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NURSING EXCELLENCE2019 Magnet®-Recognized Organization

Success Stories

38 American Nurse Today Volume 14, Number 1 www.AmericanNurseToday.com

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Nursing has appropriately increased its focuson evidence-based practice (EBP), the develop-ment of new knowledge, and baccalaureate

education as entry into clinical practice. Programsappear almost daily offering online education,courses to supplement existing knowledge, and con-tinuing education for those who’ve completed theirformal education. Clinical nurses are busier thanever with high-acuity patients, shorter hospitalstays, staff shortages, and complex technology tomaster at the bedside. In addition, nurses at all ex-perience levels need innovative strategies to helpthem conceptualize, design, and complete projects,

especially when the American Nurses CredentialingCenter (ANCC) Magnet Recognition Program® nowrequires documentation of two completed and oneongoing nursing research study in each hospital.

The skills needed to conduct EBP projects arerarely taught in associate degree or diploma pro-grams and may be minimally covered in bac-calaureate curricula. The combination of limitedknowledge, time, and mentors makes the comple-tion of a capstone or dissertation-level project dif-ficult for nurses who juggle heavy workloads,complex coursework, and family responsibilities.Identifying students and staff with similar project

Near-peer mentoring for nursingresearch education

This collaborative approach instills confidence in noviceresearchers, prepares more experienced nurses for futureleadership, and expands the reach of established experts. By Susan Mullen Kaplan, PhD, RN, CCRP; Tina Kennedy-Schlegel, DNP, CRNA, CCRN, CNS; Pamela Hammond-Miles,BSN, RN, VA-BC; Joanne Williams-Reed, DNP, RN-BC, CNS

interests who can work collaboratively helps tosupport project development and completion. Oneway to do that is through near-peer mentoring.

Testing a modelDuring the recent Magnet® site visit to our 525-bedquaternary care facility, one of the appraisers com-mented on the approach that we used to encourageresearch between two nurses who were students atthe same university; one was completing her bache-lor’s degree in nursing (BSN) and the other wascompleting her doctor of nursing practice (DNP).The situation presented us with an opportunity totest the near-peer mentoring model, which hasbeen used in medical and pharmacy education. Inthis model, a more experienced student (near-peer)men tors the less experienced student (novice).

Both students are guided by an expert who servesas a resource. In our case, a research expert facili-tated the pairing of the two individuals after speak-ing with them independently about their compati-ble research interest.

The novice applied what she learned in her di-dactic coursework and her clinical experience tothe project while the near-peer mentor made theresearch process tangible and understandable asshe worked on her DNP project. Frequent, regularlyscheduled meetings between the two facilitatedsmooth, unhurried communication (the expert metwith the team intermittently).

Planning a projectNear-peer mentored projects begin with an ideathat’s developed into a plan that incorporates theskills and knowledge of the near-peer and thenovice. With the added support of the expert, allmembers of the team accrue benefits that can ad-vance their careers and enhance patient care. Andin an age of limited resources, the near-peer ap-proach maximizes the expert’s impact and shouldresult in more poster presentations and journalpublications. Also, should one of the team mem-bers need to resign, the continuity of the projectcan be maintained more easily.

Project originationResearch projects can originate from a need identi-fied by a unit practice council, a clinical nurse’s ob-servation, or a question identified in the literature.The near-peer and novice develop the topic questioninto a plan for reviewing existing literature and de-termining next steps. Depending on the availableevidence, the project may develop into an EBP proj-ect or it may require a nursing research proposal ifinsufficient evidence can be found in the literature.

Team member rolesEach member of the team determines his or her

knowledge, skills (clinical and research or EBP),and motivation (class project, capstone, DNP proj-ect, or dissertation). The near-peer, usually a grad-uate student, assumes the role of mentor and leadsthe project design, maintains oversight, and guidesthe novice. The novice focuses on specific assignedtasks related to the project, such as literature re-views, article critiques, data collection, or studysubject consent, knowing that he or she is in a safesetting with back-up from the near-peer mentor.The expert mentor, ideally someone with doctoralpreparation that includes research experience, re-views the process and provides feedback and over-sight for both the near-peer and the novice. Theexpert could be an advanced practice nurse or afaculty member from an academic setting. Allthree members of the team can benefit from thisarrangement. (See Benefits abound.)

