W

The Official Publication of the American Academy of Ambulatory Care Nursing

Volume 29 Number 4

laborers to sustain work-related muscu-loskeletal disorders (MSDs). The increaseduse of computers at home and at work hasalso resulted in a higher incidence of relat-ed cumulative trauma disorders (CTDs). In1999, RNs in the United States sufferedfrom over 13,000 nonfatal occupationalMSDs requiring days away from work,23% involving the upper extremity.”

Ergonomics has been defined as a“multidisciplinary science,” one that“studies the mental, physiological, emo-tional, and behavioral costs incurred byhumans in their interaction with their workenvironment” (Nielsen & Trinkoff, 2003).It is further defined by the OccupationalSafety and Health Administration (OSHA)as “the practice of designing equipmentand work tasks to conform to the capabil-ity of the worker” (Nielsen & Trinkoff,2003). Applying patient care ergonomicsto the interaction of “nurse-patient-machine” was established as a priority in

When we, as nurses, care for immobi-lized patients, we need to consider possi-ble implications. We are proactive inreducing the potential hazards of immo-bility, and we ambulate postoperativepatients as soon as possible. We encour-age coughing and deep breathing as ameans to prevent pneumonia, and wemay apply intermittent pneumatic com-pression devices to prevent deep veinthrombosis (DVT). We are meticulous inour efforts to prevent skin ulcers in animmobile patient by assessing for risk andthen incorporating preventative meas-ures. Yet, we have placed ourselves in apotentially risky situation when we areemployed as telehealth triage nurses. Ourwork requires us to sit in front of a com-puter terminal, assessing patients by tele-phone for extended periods of time, andperforming repetitive movements.

Nielsen and Trinkoff (2003) state that“nurses are more at risk than construction continued on page 10

Kathryn Koehne, RNC

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InsideFEATURESPage 4Nurse Entitlement:Protecting What Is OursThe roles of nurses and unlicensedassistive personnel are clearlydefined, yet title abuse occursregularly. Know the difference anddon’t be afraid to defend yournursing title!

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2 V I EWPO I NT J U LY /AUGU ST 2007

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(800) AMB-NURSFax (856) 589-7463E-mail: aaacn@ajj.comWeb site: www.aaacn.org

AAACN Viewpoint is owned and publishedbimonthly by the American Academy ofAmbulatory Care Nursing (AAACN). Thenewsletter is distributed to members as adirect benefit of membership. Postage paid atBellmawr, NJ, and additional mailing offices.

AdvertisingContact Tom Greene, AdvertisingRepresentative, (856) 256-2367.

Back IssuesTo order, call (800) AMB-NURS or(856) 256-2350.

Editorial ContentAAACN encourages the submission of newsitems and photos of interest to AAACN mem-bers. By virtue of your submission, you agreeto the usage and editing of your submissionfor possible publication in AAACN's newslet-ter, Web site, and other promotional and edu-cational materials.

To send comments, questions, or article sug-gestions, or if you would like to write for us,contact Editor Rebecca Linn Pyle atbeckypyle@msn.com

AAACN Publications andProductsTo order, visit our Web site: www.aaacn.org.

ReprintsFor permission to reprint an article, call(800) AMB-NURS or (856) 256-2350.

SubscriptionsWe offer institutional subscriptions only. Thecost per year is $80 U.S., $100 outside U.S.To subscribe, call (800) AMB-NURS or (856)256-2350.

IndexingAAACN Viewpoint is indexed in theCumulative Index to Nursing and AlliedHealth Literature (CINAHL).

© 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.

TTraditions

This past January, I had an occasion to see “Fiddleron the Roof.” In the play, Tevye (the father character), isstruggling to hang on to old family traditions in themidst of political upheaval, while his children, who are ofthe next generation, are transitioning from the “oldways” to the more modern ways of life. The play remind-ed me of how important it is, even in the midst of rapid-ly evolving changes in our environment and cultures, tocontinue to build traditions that we can share and passon to the next generation of family, friends, and AAACNvolunteer members.

AAACN’s traditions are rooted in its membership, built on its strategic plan,and shared through its experiences and accomplished goals. In 2006, the orga-nization’s membership reached a record high of 2,071. This increase in mem-bership has added value to the organization and helped it achieve its strategicgoals. There was also a record attendance of 726 registrants at the AAACN annu-al conference in Las Vegas this past March. Seventy-nine members attended thePre-Conference Workshop, 120 took the Ambulatory Care Certification ReviewCourse, 58 people sat for the ambulatory nursing exam, and of those, 45 passed.To sustain the momentum and retain membership, the AAACN Board leadershipplans to continue its tradition of providing opportunities for feedback from itsmembers and using a knowledge-based approach to guide its decision makingduring the strategic planning process.

It is also important to share experiences from traditions. Therefore I wouldlike to highlight some of this past year’s accomplishments and show how volun-teer members have helped add value to AAACN. As has been its tradition of theprevious two years, the AAACN leadership team developed project charters thatidentified the activities and deliverables of short-term task forces. The activitieswere prioritized and carried out using the strategic planning goals of Knowledge,Education, Advocacy, and Community. Projects accomplished by short-term taskforces developed under the 4 goals included the following.

Goal 1 – Knowledge• Ambulatory Care Nursing Administration and Practice Standards (7th Edition)

(2007) was published. Task force members included Peg Mastal (Chair),Barbara Miller (Co-Chair), Bonnie Albaugh, Lt. Col. Carol A.B. Andrews, GayBailey, Michelle Budzinski-Braunscheidel, Diane Mathews, Janet Moye,Cynthia O’Brien, and Karen Griffin (Board Liaison).

• Telehealth Nursing Practice Administration and Practice Standards (4th Edition)(2007) was published. Task force members included Sherry Smith (Chair),Lisa Monteleone (Co-Chair), Carole Becker, Maureen Espensen, MelissaKwittken, Carol Rutenberg, and Marianne Sherman (Board Liaison).

• Core Curriculum for Ambulatory Care Nursing (2nd edition) (2006) was pub-lished. Candia Baker Laughlin served as the Editor.

• Ambulatory Care Nursing Review Questions (formerly titled Self-AssessmentGuide) (2nd Edition) (2007) was published. Candia Baker Laughlin served asthe Editor.

Goal 2 – Education• Four live audio seminars were presented on Pandemics, New Vaccines, and

Other Coming Attractions by Dr. Atkinson, Triage Housekeeping 101 by

Charlene Williams

continued on page 5

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

AAACN’s 33rd Annual Conference, to be held at the HyattRegency in Chicago, IL, will be an event you won’t want to miss.The Program Planning Committee has been feverishly working toobtain quality speakers who will offer the latest information vital toyour professional practice. Watch AAACN’s Web site and futureissues of Viewpoint for more specific information about sessionspeakers and topics.

The city of Chicago, known as both “The Windy City” and“The City of Broad Shoulders,” has gorgeous architecture, plentyof shopping experiences, more places to eat than one can imag-ine, and incredible museums. There just isn’t enough time to do itall, but there will be a lot to keep you energized and entertainedwhen education sessions have wrapped up for the day.

The Loop, housing modern skyscrapers that reside next to19th century buildings, gives you an idea of the different kinds ofarchitecture to see on tours and walking expeditions. Trading cen-ters, department stores, the Sears Tower, the Art Institute,Millennium Park, the Navy Pier, and the El are all sites to see whenvisiting this extraordinary city.

