Inside · cal appraisal, and evaluative skills. In addi-tion, nursing journal clubs help...

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The Official Publication of the American Academy of Ambulatory Care Nursing

Volume 29 Number 3

development of systematic critiquing, criti-cal appraisal, and evaluative skills. In addi-tion, nursing journal clubs help participantsassimilate information for change in clinicalpractice, generate ideas, disseminate andutilize the results of research, and challengedependency on tradition. Finally, nursingjournal clubs help narrow the research-theory-practice gap and provide forums forthe development of collegiality betweenclinical scholars (Goodfellow, 2004; JointCommission Benchmark, 2000; Pasek &Zack, 2004; Wright, 2004).

Assessing Interest and PlanningStrategies

How does one approach developing anursing journal club? First, you have todetermine if there is interest by the staff.Tap on one or more individuals who arewilling to join you in this journey and are

Development and implementation of anursing journal club can be one of themost rewarding staff development initia-tives that you and your colleagues willexperience. Nursing journal clubs havebeen an active part of our institution’s cul-ture since 1997. Currently, there are 11active groups meeting within our threecampuses in a number of specialty areas,such as pediatric, oncology, endoscopy,multi-specialty, and critical care.Participation ranges from 7 to 70 attendeesand the clubs occur monthly. The multidis-ciplinary focus of each nursing journal cluboffers opportunities for collaboration, deep-er clinical inquiry, and enhanced learningfor all participants. Colleagues from rehabil-itation services, respiratory care, nutritionand dietetics, chaplaincy, pharmacy, andsocial work are frequent participants.

The literature identifies advantages ofdeveloping nursing journal clubs, whichinclude helping participants enhance the continued on page 14

AAACN has an effective tool to help youcustomize the orientation process foryour new employees. See page 16.

MAY/JUNE 2007

InsideFEATURESPage 3 – CNEIntegrating Evidence intoPracticeLearn how one facility is applyingresearch findings to its dailynursing practice.

Page 5 – CNEKeeping Cool Under theCollar: A Survivor’s Guideto BurnoutBurnout, negativity, and poorperformance affect ourcolleagues and ourselves. Identifythe factors and learn how toeffectively avoid burnout.

AAACN NewsPage 9Viewpoint Writer’s AwardAnnounced

Pages 11-13AAACN Annual ConferenceHighlights – Las Vegas, NV

8Real Nurses, Real Issues,Real Solutions

Page 19Spotlight on Practice

Jennifer Dwyer MSN, RN BC, CCRN, CNRN, APRN BC

Products p o t l i g h t

2 V I EWPO I NT MAY/J U N E 2007

From thePRESIDENT

Real Nurses. Real Issues. Real Solutions.

American Academy ofAmbulatory Care Nursing

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© Copyright 2007 by AAACN. All rightsreserved. Reproduction in whole or part, elec-tronic or mechanical without written permissionof the publisher is prohibited. The opinionsexpressed in AAACN Viewpoint are those of thecontributors, authors and/or advertisers, and donot necessarily reflect the views of AAACN,AAACN Viewpoint, or its editorial staff.

Publication Management by Anthony J. Jannetti, Inc.

ILeading from

Wherever You Are in AAACNI am delighted to have been selected to serve as

your AAACN president for the coming year. I look for-ward to the opportunity to work with a synergisticBoard of Directors, AAACN’s management firm, andan exceptional group of AAACN volunteer leaders andmembers.

A very influential person in my life once told methat I would be a leader of my people some day. In1998, things begin to fall into place which helped meto arrive at this moment in life. Marilynn Breudigam,my former clinical manager and mentor, encouraged meto do a poster presentation and join the Telehealth Nursing Practice SIG. Thatwas my first annual conference, and I have attended each year since as anactive member of AAACN. In 2003, I received a call from Susan Pashke, anoth-er of my influential colleagues, requesting that I submit my name as a candi-date for the Board of Directors. Initially, I declined, saying that I was too busy,but in her very persuasive manner, Susan encouraged me to run. Three monthslater, I received a call from Candy Laughlin, who informed me that I had beenelected to the Board of Directors. Katherine Futch, another influential person inmy life and a past-president of AAACN, became my Board mentor. In 2004, Iserved as treasurer, and in 2005, I was voted president-elect. As the presidentof AAACN, I feel that I am fulfilling my destiny of being a leader of my people.Indeed, you are truly my people because like me, you are passionate aboutnursing and AAACN.

In his book, The 360-Degree Leader, John Maxwell says that you can chooseto become a leader and make a difference wherever you are in an organiza-tion. He goes on to say that the middle of an organization is often the optimalplace to practice, exercise, and extend your influence. In adopting the threeprinciples of 360-degree leaders, which Maxwell describes as leading up,down, and across, many of you as members of AAACN have made significantcontributions by leading from where you are in the organization.

In leading up, you have lightened the executive leader’s role by performingyour jobs well and helping the Board of Directors live out its strategic plan. Thishas been accomplished whether you were an individual member or a memberof a special interest group, task force, or a committee. In member surveys, youhave provided valuable feedback by telling us what we need to hear, not whatwe want to hear, which has strengthened the Board’s ability to make knowl-edge-based decisions. Many of you have gone the extra mile by taking onextra responsibilities and wearing many hats in the effort to get the job done.

In leading across, you have completed rather than competed with your fel-low members by including others, sharing ideas, combining expertise, and put-ting the organization first in order to succeed. As 360-degree leader members,you have networked with your colleagues and expanded your circle of influ-ence by identifying ways to use technology to create a sense of community.

In leading down, you have walked through the halls slowly to listen to,connect with, and help develop fellow members and the people you lead. Indoing so, AAACN 360-degree leader members are recruiting younger membersby making activities more interactive and fostering an environment of

Charlene Williams

continued on page 10

Contact hour instructions, objectives, and accreditation information may be found on page 7.

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

TJackie Bartlett, BSN, RN

The term evidence-based practice (EBP) came to lightin the early 1990s (Steinberg & Luce, 2005). Since itsintroduction, the term has become ubiquitous in medicalliterature and has also found its way into regulatory lan-guage within the past five years. The spotlight on EBP hasled health care organizations to (1) define what EBP meansto the organization and (2) determine how EBP should beintegrated into the organization’s patient care culture.

Early on, proponents of EBP believed that it was nar-rowly defined as the application of research findings totreat patients (Tanenbaum, 2005). However, over thecourse of time, this definition was expanded to includepractitioner expertise and patient values. The most currentdefinition of EBP is the integration of current evidence, clin-ical expertise, and patient values to optimize not only thepatient outcome but their quality of life as well (Sackett,Straus, Richardson, Rosenberg, & Haynes, 2000).

Clinicians might argue they practice evidence-basednursing every day that they work. Traditionally, health careproviders (RNs, Allied Health, and MDs) have obtainedprofessional practice information from both formal andinformal sources. Once practice information is obtained,clinicians often look no further to substantiate this informa-tion, nor do they employ a standard tool if they find morethan one approach to the practice. Clinicians may not doc-ument how they arrived at this practice decision, so otherclinicians would be able to arrive at the same decisions.

Examples of formal sources range from dictionaries totextbooks, while examples of informal sources are identi-fied as the provider peer group (Duffel, 1995). This way ofobtaining practice information has created a disconnectbetween front line research and actual clinical practice.This disconnect continues to widen because of the intro-duction of new technologies, the rapid growth of currentevidence as well as the demonstration that cutting edgeresearch typically takes 17 years before it is reported intextbooks (Lappa, 2005; Melynk et al., 2004). As of May 1,2004, MEDLINE database contained over 1 million articles

from over 4,500 journals (Haynes & Wilczynski, 2004).Given the daunting task of sifting through EBP literature,Children Mercy Hospitals and Clinics (CMH&C) began ajourney to develop its EBP program approximately fiveyears ago.

CMH&C is like most organizations in that it continuallyimplements different approaches to assist clinicians in allareas (home health, ambulatory, and acute care) toimprove patient care. EBP is one of these approaches.Obtaining sponsorship from Hospital Administration to cre-ate an EBP structure was the first step on our journey.Next, we determined that a multi-disciplinary model thatcould be used with all disciplines would best meet theneeds of the organization. This model, known as theEvidence-Based Practice Collaborative (EBPC), had repre-sentatives from medicine, nursing, and allied health depart-ments. It is based in the Quality Improvement Department.

To integrate EBP into the culture of the organization,several different approaches were used. These were (1)educating small groups of individuals on the principles ofEBP, (2) assisting these groups to have success in actualiz-ing EBP literature reviews, (3) sending representatives ofthese groups to regional and national EBP conferences, and(4) asking EBP experts to present EBP lectures within theorganization. Some clinicians will naturally gravitate to EBPwhile others will need to be shown the way.