Capitalizing on congruenceThe strength of the near-peer model rests on thetheoretical construct of social congruence, whereindividuals in a shared social setting who havesimilar experiences are able to relate more easilythan those who don’t share those experiences. Inthe hospital setting, a nurse completing his or herundergraduate degree while working in a clinicalcapacity can relate more easily to a peer who’s ahigher-level student than she can to a facultymember or a senior expert. Additionally, cognitivecongruence (similar knowledge base) enhances thelikelihood of good communication, shared under-standing, and a perception of being supported.

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Benefits abound The near-peer mentoring model includes three members:the novice nurse, the near-peer mentor, and senior expert.Each member of the team benefits from this model.

Novice nurses• gain research experience in a safe environment where

they can ask questions of a near-peer, which may be lessintimidating than asking an expert

• build confidence as beginning researchers, increasingthe likelihood that they will participate in more projects.

Near-peer mentors• hone their teaching and mentoring skills under an ex-

pert’s guidance• gain experience as project leaders• may develop an interest in teaching and joining nursing

faculty, an area where shortages are predicted.

Senior experts• expand their reach by overseeing multiple projects

simultaneously• share their mentoring skills while providing advice and

guidance• gain access to up-to-date clinical information.

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Exploring together Our success with this model was based on ashared project idea that benefitted from the clini-cal expertise of a staff nurse, who was completinga BSN degree and was a novice to the researchprocess, paired with a DNP student who neededthat clinical expertise to conduct her research.Working through the research process togethermade the project more meaningful and less intim-idating for both. Each benefitted from what theother provided and together their project was apositive learning experience as well as a model ofcollaboration. The team graduated from their re-spective degree programs, presented their findingsthrough posters and presentations, and look for-ward to developing more projects.

Our organization is in the process of evaluatingthis model of near-peer mentoring in the hospitalsetting by developing a nursing research study us-ing mixed methodology. Currently, we have an ac-tive nurse residency program with required EBPprojects, several nursing staff who are BSN students,and many nurses pursuing graduate degrees. Ouractive nursing research/EBP council is composed ofadvanced practice nurses (several with doctoralpreparation) and is chaired by a doctorally pre-pared research lead. These resources provide an ide-al setting for testing this model.

As we prepare for the future of our profession,we reflect on a statement that appeared in an arti-cle in the Journal of Nursing Education: “We are col-leagues at different levels, sharing and exploringthe field of nursing together.” n

The authors work at Sentara Norfolk General Hospital in Norfolk, Virginia. SusanMullen Kaplan is a nurse specialist and coordinator of nursing research and evi-dence-based practice. Tina Kennedy-Schlegel is a nurse anesthetist and patientcare supervisor. Pamela Hammond-Miles is an I.V. team/midline inserter. JoanneWilliams-Reed is the director of patient care services, education, wound services,diabetes, chaplaincy, AV, Telemetry, and eICU.

Selected referenceDeal EN, Stranges PM, Maxwell WD, et al. The importance of re-search and scholarly activity in pharmacy training. Pharmacotherapy.2016;36(12):e200-5.

Evans DJ, Cuffe T. Near-peer teaching in anatomy: An approach fordeeper learning. Anat Sci Educ. 2009;2(5):277-33.

Irvine S, Williams B, McKenna L. Near-peer teaching in undergraduatenurse education: An integrative review. Nurse Educ Today. 2018;70:60-8.

Lee BJ, Rhodes NJ, Scheetz MH, McLaughlin MM. Engaging pharma-cy students in research through near-peer training. Am J PharmEduc. 2017;81(9):6340.

Legg TJ, Adelman D, Mueller D, Levitt C. Constructivist strategies inonline distance education in nursing. J Nurs Educ. 2009;48(2):64-9.

Lockspeiser TM, O’Sullivan P, Teherani, A, Muller J. Understanding theexperience of being taught by peers: The value of social and cognitivecongruence. Adv Health Sci Educ Theory Pract. 2008;13(3):361-72.

Vaill AL, Testori PA. Orientation, mentoring and ongoing support: Athree-tiered approach to online faculty development. Journal ofAsynchronous Learning Networks. 2012;16(2):111-9.