Also on your list of places to visit could be the Chicago Boardof Trade, which is located in an historical landmark Art Deco build-ing at Jackson Boulevard and LaSalle Street. Historical artifacts fromthe early days of trading are highlighted next to examples of thetechnological advancements used in global trading today.Admission to this historical area is free.

The Sears Tower has an observatory that allows you to seeMichigan, Wisconsin, Indiana, and Illinois on a clear day.Interactive exhibits at the top tell about Chicago’s dreamers,schemers, architects, musicians, writers, and sports stars.

Consider stopping by the Navy Pier, which hosts a mall,minigolf, IMAX movies, and the Chicago Children’s Museum foryour enjoyment. Take a spin on the Ferris wheel, or if you prefer,simply snap a photo to prove you were there!

Sightseeing tours can be done by bus or by boat. A popularboat tour is the Chicago Architecture Foundation River Cruise thatdeparts from the Michigan Avenue and Wacker Drive landing –right in front of the Hyatt Regency Hotel. A 90-minute cruise fea-tures over 50 buildings and bridges with tour commentary pro-vided by foundation-certified docents.

Museums are abundant throughout Chicago. The FieldMuseum of Natural History is home to Sue, the gigantic T-Rex; theShedd Aquarium and the Adler Planetarium are world-renownedand some of the most visited museums in the U.S. Other interna-tionally known institutions include the Museum of ContemporaryArt, the Museum of Science and Industry (which has a “working”coal mine underneath the museum), and the Art Institute ofChicago.

Chicago is a food-lover’s paradise! Restaurants abound every-where with offerings that range from steak, hot dogs, and ribs, tosushi and other international fare. Chicago is well known for itspizza, so make sure to find some Deep Dish before you leave.

If you love sports, the Chicago Cubs in Wrigley field are aninstitution; the Bears at Soldier Field and the Bulls give peoplesomething of everything. Visits to each of the stadiums is a possi-ble trip to enjoy, even if the team is away during your time inChicago.

If that isn’t enough, Fodor’s recommends shopping on theMagnificent Mile (less than a block away from the Hyatt Regency),listening to live Jazz on the Blues Scene, and viewing the architec-ture of Frank Lloyd Wright.

As you can see, there are many reasons to visit Chicago. Addall this to the fantastic education and networking opportunities,and the excitement of being with other ambulatory nurses, this issomething that you won’t want to miss. Join us!

Make Plans NOW to Attend AAACN’s 33rd Annual Conference in Chicago

F

4 V I EWPO I NT J U LY /AUGU ST 2007

For about seven years, my husband and I had differentprimary care providers (PCPs) within the same ambulatorycare clinic and organization. When either of us called theclinic, it was not unusual to hear such phrases as, “Thenurse will call you back,” “I’ll check with his nurse,” or “Thisis Dr. Smith’s nurse.” Naturally, we thought we were speak-ing to the nurses who worked with our respective PCPs.

During those years, whenever I would ask the “nurse” aquestion, such as, “What are my lab results?”, the responsewould be, “You’ll have to ask the doctor about that,” or “I’llhave to check with the doctor.” Although these responsesgave me pause – what kind of nurse was this? – I never inves-tigated. Imagine my surprise when, after seven years, I dis-covered that my health care organization did not employnurses, registered nurses, or licensed practical nurses as care-givers in the clinics.

My first reaction to this revelation was one of betrayal andembarrassment toward the so-called “nurses.” How couldsuch misrepresentation of self, staff, or co-workers exist? Howembarrassing to think that we had been discussing our healthand expecting information/advice from a medical assistant,rather than the licensed professional we had thought at thetime. No wonder she had to check with the doctor beforeanswering basic nursing questions. What made this more dis-turbing was the probability that each time I wondered whythis “nurse” needed to check with the doctor, someone elsein the community was equating the statement, “I need tocheck with the doctor” (before I can do or say anything else)with the role of the nurse, and thus perpetuating the idea of“nurse as handmaiden to the physician.”

Then I felt ripped off. For almost seven years, my hus-band and I had taken comfort in the knowledge that a nursewas available, and in part, overseeing our care. When we feltwe needed to be seen, receive meds, have lab work, and begiven referrals, there was always the reassurance of knowingthat an RN was there to help identify and meet our needs byworking with our PCPs to coordinate our care and ensurecontinuity and quality. How could our PCPs do that whileseeing other patients and supervising the MAs?

Finally, I became outraged and reported it to the admin-istration of the health care group. The organization hadsome RNs employed but none in the ambulatory care clin-ics. Surely they or someone had been aware of the misuse ofthe “nurse” title and the misrepresentation of non-licensed

staff. Why was it allowed to continue for almost a decade?Arizona, like many other states has Title protection laws(found in the Nurse Practice Acts) making it a misdemeanorto misuse the title “Nurse.” Since the issue was reported,efforts have been made to educate all organizational per-sonnel – providers, managers, and front and back office staff– to eradicate this practice. However, to this day, there areproviders within the organization who continue to call theirMAs nurses.

Defined RolesMost states have clearly defined roles and specific proce-

dures that unlicensed assistive personnel (UAPs) can performwithout direct supervision and those that require directsupervision from a licensed provider. A medical assistant isone of many UAPs (for example, patient care technicians,nurse’s aides). UAPs are often referred to as care extenders.They serve a valuable role by performing many of the func-tions that keep clinics running (such as scheduling, patientintake, record keeping, information transmission, visual/audi-tory testing, and obtaining specimens). UAPs provide an eco-nomic way to deliver care, and many clinics are moving awayfrom hiring nurses altogether. However, the titles and roles ofthose delivering care should be clearly defined and differen-tiated for patients and the public.

Unlike UAPs, nurses practice autonomously; they areskilled professionals who serve a unique role in health caredelivery. An RN can perform an independent assessmentand triage patients. Nurses practice collaboratively withother disciplines to coordinate care and services, and ensurecontinuity and quality care. The role and value of the nursein ambulatory care has been reviewed and described bySwan, Conway-Phillips, and Griffin (2006).

This is an era of wide nursing focus – nursing shortage,nursing value, nursing role in health care, nursing evidence.This is the era where the numbers of RNs in acute care isdecreasing while the numbers of RNs in ambulatory care isincreasing. This is the era for ambulatory care nurses to focuson professional development and leadership (Sherman,2007; Williams, 2007). How can this possibly be the sameera in which the title “nurse” is given to anyone who assiststhe physician?

M. Elizabeth Greenberg, PhD, RNC

continued on page 5

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

ConclusionI cannot imagine that this experience is an isolated inci-

dent. Have you ever heard the term nurse used inappropri-ately? Did you investigate and correct it? Use the opportu-nity to educate and advocate? Or did you let it slide by? Thisissue may seem minor or petty to those outside the profes-sion, but it is not. Misuse and misrepresentation of the title“nurse’” affects the public image of nursing and disrespectsour training and expertise. We have to take leadership rolesfor our profession by making sure our colleagues take thismatter seriously and that our organizations correct theseerrors. How do you think physicians would feel if nurseswere referred to as doctors? They wouldn’t put up with that,and neither should we put up with anyone without a nurs-ing license being referred to as a nurse. By correcting suchmisrepresentation and misconceptions, we take an activerole in facilitating the advancement of the art and science ofambulatory care nursing.