CMH&C developed its EBP approach by combiningtwo established EBP programs – the Center of EvidenceBased Medicine in Oxford and the Clinical EffectivenessDepartment at Cincinnati Children Hospital. Additionally,the EBPC has had the opportunity to develop collegial rela-tionships with national and international EBP experts toassist CMH&C in its goal to transform its culture into a richenvironment for the growth of EBP. The unique elementsfor the CMH&C EBPC are its composition and reportingstructure. It is comprised of medical staff, nursing staff,allied health staff, and a biostatistician, and it reportsthrough the Quality Department.

continued on page 4


A nurse or a physician (or perhaps both) usually leadsan organization’s EBP program, but these positions are notalways connected to each other within the organization.This is the key difference with CMH&C’s program. The EBPMedical Director and the EBP Program Manager facilitatethe CMH&C EBPC. They call upon other members of thecollaborative when needed. Furthermore, the EBP programis found within the Quality Department of CMH&C. Manyorganizations intertwine Research and EBP; however, theEBPC believes that the translation of research (or currentliterature) into practice is a quality improvement initiativerather than a research initiative.

Given this background, CMH&C has created a multi-disciplinary arena in which any staff member can pose ananswerable clinical question. The EBPC will not only edu-cate key hospital staff on the five basic EBP principles (askthe question, access the literature, appraise the literature,apply the literature, and assess the application), but it willalso assist staff in the application of these principles toanswer the clinical question. An important component torealize about EBP is that only 2 out of every 9 clinical ques-tions are answered by current research. If the clinical groupis not able to find any available evidence, then the EBPCwill assist the group to develop a consensus statementbased on its experience to answer the clinical question.The entire process is well documented in order to create atransparent system for clinicians not involved in the processto understand how the practice decision was determined.

Translation BarriersThe EBPC continues to identify the same barriers that

other organizations have found with translating researchinto practice. These identified barriers are lack of cliniciantime, lack of electronic access, and lack of literature analysisability.

Lack of Clinician TimeAs noted previously, clinicians obtain practice informa-

tion from both informal and formal sources. However,given the high volume and acuity of patients seen in boththe outpatient and inpatient environments at CMH&C, theEBPC still finds that clinicians continue to initially gravitateto obtaining practice information from informal sources.The hope is that this barrier will be minimized as electronicaccess and literature analysis abilities rise.

Lack of Electronic AccessThe organization gained electronic access to literature

via the Ovid portal approximately three years ago. If staffmembers have previously used an electronic informationportal, they do not struggle using Ovid. However, the learn-ing curve is high for staff who are not used to this type ofliterature retrieval. Due to staffing issues in the MedicalLibrary, EBPC members train interested staff on how toobtain literature using this portal. Recently, library staff insti-tuted electronic teaching modalities to assist staff memberswith electronic search strategies.

Lack of Ability to Analyze LiteratureDespite literature analysis being a part of nursing

curricula, the use of critical appraisal tools is a barrier for

staff nurses (Hutchinson & Johnston, 2006). This barrieris decreasing with the ever-expanding synthesis work ofthe Cochrane Collaboration and the increase of journals,such as Evidence-Based Nursing. However, this does notnegate the need for nurses to become more familiar withliterature analysis, which is occurring with the develop-ment of more user-friendly critical appraisal tools such asthe Critical Appraisal Skills Programme (CASP) Tools(http://www.phru.nhs.uk/casp/critical_appraisal_tools.htm)and the AGREE Guideline appraisal tool(http://www.agreecollaboration.org/instrument/).

ConclusionEBP programs must be built to best meet the needs of

the organization. The foundational structure may be differ-ent between organizations; however, there are basic com-ponents that will be the same in every EBP programregardless of the program. These are (1) the developmentof a transparent system identifying how the care practicewas determined, (2) identification of clinician barriers andthe creation of mechanisms to diminish these barriers, and(3) the establishment of inter- and intra-organizational EBPnetworks.

All clinicians want to deliver the best care for eachpatient. With the increase in the number of research proj-ects, publications, and the Internet, clinician’s mustbecome savvy in accessing, assessing, and employing cur-rent literature. Every organization must determine whatEBP means to them. Changing practice is never easy. Startwith baby steps and celebrate milestones!

Jackie Bartlett, MSN, MBA, HCA(c), is the Evidenced-BasedPractice Guidelines Program Manager, Children’s Mercy Hospitalsand Clinics, Kansas City, MO. She can be reached [email protected]

Acknowledgement: The author thanks Dr. Y. Raymond Chan forcritiquing this manuscript before its submission.

ReferencesDuffel, P.G. (1995). Finding information in the medical literature. Insight

(American Society of Ophthalmic Registered Nurses), 20(2), 21-24.Lappa, E. (2005). Undertaking an information-needs analysis of the

emergency-care physician to inform the role of the clinical librarian:A Greek perspective. Health Information & Libraries Journal, 22(2),124-132.

Melynk, B., Fineout-Overholt, E., Feinstein, N.F., Li, H., Small, L., Wilcox,L., et al. (2004). Nurses’ perceived knowledge, beliefs, skills, andneeds regarding evidence-based practice: Implications for acceler-ating the paradigm shift. Worldviews on Evidence-Based Nursing,1(3), 185-193.

Haynes, R.B., & Wilczynski, N.L. (2004). Optimal search strategies forretrieving scientifically strong studies of diagnosis from Medline:Analytical survey. British Medical Journal, 328(7447), 1040.

Hutchinson, A.M., & Johnston, L. (2006). Beyond the BARRIERS scale:Commonly reported barriers to research use. JONA, 36(4), 189-199.

Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W., & Haynes,R.B. (2000). Evidence-based medicine. Edinburgh, Scotland:Churchill Livingstone.

Steinberg, E.P., & Luce, B.R. (2005). Evidence-based? Caveat emptor!Health Affairs, 24(1), 80-92.

Tanenbaum, S.J. (2005). Evidence-based practice as mental health poli-cy: Three controversies and a caveat. Health Affairs, 24(1), 163-173.

Contact hour instructions, objectives, and accreditation information may be found on page 7.

I


It was the mid-1970s, and while I was in nursing school,I heard about burnout for the first time. I thought it was astrange topic to introduce to students so eager to graduateand become nurses. In hindsight, my instructors were veryproactive in preparing us to face a very real phenomenonfound in the work environment.

Currently, we are in what many are calling the worstnursing storage ever (Clarke & Aiken, 2003). The currentshortage is a contributing factor in the development ofburnout. Experiencing burnout often causes people to leavetheir profession and therefore creating a vicious cycle – theincreasing nursing shortage (Waldrop, 2003).

What better time to learn about the factors that maylead to burnout. The goal of this article is to bring the con-cept of burnout to the attention of nurses, and by doing so,encourage dialogue and problem solving. What can be doneas a group, unit, or as classmates to keep burnout, negativi-ty, and poor performance frominfecting our colleagues andourselves? Support systems forour teams and ourselves canhelp in avoiding burnout(McGrath, Reid, & Boone,2003). Being able to identifythe subtle beginning signs ofburnout and to effectively copewith these signs will help andavoid burnout escalatingbeyond control. By understand-ing burnout, it may becomeone less contributing factor in the nursing shortage.

According to Waldrop (2003), burnout is a syndrome ofphysical and emotional exhaustion involving the develop-ment of both a negative self-concept and a poor or negativeattitude toward one’s job. Three manifestations of burnoutare the physical and psychological characteristics and thebehavior one may demonstrate. While these are the mostcommon physical, psychological, and behavioral manifesta-tions, this is by no means a complete list.

• Physical characteristics: Fatigue, headache, eating disor-ders, sleeping disorders, GI symptoms, palpitations, andpain.

• Psychological characteristics: Anxiety, depression, fear,grief, isolation, and apathy.

• Behavior manifestations: Crying, irritability, short atten-tion span, short temper, and blaming others (Swenson,2003; Waldrop, 2003).In order to ward off burnout before it can take hold, it is

important to identify some of the most common causes. Theliterature notes several work factors that contribute to theincidence of burnout. Inadequate staffing and increasedpatient load can lead to emotional and physical exhaustionand greater job dissatisfaction (Aiken, Clarke, Sochalski, &Sloane, 2002; Swenson, 2003). Patients hospitalized todayhave a higher acuity and are much sicker than patients inthe past. A lack of control in decision making regarding the

care of our patients and autonomyin your practice may lead toburnout. Excessive criticism by col-leagues has detrimental effects onour performance (McGrath et al.,2003). Nurses may start havingfeelings of inadequacy and start todoubt their ability, knowledge,and having the time to give thepatients the care they deserve(Manion, 2003; McGrath et al.,2003)? Disillusionment develops,and nurses may question if nursing

is what they thought it would be? Other considerations are alack of support from administrators, working rotating shifts,long hours, and mandatory overtime.

Frequently, work issues alone do not lead to burnout.There are those who have very stressful positions but areable to go home and refresh themselves. They do not sufferfrom burnout. But if we are stressed at work and add to thatstress at home, we put ourselves at a much higher risk.Think about it. Are you driving the kids from one event to

continued on page 6

Flo Schaefer, MS, RN,BC

Being able to identify thesubtle beginning signs ofburnout and to effectivelycope with these signs willhelp and avoid burnout

escalating beyond control.


