vendor Survey

(www.aafp.org).• Forrester Vendor Reports (www.forrester.com).• Advance EHR Systems Review (http://health-infor-

mation.advanceweb.com/).• TEPR/Medical Records Institute

(http://www.medrecinst.com).

lack of national interconnectivity standards (If the internistdown the street buys a different EHR than me, will we beable to exchange data?), and everyone is always worriedabout adherence to security and privacy regulations.

Perhaps the most substantial barrier to HIT adoption inhealth care is a behavioral barrier. How many physicians doyou know who can type? Can you? Health care profession-als are taught to write. And write, we do! We write vol-umes of information that is largely illegible to anyone butthe author. Many productive health care providers did notgrow up with the Internet or e-mail, and some do not cur-rently use either. There is a level of technical competencethat is required to use EHR technology successfully, andsome people are just simply afraid to adopt new technolo-gy. The banks are filled with people who would prefer togive up their lunch hour and stand in line waiting to talk toa teller rather than learn to use the ATM machine.

Physicians have concerns about being asked to entertheir own data into an EHR and sometimes feel more like“data entry clerks” than doctors. Medical records staff haveconcerns about losing their jobs (after all, we wouldn’tneed people to push around paper charts anymore). Officestaff who are already stretched to perform all of the giventasks on any given day do not feel they have the time tocommit to learning a new skill. Certainly, adopting an EHRsystem is a significant quality improvement project in theoffice, and it has profound effects on the clinic’s cultureand the way it operates. EHR adoption is a project thatrequires change management skills and the appropriateleadership to ensure that everyone is comfortable with –and competent to use – the EHR.

Finally, taking on a project of this magnitude necessi-tates some kind of organizational change. There is a sayingin the HIT movement that “automating a bad process notonly ensures that we can do a bad job every time, but thatwe can do it faster and with less effort” (Harrington, 1991).Simply put, continuing to do things the way they have



had their cholesterol checked? Did every eligible womanin your practice have a pap smear last year? What aboutyour mammography rate? Colonoscopies? Influenza vac-cines? These are normal preventive care, health-maintenance strategies that nurses play a huge role inevery day. Wouldn’t it be nice to toss the five log booksyou currently have going and simply have an alert flash upon the computer screen telling you that it’s time for Mr.Greg’s pnuemonococcal vaccination when he calls toinquire about recent lab results?

Of those studies that have been conducted on thistopic (Agency for Healthcare Research and Quality[AHRQ], 2006), evidence shows that ambulatory EHRsimprove the quality of care through improved structure ofcare delivery, improved clinical processes, and enhancedoutcomes.

Disease ManagementNurses understand the necessity of health care teams

to care for patients with complex, chronic diseases. Nursesoften connect physicians and health care providers withinformation about a given patient in hopes that the infor-mation arrives at the doctor’s office before the patientdoes. Today, the very act of connecting key members ofthe health care team is a tremendous task that involvestracking down documentation that might never have beendictated or is otherwise unavailable, and then copying it,faxing it, and hoping that someone responsible on theother end received it, reviewed it, and sent it wherever ithad to go. If you do any kind of billing in your office orhave to obtain preauthorization for procedures or prescrip-tions, you know how cumbersome it is to send mounds ofpaper wherever it needs to go in a timely fashion.

Personal Health ManagementHealth care philosophies are changing toward a belief

that nurses have held dear for many years: that the patientis central to the management of his or her own health andwellness. HIT makes it easier for patients to be activelyinvolved in their own health care. The personal healthrecord, or PHR, is already available to patients via Websites and will become a central component in an EHR.Giving patients access to the clinic’s schedule, educationalmaterials, or their own test results through portals isbecoming a critical element of primary care practice.

always been done will not allow you to maximize the utili-ty of your EHR and may even contribute to error. Athoughtful examination and review of current workflowstrategies can reveal “pain points” in a practice that can besolved with HIT. This, of course, requires time to study cur-rent processes, creative “out of the box” thinking to comeup with solutions, and a willingness to try new strategies.Couple that with the substantial amount of teamworkrequired to accomplish this task, and you’ve thrown awhole new dimension into your clinic’s current organiza-tional culture.

The Benefits of EHR AdoptionWho better than a nurse to champion such an initia-

tive? This is an initiative that requires teamwork, collabora-tion, leadership, enthusiasm, clinical experience, and aprocess-oriented approach. Dust off your old textbooks;the nursing process – Assess, Diagnose, Plan, Implement,Evaluate—is alive and well! The nurse, typically the masterof documentation and manager of the paper record in anyorganization, is well positioned to champion the benefits ofan EHR. Who possibly understands the problems with thepaper record better than the nurse?