M. Elizabeth Greenberg, PhD, RNC, is Manager of an after-hoursnurse triage call center in Tucson, AZ, and is a member of AAACN’sTNP SIG and leader of the Educational Resources Workgroup. Shemay be contacted via e-mail at greenberg.liz@gmail.com

ReferencesSherman, M. (2007). Ambulatory care nursing professional develop-

ment. Viewpoint, 29(2), 17.Swan, B. A., Conway-Phillips, R., & Griffin, K.F. (2006). Demonstrating

the value of the RN in ambulatory care. Nursing Economics, 24(6),315-322.

Williams, C. (2007). Leading from wherever you are in AAACN.Viewpoint, 29(3), 2, 10.

Maureen Power, Using Evidence-Based Practice toImprove Patient Care by Dr. Grindel, Patient Safety: It’sMore than Medication Errors and Falls by Lt. ColAndrews, and Nurse Licensure Compact: Just the Facts byGina Tabone.

• Five On-the-Road Ambulatory Care Certification ReviewCourses were presented by E. Mary Johnson, CandidaBaker Laughlin, and Susan Paschke.

• Six On-the-Road Telehealth Nursing Practice Core Courseswere presented by Maureen Espensen, Traci Haynes,Sherry Smith, and Carol Zeek.

Goal 3 – Advocacy• Task force members:

– Participated in public relations and marketing ini-tiatives, new member marketing, and memberrecruitment and retention.

– Provided national representation on committees,boards, and at national conferences. Served asconsultants, contributed to benchmarking sur-veys, and provided endorsements on importantpatient and nursing health care initiatives.

Goal 4 – Community• Telehealth Nursing Resource Directory (2007) was updat-

ed by Traci Haynes, Christi Camizzi, Barbara Foley, AlmaJohnson, Lin Scheurich, and Marsha Slabaugh.

• AAACN’s logo, “Real Nurses, Real Issues, Real Solutions” isavailable on T-shirts, calculators, and drinking mugs, whichdebuted at the annual convention.In my President’s Address at the Annual Conference, I

encouraged AAACN volunteer members to be 360-degreeleaders by practicing John Maxwell’s principles of “leadingup, down, and across” (Maxwell, 2005) to continue to makea difference from wherever you are in the organization.Many of you have already responded to that request. On-the-Road courses for ambulatory care review and telehealthnursing practice are being scheduled, new short-term taskforces are in the process of being formed, and SpecialInterest Groups (SIGs) are gearing up for a banner year. I willcontinue to keep members informed in my President’sMessage in each issue of Viewpoint of the many strategicvalue-added activities that AAACN is planning, as we buildon the rich tradition of serving its past, present, and futurevolunteer members.

Charlene Williams, MBA, BSN, RNC, BC, is AAACN Presidentand Manager, Cleveland Clinic Nurse on Call, Cleveland Clinic,Cleveland, OH. She may be contacted via e-mail at williac7@ccf.org

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

Nelson, Inc.

President’s Messagecontinued from page 2

Two Members SelectedFor Robert Wood

Johnson FellowshipsMember Janet P.

Moye, RN, PhD,CNAA, and PastPresident Beth AnnSwan, PhD, CRNP,FAAN, have beenselected to participatein the Robert WoodJohnson ExecutiveNurse Fellows Pro-gram. This fellowshipis an advanced leader-ship program for nurs-es in senior executiveroles in health services,public health, andnursing educationwho aspire to helplead and shape theU.S. health care sys-tem. Beth Ann andJanet learned in Junethat they were among

the 20 people selected to participate inthe three-year fellowship. Beth Ann isAssociate Dean of Graduate Programs,Thomas Jefferson University, Philadelphia,PA. Janet is Director of Nursing, EastCarolina University, Greenville, NC.Congratulations Beth Ann and Janet!

New Representative toANCC Content Expert

Panel AppointedMaureen “Reenie” Zaccardi, MSN,

RN-BC, ANP, was nominated by AAACNand appointed by the American NursesCredentialing Center (ANCC) toreplace Cynthia Myers on the ANCCContent Expert Panel for theAmbulatory Care Nursing Certificationexam. Reenie is a member of AAACNand Director of Ambulatory Services,University of Colorado Hospital.Representation on this committee is a3-year term. Members of the ContentExpert Panel review and revise old andnew test items, participate in a roledelineation study conducted every 5

years to update the test content outlinefor the exam, and set the passing scorefor the exam. Members must be up todate with current practice and literatureto be an effective panel member.Thanks to both Cynthia for her pastservice and Reenie for her commitmentto advancing ambulatory care nursingby her involvement in this panel.

Save $$$ With YourAAACN MembershipAre you taking advantage of all your

AAACN member benefits? Several bene-fits will save you money as you accumu-late CNE credit for your licensure or cer-tification renewal. AAACN membersreceiving the Dermatology Nursing,MEDSURG Nursing, Pediatric Nursing, orNursing Economic$ journals throughtheir membership in AAACN are entitledto the “member” or “subscriber” ratefor processing CNEs from each journal.Further, if you are receiving PediatricNursing, you may attend the PediatricNursing annual conference at the special“subscriber” rate. Take advantage of

these cost savings – a valuable benefit ofyour membership in AAACN.

Member-Get-a-MemberCampaign Underway

The annual Member-Get-a-Member Campaign kicked off at theannual conference in Las Vegas.Members are asked to inform their col-leagues of the benefits they enjoy asAAACN members. The campaign runsfrom April 1 to December 31, 2007. Bethe AAACN member who recruits themost new members (6 or more) andreceive paid registration, coach airfare(maximum of $400), and 3 nights lodg-ing at the headquarters hotel (doubleoccupancy). Any member recruiting 3or more new members will receive acertificate worth $100 off futureAAACN programs or products. To qual-ify, make sure the colleagues you recruitfill in your name on the “Who referredyou to AAACN?” line on the member-ship application. Download the applica-tion from the Web site or call 800-262-6877 to request several applications toshare with your colleagues.

6 V I EWPO I NT J U LY /AUGU ST 2007

AAACNN E W S

Beth Ann Swan

Janet Moye

AAACN Corporate Affiliate MemberCareNet has renewed its Corporate Affiliate Membership in

AAACN. With almost two decades of experience, CareNet, a URACAccredited Health Call Center, is a premier provider of care manage-ment services, including Nurse Triage, Disease Management, andMember Services. CareNet continually strives to help its clientsimpact patient/member outcomes by providing consistent, profes-sional, and passionate care resulting in an extraordinary track recordof high value and progressive solutions. CareNet’s clients range fromemployers, health plans, hospitals and facilities, provider groups,membership and marketing organizations, and the private sector.

Vikie Spulak, Executive VPCareNet9725 Datapoint Drive,

Suite 300ASan Antonio, TX 78229

Phone: 210-595-2000 • Fax: 210-595-2001www.callcarenet.com • E-Mail: vspulak@callcarenet.com

Is there a topic that you would like to seepublished in Viewpoint? Let us know!