Clarke and Aiken (2003) further suggests that increasedturnover rates resulting from burnout yield a decrease inpositive patient outcomes. With a higher number of RNs onstaff, there are decreased rates of decubiti, patient com-plaints, and the occurrence of health care-acquired infec-tions. There is also a decrease in failure to rescue and deathfrom complications (such as pneumonia, shock, cardiacarrest, UGI bleed, sepsis, or DVT). A nurse’s length of stayand clinical experience on a specific unit are associated witha decrease in the 30-day mortality rate. There is a benefit ofhaving long-term staff on a unit. Aiken (2003) has alsofound that nurses report dissatisfaction in the work placeand emotional exhaustion when encountering increasedwork loads that are compounded by higher patient acuity.These factors increase the risk of developing burnout and adesire to leave.

Fatigue results from insufficient sleep, disruption of thebody’s clock, and extended duty periods (McGrath et al.,2003). For every hour of wakefulness between 10 to 26hours, a person’s performance is equivalent to a .004%increase in blood alcohol concentration. What that means isthat a person who has been awake for 18 hours will act andperform as if they have consumed enough alcohol to raisetheir blood level to .05% while the person is totally unawarethis is occurring (Crosby, 2006). When fatigued, we exhibitdelayed response and reaction time, impaired reasoning,reduced vigilance, and impaired hand-eye coordination. Weare more willing to accept below par performance andbegin to show signs of poor judgment.

Warding off the negative effects of burnout does nothave to include major changes. Two self-help books that arequick reads will give you insight into how little changesmade one at a time will have a positive impact on yourselfand when shared can help those around you. The twobooks are:

• I Should Be Burnt Out By Now...So How Come I’m Not, byPeg Neuhauser, Ray Bender, and Kirk Stromberg.

• Don’t Sweat the Small Stuff...and It’s All Small Stuff, byRichard Carlson, PhD.Neuhauser, Bender, & Stromberg (2004) did a qualita-

tive study interviewing 400 individuals. Those who wereinterviewed described periods of their lives when they wereburned out and when they felt they were functioning fairlywell. During what was called their successful times, theyidentified effective coping, producing high-quality work, andliving a happy and satisfied life as key elements for success.When these elements were not occurring in their lives, thoseinterviewed said they found there was a need to take action.

To keep burnout from infecting ourselves, Neuhauser etal. (2004) explain that we need to incorporate these essen-tial messages into our belief system. We cannot sit and waitfor the right circumstances. We need to rescue ourselves andmake the best of life. We need to keep things in perspectiveand stop over reacting. We have to work at being good atnot burning out by learning to manage behavior and think-ing. It is important to remember that no one is perfect andthat we need to learn from our experiences and keepbouncing back. We should not waste our energy on the pastbut concentrate on the present.

another? Are you stopping for fast foods instead of prepar-ing meals at home? For many, the pace they keep after workis just as hectic as the pace at work. We are not affordingourselves the liberty of rest and relaxation. Experiencingburnout is a combination of all the many facets of life andhow we choose to cope – or not.

Home factors can also play into the development ofburnout. Are family relationships stressful? Do you have con-flicts? Are you the caregiver to a family member who is ill?Are you able to re-energize and refresh at home? Do youhave busy schedules (for example, work long hours, go toschool, and have a problem saying no when asked to beinvolved in church, school, and community activities)? As aresult, we wake up exhausted before we start the next workday (Crosby, 2006; Waldrop, 2003).

It is important to pull this information together and real-ize its implication to our nursing practice. Those experienc-ing burnout will exhibit a decreased level of performance atwork (Aiken et al., 2002; McGrath et al., 2003) and anincrease in risk-taking behaviors, and will demonstrate a lossof concern (Crosby, 2006). Eventually, they will leave theprofession. To end this cycle, we need to work together andsupport each other. It is hoped that we can keep ourselvesand our peers from getting to the point where giving upand leaving nursing seems like the only viable option.

Staffing and fatigue have definite effects on patient out-comes. Patient-to-Nurse Ratio is currently a hot topic. Sinceits implementation in Australia, there has been a decrease instaff turnover and absenteeism. Clarke and Aiken (2003) sitethat it may be a credible approach in decreasing patientmortality and increasing nurse retention if it can be success-fully implemented.

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Neuhauser et al. (2004) move from internal, personalissues to external, environmental issues in describing whatwe can do to keep ourselves from experiencing burnout.“Burnout starts in the brain” (Neuhauser et al., 2004). Tokeep from burning out, we need to think positively and beoptimistic. We need to stay focused on the present, findmeaning in what we do, and keep things in perspective. Toimprove your mood quickly, change your thoughts. Don’tobsess in the “everything is bad” mode. Repeat phrases suchas, “I am a successful, happy person.” “I love being a nurseand am great at my job.” Keep most of your thoughtsfocused on the present. If you find yourself obsessing on thefuture or the past, pull yourself back to today. Think aboutwhat you can do today to lead your life in the right direc-tion. Look for the meaning in your work. Knowing what youdon’t want is just as important as knowing what you want.Identify what is important to you and make it your priority.

By changing your actions and habits, you can make pos-itive changes in your life. Laugh more than you whine.Laughter is a great stress releaser. Smile more often. Learn toeffectively delegate and let go of some responsibilities.Healthy habits are anything that relaxes you – family dinners,game night – use your imagination. Make sure you getenough sleep. Build slow, deep breathing into your daily rit-uals (Neuhauser et al., 2004; Waldrop, 2003).

Developing relationships with peers does much todecrease the development of burnout. Try to have at leastone colleague you can trust to be totally honest with youand be that for them as well. Teams are more effective whenits members cooperate, help each other, and communicatefrequently. We must learn the art of give and take and ofbeing flexible. Identify people that drain you, leaving youtired, depressed, or irritated. Avoid them as much as possi-ble. If you can’t avoid them, limit your contact with thembeing sure to set limits on the behavior that upsets you(Manion, 2003; Neuhauser et al., 2004).

Maybe the source of your burnout is your work environ-ment. Be aware of the organization’s culture. Is it a good fitfor you or is it a mismatch? A mismatch will lead to burnout(Manion, 2003; Neuhauser et al., 2004).

Staying connected with what is going on in nursing willhelp decrease the risk of burnout. Try not to isolate yourself.Instead of burning out, we need to learn how to stay well bycreating a sense of well-being within us. We must learn totake care of our needs as well as the needs of others. Beopen to change either in your work environment or in your-self. Start by making a list of what you like and what youdon’t like, as well as things you can change and things youcan’t. Include what you can do to change your situation forthe better.

Flo Schaefer, MS, RN,BC, is an Educational Specialist, St. Luke’sEpiscopal Hospital, Houston, TX. She may be reached via e-mail [email protected]

ReferencesAiken, L., Clarke, S., Sochalski, J., & Sloane, D. (2002). Hospital nurse

staffing and patient mortality, nursing burnout, and job dissatis-faction. JAMA, 288(16), 1987-1993.

To Obtain CNE Credit1. For those wishing to obtain CNE credit, please use the eval-

uation form inserted in this newsletter, or visit the AAACNWeb site (www.aaacn.org). Read the articles, “IntegratingEvidence into Practice,” and “Keeping Cool Under theCollar: A Survivor’s Guide to Burnout” and complete theanswer/evaluation form.

2. Photocopy and send the answer/evaluation form along withyour 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 June 30, 2009.Upon completion of the answer/evaluation form, a certifi-cate for 2.0 contact hour(s) will be awarded and sent to you.

ObjectivesThe purpose of this continuing nursing education series is toincrease the awareness of burnout in nurses and other healthcare professionals, and how to integrate evidence into nurs-ing practice. After studying the information presented in thisseries, you will be able to:1. Outline the evolution of beliefs about the use of

evidence-based practice.2. Elaborate on the difficulties found in translating research

into practice.3. Relate causes of burnout to the environment that nurses

often experience.4. Summarize methods that should be used to avoid pro-

fessional burnout.

Note: The authors and editor reported no actual or potentialconflict of interest in relation to these continuing education nurs-ing articles.Sally S. Russell, MN, CMSRN, disclosed that she is on theAdvisory Board for Roche/Abbott Labs.

This educational activity has been co-provided by AAACN and AnthonyJ. Jannetti, Inc.

Anthony J. Jannetti, Inc. is accredited as a provider of continuing nursingeducation by the American Nurses’ Credentialing Center’s Commission onAccreditation (ANCC-COA).

AAACN is a provider approved by the California Board of RegisteredNurses, provider number CEP 5336. Licenses in the state of CA must retainthis certificate for four years after the CE activity is completed.

These articles were reviewed and formatted for contact hour credit bySally S. Russell, MN, CMSRN, AAACN Education Director; and Rebecca LinnPyle, MS, RN, Editor.

Clarke, S., & Aiken, L. (2003) Registered nurse, staffing, and patientoutcomes in hospitals: A commentary. Policy, Politics, and NursingPractice, 4(2), 104-111.

Crosby, S.J. (2006). Fatigue is a safety threat. Retrieved April 13, 2007,from http://www.atsb.gov.au/aviation/editorials/e00008.aspx

Manion, J. (2003). Joy at work! Creating a positive workplace. Journalof Nursing Administration, 33(12), 652-659.