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www.AmericanNurseToday.com January 2019 American Nurse Today 41

The past 10 years haveseen an increase in theuse of oral chemothera-

py to treat cancer. Patients ad-minister these medications athome, which provides treat-ment option flexibility but also can lead to potentialcomplications, including med-ication nonadherence and un-reported side effects. For ex-ample, a systematic review oforal chemotherapy by Greerand colleagues reported pa-tient adherence rates from46% to 100%. In addition,many chemotherapy and tar-geted cancer agents have anarrow therapeutic window,requiring them to be takenwithin a specific time frameand dose to prevent cancerprogression.

In 2013, the American Soci-ety of Clinical Oncology (AS-CO) and the Oncology Nurs-ing Society (ONS) publishedrecommendations that cancercenters develop outpatient oral chemotherapyguidelines to help nurses and providers teach pa-tients about the medications and monitor them foradherence and side effects between provider visits.As part of creating these types of guidelines atMedStar Georgetown University Hospital LombardiComprehensive Cancer Center (MGUH LCCC), anurse coordinator, acting as project investigator,developed and implemented a quality improve-ment (QI) project in which an oral chemotherapytracking tool for the nurse coordinator departmentwas piloted.

Project goals The tracking tool, which was created based on pub-lished guidelines and recommendations, promptsnurse coordinators to ask patients specific questionsrelated to medication adherence and side effectsand to reinforce initial medication education dur-ing phone calls 7 to 14 days after chemotherapyinitiation. (See Oral chemotherapy tracking tool.)Project goals included: • making all nurse coordinators aware of the tool• achieving at least 80% of nurse coordinators report-

ing the tracking tool as helpful to their practice

Implementing and evaluatingan oral chemotherapy trackingtool

An academic medical center develops guidelines for monitoringmedication adherence and side effects in outpatients. By Kristin M. Ferguson, DNP, RN, OCN; Laurie J. Dohnalek, DNP, MBA, RN, NE-BC, CENP; Susan S. Moreland, DNP, RN,AOCN, CRNP; Susan M. Schneider, PhD, RN, AOCN, FAAN

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www.AmericanNurseToday.com January 2019 American Nurse Today 43

• contacting 80% of patients newly prescribed oralchemotherapy by the nurse coordinator (by phoneor email) 7 to 14 days after medication initiation toevaluate for side effects and medication adherence

• ensuring that patients can state three common sideeffects of their prescribed medication and under-stand that they should contact the medical teamwhen experiencing side effects

• ensuring 85% patient medication adherence asmeasured by self-report.

Project scope and design The sample for this project included adult oncologypatients recently prescribed oral chemotherapy inthe outpatient setting at MGUH LCCC and 10 on-cology nurse coordinators. Patients were includedregardless of primary language, diagnosis, or can-cer stage. Exclusion criteria included pediatric can-cer patients, adult patients prescribed hormonal/endocrine therapy only, those enrolled in researchprotocols, and those who were admitted as inpa-tients when they started oral chemotherapy. Theoncology nurse coordinators (many of them on-cology certified nurses) work directly with medicaloncologists, providing initial in-person educationabout oral chemotherapy at the medical oncologyvisit when it’s first prescribed and meeting with pa-tients at various points during care.

Data collected through random audits of the

electronic health record (EHR) were used to evalu-ate patients before (July 2016 to December 2016)and after (August 2017 to December 2017) the toolwas implemented to assess improvement in theirknowledge of side effects and medication adher-ence. A total of 45 audits of patient records werecompleted before implementation, with 45 auditsperformed after implementation. Comparisonswere made using baseline data and data collectedafter intervention implementation to evaluate pa-tient knowledge and the effectiveness of patienteducation. The date of initial prescription of oralchemotherapy was noted by viewing the “Rx/Pre-scription” tab in the EHR, and then the “ProgressNotes” section was reviewed to determine if the on-cology nurse coordinator documented communica-tion with the patient to assess for side effects and ifthe patient knew who to contact if he or she expe-rienced side effects.

Patient adherence was measured by asking pa-tients open-ended questions derived from a validat-ed tool. The nurse coordinators also asked patientsduring their calls if they had missed any medica-tion doses since starting oral chemotherapy 7 to 14days before. Adherence was assessed in 68 patients.Because the tracking tool was anonymous, some ofthe chart audits completed postintervention mayhave included some of these 68 patients.

In addition to these random chart audits, the

Based on published guidelines and recommendations, this oral chemotherapy tracking tool helps oncology nurse coordinatorsmonitor medication adherence and side effects and reinforce initial education.