Send your topic ideas to fordc@ajj.com

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 info@healthecareers.com

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 EducationResource Survey GiftCertificate Winners

Thanks to everyone who responded tothe AAACN education resource survey con-ducted earlier this year. Colleagues whopurchased these resources were asked toshare how they used them so others mayalso benefit. The survey information wasused to develop AAACN’s new EducationResources Catalog. The catalog describeshow our resources can be used rather thanlisting what the products contain. A draw-ing was held to select a winner from eachgroup of respondents. The winners of $25AAACN gift certificates were:

Elizabeth Anderson Cara MoggoKelly Clark Roberta MoorePam Guntrum Carol RutiglianoSandra Higgison Maria ScarpelliBarbara R. Johnson Catherine SykeGreg Laukhuf Karen J. Wilson

Provide AAACN Educationat your Location

Did you know you can offer AAACN’sTelehealth Nursing Practice Core Course(TNPCC) or the Ambulatory Care NursingCertification Review Course at your loca-tion? AAACN’s expert instructors travelacross the country to provide these all daycourses at facilities that desire to educategroups of nurses.

The Telehealth Nursing Practice CoreCourse can be used to orient nurses new totelehealth practice, enhance knowledge oftelehealth practice, and provide staff educa-tion and training in telehealth nursing. Thiscourse is an excellent resource for nursesproviding telehealth care in any setting.

The Ambulatory Care NursingCertification Review Course helps preparenurses to take the American NursesCredentialing Center’s Ambulatory CareNursing Certification Exam. The courseexplores potential content that may betested on the certification exam, reinforcesknowledge of ambulatory care, and identi-fies areas for further study.

To find out more information on offer-ing one of these courses at your facility,contact reichartp@ajj.com

T

8 V I EWPO I NT J U LY /AUGU ST 2007

The faculty for the TelehealthNursing Practice Core Course*(TNPCC) hit the ground running thispast year with a record number ofrequests to teach. A contributing fac-tor is that organizations seekingMagnet status have increased thenumber of nurses becoming certified in their specialty. Whilethe TNPCC is not a pre-certification course, it can help pre-pare nurses seeking Telephone Nursing Certification.

The TNPCC instructors are Maureen Espensen, BSN,RNC, MBA (who helped develop the course); Carol Zeek,BSN, RNC, MBA; Sherry Smith, MSN, RN, MBA; TraciHaynes, MSN, RN, CEN; Lynn Smith-Cronin BSN, RN; andBeth Conaghan, RN, MBA.

The first course of 2006 was offered at the AAACNAnnual Conference, held in March 2006 in Atlanta, andtaught by Sherry Smith and Traci Haynes. There were somany last minute registrants the room had to be changedmid-morning to allow more space. One nurse commented,“All the topics were important and timely,” while anotherstated, “The manual is good. I like having the references atthe end of each section.” The attendees were from varioussettings that included office practices, hospital-based clinics,and call centers.

In April 2006, the course was taught in Elmira, NY, forthe Chemung Valley Health Network in collaboration withArnotHealth. These two groups offered the course as “partof the work plan in helping to meet their objectives relatedto work force development and education,” stated JoyceHyatt, PhD, RN, PCNP. This course was taught by MaureenEspensen and Traci Haynes. The Chemung Valley HealthNetwork contracted with AAACN to videotape the course,so they could continue offering the TNPCC to nurses withinChemung Valley Health Network at later dates. The DVD ofthe course was also provided to AAACN. The 52 attendeesat the first course practiced in call center settings as well asoffices and clinics. Cathey Mathey, RN, stated, “TheTelehealth Nursing Practice Core Course provided nurses inour organization a very comprehensive overview of tele-health nursing, covering everything from techniques tostandards to liability, as well as a chance to network withother individuals who perform telehealth. As a result of thecourse, we have been reviewing and revamping many of ourpolicies. Three of our nurses have since become certified intelehealth nursing.”

Kaiser Permanente MedicalFacility in Willoughby, OH, hostedtwo courses in September andDecember 2006. Lynn Smith-Croninand Traci Haynes taught the firstcourse, while Carol Zeek and SherrySmith taught the second course.

Thirty-seven participants at the first session and 30 partici-pants at the second session were from various practice set-tings throughout the organization, including Kaiser’s callcenter. Some reasons for offering the course were for theparticipants to learn more about medical-legal implications,scope of practice, and documentation. One nurse com-mented on the strength of the course saying, “There wasinformation presented on topics not available elsewhere.”Another wrote, “The discussion on documentation is alwayshelpful.”

Due to interest from their nurse triage call center clients,LVM Systems hosted a course at their Fall LVM Users Groupmeeting, held October 2006 in Scottsdale, AZ. This was thesecond time the course was offered in the last two years. The6 attendees were from various sites, and all had formalizedcall center backgrounds. Course instructors were Carol Zeekand Sherry Smith. Though the group was small, there wasexcellent networking, and those in attendance believed thattheir objectives of learning about the practice of telehealthnursing were met.

Also in October 2006, a course was offered at theHospital of the University of Pennsylvania for out-patientpractice nurses. Beth Conaghan and Traci Haynes were theinstructors for over 30 participants. Feedback included,“Addressed all aspects of telehealth nursing,” “Enjoyedinteractive sessions,” and “Useful acronyms and models pre-sented.”

The City of Austin hosted a course in November 2006.This course was taught by Sherry Smith. The majority of the57 participants were from primary care clinic settings.Comments received were very positive especially for the ses-sions involving policy and procedure documentation, andlegal aspects.

Denver Health’s Community Health Services hosted twoTelehealth Nursing Practice Core Courses in February 2007to over 80 clinicians. Attendees were from their organiza-tion’s various out-patient community clinics and their cen-tralized call center. Course instructors were MaureenEspensen and Traci Haynes. Their goal was to learn more

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

about the standards of practice for telehealth nursing, focus-ing on decision support tools and documentation.Additionally, the TNPCC was provided to their employees toprovide each participant with core knowledge in telehealthnursing practice and to set the foundation for further tele-health training. Comments included, “Love the examples oftelephone calls,” “Comprehensive amount of material, all theimportant information is there,” and “Very thorough presen-tations.”

Carol Zeek, past Chair for the TNPCC SteeringCommittee said, “The course is continually being reviewedand updated to assure that it meets the needs of telehealthnurses in a number of settings.” In anticipation of anotheryear of many course offerings, additional instructors havebeen added. They are Gina Tabone, RNC, Pam Luhrsen, RNC,and Gene Young, RNC.

The Telehealth Nursing Practice Core Course was pre-sented 9 times between March 2006 and February 2007.Over 200 registered nurses participated in the 7.5 hour CNE

course offering and successfully completed the self-assess-ment at the end of the day. The course continues to providenurses with information on the evolving practice of telehealthnursing along with encouraging expansion of telehealthknowledge and skills.

For information about the TNPCC or to host a course,please visit the AAACN Web site at www.aaacn.org, or contactAAACN by phone (800-262-6877) or email (reichartp@ajj.com).

Traci Haynes, MSN, RN, CENTraci.haynes@mckesson.com

*AAACN’s Telehealth Nursing Practice Core Course (TNPCC) pro-vides baseline knowledge on telehealth concepts and benefitsnurses who handle telephone/telehealth inquiries from patients inany practice setting, including those new to telehealth nursing,those interested in formalizing their telehealth education and skilldevelopment, or those researching education and training fortheir colleagues/staff. The course is available in person or on CD-ROM..

AAACN publish-es “Perspectives inAmbulatory Care” asa regular column inNursing Economic$:The Journal forHealth Care Leaders.The column is writtenby AAACN membersand edited by CandyLaughlin, MS, RN, C.