McGrath, A., Reid, N., & Boone, J. (2003). Occupational stress innursing. International Journal of Nursing Studies, 40, 555-565.

Neuhauser, P., Bender, R., & Stromberg, K. (2004). I should be burntout by now…So how come I’m not: How to survive and thrive intoday’s uncertain world. Ontario, Canada: John Wiley & Sons.

Swenson, R.A. (2003). Overcoming overload. Family PracticeManagement, 10(3). Retrieved April 13, 2007, fromhttp://www.aafp.org/fpm/20030300/76over.html

Waldrop, S. (2003). Battling burnout: Maintaining enthusiasm in achallenging environment. Physical Therapy, 11(6), 38-49.


Silent Auction Boasts RecordNumber of Donations – More

Than $4,900 RaisedEvery year, the Silent Auction gets bigger and better.

AAACN kicks off its Annual Conference with this event, andthis year, we had the largest number of donations ever – morethan 90. If this was your first conference and first SilentAuction, what an introduction! Seasoned shoppers have seenthe auction grow in terms of size and fierce bidding over theyears. Each year, the generosity of our members increases, asdoes the fun and fundraising. The 2007 Silent Auction offeredan incredible and eclectic assortment of items, including cus-tom jewelry, what seemed like a library of vintage CherryAmes and Sue Barton books, nursing dolls, cookbook collec-tions, artwork, scrubs, purses, crystal, and much more. Morethan $4,900 was raised.

The Silent Auction raises monies for the AAACNScholarship Program that provides funding for academic,research, and professional activities. This year, we were able tosupport 2 scholarships and 1 research grant. For more infor-mation about the Scholarship Program and how to apply, visitthe AAACN Web site (click on “About AAACN” on the topmenu bar, then “Awards” to the left), or you can contact theNational Office.

Once again, we were overwhelmed by the generosity ofour members. Kudos and a huge thank you to all who donat-ed items. An even bigger thank you goes to all who graciouslyopened your wallets and checkbooks to support the auction.

Time goes by quickly, and it’s never too early to startthinking about next year!

Pam Del Monte, MS, RN,C

59 Participants Take Certification Exam

For the first time ever, the American NursesCredentialing Center (ANCC) Ambulatory Care NursingCertification Exam was offered at the close of the confer-ence. Fifty-nine well-prepared nurses were armed with pen-cils in hand to “ace” the exam. AAACN was pleased that somany participants liked the idea of holding the exam inconjunction with the conference. Plans are already under-way to offer the exam in Chicago, on Sunday, April 20,2008.

Kudos to those nurses who passed the AmbulatoryCare Nursing Certification exam at the Las Vegas confer-ence. These nurses will proudly display their newly earnedRN-BC credential. Thirty-five of these nurses attended theAmbulatory Care Nursing Certification Review Course priorto the conference. It appears thorough preparation andrefresher information from the course proved very helpful.

No Problem!Purchase the ConferenceLibrary or CD-ROM Today!

To Order:Visit www.prolibraries.com/aaacn

Call 800-679-3646

Missed a Session from the32nd Annual AAACN Conference?

Online Library & CD-ROMs Include:MP3 Downloadable Audio

Downloadable PowerPoint Slides24/7 Access Via the Internet

Fully Searchable Content

Letter to the EditorTo the Editor:

I just received my Jan/Feb 2007 AAACN Viewpoint,and I noticed an error in the article, “Nurse-ManagedClinics: Opportunity or Benefit” (vol. 29, no. 1, pp. 1,14-15). To some, it may seem to be irrelevant, but tome, it is very important to be correct when addressingdiagnoses. The error is noted on pages 14 and 15 inboth the tables 1 and 2. Ms. Agbisit lists DiabetesType II. This classification was changed in 1997 totype 1 and type 2. The American Diabetes Associationand the World Health Organization were very specificabout the need to list this disease as Type 1 and 2 andnot I and II to decrease the confusion for professionalsand patients.

It seems that the nursing profession in general hasbeen very slow to grasp this not-so-new classificationand continues to be misinformed about such animportant disease that affects almost everyone insome way. I think that as nurses we should be strivingto lessen confusion rather than creating more.

Linda Arnett, RNAuthor’s Response:

Thank you to Ms. Arnett for alerting me of theerror. It was a typo error on my part. All handoutsgiven to our diabetic patients are current, and whencounseling them, they are told they have type 2 dia-betes. We only see type 2 diabetes in the clinic. Thearticle was reviewed prior to submission, and this over-sight had not been highlighted. Thank you for bring-ing this current information to our attention.

Margarita D. Agbisit, MSN/MA, RN, RNC

Editor’s Note: Letters have been edited for space.


AAACN Recognizes Volunteer Leaders At 2007 Leadership Symposium

AAACN holds an annualLeadership Symposium to rec-ognize the many efforts of itsvolunteer leaders. During thesymposium, these leaderslearn first hand how to lead anorganization at a nationallevel. Symposium participantscontribute many creative ideasand become energized aboutthe contributions they haveand will make to AAACN.

Volunteer leaders are themany AAACN members whogo the extra mile and volun-teer as committee/task force members, chairpersons, andeven board members. They write articles for our various pub-lications, contribute to the content of the Web site, teachcertification review courses, develop education resources,plan conferences, recruit new members, and develop othervolunteer leaders, to name a few of their contributions.AAACN thrives as an organization because of its volunteersand the many hours they devote to its success.

Charlene Williams, 2006-2007 AAACN President-Elect,was responsible for planning and conducting the 2007Leadership Symposium held prior to the annual conferencein Las Vegas. She opened the meeting with a warm welcomeand thank you to over 60 volunteer leaders who attended.Charlene described the strategic goals for 2007 and how thesynergy created by the volunteer leaders would moveAAACN toward meeting its goals.

Charlene also introduced John Maxwell’s concept of 360Degree Leaders and discussed how individuals can make adifference from wherever they are in an organization. Aleader does not necessarily need to have a certain positiontitle to be influential as a 360 Degree Leader. Charlenedescribed how AAACN’s 360 Degree Leaders would lead up,down, and across to achieve AAACN’s mission.

Beth Ann Swan, 2006-2007 AAACN President, updatedleaders on the awesome accomplishments made by the vol-

unteers and staff over the lastyear. These accomplishmentsincluded the production offour new editions of AAACNpublications and a new cata-log to promote all AAACN’seducation resources. Many ofthe accomplishments weremade by the leaders presentat the symposium andthrough the recommenda-tions provided at the 2006Leadership Symposium.

AAACN has committed tousing Knowledge-Based

Governance as a strategy for leading and managing theorganization. This knowledge-based approach is grounded inusing data and knowledge (or evidence) as the foundationfor making decisions. Using this approach, the volunteerleaders engaged in a dynamic discussion to answer the megaquestion, “How can AAACN increase value to sustain andretain members?”

In preparation for answering the mega question, CynthiaNowicki Hnatiuk, AAACN Executive Director, provided dataabout AAACN, its members, and former members. Throughsmall group discussions, the volunteer leaders recommendedmany strategies for increasing value to our members. Theserecommendations will provide valuable information to theBoard of Directors as it strategizes the future of AAACN.

AAACN is proud of the accomplishments of its volunteerleaders, and the annual Leadership Symposium is one way torecognize their contributions. The volunteer leaders enjoythis symposium because it provides them the opportunity toconnect with other leaders, enhance their leadership skillsthat are transferable to their work setting, and contribute toAAACN’s strategic direction.

Charlene Williams, MBA, BSN, RNC, BCAAACN President

Cynthia Nowicki Hnatiuk, EdD, RN, CAEAAACN Executive Director

AAACN Leadership Symposium participants learn and contribute new andcreative ideas to enrich AAACN.

Viewpoint Writer’s AwardThe 2006 Writer’s Award was presented to a group of col-

leagues from Denver Community Health Services for an articleentitled, “Hand Hygiene in Primary Care Clinics.” The articlediscussed infection control processes in outpatient/primary careclinic environments. Denver Community Health Services insti-tuted an agency-wide program of documenting, evaluating,maintaining, and where necessary, improving hand hygieneactivities. The article was written by Kenneth L. Stiefvater, BSN,RN; Cathy Vigil, RN; Karen L. Jones, MS, RNC, CNS; and JeanneM. Yocke, MS, RN. AAACN members Kenneth Stiefvater andKaren Jones were in Las Vegas to accept the award and theircheck for $250.00.


camaraderie. Many members, who are Baby Boomers, rec-ognize that X-generations and Millennials are unwilling topay the same price that we paid for our lifestyles. Weknow that they expect immediacy because they have beenraised in a culture of instant results, instant money, drive-through windows, 24/7 information, and media accessand constant connection. We also know that they careabout the here and now, are innovative, expect to have alife and a job, and are peer-focused. Therefore, in shapingthe future of ambulatory care nursing, I encourage you tocontinue walking through the halls slowly, getting to knowtheir stories, and identifying ways that we can meet ournext generation of 360-degree leader’s wants and needs.