Patient Date Oral Start Date spoke Can patient How many Have you When is When is Is of chemotherapy date with patient identify doses has documented patient’s patient’s follow-up birth agent/specialty after starting possible patient communication next set next needed? pharmacy chemotherapy side missed in EHR* via of labs? provider effects? since progress note? visit? beginning medication?

Questions to ask patient 7 to 14 days after beginning oral chemotherapy:

• Do you have any concerns about your medication?

• What are three common side effects of your medication?

• Since beginning the medication, how many doses have you missed? (Example: Missed 2 out of 14 days or 2/14.)

• Do you know when you’ll next need lab work?

• Do you know the date of your next appointment?

*EHR = electronic health record

Oral chemotherapy tracking tool

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coordinator’s tracking tool 3 months after imple-mentation to determine how many patients werecontacted and if they could identify teaching con-ducted by the nurse coordinator at a prior visit.

ResultsPre- and postimplementation chart audits demon-strated that communication with patients 7 to 14days after they began oral chemotherapy increasedfrom 42.2% to 51.1%. Education on side effects doc-umented in progress notes during calls showed astatistically significant increase of over 25% (p =.010). Before the intervention, only 15.6% of EHRprogress notes about patient calls mentioned sideeffect discussions. After the intervention, 42% docu-mented a discussion of side effects. A statisticallysignificant increase (from 11.1% preintervention to31.1% postintervention [p = .037]) also was notedin the number of patients who could identify whenthey should call their provider about side effects.The 89.7% self-reported adherence rate reported bythis sample was higher than national rates, whichcan be as low as 46%.

Three months after implementing the oralchemo therapy tracking tool, the 10 oncology nursecoordinators participated in an anonymous papersurvey at a staff meeting. (See Nurse coordinator sur-vey.) Descriptive statistics were used to evaluate sur-

This anonymous survey was given to the 10 oncology nursecoordinators 3 months after implementation of the tracking tool.

Please circle or write Question your answer

1 Are you aware of the new 1. Yes outpatient oral chemotherapy 2. No tracking tool our clinic is trialing?

2 Have you found this tool helpful in 1. Yes monitoring and assessing your 2. No patients who are self-administering oral chemotherapy at home?

3 Have you found this tool helpful 1. Yes when covering other oncology 2. No nurse coordinators whose patients 3. Not applicable have been prescribed oral 4. Not sure chemotherapy?

4 Have you found this tool to be 1. Yes helpful in your electronic health 2. No record (EHR) documentation of 3. Not applicable patients prescribed oral 4. Not sure chemotherapy?

5 How can this tool be improved?

Nurse coordinator survey

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44 American Nurse Today Volume 14, Number 1 www.AmericanNurseToday.com

vey data. The results showed that all were aware ofthe tool and how to use it, and 80% found it help-ful when monitoring patients receiving oralchemotherapy and in their EHR documentation.

Some comments from the nurse coordinators in-cluded: “Helpful to keep tracking new patients tomake sure they start and receive their drugs” and“It was helpful in tracking and reminding me ofwho is on oral therapies.” One nurse coordinatorcommented that tracking medication adherence sosoon after initiation “was not necessarily informa-tive because patients were so early in treatmentthat they had not missed a dose” and one suggest-ed that “doing a check-in at a later point, like 30days, would be better.” Another nurse coordinatorsaid that it would have been helpful to have thetool integrated into the online EHR database.

Filling a gapThis QI project sought to implement a structured setof guidelines in the form of a standardized trackingtool to meet evidence-based standards recommendedby ONS and ASCO with regard to side effect andmedication adherence monitoring. The piloted toolproved to be an effective way to facilitate care coor-dination in a large cancer center clinic, and im-provements will be made based on nurse coordinatorfeedback. This tracking tool can be easily adopted byother practices to promote continuity of care. n

Kristin M. Ferguson is the clinical operations manager at MedStar Georgetown University Hospital, Lombardi Comprehensive Cancer Center, in Washington, DC.Laurie J. Dohnalek is the nursing director in oncology, medicine, and emergencyservices at MedStar Georgetown University Hospital. Susan S. Moreland is a nursepractitioner at Annapolis Internal Medicine in Annapolis, Maryland. Susan M.Schneider is an associate professor and lead faculty oncology nursing specialty atDuke University in Durham, North Carolina.