The following is a call for columnists fromCandy to submit articles for this important andinformative regular feature.

Dear Prospective Writer:I am the editor of a column,

“Perspectives in Ambulatory Care,” inthe nursing journal, Nursing Economic$.I am seeking authors of potential manu-scripts for the column and am lookingfor topics of interest to nursing leaders

in ambulatory care settings, such asscope of practice, new roles, approach-es to improve quality, effectiveness andefficiency, collaboration with other disci-plines, new models of care and staffing,advancement of the electronic patientcare environment, patient safety, ethicaldilemmas, measurement of patient out-comes, and evidence-based practiceapplications.

The format for submitting manu-scripts for consideration includes:

• Work directly with me on your idea,outline, and manuscript, ratherthan sending them to ConnieCurran or other members of theeditorial staff of the journal. I willwork directly with the managingeditor of the journal. One electroniccopy submitted via e-mail or on diskis sufficient.

• Articles submitted for the columnare not officially peer reviewed,although I will seek content expertsto help me review articles, as appro-priate.

• The article length for the column isshorter than is required of featurearticles. Although there is noabsolute length, I would target alength of 6-10 pages typed double-spaced.

Graphics, figures, and forms arealways interesting to readers. If you areusing graphics published elsewhere, you

as the author must obtain permission toreprint. Otherwise, all the material mustbe original and never published before,and not being submitted to another jour-nal simultaneously. References and otheraspects of the manuscript format shouldadhere to the Publication Manual of theAPA, 5th edition.

These are the questions I considerwhen looking for a good article:

• What contribution does thismanuscript make? Is it new tothe reader? Is it timely? Is it use-ful to the reader?

• Is the information correct, com-prehensive, and current?

• Do the figures/tables supple-ment the text? Would any addi-tional tables/figures be helpful?

• Are the ideas clearly expressed?• Is the content appropriately

organized and logical?Please contact me with your ideas

for articles, outline, or manuscript. I canbest be reached by e-mail atcandial@umich.edu , but you may try toreach me by phone in the evenings andweekends at home at (734) 973-7931(1:00 a.m. Eastern Time).

Thank you for considering writingfor this column in the journal. I look for-ward to hearing from you.

Candia Baker Laughlin, MS, RN, BC

Call for Columnists

A Jannetti Publications Inc. Journal

In This Issue:

The Role of Nursing Leadership in Creating a Mentoring

Culture in Acute Care Environments

The Economic Impact of Implementing

An Ergonomic Plan

Technicity in Nursing and the Dispensation of Thinking

Improving Patient Care by Making Small Sustainable

Changes: A Cardiac Telemetry Unit’s Experience

Learning the Available and Supplied Religious

Facilities For Inpatient Services:

An Example of Taiwan’s Hospital Environment

Volume 25 Number 3

May/June 2007

TTHHEE JJOOUURRNNAALL FFOORR HHEEAALLTTHH CCAARREE LLEEAADDEERRSS

®

Earn 1.4CNE Credits in

this Issue!Nurse Faculty/

Nurse Executive

Candy Baker Laughlin

10 V I EWPO I NT J U LY /AUGU ST 2007

1993 by the National Council on Nursing Research.Since this time, there has been limited research concern-ing the relationship between nurse computer worksta-tions and ergonomics (Nielsen & Trinkoff, 2003).

The American Academy of Ambulatory Care Nursing(AAACN) Telehealth Standard VII states that telehealthnursing staff should have a “safe, hazard-free, ergonom-ically correct and efficient environment” (2007, p. 14).AAACN acknowledges that environmental factors mayhave a significant impact on health, safety, and effective-ness of telehealth care. The measurement criteria in thisstandard address the specific issues that support a safework environment.

It has been determined that those most at risk fordeveloping CDTs are those who work at a computerworkstation for more than four hours a day. However,because of the high physical demands nurses mustencounter at work, the threshold for nurses to developCDTs is lower. According to OSHA, if breaks away fromthe computer workstation are not taken, and if motionsare repetitive and posture is static, the risk of injuryincreases (Nielsen & Trinkoff, 2003).

Study findings from workstation research and litera-ture, as cited in Nielson and Trinkoff (2003), emphasizethe need to have adjustable workstation equipment,

although exact specifications vary from study to study.Recommended viewing distances for monitors rangefrom 16 to 48 inches. One study recommended using aflat keyboard, whereas other studies recommended 0 to15-degree keyboard slopes. Still other studies suggesteda relationship between perceptions of occupational stressand psychosomatic symptoms.

Literature about chair design emphasizes the needfor lumbar support, 90-degree leg angles, and the needfor the computer user’s legs to reach the floor. The num-ber of injuries related to mouse use has risen becausecomputer users have become more dependent onmouse computer input devices. Some sources advisethat the mouse and trackball be placed on the left side ofthe user (regardless of handedness) to reduce neck andshoulder stress, especially when the number keys on theright side of the keyboard are frequently used (Nielsonand Trinkoff, 2003)

In 2004, after working in a telehealth call center foreight years, I began noting an increase in the amount ofcomplaints of pain and discomfort from my colleagues.I, too, felt aching in my neck and hands after a long shift,sitting at my workstation taking consecutive calls. Inaddition, I had noticed eyestrain from reading andreviewing detailed triage information from a computerscreen. This situation made me contemplate whetherthere was a relationship between the length of time anurse works in telehealth and the amount of physical dis-comforts that occur over time.

I designed an unscientific yet useful survey for thenursing staff in our call center. The survey had nurses ratetheir work-related physical discomforts. Seventy percentof the nursing staff (20) returned the survey. Nurses wereplaced in 3 different categories, according to time spentin telehealth (less than 2 years; 2 to 5 years, and morethan 5 years). The staff identified the degree of work-related neck, back, and arm discomfort, as well as eye-strain. The results were just as I had projected. I strictlyused longevity in the telehealth department as a factor.Nurses, regardless of age and prior medical history, didnot notice any discomforts when they were employedfor less than 2 years. Nurses who had 2 to 5 years expe-rience noted an increase in back pain. Nurses who wereemployed for over 5 years consistently noted neck andarm pain as well as visual strain. In all cases, nurses citedtheir work as a telehealth nurse as a cause for theincreased musculoskeletal discomfort. It should be notedthat as a department, we had encouraged ergonomicassessments, and the majority of nurses who took thesurvey were assessed. However, assessments were donein response to musculoskeletal complaints.

With the support of our nursing manager, we devel-oped a plan that would decrease the effects of worksta-tion immobility and increase the well being of our staff.The following measures were implemented in ourdepartment:• The Telephone Nurse Advisor Department arranges

for ergonomic assessments to be done for each nurseduring the orientation process. The results of these

Care for Thyselfcontinued from page 1

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E nhancing patient safety. Turning evidence-basedresearch into practice. Recruiting and retaining nurses.Not quite the exotic setting of CBS’s Survivor, but man-aging and surviving today’s health care jungle can be

quite a challenge. For nurse executives and faculty, the health care system

could turn into a lonely island if collaborative partnerships arenot developed. To help the two groups establish bonds for thefuture, Nursing Economic$, The Journal for Health Care Leaders,will host the Nurse Faculty/Nurse Executive Summit,November 29-December 1, 2007, at the Hyatt RegencyScottsdale Resort and Spa at Gainey Ranch, Scottsdale, AZ.