In embodying these principles of 360-degree leader-ship, you have exerted your influence on others and addedtremendous value to AAACN by leading from where youare in your organization. This value recognition can be seenin the form of teamwork, increased productivity, and theopportunity for growth. Maxwell (2005) describes 360-degree leaders as possessing “qualities every organizationneeds;” therefore, these qualities, experiences, and growthare just as applicable to your organizational work settingsas it is to belonging to AAACN.

Maxwell (2005) further notes that “value recognitioncan also be seen in the ability to sustain success.” A strate-gic assessment of AAACN shows that it has high programattractiveness in that it values people, commits resources,rewards initiative, develops leadership teams, allows lead-ers to grow, and grows with its people. Its strong competi-

tive position consists of assets, resources, expertise, andtime, and therefore, AAACN has a reputation for value.Over time, these positive attributes have increasedAAACN’s success.

Keys to Sustaining SuccessExperts tell us that the three keys to sustaining the

success of an organization are that they have a reputationfor value, an enjoyable culture, and a nimble infrastruc-ture. A reputation for value includes a portfolio of “goodstuff,” an enjoyable culture that is based on trust and com-munication, and a nimble infrastructure that allows anassociation to quickly seize opportunities to create value.AAACN’s portfolio of “good stuff” contains core ambulato-ry knowledge, education resources, advocacy efforts, andthe community that we provide.

AAACN will continue to provide value to our membersin using the four strategic plan outcome-oriented goals.

Goal 1 – Knowledge: AAACN will be the recognizedsource for knowledge in ambulatory care nursing.

Goal 2 – Education: Nurses will have the leadershipskills and capabilities to articulate, promote, and practicenursing successfully in an ambulatory care setting.

Goal 3 – Advocacy: Nurses, employers, and third partypayers will recognize and value ambulatory care nursing.

Goal 4 – Community: Ambulatory care nurses willhave a supportive and collaborative community in whichto share professional interests, experience, and practice.

AAACN has a strategic business plan in place that con-tains the objectives and strategies that will guide us tomeet these goals for 2007. In determining your role inhelping the organization accomplish these goals, I encour-age you to continue using the qualities of 360-degreeleaders and exerting your influence by leading from wher-ever you are in the organization to help sustain and retainvolunteer members.

Thank you for your active participation, volunteer spir-it, and leadership. I am interested in your views, and youcan reach me at [email protected]

Charlene Williams, MBA, BSN, RNC, BC, is Manager, ClevelandClinic Nurse on Call, Cleveland Clinic, Cleveland, OH. She may becontacted via e-mail at [email protected]

ReferenceMaxwell, J. (2005). The 360-degree leader. Nashville, TN:

Thomas Nelson, Inc.

President’s Messagecontinued from page 2

Viewpoint Call for ManuscriptsFor more information or to request

author guidelines, contact:Carol Ford, Managing Editor,

[email protected]

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1. The Las Vegas Hilton was noheartbreak hotel as Elvis rockedconference attendees to their feetduring the Opening Ceremonies.

2. Conference attendees met andtalked with vendors, networkedwith colleagues, and made newfriends in the Exhibit Hall.

3. The Silent Auction raised morethan $4,900 for the ScholarshipFund, with more than 90 itemsdonated for the event.

4. Attendees listen intently to infor-mation being presented at theCertification Review Course.

5. Members of the Staff EducationSIG are all smiles as they enjoy theOpening Reception and SilentAuction.

6. Betty Cody and Carol Brautiganenjoyed participating in theLeadership Symposium.

7. Candia Baker Laughlin receives abound edition of the CoreCurriculum for Ambulatory CareNursing, 2nd edition, for whichshe served as editor, from CynthiaHnatiuk.


AAACN Recognizes Outstanding Achievement and Excellence at 2007 Annual Conference

AAACN recognized members for their dedication to the association and the specialty of ambulatorycare nursing. Awards were presented on Friday, March 30, during the Opening Ceremony.

Presidents’ Above & Beyond AwardThis award is given to an individual or group who goes

“above and beyond” the expectations of a volunteer role inAAACN. Maureen T. Power, RN, MPH, LNC, Senior Consultant,Power and Cronin, Ltd., Oak Brook, IL, received the award fromAAACN President Beth Ann Swan for her “dynamic support ofAAACN. Maureen travels across the country and connects liveto the AAACN Web site to share her expertise and introduceeveryone to AAACN. She is someone AAACN can count on in apinch to help out, no matter what the task.”

Administrative Excellence AwardJanet P. Moye, RN, PhD, East Carolina University,

Greenville, NC

Cynthia Hnatiuk, Vice President, Anthony J. Jannetti, Inc., and AAACNExecutive Director (left), presents Janet Moye with the AdministrativeExcellence Award.

Clinical Excellence AwardLCDR Faria Belmares, NC, USN, San Diego, CA

LCDR Faria Belmares (right) receives the Clinical Excellence Awardfrom Cynthia Hnatiuk, Vice President, Anthony J. Jannetti, Inc., andAAACN Executive Director.

Excellence AwardsThe two Excellence Awards, sponsored by Anthony J.

Jannetti, Inc., through the Nursing Economic$ Foundation, areawarded to AAACN members who display excellence inadministrative or clinical nursing practice. This year, this veryspecial honor was bestowed upon two outstanding nurseswho are mentors, innovators, and who have displayed thehighest level of excellence in nursing practice and patient care.

Additional AwardsEducation Scholarships were awarded to Peggy Kaminsky, RNC, BSN, Palo Alto Medical Foundation, Palo Alto, CA, and

Bonnie L. McGuire, BS, RN, Grand Itasca Clinic and Hospital, Grand Rapids, MN. The scholarships will go toward payment oftuition, books, and academic supplies.

A Research Grant was awarded to Capt. Sara Marks, NC, US Navy, San Diego, CA, principal investigator for the project“Evaluation of Two Nurse-Run Interventions for Blood Pressure Control: An Evidence-Based Practice Project.” Capt. Marks andco-investigators will share their findings at a future AAACN Annual Conference.

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

Founder’s Scholarship Winning Essay Carol Golden, new member

and first-time conference partici-pant, won free registration to the2008 conference in Chicago, April17-20, 2008, for her 100-wordessay on why she would recom-mend AAACN to her colleagues:

When I left the secure land of reg-ulated hospital nursing and dove intothe vast murky waters of ambulatorycare, I felt lost in the nebulous transla-

tions of hospital-based standards. Where were the guidelines?The expert leaders? I found them! The AAACN conference is likea treasure chest! I discovered not only a network of ambulatoryprofessionals, but an entire organization dedicated to the edu-cation, nurturing, and promotion of the ambulatory care nurse.How could you not feel inspired by the amazing accomplish-ments already done by this body of nurses? This lifeline will defi-nitely be passed on to my colleagues.

Carol GoldenGreenville Hospital System

Greenville, SC

Military Pre-Conferences Filled to Capacity

The U.S. Air Force Health Care Integrator and the Tri-Service Military SIG pre-conference all-day meetings wereattended by an overwhelming number of participants,including an amazingly high number of on-site registrants.The presentations were well received by everyone, andboth conferences were considered a huge success.

Carol Golden

Poster Winners AnnouncedThe poster judges had a difficult time determining the

winners among the record-breaking number of postersthat were submitted this year. Over 50 posters on displayprovided information on topics that ranged from ImprovingEfficiency in the Outpatient Setting, Face to Face Leadership, aThing of the Past: Leading the Remote Team, to From Crisis toCutting Edge: Balancing Costs, Compassion, and Quality Care.AAACN extends its thanks to all poster presenters forpreparing and bringing their sometimes cumbersomeposters to the conference. The additional education andextra CNE credit were appreciated by all participants.

1st Place: Preventing Diabetes in Latino Families in OrangeCountyPresented by: Patricia Hawk, MS, CDE and Sarah Flores,MS, RN

2nd Place: Well Care: Moving Ambulatory Care NursingBeyond the Medical ModelPresented by: Sharon S. Thompson, BSN, RN, Captain,USAF, Nurse Corp.

3rd Place: The RN Health Coach: A Proactive Approach toHealth ManagementPresented by: Kathleen M. Dargie, RN, CCM and KathyM. Sherman, RN

Poker Chip PrizesGold Poker Chips earned the recipients a $100 AAACN

Certificate for Education Resources. The lucky winnerswere:

Anna Walking Eagle, William Coleman, Wilhelma Badger

Las Vegas Poker Chip Give-a-Way WinnersEach participant received a poker chip to place in a con-

tainer for their choice of a Las Vegas memento. The winnerswere:

Las Vegas Tee Shirts – Marlene Ferguson, Marsha Harris,Jackie Rivers, Earlie H. Thorn, and Amanda Roth.

Las Vegas Cap – Lillian ShoemakerLas Vegas Clocks – Mary Brinkman and Gail WrightSlot Machine Banks – Lena Tyau and Elizabeth QuinonesLas Vegas Historical Book – Carolyn RobinsonLas Vegas Bear – Prudence Anderson


willing to provide leadership to the nursing journal club;consider these individuals as your early adopters becausethey will be pivotal in leading others to join. Second, enlistthe assistance of support resources in your organization,such as an advanced practice nurse, a staff developmenteducator, nursing leaders, a member of the NursingResearch Council, or one of your peers.