Selected referencesBourmaud A, Pacaut C, Melis A, et al. Is oral chemotherapy prescriptionsafe for patients? A cross-sectional survey. Ann Oncol. 2014;25(2):500-4.

Greer JA, Amoyal N, Nisotel L, et al. A systematic review of adher-ence to oral antineoplastic therapies. Oncologist. 2016;21(3):354-76.

Komatsu H, Yagasaki K, Yoshimura K. Current nursing practice forpatients on oral chemotherapy: A multicenter survey in Japan. BMCRes Notes. 2014;7:259.

Neuss MN, Polovich M, McNiff K, et al. 2013 updated American Soci-ety of Clinical Oncology/Oncology Nursing Society chemotherapy ad-ministration safety standards including standards for the safe adminis-tration and management of oral chemotherapy. J Oncol Pract.2013;9(suppl 2):5s-13s.

Roop JC, Wu HS. Current practice patterns for oral chemotherapy:Results of a national survey. Oncol Nurs Forum. 2014;41(2):185-94.

Schneider SM, Adams DB, Gosselin T. A tailored nurse coaching in-tervention for oral chemotherapy adherence. J Adv Pract Oncol.2014;5(3):163-72.

Wong SF, Bounthavong M, Nguyen CP, Chen T. Outcome assessmentsand cost avoidance of an oral chemotherapy management clinic. JNatl Compr Canc Netw. 2016;14(3):279-85.

Yagasaki K, Komatsu H. The need for a nursing presence in oralchemotherapy. Clin J Oncol Nurs. 2013;17(5):512-6.

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Peripheral IV (PIV) assessment and care is animportant component in clinical nursing. Or-ganizations must ensure that nursing practice

policies regarding the use and care of PIVs are up-dated according to the best available evidence. Af-ter reviewing guidelines from the Infusion NursesSociety (INS) about the frequency of rotating PIVs,nurses at Salem Health formed an interprofessionalteam and used lean methodology, in conjunctionwith evidence-based practice (EBP), to align nurs-ing practice with the updated national standards.The lean culture prompted our nurses to close thegap between what should be happening and what isactually happening when it comes to PIV rotation.

Preparing for change In 2015, a clinical nurse from one of our criticalcare units attended the American Association ofCritical-Care Nurses’ National Teaching Institute(NTI). While in a conference session, she learnedthat the INS had updated their standards of practicefor changing PIVs based on results from a CochraneDatabase systematic review. The new standard rec-ommended changing PIVs only when clinically in-dicated, as opposed to rotating based on a routinefrequency. However, our organization’s policy, “Pe-

ripheral I.V. assessment & care,” still required thatRNs change PIV cannulas every 72 to 96 hours.

Getting things moving After returning from NTI, the nurse conducted a lit-erature search to find the Cochrane review present -ed at the conference. In her search, she uncoveredother original research studies, as well as the INSstandards. The 2011 INS Standards of Practice stated,“The nurse should consider replacement of the shortperipheral catheter when clinically indicated…[t]hedecision to replace the short peripheral cathetershould be based on assessment of the patient’s con-dition.” The 2015 Cochrane review, which includedseven trials of 4,895 patients, concluded that “Nodifference in phlebitis rates was found whether cath -eters were changed according to clinical indicationsor routinely.” The INS’s recommendation was vali-dated in its 2016 Policies and Procedures for InfusionTherapy: “A vascular access device (VAD) is removedon the order of a licensed independent practitioner(LIP) when therapy is completed, when clinicallyindicated, or when deemed no longer necessary forthe plan of care.” The INS does not base removalon a specified timeline.

The nurse presented a summary of these findings

Rotating peripheral IV cathetersbased on clinical indication

How one hospital used lean methodology coupled withevidence-based practice to update nursing care.By Ellie Barnhart, MSN, RN, PCCN; Ann Alway, MS, RN, CNS, CNRN; Margo Halm, PhD, RN, NEA-BC

M A G N E T ® N U R S E S I N AC T I O N

www.AmericanNurseToday.com January 2019 American Nurse Today 47

in the form of an evidence synthesis table, alongwith associated proposed policy updates, to the EBPand Practice Councils at Salem Health. After receiv-ing support from these councils and nursing ad-ministration, the nurse proceeded to establish aninterprofessional team (including the nurse propos-ing the change, nurse manager, clinical nurse spe-cialist, Kaizen clinical nurse consultant, I.V. therapynurse, other clinical representatives, and a studentintern) to formulate an intervention to address theproblem. The neuro-trauma care unit (NTCU) vol-unteered to serve as the pilot unit.