Nurse executives, nurse managers, nurse educators, andother health care administrators from hospitals and schools ofnursing will hear from dynamic experts in health care leader-ship, nursing, education, and finance. Attendees will collaborateon ways to break old patterns, identify best practices, and cre-ate and sustain meaningful partnerships between clinicians andeducators.

In addition to education sessions, participants will networkwith colleagues, earn continuing education credits, and meetwith leading publishers, hospitals, schools of nursing, and edu-cators in the exhibit hall. Attendees will close the summit withan exciting Town Hall meeting designed to create a dialogueand bridge the nurse faculty/nurse executive divide.

RegistrationComplete conference registration information and online

registration are available on the Nursing Economic$ Web site,www.nursingeconomics.net. For additional information, con-tact Nursing Economic$ at 856-256-2429 or e-mailnejrnl@ajj.com.

About Nursing Economic$Nursing Economic$, The Journal for Health Care Leaders is a

valuable resource for nurse executives and faculty, publishing awide variety of articles that aim to advance nursing leadershipin health care by providing information on current and emerg-ing best practices.

assessments allow for customization of the workstationset-up according to height and body structure as wellas the personal needs of each nurse. These evaluationsare completed by an ergonomist from the hospital’sIndustrial Rehabilitation Department. The reportincludes an evaluation of chair adjustment,mouse/track ball location and type, monitor positionand distance, phone headset versus handset, keyboardlocation, data holders, and need for wrist rests and/orfootrests.

• The department purchased sit-stand stations for eachcubicle. The sit-stand has the ergonomic benefit ofallowing the nurse to change positions frequently.

• A “Micro-Break” stretching sheet was posted in eachcubicle that illustrates workstation exercises. Thestretches include shoulder rolls, chin tucks, wrist/fore-arm stretches, and backbends. These exercises are tobe done before work and “as often as needed.”

• The department leadership encourages staff to walkduring breaks. This movement promotes physicalhealth but has a secondary mental health benefit.

• The staff collectively purchased a treadmill for use onbreaks, allowing for walks when the weather isinclement or during the night shift.

• A pedal exerciser is available to use under the desk forleg movement.

When the nursing staff actively incorporated theabove measures into their daily work, they report adecrease in their musculoskeletal discomforts. Nurses whohad ergonomic assessments completed and were educat-ed about workstation issues during orientation continue todeny overuse discomforts.

Just as we promote wellness and are proactive in pre-venting untoward events from immobility for our patients,we have to be just as responsible with our own health. Weneed to adjust our workstations and increase our move-ment to decrease physical discomforts. As telehealth nurs-es, we engage in an innovative and exciting area of pro-fessional nursing. In order to sustain us and keep usengaged in this necessary area of health care delivery, weneed to practice self-care by adding ergonomic measuresto our work setting everyday.

Kathryn Koehne, RNC, is a Nursing Systems Specialist, Departmentof Nursing Practice, Gundersen Lutheran Health System, La Crosse,WI. She may be contacted via e-mail at krkoehne@gundluth.org

ReferencesAmerican Academy of Ambulatory Care Nursing (AAACN). (2007).

Telehealth nursing practice administration and practice standards(4th ed.). Pitman, NJ: Author.

Nielsen, K., & Trinkoff, A. (2003). Applying ergonomics to nursecomputer workstations: Review and recommendations. CIN:Computers, Informatics, Nursing, 21(3), 150-157.

This offering, sponsored by Anthony J. Jannetti, Inc., offers up to 16contact hours.

Anthony J. Jannetti, Inc. is accredited as a provider of continuingnursing education by the American Nurses Credentialing CenterCommission on Accreditation (ANCC-COA).

Anthony J. Jannetti, Inc. is a provider approved by the CaliforniaBoard of Registered Nursing, CEP5387.

For more information and to register online, visit www.nursingeconomics.net.

• Discover and networkAttend AAACN’s Annual Conference: Top experts and dynamic sessionson the latest innovations in nursing practice. Networking, continuingeducation credit, special member rates.

• Lead and advocateExperience the rewards of volunteering: Influence the future of ambulatory care nursing. Serve at the national level; join special interestgroups, task forces, and committees; start or participate in LocalNetworking Groups.

• Learn and growAccess the industry’s best publications: Members receive Viewpoint,AAACN’s award-winning newsletter, your pipeline to advances in practice,news, and resources. Membership alsoincludes an additional subscription toa leading nursing journal of yourchoice and our monthly e-newsletter.

Ambulatory care nursing is one of today’s mostdynamic and challenging nursing specialties.

As health care delivery moves increasingly to outpatient settings,ambulatory care nursing becomes more essential to efficient, qualitycare.

This is why the American Academy of Ambulatory Care Nursing(AAACN) works toward its overarching goal of advancing the art andscience of ambulatory care nursing while at the same time creatingmemorable experiences to nurture your professional goals.

The specialty calls for a high level of autonomy, critical thinking, andleadership skills. It is the variety and fluidity of the profession that manycite as unique, and why ambulatory care nurses practice in a sweepingrange of settings, from the community to physician group practices tocall centers.

When you join AAACN, you become part of a nurturing communitywith the common goals of visionary leadership, compassionate patientcare, and commitment to nursing’s future.

Our member benefitsgive you the opportunity to . . .

Our member benefitsgive you the opportunity to . . .

You are atthe forefrontof ambulatory carenursing. AAACN ishere to guide you on your path toexcellence.

You are atthe forefrontof ambulatory carenursing. AAACN ishere to guide you on your path toexcellence.

Two easyways to

joinAAACN

Membership application atrightSimply fill out theattached application,enclose your payment,and return by mail.

Join online atwww.aaacn.orgVisit AAACN’s Web siteand fill out the onlineform. It’s quick and easy!

Additional benefits:• Discounts on a vast array of

education opportunities, services,learning tools, and specialtypublications (visit www.aaacn.org).

• Scholarships, research grants, andawards.

• Member-focused Web site(www.aaacn.org) - forums, chatrooms, electronic mailing lists,career center. Access to experts toanswer your practice questions.

• Membership directory - networkwith members across the country.

• Choice of membership in a SpecialInterest Group. Visit www.aaacn.orgfor a complete listing.

Preparing for CertificationIf you are seeking ambulatory care

nursing certification, AAACN offers manyvaluable resources to help you prepare.For more information on AAACN's studytools, visit www.aaacn.org.

The Web site outlines the two areasyou may choose from: Ambulatory CareNursing Certification, offered throughANCC; and Telehealth NursingCertification, provided by NCC.

Join AAACN and shape your future in ambulatory

care nursing.

Join AAACN and shape your future in ambulatory

care nursing.

www.aaacn.org

D

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 thecontinued 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 AwardAnnouncedPages 11-13AAACN Annual ConferenceHighlights – Las Vegas, NVPage 18Real Nurses, Real Issues,Real SolutionsPage 19Spotlight on Practice

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

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There were close to 5,000 entries,with 1,521 Awards of Excellence dis-tributed to publications in 11 main cat-egories and 105 sub-categories. APEXAwards are based on excellence ingraphic design, editorial content, andthe ability to achieve overall communi-cations excellence. APEX Grand Awardshonor the outstanding works in eachmain category, while APEX Awards ofExcellence recognize exceptional entriesin each of the sub-categories.