Financial ManagementStudies show that most providers realize financial ben-

efits from better coding (which results from more completedocumentation) and improved claims submission. A goodEHR makes it easy to document all of those things you talkabout but fail to write down, and therefore, don’t receivepayment for doing. There are hard dollar benefits from thereduction in data entry and data handling costs. Most EHRclinics can reduce or eliminate the need for a transcriptionservice. Paper charts don’t have to be created, filed, pulled,stored, or retrieved. Clinics can begin to collect data on thecost of clinical services, which allows providers to set feesand negotiate rates with far greater accuracy.

Utilization ManagementAny clinic that contracts with health plans, embarks on

pay-for-performance or quality improvement initiatives, orconducts research projects has substantial measuring andreporting requirements. How much fun is it to audit apaper chart? Ensuring the efficient and appropriate use ofresources, not to mention the provision of evidence-basedcare, is a time-consuming and cumbersome task with thecurrent paper record. Contrast the days spent auditingcharts, or keeping hand-written log books, to querying apowerful computer database and running a report withinminutes.

Quality Management Speaking of quality, how well positioned is your clinic

to report on the quality of the direct patient care you pro-vide? Whether you practice in a clinic setting, rehab facility,nursing home, or laboratory, quality measures are of greatinterest these days, which is a trend that will not go away.How many of your diabetic patients had a dilated eyeexamination last year? How many of your CAD patients

Figure 3.DOQ-IT Information

To learn more about the DOQ-IT program in your state,go to www.doqit.org. There you will find a listing of thestate Quality Improvement Organizations (QIOs).Contact the QIO for your state to learn about its DOQ-ITprogram (they vary slightly from state to state). The QIOservices are offered at no charge to a limited number ofeligible practices for a limited period of time.

W W W . A A A C N . O R G 1 7

Population Health ManagementAny nurse who has sifted through mounds of scrib-

bled notes each year in August to prepare another hand-written version of an immunization record can easily seethe value in having a centralized database for populationhealth metrics like immunization history. Whether littleSuzie had her immunization at school, at the mall,through public health, or your office, it is possible that youcould have access to these data by logging on to one cen-tralized system. This is the value of the Regionalized HealthInformation Organization (RHIO) (see Figure 4). Today,individual physicians are hard-pressed to manage andreport public health issues adequately. Think about howmuch easier it would be to manage vital health statistics orcommunicable disease data with a centralized data reposi-tory. Even within your own practice, an EHR registry canhelp you to manage your patient populations with specificdiseases more efficiently and effectively. How powerfulwould it be to be able to run a report and gather a list ofall your patients on lipid-lowering medications with theirmost recent lab results side by side?

Problems with the paper medical record are plentiful.Only one person can use the paper record at any giventime. Information within the paper record may be illegibleand may simply be lost because it falls out or is misfiled.Charts may be misplaced or lost. Data cannot be easilytrended across time. Data within the chart is difficult tofind. The paper chart does not support decision-supportlogic, reminders, or prompts that enhance patient safety.The data are not structured and nothing about the paperchart is amenable to fast processing. The Institute ofMedicine (IOM) has released multiple landmark reportsregarding issues with quality in the current medical system(IOM, 1997; 2000; 2001). In the 2001 report, Crossing theQuality Chasm, the IOM writes, “between the health carewe have and the care we could have lies not just a gap,but a chasm.” Health information technologies such as theEHR are emerging as a bridge that allows clinicians tocross that quality chasm.

The EHR Business PlanBy now, you are convinced that adopting an EHR is

the right thing to do and you can’t possibly practice onemore year without it. Before you go charging into the

doctor’s office with your project proposal, take a minute toconsider the costs associated with adopting an EHR andthe types of financial benefits you are likely to achieve.

The costs of EHR are generally broken down into fivemajor categories. First, there are hardware costs. Most doc-tors’ offices need to upgrade existing computer equip-ment and even purchase new terminals and servers.(You’re going to have to throw out anything older thanyou!) Most EHR vendors will provide a “spec” sheet (simi-lar to a shopping list) so that you can be sure their soft-ware will function properly on your new equipment.

Next, there are software costs. Most EHR vendorslicense their software based on the number of physicianusers, giving discounts to mid-level providers and givingunlimited access to other staff in the office.

