A Message from the President
Ann Plohal, MSN, RN, ACNS-BC, CRNI®
“Infuse Knowledge, Confidence, and Competence.”
The need for care of the acutely ill and injured was first written about more than 2,000 years ago when a Good Samaritan saved the life of a wounded traveler. The first notes of infusion therapy appeared in 1644 with a mention of a new method of introducing medicine into the body by injecting the medicine directly into the veins. The first hospital in the United States was organized in Philadelphia in 1751. The duties of the nurses included monitoring IV solutions so the bottle would not run dry, monitoring blood transfusions, cleaning IV tubing, and hand-sharpening needles. Nurses had limited education regarding IV therapy, receiving instruction on two known risks of IV therapy. The two risks included the metal band loosening on the glass IV bottle and the bottle falling and breaking, and the bottle running empty during infusion of the fluid, both putting the patient at risk for an air embolism. During the 18th century, hospitals had no definable standards for infusion therapy or nurses educated to provide infusion care. Knowledge was passed from nurse to nurse.
Today, nursing programs across the country vary on course curriculum content for infusion therapy. All programs are encouraged to have theoretical and practical experience, but many site rotations no longer allow student nurses to start IVs or participate in line care. The reason? Patient experience and reimbursement. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) accounts for 35% of the value-based purchasing score, which has a direct impact on the hospital reimbursement from the Centers for Medicare & Medicaid Services. The HCAHPS survey identifies details on specific services, such as patient satisfaction and IV skills. Patient satisfaction scores are directly tied to reimbursement.
How could this affect practicing nurses? Every day, nurses make decisions regarding infusion therapy. When surveyed in 2009, nurses felt caring for patients with IV access was a balancing act between minimizing patient discomfort and preventing complications. The nurses’ approaches differed depending on the patient and their knowledge, confidence, and experience with infusion therapy.
What about the patient? Patients tell us the worst part of being sick or having to be in the hospital is the IV. In one survey, oncology patients were asked what is what like to have IV access obtained when their treatment depended on it. From the patient perspective: (1) The experience is scary but a necessary evil; (2) I surrender my trust to be helped; (3) I fear a bad experience knowing it will happen again; and (4) It is the only thing I dread about coming to the hospital.
As nursing leaders in the specialty field of infusion, we are challenged at all levels regarding infusion knowledge, confidence, and competence. The Bureau of Labor Statistics reports 2.7 million registered nurses positions in 2012. Unfortunately, less than 1% of the nurses in the United States currently hold the CRNI® certification. Although most patients have some sort of infusion therapy, most nurses do not see themselves as “an IV nurse.”
The Institute of Medicine (IOM) advises on strategies to improve health; one of their recommendations in 2010 was for nurses to practice to the full extent of their education and training. This directive provides guidance for all nurses, but more important, for our infusion specialty. As an infusion specialty organization, we provide standards of practice for infusion therapy. The standards are rated according to the strength of evidence, giving the clinician confidence in the evidence supporting their practice. Unfortunately, literature is lacking in many areas of infusion therapy. As leaders in infusion therapy, we need to share our practice and outcomes through publication.
Confidence will grow as knowledge increases. Self-assurance increases with the strength of evidence. Levels of evidence are based on the strength of evidence, which is based on opinion, process improvement, evidence-based practice, and the type of research.
Knowledge and confidence increase with competency, the ability to perform the technical, knowledge-based, critical thinking, and interpersonal skills required to do a job. Competency requires an integration of population, culture, safety, and scope of practice. Leaders look to the IOM not only for nurses to work to the full extent of their education, but also for multidisciplinary teams to provide care to patients. As infusion nurses, it is our role and challenge to provide knowledge to these leaders and teams. We need to assist leaders in identifying the importance of the infusion nurse’s role in multidisciplinary teams and to provide knowledge on the core competencies of infusion nursing.