Congratulations to everyone involved in helping makeViewpoint an award-winning publication! This marks the secondaward for Viewpoint; in 2004, Viewpoint was honored with aSilver Award in the Society of National Association Publishers(SNAP) 2004 EXCEL Competition. In addition, congratulationsto everyone who helped produce a beautiful membershipbrochure. Together, AAACN volunteers and staff have doneawesome work, and these awards validate the quality of thoseefforts.

We are pleased to announce that AAACN received twoAPEX (Awards for Publication EXcellence) awards fromCommunications Concepts, Inc. based in Springfield, VA.

Viewpoint received the 2007 APEX Award for PublicationExcellence in the category of Best Newsletter Writing. RebeccaLinn Pyle, MS, RN, is editor of Viewpoint along with Carol Ford,managing editor, and Bob Taylor, layout designer.

The AAACN Membership Brochure received the 2007 APEXAward for Publication Excellence in the category of MostImproved Brochures, Manuals, and Reports. Staff members whocreated the brochure are Janet D’Alesandro, director of publicrelations and association marketing; Linda Alexander, publicrelations specialist; and Darin Peters, layout designer.

AAACN staff members (L to R) Darin Peters, layout designer; Carol Ford,Viewpoint managing editor; Linda Alexander, public relations specialist;Bob Taylor, layout designer; Janet D’Alesandro, director, public relations.

AAACN Honored with Publication Excellence Awards

You have the power toshape the future.

You have the power toshape the future.

Join AAACN todaywww.aaacn.org

As an ambulatory care nurse,you are a leader.

As an ambulatory care nurse,you are a leader.

Becky Pyle

Sometimes unlocking knowledge lies simply in asking the right questions.AAACN helps you do just that in the new edition of the Ambulatory Care Nursing

Review Questions, 2nd Edition, 2007. The booklet presents 200 multiple-choice ques-tions designed to test your knowledge of ambulatory care nursing and prepare forcertification.

The beauty of the Review Questions guide (formerly the Self-Assessment) is thatit helps you identify your strengths and pinpoint any weak areas needing attention.

The questions follow the same format as the items on theAmerican Nurses Credentialing Center (ANCC)Ambulatory Care Nursing Certification Exam, making it avaluable study tool.

The questions are grouped into five domains of prac-tice corresponding to those on the examination:

I. Clinical Practice (50 questions)II. Communication (46)III. Issues and Trends (32)IV. Systems (28)V. Patient Education (44)All review questions and their answers are drawn

from and referenced in AAACN’s Core Curriculum forAmbulatory Care Nursing, Second Edition (2006). Ifyou are preparing for certification, AAACN stronglyrecommends including these tools to help you pre-

pare for the certification exam.The Review Questions booklet was edited by AAACN Past President

Candia Baker Laughlin, MS, RN, C. The questions were prepared by an expert panelof item writers and rigorously reviewed.

Feedback from those who have purchased the Review Questions shows theusability and value of the guide.

“We are promoting professional development and so staff are learning moreabout AAACN and certification,” one user said. “Having the self-assessment availableto them helps to see what kind of questions there are. We have even used the ques-tions randomly in meetings as discussion points!” (Respondent, product survey results,February 19, 2007).

Other purchasers told us they used the Review Questions for training programs, staffcollaboration, to establish baseline knowledge, and to help organize their study timeeffectively.

Ordering InformationTo learn more about Ambulatory Care Nursing Review Questions and to order

($30 member price; $40 nonmember), visit the AAACN Web site, www.aaacn.org;e-mail aaacn@ajj.com, or call 800-AMB-NURS (800-262-6877).

Certification in Ambulatory Care Nursing

Certification in ambulatory care nursing is offered annually at the AAACNconference and twice a year through the American Nurses CredentialingCenter (ANCC). Contact ANCC at 800-284-2378 or www.nursecredential-ing.org. AAACN members save $70 on the exam fee.

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Ambulatory CareNursing Review

Questions, 2nd Edition, 2007 Corporate

Members

Do you have astory to share

about your life asan ambulatory

care nurse?Contact Carol Ford,Managing Editor, at

fordc@ajj.com.

Carol Ford

The wiki:

14 V I EWPO I NT J U LY /AUGU ST 2007

someone else to jump in and toss another tidbit into the mixthat may or may not be accurate.

Welcome to the world of Wiki. But this is not to say thatWikipedia is without total merit. A Wiki article can and shouldbe used as a springboard on your pursuit of research. Linksburied within each article will direct you to reputable Web sitesthat contain material specifically related to your topic. Manytimes, a Wiki article will be taken verbatim from a respectedWeb site, and this will be indicated, usually with a link directlyto that original site.

Jannetti Publications, Inc. (JPI), a division of Anthony J.Jannetti, Inc. (AJJ), publishes seven peer-reviewed scholarlynursing journals, as well as all special products and resourcesfor the nursing associations managed by AJJ. On a daily basis,the Editorial Services Department receives manuscripts that aresubmitted to these publications. Most all manuscripts containa list of references to substantiate authors’ findings in the effortto prove that their research is accurate and worthy of beingpublished in a peer-reviewed journal or book. With the abun-dance of online articles and the unsettling migration of journalsmoving to Open Access, Internet references are growing innumber. The American Psychology Association (APA) dedicatesa full section in its fifth edition of the APA Publication Manual toexplaining how to cite an Internet source. As with all research,it is crucial to verify that your references are credible. Simplystated, Wiki sites included as academic references are not.

Health care professionals stress to their patients that asthey search for information about their health condition, diag-nosis, and treatment, they must be aware that the Internet hasits drawbacks. Quick and easy do not always mean truthful anddependable. Likewise, we need to relay to our associationmembers that basing their research findings on informationfound through Wikipedia is not only telling readers that theywere too lazy to go beyond the springboard, but that theirmanuscript may be inaccurate. Some peer-reviewed journaleditors will not even bother with manuscripts that rely on Wikireferences, rejecting those submissions or forcing a revisionthat insists upon valid research.

In the end, the research you conduct for the manuscriptyou will eventually write is only as good as the source. In thishigh-speed world of instant gratification, sacrificing conclusiveevidence for saved time and money may only prove more cost-ly in terms of additional work, or worst-case scenario, adverseevents in patients. Remember the saying, “You get what youpay for.” In the case of “the Free Encyclopedia,” costs are paidnot in dollars, but in sense.

Carol Ford, BA, is Director of Editorial Services, JannettiPublications, Inc., a Division of Anthony J. Jannetti, Inc., AAACN’smanagement firm, and Managing Editor, AAACN Viewpoint. Shemay be contacted via e-mail at fordc@ajj.com

FriendFoe?or

WPrinted with permission from Anthony J. Jannetti, Inc.

We’ve all been there, whether it’s for in-depth research ona subject of interest or a quick search for a piece of trivia. Wehop on the Web to learn something we didn’t know before.Gone are the days of dragging out the dusty World BookEncyclopedia that consisted of twenty-six volumes and a dic-tionary, and took up an entire shelf in the family room, wherewe sifted for information that was limited in its scope of knowl-edge and reference. Today, the resources are endless, and anyInternet search will take you to Web pages on just about every-thing imaginable. The unwritten rule of thumb is that the firsthit is usually understood to be the most reliable. However, thisis not always the case.