The third category is implementation and training. It isthe practice’s responsibility to pay separately for the ven-dor team that will install the product and train your staffon how to use it. This can be very costly, as you are pay-ing an hourly rate for professionals (technical advisors,project managers, trainers, and clinicians) as well as theirtravel expenses.

The fourth category, maintenance, is usually calculatedat a percentage of the original cost of software. Industryaverages at the present time are anywhere from 18% to25% of the cost of the original license. Vendors will chargethe practice this amount to cover the cost of providingsome technical support, routine software upgrades, andupdates to things like third-party drug, formulary, andpatient education databases.

Finally, the practice must include the cost of supportservices, such as an attorney to review the contract, a clin-ic-based project manager to keep things moving, or theservices of an information technology company to set upservers or wireless connections within the office. Keep inmind that the total cost of ownership may be higher thanthe expenses represented in the vendor contract if youinclude the time the clinic spends on project managementand planning tasks, traveling to see clinics using EHRs, andreviewing products at trade shows or through vendordemos. Also, consider that you may need to makechanges to your staff (hiring new staff or letting go ofexisting staff who aren’t interested in using an EHR), andthat hiring more technology-savvy staff might mean hiringpeople at a higher hourly wage.

The financial benefits of an EHR include cost savings tothe practice. This includes the direct reduction in expendi-tures, like chart supplies, transcriptionists, or medicalrecords staff. The practice also profits through productivityimprovements. For example, the space formerly used tostore paper charts could be put to use in another way,hopefully in a way that directly enhances revenue, such asan examination room or procedure room. The clinic maysee a reduction in overtime because staff members nolonger have to stay late to “prep” a chart. Clinicians cansee an extra patient each day through productivityimprovements (Redfeam, 2006). Cost avoidance – forexample, not having to hire another medical records staffperson or spend money on storing medical records off site

Figure 4.Regional Health Information Organizations

According to the Health Information Systems Society(HISS), “An RHIO (regional health information organiza-tion) is a group of organizations with a business stake inimproving the quality, safety, and efficiency of health caredelivery. The purpose of an RHIO is to electronicallyexchange health information in a secure format so that thereceiver can use the information.” Visit the HISS Web sitefor more information (www.himss.org/rhiofederation).


– is another potential financial benefit of EHR. In addition,the potential for enhanced revenue is realized through bet-ter coding habits and the ability to easily recall patientswho are due for routine examinations and procedures thatmight have been otherwise missed with the old paper sys-tem.

Finally, the savvy practice finds ways to use its newEHR to contribute to profit. How? The EHR helps you toavoid ordering repeat diagnostic tests or expensive drugsin a capitated population. Without a stack of charts to dic-tate at the end of the workday, a clinician may be able tosee one or two extra patients in the schedule. Dataabstraction may allow you to participate in research proj-ects, which can generate income. Data abstraction alsoallows the practice to easily contribute to pay-for-perform-ance demonstration projects, which can result in higherreimbursement. Other practices have used their data todemonstrate high-quality clinical outcomes to their patientpopulation through advertising campaigns that attractmore patients to the clinic.

Let’s Do It!There are tangible and intangible benefits to adopting

an EHR. This is a concept with which nurses are familiar.Not everything of value can be easily measured. Tangiblebenefits include fewer adverse drug events, lower morbidi-ty and mortality, seamless continuity of care, greater effi-

ciencies, and lower costs (Health Financial ManagementAssociation [HFMA], 2006). The intangible benefits toEHRs are equally as important, and in this day and age ofscarce resources and increasing stress levels in medicalpractice, may arguably provide even greater incentive topush your EHR project forward. EHRs can enhance thequality of care you provide to your patients. Rememberthat spending less time on paperwork means you havemore time for other things, including spending more timewith patients and families. EHRs increase patient safety andcan greatly reduce the stress level of practitioners in theoffice. No longer should you have to chase down a physi-cian with a critical message scribbled on a sticky note. Nolonger will you have to hunt through a stack of charts fora critical lab value. No longer will you be caught emptyhanded when Mrs. Jones calls to clarify a medication orderat the end of the day. This is an exciting time in ambulato-ry medicine. Nurses are ideally situated with the skills,experience, and expertise to guide EHR adoption andchampion its benefits among the provider community andwith our patients.

Karen Colorafi, BScN, RN, CPHIT, CPEHR, is a Clinical EHRNurse Specialist, Health Services Advisory Group, Phoenix, AZ. Shemay be reached at [email protected]

Note: This material was prepared by Health Services AdvisoryGroup, Inc., the Medicare Quality Improvement Organization for

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Prepare Yourself. Protect Your Patients.