The purpose of the initiative was to align I.V.practices with best practice recommendations thatreduce the use of I.V. therapy resources and de-crease RN workload and required equipment with-out negatively impacting the patient experiencewith an increased incidence of phlebitis.

Educating staff The interprofessional team used lean methodologyand initiated four-step problem-solving. Baselinedata were collected on the NTCU to determine the to-tal number of I.V. restarts performed per protocol in1 month, as well as phlebitis incidence. The team de-veloped a test of change (TOC) where nurses wouldrotate PIVs based only on clinical indication. This

meant that instead of automatically removing a PIVwhen the 96-hour deadline was near, nurses wouldleave the current I.V. in place as long as signs ofphlebitis, infiltration, or extravasation were absent.

Before starting the TOC, the infection preventiondepartment was consulted to ensure optimal patientsafety. NTCU staff were educated on the new processand signs and symptoms of phlebitis, infiltration,and extravasation. In addition, the NTCU resourcenurses and leaders of the unit’s specialty practiceteam disseminated education about the TOC. If a PIVwas left in because of the TOC, nurses documentedthis action in the electronic health record. The NTCUwas the only unit participating in the TOC, so if apatient was to be transferred and had a PIV dwelltime of greater than 96 hours, a new PIV was startedbefore transfer. (See Unnecessary PIV restarts.)

Reviewing the changeAt the end of the 3-month (March to May) TOC,NTCU nurses were surveyed about their perceptionof the practice change. Results indicated that NTCURNs believed the TOC improved the patient experi-ence and also saved clinical nurse and I.V. therapystaff time. Before the TOC, nurses frequently pagedI.V. therapy staff when they weren’t successful withPIV restarts. In addition, patients no longer had to

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Unnecessary PIV restarts The test of change resulted in a successful decrease in the number of peripheral IVs (PIVs) unnecessarily restarted.

18

16

14

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4

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16 0 1 2 1 0

Feb ‘16 March ‘16 April ‘16 May ‘16 June ‘16 July ‘17_Number of unnecessary IV restarts

_Goal

Baseline InterventionPostintervention

48 American Nurse Today Volume 14, Number 1 www.AmericanNurseToday.com

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vation was promoted. A business intelligence report was created from

the electronic health record to accurately collectTOC data. Results showed no negative outcomesduring the intervention, including no increase inphlebitis rates. During the TOC, 137 PIVs had dwelltimes greater than 96 hours on the NTCU. Estimat-ed cost savings from the reduced supply usage andRN labor were $435 per month, with an annualizedsavings of $5,737.44 for a 30-bed critical care unit.

Moving forwardThe project team shared the TOC results with SalemHealth’s policy stakeholders. The housewide policywas updated to reflect current evidence and went livein August 2016. The Practice Council created a tipsheet that was distributed to nursing units to provideeducation, and the updated policy was shared in unitannouncements, at shift changes, and via e-mail.

After implementing the change, the team present-ed a follow-up project summary to the EBP Council.The lead nurse presented poster sessions at the Great -er Portland Chapter-AACN Critical Care Sympo-sium in November 2016, at the American NursesCredentialing Center’s National Magnet Confer-ence® in October 2017, and the American NursesAssociation’s Quality and Innovation Conferencein March 2018.

ImpactOur critical care nurse colleague learned about newevidence that could shape nursing practice anddedicated herself to bringing this new knowledgeback to her colleagues. She served as a transforma-tional leader, planting the seed and inspiring othernurses to be champions of the change to improvepatient, nursing, and organizational outcomes. n

Ellie Barnhart is a clinical nurse on the intermediate care unit at Salem Health inSalem, Oregon. Ann Alway is a critical care CNS at Salem Health Hospitals and Clin-ics in Salem, Oregon. Margo Halm is the associate chief nurse executive for nursingresearch and evidence-based practice at VA Portland Healthcare System in Port-land, Oregon.

Selected referencesInfusion Nurses Society. Policies & Procedures for Infusion Therapy.5th ed. Norwood, MA; Infusion Nurses Society: 2016.