Wikipedia®. It’s fast. It’s easy. It’s costless. And it’s at our fin-gertips. Self-declared as “the Free Encyclopedia,” Wikipedia(Wiki for short) is available in 10 different languages, with theEnglish version boasting more than 1,780,000 articles to date.Germany’s Wiki site hosts close to 600,000 articles, with Franceat 500,000, and the remaining seven sites hovering around the300,000 mark. Certainly, with all this information just a clickaway, it would seem that researchers and trivia hounds alikehave discovered a missing treasure chest of information, andit’s free! How much better could it get?

The truth is, it could get a whole lot better. The elementthat turns this wonder site into a questionable source is thatarticles appearing on Wikipedia can be created and edited byanybody. If you have access to the Internet, you can create oredit a Wiki article. What’s even more disturbing is that youdon’t need any specific knowledge on the subject matter. Allyou need is a nugget of information and a computer, and awayyou go. Where encyclopedias that were purchased one at atime over the course of several months were compiled byexperts in the field and then edited by professional publishers,the door to free Wiki information is left open for all to access,compose, and amend.

For the past two years, I have been co-researching a biog-raphy with an author about the life of a well-known actor whois deceased. The Internet has been a reliable tool in our questfor information; however, we have also been researching theold-fashioned way – through old books; radio airchecks; tat-tered newspapers; high school, college, and military records;and interviews with family, friends, and co-workers. What wehave learned through the pain-staking and expensive processof real research is glaringly and immeasurably different thanwhat the general public knows, most of which has been madeavailable via a Wiki article. The author and I visit this article rou-tinely, and with a few keystrokes, have removed untruths andslanderous comments that have ranged from this individualnever graduating from high school (when he did) to him burn-ing down a local radio station (which, in fact, he did not). Andas easy as it is for us to correct this article, it is just as easy for

Email… online shopping… bank accounts… the AAACNWeb site. You want to keep your accounts secure with dif-ferent passwords, but how can you remember them all?

Your Membership CardThe safest way to remember your username and password

is to write it down and keep it with you. Attached to yourAAACN Membership Card is a Web Site Access card. Writeyour username and password on this card and keep it in yourwallet. Your membership card also serves as a reminder ofyour membership number, membership expiration date,AAACN’s phone number, and AAACN’s Web site address.

Using Your Browser to Save Your Usernameand Password

If you are using your home computer to access theAAACN Web site and other similar sites, you may feel com-fortable allowing your browser to store some usernames andpasswords. If you do this, every time you visit that site fromyour personal computer, your username and password will befilled in automatically for you. Keep in mind that if someoneelse sits down at your computer, they will also be able toaccess that site using your stored username and password.Work computers are in a shared location, so you should notsave login information on your work computer.

If you trust your family, follow these steps to store yourlogin credentials:

If you use Internet Explorer:Internet Explorer automatically prompts you after filling in

a username and password with the question “Do you want tosave this password?” If you click yes, Internet Explorer willremember it for you. If you are not presented with this option,click on Tools, then Options/Internet Options. Click on theContent tab. In the AutoComplete settings, click on the checkboxes by “User names and passwords on forms” and “Promptme to save passwords.”

Deleting Stored Passwords: The option to delete stored usernames and passwords is

also stored in the Internet Options area. Click on the Generaltab, then the Delete button by the heading Browsing History,then click on the Delete passwords button.

If you use Firefox or Mozilla:Firefox and Mozilla have password managers in which you

can easily see all of your stored usernames and passwords. LikeInternet Explorer, when you type in a username and password,your browser will ask you if you would like to store it. Just clickon Yes and the next time you visit this Web site, your browserwill fill it in for you!

Deleting Stored Passwords:In these browsers, it is very easy to see what passwords

you have stored. Just click on Edit > Preferences >

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

Navigating AAACN’s Web Site:Remembering Your Username and Password

Security/Privacy & Security. There is an area here where youcan manage what passwords you have saved and view yoursaved usernames and passwords. However, since it is so easyto view your stored information, we also recommend youuse a master password to protect anyone else using yourcomputer from seeing all of your passwords. You can set amaster password in the Security options as well.

Password ManagersAnother way some people choose to store their pass-

words is to use a separate password manager. For instance,the program RoboForm saves passwords for you, along withother form data like your name and address information.RoboForm encrypts your passwords, so they are not storedas readable plain text. Many password managers also offerthe ability to transfer your stored usernames and passwordsacross workstations.

If You Forget Your PasswordDon’t worry! If you forget your AAACN Web site pass-

word, you don’t need to set up a new account! Click on theLog In button. Just below the username and password fieldsis a description of what to do if you’ve forgotten your pass-word. You will type in your username, and then click on theReset My Password button. AAACN will ask you a securityquestion to confirm your identity, and you will be promptedto set up a new password.

If You Forget Your UsernameDon’t open a new account just because you forgot your

username either! All of your contact information is alreadystored in your account and the AAACN National Office willbe happy to remind you of your username. Call us at 1-800-AMB-NURSE (1-800-262-6877) or send an email toaaacn@ajj.com. Now write it down this time!

Rebekah LazarAAACN Internet Coordinator

aaacn@inurse.com

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PAIDBellmawr, NJPermit #58

© Copyright 2007 by AAACN

Real Nurses. Real Issues. Real Solutions.

American Academy ofAmbulatory Care Nursing

Volume 29 Number 4

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)williac7@ccf.org

President-ElectKaren Griffin, MSN, RN, CNAAAssociate Chief Nursing Service, Ambulatory CareSouth Texas Veterans Healthcare Systems210-617-5300 x4152 (w)kfgriffin@hotmail.com

Immediate Past PresidentBeth Ann Swan, PhD, CRNP, FAANAssociate Dean of Graduate ProgramsThomas Jefferson University215-503-8057 (w)beth.swan@jefferson.edu

Treasurer Kitty Shulman, MSN, RN, CDirector of the Children’s Specialty CenterSt. Lukes Regional Medical Center208-381-7010 (w)millerki@slrmc.org

DirectorsMAJ Belinda A. Doherty, USAF, NCFlight Commander, Education and TrainingUnited States Air Force520-228-1547 (w)belindadoherty@dm.af.mil

Assanatu (Sana) I. Savage, LCDR, USNSenior Nurse OfficerUnited States Naval Training Center619-524-1309 (w)sana.savage@med.navy.mil

Marianne Sherman, RN, C, MSClinical Standards Coordinator, AmbulatoryUniversity of Colorado Hospital720-848-2397 (w)marianne.sherman@uch.edu

Nancy Spahr, MS, RN-BC, MBA, CNSClinical Nurse Specialist, Ambulatory CareMayo Clinic Arizona480-301-6680 (w)spahr.nancy@mayo.edu

AAACN ViewpointEast Holly Avenue, Box 56Pitman, NJ 08071-0056(856) 256-2350(800) AMB-NURS(856) 589-7463 FAXaaacn@ajj.com 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 ambula-tory care nursing. Manuscripts published in the newsletter on topics in ambulatory carenursing practice, clinical research, and professional development and leadership are eli-gible for consideration. Articles published in 2007 are eligible for consideration. Anawards committee will select the winning manuscripts. The awards, consisting of aplaque and one complimentary registration to the 2008 AAACN Convention, will bepresented at the 33rd Annual AAACN Convention in Chicago, IL. The winners will benotified by mail and announced in Viewpoint.

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: fordc@ajj.com

Announcing