Purchase The APIC Text Of Infection Control and Epidemiology

Log on to www.apic.org/store or call 240-646-7032Order your APIC Text today.

The only comprehensive guide to infection control guidelines and clinical standards, the APIC Textis an essential resource for every health care professional. Spanning two volumes, and more than120 chapters, the APIC Text is:

Complete: Vetted by more than 280 experts, theText is the only authoritative guide to infectioncontrol guidelines and clinical standards.

Current: The latest edition of the Text coversmore than 20 new guidelines, outlining theirimpact on clinical procedures and patient care.

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W W W . A A A C N . O R G 1 9

CALL FOR ABSTRACTSSubmission Deadline:

January 15, 2007The Emergency Nurses Association announcesits Call for Abstracts for the 2007 ScientificAssembly, September 27-29, Salt lake City, UT.Guidelines for abstract submissions for poster(research, clinical, and injury prevention) andpaper (research) presentations are available atthe ENA Web site (www.ena.org), or by con-tacting the Research Department, 915 Lee St,Des Plaines, IL 60016 at 800/900-9659, ext.4119; E-mail: [email protected]

Arizona, under contract with the Centers for Medicare & MedicaidServices (CMS), an agency of the U.S. Department of Health andHuman Services. The contents presented do not necessarily reflectCMS policy. Publication No. AZ-8SOW-1D-041306-01.

ReferencesAgency of Heathcare Research and Quality (AHRQ). (2006). Costs and

benefits of health information technology. EvidenceReport/Technology Assessment, No. 132. Rockville, MD: Author.Retrieved April 13, 2006, from www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/hitsys.pdf.

Ash, J., & Bates, D. (2004). Factors and forces affecting EHR systemadoption: Report of a 2004 ACMI discussion. Journal of theAmerican Medical Informatics Association, 12, 8-12.

Brailer, D. (2005, September 29). Statement by the NationalCoordinator for Health Information Technology. Testimony present-ed at the Full Committee Hearing on Healthcare and the ITRevolution before the U.S. House of Representatives, Committeeon Government Reform.

Harrington, H.J. (1991). Business process improvement: The break-through strategy for total quality, productivity, and competitiveness.USA: McGraw Hill, Inc.

HFMA. (2006). Overcoming barriers to electronic health record adoption:Results of survey and roundtable discussions conducted by theHealthcare Financial Management Association. Retrieved April 13,2006, from www.hhs.gov/healthit/ahic/materials/meeting03/ehr/HFMA_OvercomingBarriers.pdf.

Institute of Medicine (IOM). (1997). The computer-based patientrecord: An essential technology for health care (rev. ed.).Washington, DC: National Academies Press.

Institute of Medicine. (IOM). (2000). To Err is human: Building a saferhealth system. Washington, DC: National Academies Press.

Institute of Medicine. (IOM). (2001). Crossing the quality chasm: A newhealth system for the 21st century. Washington, DC: NationalAcademies Press.

Morantz, C. (2005, October 15). Research finds low EHR adoptionrates for physician groups. The American Family Physician NewsNow.

Redfeam, S. (2006, March). Technology: Maximizing your EMR.Physicians Practice.

A nutrition guide for heart patients

Help make good nutrition easier for heart patients. The LoveYour Heart Diet explains fat and cholesterol in food, blood choles-terol and the new food pyramid – good, foundational lessons forheart patients to diet smartly and safely. Goals for food choices,guidelines for sodium and caloric intake and even some valuablecooking tips are included. Dieting is tough. The Love Your HeartDiet shows that just a little tough love can go a long way.

Go to www.aaacn.org/store to link to the P&H site or call 1-800-241-4925 and identify

yourself as an AAACN member when you order.

AAACN Can Help with YourHoliday Gift Dilemma

Unsure what to get your staff as a holiday gift? Considerpurchasing some of AAACN’s Nurses are Everywhere Caringfor You items for them. Nurses would appreciate a stainlesssteel mug filled with some wrapped chocolates or a block ofPost-It® Notes with a matching pen. These inexpensiveitems can be ordered now! Your staff could use our expand-able tote bags as a convenient way to carry materials to andfrom work, and the NEW Core Curriculum for AmbulatoryCare Nursing (2nd edition) would provide your colleagueswith the latest information in ambulatory care nursing thatis hot off the press. Another possible gift consideration couldbe a AAACN membership. Order your gift items today atwww.aaacn.org to avoid the holiday rush!

Holiday gift certificates are also available. Contact theNational Office at 800-262-6877, press 3 to order your cer-tificates early.