Infusion Nurses Society. Infusion therapy standards of practice. Sitecare and maintenance. J Infus Nurs. 2011;34(suppl 1):S55-64.

Gorski LA, Hallock D, Kuehn SC, Morris P, Russell JM, Skala LC. Rec-ommendations for frequency of assessment of the short peripheralcatheter site. J Infus Nurs. 2012;35(5):290-2.

Morrison K, Holt KE. The effectiveness of clinically indicated replacementof peripheral intravenous catheters: An evidence review with implicationsfor clinical practice. Worldviews Evid Based Nurs. 2015;12(4):187-98.

Rickard CM, Webster J, Wallis MC, et al. Routine versus clinically indi-cated replacement of peripheral intravenous catheters: A randomisedcontrolled equivalence trial. Lancet. 2012;380(9847):1066-74.

Webster J, Osborne S, Rickard CM, New K. Clinically-indicated re-placement versus routine replacement of peripheral venous catheters.Cochrane Database Syst Rev. 2015;(8):CD007798.

www.AmericanNurseToday.com January 2019 American Nurse Today 49

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excellence, and innovations in

professional nursing practice.

Emory Healthcare 550 Peachtree St NW, Atlanta, GA 30308404-712-4938 • emoryhealthcare.org/careersnursing.careers@emoryhealthcare.org2,104 bedsAs the most comprehensive academic health system in Georgia,Emory Healthcare nurses are integral members of high-function-ing interprofessional teams that are transforming healthcareand advancing medical discoveries. We are dedicated to thehealth of our community and proud to be the only healthcaresystem in Georgia with three Magnet®-designated hospitals:• Emory Saint Joseph’s Hospital• Emory University Hospital• Emory University Orthopaedics & Spine Hospital

Children’s National Health System 111 Michigan Ave NW, Washington, DC 20010Jill Board, MS, BSN, RN, NE-BCjtitone@childrensnational.org202-476-4059BeANurse@ChildrensNational.orgChildren’s National Health System, based in Washington,DC, has been serving the nation’s children since 1870.Children’s National is #1 for babies and ranked in everyspecialty evaluated by U.S. News & World Report and hasbeen designated two times as a Magnet® hospital, a desig-nation given to hospitals that demonstrate the higheststandards of nursing and patient care delivery.

NYU Langone Health 550 First AvenueNew York, NY 10016212-404-3618nyulangone.orgNYU Langone Health is a Magnet®-recognized organization.We empower our nurses to deliver world-class nursing carein an intellectually stimulating academic environment. Ournurses are patient advocates, decision makers, and collabo-rative partners. We are among the nation’s leaders in shap-ing the future of nursing.

St Peter’s Health PartnersAlbany, NY518-525-2384www.sphp.com/artofcaringWith nearly 12,500 employees in more than 185 locationsacross seven counties in New York state, we are the CapitalRegion’s largest and most comprehensive not-for-profithealthcare network, providing high-quality, compassionate,and sophisticated care to thousands of people every day.

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Winchester Medical Center Valley Health1840 Amherst StreetWinchester, VA 22601 540-536-8000valleyhealthlink.comExpanding across Virginia, West Virginia, and Maryland,Valley Health is devoted to the health of all who call our18-county area home. A vital resource for healthcare, weare the region’s largest employer, a dependable communitypartner, and at the leading edge of clinical innovations.

VCU Health System 1250 E. Marshall Street, Richmond, VA 23219804-628-4748 • vcuhealth.org/careersBeth Hubbard • beth.hubbard@vcuhealth.org1,081 licensed beds (total for all three hospitals)VCU Health is a comprehensive system of care and pioneer ofhealth. Our VCU Medical Center is a Magnet®-designated hos-pital and the only comprehensive Level I trauma center in thestate, verified in adult, pediatric, and burn trauma care. Wehave more than 830 providers in 200 specialties, the area’sonly NCI-designated cancer center (VCU Massey Cancer Cen-ter), and a full-service children’s hospital (Children’s Hospitalof Richmond at VCU). And VCU Health’s Community Memori-al Hospital is a leading healthcare provider for the rural com-munities of south-central Virginia and northern North Carolina.

Currently, there are 441Magnet®-recognized

organizations.

Studies assessing links between

the work environment for nurses and

the patient safety climate find

Magnet® hospitals experience

increased patient satisfaction.