You will need to determine the environmental consid-erations and scope of the nursing journal club. Who willthe audience be? How often will you meet, and where willyou meet? Is the location of the nursing journal club closeto the unit or work area of the intended audience? Is thesize of the room conducive to the audience you anticipate?Some nursing journal clubs collaborate with a unit clinicalpractice forum, the research council, or staff meetings. Asyou select a location, consider any venue where yourintended audience will be present. Will you have audio-visual support resources, such as a laptop, projection sys-tem, and Internet connectivity? These resources are notrequired, especially if you desire to limit the use of technol-ogy in order to foster a non-threatening environment foryour participants.

What day of the week is best, and are weekday orweeknight offerings best or perhaps both? How will youaddress the weekend staff needs? From experience, a setday(s) of the week each month at routine times is ideal forconsistent attendance by your intended audience. Ournursing journal club meets monthly and has offerings 4times a day – twice during the day at 11:00 a.m. and12:00 noon, and again in the evening at 10:00 p.m. and11:00 p.m. Weekend offerings, held at least quarterly, meetat the same four timeframes. What will be the length ofyour session? If you anticipate awarding continuing nursingeducation credit, a full education unit will require a 60-minute session. You may desire to start at 30 minutes andbuild to 60 once you have momentum established, youraudience matures, and support resources become avail-able.

What type of article will you select? The key to successis to start out small with a clinical topic, then proceedslowly toward a research article. You will most likely fail ifyou start out in the opposite direction (Brooks-Brunn,1994). An exception was a nursing journal club that theauthor has been associated with for over 9 years. That clubchose a research article on ventilator-associated pneumoniafor its first nursing journal club gathering in September1998. Two clinical nurse specialists and the staff develop-ment educator presented the article to an audience of 14critical care staff, and the response was overwhelminglypositive. Eight years later, that nursing journal club revisitedthe same topic, and many of the staff who attended in1998 were in attendance. They commented that theirpractice had come light-years since 1998, and thatresearch articles continue to be the standard fare for thatparticular nursing journal club.

Brooks-Brunn (1994) indicates that the clinical topicapproach is the safest route for a group just beginning a

nursing journal club. A search for an article that has globalinterest to your intended audience will facilitate attendancefrom a broader group of participants. There are many ven-ues for distributing the article. The traditional approach hasbeen to make copies available in staff lounges with a flyerannouncing the topic and article. Other venues that havebecome popular are online announcements via e-mail,institution community pages, and Internet listserves.

ImplementingImplementing a nursing journal club is the culmination

of all your efforts after you have assessed its interest andscope, as well as fostered your institution’s supportresources. Determining the format for your nursing journalclub is the first step. A common trend is to have an openingperiod of networking and refreshments, followed by thepresentation of the article, and ending with group discus-sion. Another format is Internet or Intranet nursing journalclubs, where posting of information and discussion occursover time or in real time in a chat room. Others use Webpages for further discussion and for those unable to attend.Two examples of online discussion forums are www.ajc-conline.org and www.egroups.com/group/MckResearcgReview.Lastly, videoconferencing is a strategy used between institutionsto serve as a bridge for institutions that are geographically dis-tant to one another.

Depending on the type of article you choose, youneed to determine what critiquing guidelines you will uti-lize in your nursing journal club. For a clinical article, youcould pose questions that include, “How does this com-pare to our practice, policies, and procedures?”, “What arethe pros and cons of the recommendations?”, and “Whatissues are evident with implementing at your practicesite?” For research articles, you might consider a simplereview; rigorous, critical appraisal with a review tool; com-parison of research methods, results or conclusions; pre orpost-tests; quantitative versus qualitative design studies;application to practice; and comparing results toregulatory, national, or professional organization guide-lines. For a research article, there are many tools availableonline – from a local university, your own research depart-ment, advanced practice nurse or educator, or you can cre-ate your own. The format chosen will be dependent on thetype of article and can vary as your nursing journal clubevolves. The author suggests that you have a documentcontaining a glossary of research terms available for youraudience.

EvaluatingAt this stage, it is time to evaluate whether the interest

assessment and the planning and implementation effortshave contributed to a successful nursing journal club. Inyour evaluation tool, include specific objectives using aLikert-type scale for the participant to rank achievement ofobjectives. Ask if the information presented was relevant orbeneficial to his or her practice. Have the participant identi-fy what they learned and how they will apply this knowl-edge to their daily practice. Encourage participants to offersuggestions for future topics. Solicit open comments on

Nursing Journal Clubscontinued from page 1

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

the article, presentation, discussion, and format of the ses-sion. If you are providing continuing nursing education forthe session, ensure that you receive the completed evalua-tion and the participant’s demographic sheet for certificatecreation.

Collate your evaluation data to determine how you willuse this information. Provide a summary of the feedback tothe presenter(s). If your unit has a newsletter, perhaps youcould have the presenter(s) provide an overview of the arti-cle, discussion, and responses to any questions posed dur-ing the session. If the article discussed relates to a qualityinitiative or a research study that is occurring on the unit,tie the two activities together and team with thoseinvolved to use the feedback received from the nursingjournal club evaluation.

What are some indications that your nursing journalclub is a success? First, the interest, attendance, andinvolvement of your participants are key elements to meas-ure. Evidence of a practice change within your unit ordepartment is a second indication of success (Kartes &Kamel, 2003). Documentation of a cost savings realized byyour unit or department is a third, more difficult, metric toassess (Valente 2003).

Challenges to OvercomeWhat are the challenges to overcome when developing

and implementing a nursing journal club? There are fourkey areas, and these include 1) narrowing the topic to onethat is manageable, 2) staff’s hesitancy to present the arti-cle to their colleagues, 3) coverage of patients so that staffcan attend, and 4) an understanding of research jargonand statistical symbols. Your role in mitigating these chal-lenges is a key opportunity to mentor and support staff.

Work with the staff to perform a literature search andassist staff to focus on the specific item they want toaddress, then work with them to search for key words sothat their online search is not overwhelming. Have staffmembers present an article as a team and provide supportvia an educator or advanced practice nurse to help fieldquestions that may arise during the discussion. Considerhaving repeat sessions to allow as many staff to attend aspossible. It is helpful to offer to cover patients for staffmembers who wish to attend. In addition, providing toolsto staff for ongoing acquisition of knowledge, such asresearch terms and definitions, is helpful (for example,include a “term of the month” in staff break rooms).Engage those enrolled in a masters programs to team withyou to further educate staff in the research process; utilizeyour clinical practice groups and research council membersto mentor others in evaluating evidenced-based practiceon their units.

The shared role of the advanced practice nurse,research council, staff development educator, unit leader-ship, and the practicing bedside nurse are integral to thesuccess of any nursing journal club. The spectrum of topics,review of research and non-research literature, the partici-pation of the staff and presenters, the role of the facilitatorand the support of the organization for nursing journal

club activities all contribute to the successes that theauthor has experienced.

Achievement of OutcomesOne can realize the outcomes achieved by using the

nursing journal club venue on several factors. The crosstraining that occurs about issues and experiences withinthe group is a networking opportunity. The inclusion ofstudent nurses in a nursing journal club setting can stimu-late clinical inquiry for application to their theoreticalcourses. The collaboration, communication, and problemsolving that can occur across the care spectrum, especiallywith audiences reflective of many disciplines, is pivotal inlaunching shared knowledge. A nursing journal club shouldbe a safe haven for exploration and evaluation of bestpractices by utilizing evidence supported in the article andthe practice evaluation on the participants’ unit. Managers,educators, and advanced practice nurses should seeincreased confidence, communication, and leadership; anincrease in nursing satisfaction; and enhanced clinical skillsby the staff, with a long-term outcome of an effective nurs-ing journal club ultimately resulting in staff retention.

Jennifer Dwyer MSN, RN BC, CCRN, CNRN, APRN BC, is anEducation Specialist, Clarian Health, Indianapolis, IN. She may bereached via e-mail at [email protected]

ReferencesBrooks-Brunn, J.A. (1994). Developing a unit-based journal club.

Nursing Management. 25(6), 80.Goodfellow, L. M. (2004) Can a journal club bridge the gap

between research and practice? Nurse Educator, 29(3), 107-110.

Joint Commission on Accreditation of Healthcare Organizations.(2000). Talking it through face to face with your team: Make yourjournal club a multidisciplinary PI learning tool. Joint CommissionBenchmark, 2(11), 4-5. Retrieved April 12, 2007, fromhttp://www.jcrinc.com/ppdf/pubs/pdfs/BM/novbench00.pdf

Kartes, S.K., & Kamel, H.K. (2003). Geriatric journal club for nurs-ing: A forum to enhance evidenced-based nursing care inlong-term settings. Journal of the American Medical DirectorsAssociation, 4(5), 264-267.

Pasek, T., & Zack, J. (2004). Journal clubs in the pediatric intensivecare unit. Critical Care Nurse, 24(6), 95-96.