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© Copyright 2006 by AAACN

Real Nurses. Real Issues. Real Solutions.

American Academy ofAmbulatory Care Nursing

Volume 28 Number 5

AAACN is the association of professional nurses and associates who identify ambulatory care practice asessential to the continuum of accessible, high quality, and cost-effective health care. Its mission is to advance theart and science of ambulatory care nursing.

Viewpoint is published by theAmerican Academy of Ambulatory

Care Nursing (AAACN)

AAACN Board of DirectorsPresidentBeth Ann Swan, PhD, CRNP, FAANAssociate Dean of Graduate ProgramsJefferson School of NursingCollege of Health ProfessionsThomas Jefferson University130 South 9th Street, Suite 1230APhiladelphia, PA 19107-5233215-503-8057 (w)[email protected]

President-ElectCharlene Williams, MBA, BSN, RNC, BCManager, Cleveland Clinic Nurse on CallCleveland Clinic2972 Somerton RoadCleveland Heights, OH 44118216-738-4888 (w)[email protected]

Immediate Past PresidentRegina C. Phillips, MSN, RNProcess ManagerHumana, Inc.30 S. Wacker Dr., Suite 3100Chicago, IL 60606312-627-8748 (w)[email protected]

SecretaryKaren Griffin, MSN, RN, CNAA210-617-5300 x4152 (w)[email protected]

Treasurer Kitty Shulman, MSN, RN, CDirector of the Children’s Specialty CenterSt. Lukes Regional Medical Center208-381-7010 (w)[email protected]

DirectorsMAJ Belinda A. Doherty, USAF, NC520-228-1547 (w)[email protected]

Marianne Sherman, RN, C, MS720-848-2397 (w)[email protected]

AAACN ViewpointEast Holly Avenue, Box 56Pitman, NJ 08071-0056(856) 256-2350(800) AMB-NURS(856) 589-7463 [email protected] www.aaacn.org

Rebecca Linn Pyle, MS, RNEditor

Cynthia Nowicki Hnatiuk, EdD, RN, CAEExecutive Director

Sally S. Russell, MN, CMSRNEducation Director

Patricia ReichartAssociation Services Manager

Carol FordManaging Editor

Bob TaylorLayout Designer

Tom GreeneDirector of Marketing

Robert McIlvaineCirculation Manager

AAACN has made arrangements with theAmerican Nurses Credentialing Center (ANCC)to offer the Ambulatory Care NursingCertification Exam for the first time at the 2007conference in Las Vegas, March 29-April 1.

To help prepare you to take the exam, theAmbulatory Care Nursing Certification ReviewCourse will be held all day Thursday, March 29.The exam will be offered Sunday afternoon, April1 – tentatively at 1:30 pm., following ClosingCeremonies.

If you have been thinking about becomingcertified but just have not made the commit-ment, here is your chance! Certification validatesyour knowledge and level of excellence in ambu-latory care nursing practice. If you are coming tothe conference, why not take that extra step andtake the certification exam while you are in LasVegas? If you were not planning to come to theconference, maybe the exam will change yourmind or prompt your employer to send you!

Begin studying now to ensure you pass theexam by ordering any of the following resources:

• Hot off the Press – Core Curriculum forAmbulatory Care Nursing, 2nd Edition – themain study resource to prepare for theexam.

• Ambulatory Care Nursing Self Assessment –200 multiple choice test questions written inthe same format as the exam. A blank

answer sheet and the answers are providedto help you determine your strengths andareas for further study.

• Ambulatory Care Nursing Administration andPractice Standards. All nurses practicing inambulatory care should be practicing withinthese standards.

• Certification Review Course Syllabus (providedas a handout to nurses who take the ReviewCourse in Las Vegas).

• If you are unable early to take the reviewcourse live on March 29, consider purchas-ing the Ambulatory Care Nursing CertificationReview Course CD-ROM.Details are still being worked out with ANCC,

including providing you with a special applicationthat will show the AAACN test date and Las Vegassite. You will mail your application directly toANCC. Watch the Web site (www.aaacn.org) andfuture e-mails containing the special applicationand more information about the exam. For gen-eral information about the exam, test content,etc., go to www.nursecredentialing.org

Start planning now to”get certified” at theAAACN Las Vegas conference! Remember,AAACN members save $70 off the regular $320non-member exam application fee. Members ofANA Constituent Member Associations pay a$180 fee.

Ambulatory Care Nursing Certification Exam to be heldfor the first time at AAACN’s Las Vegas Conference

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