Valente, S.M. (2000). Creative way to improve practice. HomeHealthcare Nurse, 21(4), 271-274.

Wright, J. (2004). Journal clubs: Science as conversation. NewEngland Journal of Medicine, 351(1), 10-12.

AmbulatoryCertification Fall Date

Exam: October 20, 2007Application deadline:

July 6, 2007August 3, 2007, with $35 late fee

Go to www.nursecredentialing.orgfor more information or call

800-284-2378Go to www.aaacn.org

for more information on test preparation resources.

O

E16 V I EWPO I NT MAY/J U N E 2007

Orienting staff and matching theircompetencies with job duties can oftenfeel like putting together a complicatedpuzzle. Instead of scratching your headand searching endlessly for the rightpieces to fit together, you can turn toAAACN for a practical solution.

The Guide to Ambulatory CareNursing Orientation and CompetencyAssessment helps you develop a cus-tomized orientation process for newemployees based on specific compe-tencies. Chapter 1 is an overview andanalysis that includes key informationon assessment, planning, implementa-tion, evaluation, and setting your pro-gram in motion. The other chapterspresent the major roles of ambulatorycare nursing practice.

• Chapter 2: Organizational/SystemsRole of the Ambulatory Care Nurse

• Chapter 3: The Clinical Nurse Rolein Ambulatory Care

• Chapter 4: The Professional NurseRole in Ambulatory Care

• Chapter 5: Telehealth NursingPracticeThese chapters are followed by five

appendices that include examples of

organizational competency assessmenttools, nursing practice competencies, amedical record review tool, orientationplan examples, and orientation compe-tency validation checklists.

Positive FeedbackUsers of the guide have found it

invaluable for taking the guesswork outof the orientation process. They’ve toldus that their staff members are moreconfident because they know exactlywhat is expected of them at the nuts-and-bolts performance level.

AAACN surveyed thepeople who bought the guide. Here’swhat they told us:

• “We used the guide to help createan orientation manual for new nurs-es in an internal medicine practice.”

• “It’s been a resource for buildingand revising orientation/competen-cy assessments.”

• “We use it as a reference for plan-ning orientation activities and roledefinition.”

• “I used [the guide] to develop jobdescriptions and new orientee skillsinventory checklists. It can beadapted to any specialty area.”The guide has been extremely pop-

ular because ambulatory care managersknow a strong orientation results inimproved outcomes and enhancespatient care.

The guide was developed by theAAACN Staff Education Special InterestGroup, whose members are among thecountry’s leading ambulatory care nurs-ing experts. It was reviewed by a presti-gious panel of specialists whose knowl-edge areas include education,ambulatory patient care, and adminis-tration.

The competencies are designed forregistered nurses, and can easily beadapted for licensed vocational/practi-cal nurses and other staff.

Ordering InformationTo learn more about the Guide to

Ambulatory Care Nursing Orientation andCompetency Assessment and to order($59 member price; $69 nonmember),visit the AAACN Web site,www.aaacn.org; e-mail [email protected],or call 800-AMB-NURS (800-262-6877).

Products p o t l i g h t

Short- and Long-Term Nursing Shortages Exist; Solutions Differ for Each

Economic forces such as unemployment rates andstagnant wages influence RNs’ decisions to be active in thenurse labor market and will likely affect future employmentlevels. In the March/April 2007 issue of Nursing Economic$,Peter I. Buerhaus, PhD, RN, FAAN, and co-authors reportthese findings and discuss changes in RN earnings andemployment over the past four years and note that if RNwages do not increase (a draw to the profession), theUnited States can expect falling national unemploymentrates to lead to shortages in RN employment.

Two shortage crises exist, say the authors, one short-term and one long-term. Resolving the short-term crisisrequires increasing workforce participation from currentRNs and increasing the number of hours this group is will-ing to work. According to Buerhaus and co-authors, while

expanding the number of potential RNs won’t help thecurrent crisis, this strategy will help prevent a future short-age. In addition, the authors see employment growth ofolder RNs and foreign-born RNs.

Buerhaus and co-authors postulate that if working con-ditions improve or worsen, this, too, may factor into RNs’employment decisions and affect the nursing shortageeither positively or negatively. They say longer-term trendswill continue as the RN workforce becomes older and com-posed of more foreign-born RNs. (Recent Trends in theRegistered Nurse Labor Market in the U.S.: Short-Run Swingson Top of Long-Terms Trends; Peter I. Buerhaus, PhD, RN,FAAN; David I. Auerbach, PhD; Douglas O. Staiger, PhD;Nursing Economic$; March/April 2007; www.nursingeconom-ics.net)

A 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 at www.aaacn.org,

click on “Jobs.” It’s quick,convenient and confidential.

AAACN’s ManagementCompany, Anthony J.

Jannetti, Inc., ReceivesAssociation ManagementCompany Accreditation

Anthony J. Jannetti, Inc. (AJJ), AAACN’smanagement company, has been recognizedby the American Society of AssociationExecutives (ASAE) as an accredited associationmanagement company (AMC). This is thehighest recognition an AMC can receive.

AJJ (www.ajj.com) has managed AAACNfor 22 years, providing full-service associationmanagement, public relations and marketing,creative design and publishing, corporate sales,professional education, Web site and Internet,membership and database management, andconference management services. AJJ publishesAAACN’s official publication, Viewpoint, peer-reviewed nursing journals (including NursingEconomic$, MEDSURG Nursing, Pediatric Nursing,and Dermatology Nursing), and AAACN’s educa-tion resources.

“This is such an honor for AJJ,“ saidAnthony Jannetti, AJJ president. “We will con-tinue to meet and exceed the standardsendorsed by ASAE by providing outstandingmanagement services to AAACN.”

ASAE’s AMC accreditation is a voluntaryprocess that validates a company meets thestandards set forth by ASAE’s AccreditationCommission. This program identifies qualityAMC services, assesses the procedures of indi-vidual AMCs, formally recognizes those AMCsthat meet requirements set forth by the AMCAccreditation Commission, and improves thequality of services provided to the associationcommunity.

“AMC accreditation distinguishes AJJ’s lead-ership and demonstrates our company has metindustry-established standards for top-qualitymanagement services. Over 500 AMCs exist,and only 66 companies, including AJJ, haveachieved accreditation,” said Cyndee NowickiHnatiuk, EdD, RN, CAE, AJJ vice president fororganizational development and AAACN exec-utive director.

The American Society of AssociationExecutives (www.asaecenter.org) is an individ-ual membership organization of more than22,000 association executives and industrypartners representing nearly 11,000 organiza-tions. Its members manage leading trade asso-ciations, individual membership societies, andvoluntary organizations across the UnitedStates and in 50 countries around the globe, aswell as provide products and services to theassociation community.


Editor’s Note: This column will highlight some of our AAACNmembers by looking at the types of ambulatory roles they fill,their day-to-day challenges, their reasons for joining AAACN,and how AAACN membership has helped them as professionalambulatory nurses.

Our ambulatory nursing spot-light focuses on two AAACN mem-bers from the Southwest. MargaritaGore, MBA, RN, BC, is the NurseManager for the Neurology Clinicsat Mayo Clinic Arizona, but that isreally only a small part of whoMargarita is and how far she hastraveled in her nursing career.Margarita, the eighth child of ten,was taught early in her life the

importance of education. Her parents were Hispanicmigrant workers who instilled in all their children the loveof learning and the fact that education is the only way toachieve a better life. Margarita got married shortly afterhigh school and soon had a family of her own.Unfortunately, she soon found herself as a single motherwith few financial resources. She had been working as amedical assistant in a small rural family practice clinicwhen she decided that nursing was truly her passion. Atage 30, she started in the LPN to RN to BSN track whilestill working part-time and raising her two sons. Upongraduation 4 years later, she enlisted in the Army NurseCorp and spent “eight wonderful years” as a military nursein various locations throughout the United States. Duringthis time, she remarried, and her family grew by two morechildren.

After 16 years at the bedside in Hematology/Oncology(mostly on the night shift), Margarita decided to return toschool and obtained an MBA with a Health CareManagement focus. With her new degree in hand,Margarita left hospital nursing and returned to her ambu-latory roots. She joined Mayo Clinic Arizona 5 years agoand spends her days (and sometimes evenings as well)putting out fires and managing a staff of 21 physicians, 2mid-levels, 3 fellows, 6 residents, 10 nurses, and manyother neurology allied health staff members.

Margarita remembers that she was brought to her firstAAACN conference (held in Tampa) by a colleague whoconvinced her to take a look at this professional organiza-tion. Margarita writes, “I have always found value in beinga member of my professional organization. When I wentfrom the bedside to ambulatory, it made sense to seek anew professional organization that would truly address theissues faced by ambulatory nursing. The first annual con-ference I attended was wonderful! I made new friends and

networked with other nurses from across the country. Thenext year, the conference was in my home state ofArizona, so I volunteered to help with the opening recep-tion. It was great fun, and it allowed me an opportunity toget to know others in the organization.”

Margarita’s involvement didn’t end there. She was likea sponge, the more she got involved in AAACN, the moreshe was impressed with the energy and professionalism ofits members and the more she wanted to be a part of theorganization at a leadership level. Margarita submitted anabstract to speak at the San Diego conference, and whenit was accepted, she was hooked. She signed the“Willingness to Serve” form and was immediately asked tojoin the Web Site Advisory Committee. She now chairs thiscommittee, and at the Atlanta conference, Margaritadecided to become active in the Leadership SIG. “AAACNchallenges me on a professional and personal level. It feedsmy creative side and lets me be as involved as I want tobe,” Margarita notes.

Last year, Margarita used the AAACN Core Curriculumand Self Assessment Manual to study and pass the ANCCAmbulatory Nursing Certification Exam. Way to goMargarita! This year she has been actively involved in theLeadership “Boot Camp,” which was developed by theLeadership SIG and presented for the first time at the con-ference in Las Vegas. AAACN is grateful for enthusiasticmembers like Margarita who are passionate about ambula-tory care nursing and who enjoy getting involved andmaking AAACN the professional organization that repre-sents “Real Nurses, with Real Issues, and offers RealSolutions.”

Our spotlight now moves a lit-tle to the east, where we meetAAACN member Lula Smith, MSN,RN, Nursing Coordinator for theNorth May Avenue Clinic (part ofthe VA Medical Center) inOklahoma City, OK. Lula writes, “Ibecame a member of AAACNimmediately after taking my currentposition, thanks to the strongencouragement from my sister-in-

law Ann Smith, RN, from Houston, TX, who has been amember for many years. Ann loaned me her well-usedcopy of the Core Curriculum for Ambulatory Care Nursing,and it has been invaluable to me in my current position. Ipurchased my own copy at the annual convention in LasVegas.”

Lula became a first-time member and attended hervery first AAACN conference last year in Atlanta. Our read-ers might remember her because she was the recipient ofthe 2006 Founders’ Scholarship. Lula quickly renewed hermembership this year because in her words, “AAACN pro-vides me with relevant and timely information. I haveincorporated many of the valuable tips into my daily work,and I share them with other staff members. I have encour-aged my staff to join AAACN and become active mem-bers. Being a member of AAACN has allowed me to net-

REA

L

Lula Smith

Margarita Gore

continued on page 19

work with like-minded ambulatory care nurses.” LikeMargarita, Lula Smith studied from the AAACN SelfAssessment Manual, and she is very proud to report thatshe passed the Ambulatory Nursing Certification Exam inNovember 2005. Way to go, Lula!

What is a typical day like for Lula as she manages avery busy VA satellite clinic? Lula relates, “We provide pri-mary care for nearly 5,000 veterans who are assigned to 4primary care physicians at our site. There are 2 RNs, 7LPNs, 1 clerk, along with myself, who care for this group ofpatients including Telecare, our telephone screening andtriage service. A typical day for me may start with makingdaily assignments, screening unscheduled walk-in patients,monitoring patient satisfaction, and helping with the NurseClinics (hypertension and anticoagulation monitoring). Inbetween my clinical responsibilities, I manage to squeezein all the administrative responsibilities as well (such as per-formance measures, staffing, staff development, and edu-cation).” The North May Clinic is a new concept forOklahoma City, Lula explains, and she has enjoyed thechallenge of helping the VA be a visible force in the com-munity. The lessons learned in establishing this clinic havehelped pave the way for other clinics to be established.

Lula can always remember wanting to be a nurse andfollow in the footsteps of her mother and her aunt. Shecompleted a BSN from Central State University in Edmond,OK, in 1974, and she immediately began a 30+ year careerwith the Veterans Administration Medical Center inOklahoma City. Because community health was her pas-sion, Lula went on to obtain a Masters’ Degree in PublicHealth from the University of Oklahoma Health ScienceCenter in 1981. Throughout her years at the VA, Lula has“done it all,” but her first love is ambulatory care nursing.She relates, “The best part of being an ambulatory carenurse is the diversity of patients, the range of care theyrequire, and the joy one experiences by providing themwith the education they need to take better care of them-selves. Each day is different. There is no such thing as aboring day when you work in the ambulatory care setting.A special bonus for me is being able to care for those whohave given so much for their country. I can’t think of a bet-ter profession than providing our veterans with exceptionalhealth care and letting them know how much we appreci-ate all they have done for this country.”

Nancy Spahr, MS, RN,C, MBA, CNSClinical Nurse Specialist,

Ambulatory CareMayo Clinic Arizona

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

LeadershipLeaders in ambulatory care and

telehealth nursing practice, whether inclinical roles or administrative roles, arefamiliar with the diversity anddemands of this specialty nursing prac-tice. The specialty of the work carriedout in ambulatory care settings requiresRNs with specialized education andtraining. RNs are responsible for atremendous number of patients seeneach day in outpatient settings. There

is often only one RN in any given prac-tice. In addition, they are responsible fortelephone triage and other telehealthnursing practices, and therefore, special-ty knowledge, skills, and competenciesare required. RNs are expected to haveautonomy and achieve a certain level ofindependence while keeping outpatientpractices running productively; maintain-ing quality, effective, and safe care; andexpanding areas of nursing practice asneeded.

This practice spotlight focuses onfour resources that ambulatory carenurse leaders can use whether in a clini-cal role or an administrative role:• Ambulatory Care Nursing

Administration and Practice Standards(2007).

• Telehealth Nursing PracticeAdministration and Practice Standards(2007).

• Core Curriculum for Ambulatory CareNursing (2006) (2nd edition).

• A Guide to Ambulatory Care NursingOrientation and CompetencyAssessment (2005).The purposes of these knowl-

edge resources are to assist leadersto 1) guide professional practice; 2)provide a foundation for the level ofcompetence expected; 3) evaluateRNs’ performance; 4) improve thequality of nursing care; 5) planhealth services, staffing, and resource requirements; and 6)enhance professional identity. Description and excerptsfrom these resources may be found at AAACN Web site(www.aaacn.org).

Beth Ann Swan, PhD, CRNP, FAAN, is Associate Professor andAssociate Dean of the Graduate Program, Jefferson School ofNursing, Thomas Jefferson University, Jefferson College of HealthProfessions, Philadelphia, PA.

spotl ighton

PracticePractice

Beth Ann Swan

TelehealthNursing PracticeAdministration andPractice Standards

2007 - 4th Edition

TelehealthNursing PracticeAdministration andPractice Standards

2007 - 4th Edition

AmbulatoryCare NursingAdministration andPractice Standards

2007 - 7th Edition

AmbulatoryCare NursingAdministration andPractice Standards

2007 - 7th Edition

Do you have a story toshare about your life as anambulatory care nurse?

Contact Carol Ford,Managing Editor, at [email protected].

Presorted StandardU.S. Postage

PAIDBellmawr, NJPermit #58

© Copyright 2007 by AAACN

Real Nurses. Real Issues. Real Solutions.

American Academy ofAmbulatory Care Nursing

Volume 29 Number 3

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 DirectorsPresidentCharlene Williams, MBA, BSN, RNC, BCManager, Cleveland Clinic Nurse on CallCleveland Clinic216-738-4888 (w)[email protected]

President-ElectKaren Griffin, MSN, RN, CNAAAssociate Chief Nursing Service, Ambulatory CareSouth Texas Veterans Healthcare Systems210-617-5300 x4152 (w)[email protected]

Immediate Past PresidentBeth Ann Swan, PhD, CRNP, FAANAssociate Dean of Graduate ProgramsThomas Jefferson University215-503-8057 (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, NCFlight Commander, Education and TrainingUnited States Air Force520-228-1547 (w)[email protected]

Assanatu (Sana) I. Savage, LCDR, USNSenior Nurse OfficerUnited States Naval Training Center619-524-1309 (w)[email protected]

Marianne Sherman, RN, C, MSClinical Standards Coordinator, AmbulatoryUniversity of Colorado Hospital720-848-2397 (w)[email protected]

Nancy Spahr, MS, RN-BC, MBA, CNSClinical Nurse Specialist, Ambulatory CareMayo Clinic Arizona480-301-6680 (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

4th Annual ViewpointWriter’s Award

Call for Manuscripts

Viewpoint, the official publication of the American Academy of Ambulatory CareNursing, announces a call for manuscripts for the 4th Annual Viewpoint Writer’sAwards.

The purpose of this annual award is to encourage and recognize excellence in ambulatorycare nursing. Manuscripts published in the newsletter on topics in ambulatory care nursingpractice, clinical research, and professional development and leadership are eligible for con-sideration. Articles published in 2007 are eligible for consideration. An awards committeewill select the winning manuscripts. The awards, consisting of a plaque and one compli-mentary registration to the 2008 AAACN Convention, will be presented at the 33rd AnnualAAACN Convention in Chicago, IL. The winners will be notified by mail and announced inViewpoint.

Please contact the AAACN National Office for author guidelines and more information:

Carol Ford, Managing EditorViewpoint

East Holly Avenue Box 56Pitman, NJ 08071-0056

(856) 256-2433 • FAX (856) 589-7463e-mail: [email protected]

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