The consensus statement reflects current evidence, best practices, and the expert opinions of AACN’s nine-person Tele-critical Care Task Force. It underscores how the contributions of tele-critical care nurses continued to expand by embracing additional risk assessments, interventions, and patient safety measures.
During the pandemic, tele-critical care nurses addressed the loss of experienced nurses from the on-site team, leaving a knowledge gap. Their work includes mentoring on-site nurses, facilitating the ongoing development of newer nurses, and supporting excellent nursing care.
The AACN updated its landmark standards for tele-critical care nursing practice, offering specific recommendations for developing and enhancing tele-critical care programs
The initiative brought together tele-critical care nursing leaders from varied backgrounds to share their expertise and dynamic front-line perspectives, resulting in a comprehensive, patient-centric update. The task force was led by Theresa Davis, Ph.D., RN, NE-BC, CHTP, FAAN, and Lisa-Mae Williams, Ph.D., RN, CCRN-K, two national leaders in tele-critical care nursing.
“Tele-critical care programs have become more pervasive with advances in technologies and expansions in modalities, and the number of patients served,” Davis says. “We’ve seen significant growth in tele-critical care services, including expanding beyond traditional critical care areas, medical-surgical units and even home-care settings. This document offers a broader definition of the term ‘teleICU’ to reflect how these nurses contribute to care beyond intensive care units.”
“In addition to caring for patients, tele-critical care nurses are helping to address the experience gap by providing an extra layer of support and expertise to the on-site team,” Williams says. “Knowledge and expertise are precious commodities, especially when caring for critically ill patients. Mentoring a novice nurse, a float nurse, or traveling nurse can instill a greater sense of confidence, while peer-to-peer collaboration can help on-site colleagues feel more supported.”
The consensus statement’s practice recommendations include essential elements for tele-critical care nurses, nurse leaders, and their healthcare organizations.
The document includes clinical scenarios with real-world examples of how clinicians implemented each key recommendation in various environments, including natural disasters and the COVID-19 pandemic. An increased focus on the importance of equity, diversity, and inclusion has been integrated throughout the document, beginning with its first recommendation and continuing through the practice model and clinical vignettes.
The statement includes the AACN Tele-critical Care Nursing Practice Model, which provides the conceptual framework for implementing and evaluating tele-critical care nursing practice.
“The future of nursing and health care is unknown, and the COVID-19 pandemic has brought a newfound urgency for us to work together to find solutions to both long-standing issues and new challenges,” said Bettencourt. “Starting now, we step forward with a renewed sense of purpose, a commitment to action and a focus on a better tomorrow.”
Bettencourt is an assistant professor in Penn Nursing’s Department of Family and Community Health. As an educator, researcher and pediatric clinical nurse specialist, her focus is on achieving the best possible outcomes for acutely and critically ill children. Her current research involves evaluating factors influencing the research-to-practice gap in critical care settings and testing implementation strategies targeting the interprofessional team to improve evidence-based care. She was recently a postdoctoral fellow at the University of Michigan, where she was appointed to the National Clinician Scholars Program and received advanced training in implementation science. Previously, she was responsible for ensuring high-quality nursing care and optimal outcomes for burn, trauma and pediatric patients as a clinical nurse specialist at Regions Hospital in St. Paul, Minnesota, and at UF Health Shands Children’s Hospital in Gainesville, Florida.
Bettencourt’s extensive volunteer service with AACN includes board liaison, NTI Program Planning Committee (2021), AACN – AACN Certification Corporation Nominating Committee, (2020-2021), community moderator, online AACN Peer Support Community Development Team (2020) and board liaison, Chapter Advisory Team (2019-2020).
Her additional affiliations include the American Burn Association and Sigma. In addition to presenting at the National Teaching Institute & Critical Care Exposition (NTI), she has led sessions at several other conferences, including the American Burn Association’s annual meeting. Bettencourt’s publications are in the areas of implementation science, nursing and patient safety, nurse staffing and work environments, burn critical care and pediatric delirium.
Bettencourt earned a Bachelor of Science in exercise science from the University of Florida, an accelerated Bachelor of Science in Nursing from the University of North Carolina at Chapel Hill, and a Master of Science in Nursing from Johns Hopkins University, Baltimore. She earned a PhD from the University of Pennsylvania and a Master of Science in health care research at the University of Michigan.
Before she assumed the role as president, Bettencourt served a one-year term as president-elect. Before that, she completed a three-year term as a director from July 1, 2018, through June 30, 2021, and a one-year term as treasurer from July 1, 2019, through June 30, 2020.
For more than 50 years, the AACN has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.
Nurse of the Week Elizabeth Anh-Trinh Stulac, RN/BSN is an established nurse leader working toward a Ph.D., but she remembers where she came from. So, earlier this month she went back home to Elk River, Minnesota to share a message with graduating seniors at tiny Ivan Sand High School, the alternative learning center she graduated from herself in 2008.
“It is not a secret that when you go to an ALC school, sometimes people view you as being a bad kid, an outcast, or not smart enough to make it in a traditional high school. I am here to tell you: That is false.”
Stulac, who later graduated from college Summa Cum laude and in the top 15 percent of her class, is studying for a doctorate in transcultural nursing while working as a charge nurse in the Mayo Clinic’s COVID-19 intensive care unit. Her older sister, now a nurse practitioner, was a high school dropout who eventually earned her GED. Thus, Elizabeth Anh-Trinh Stulac knows just how grave an error it can be to make assumptions about someone’s capabilities.
When the latest Ivan Sand grads gathered on June 7 for their graduation ceremony, she urged them to believe in themselves and get in touch with their own leadership skills.
First, the alumna told them, don’t buy into stereotypes of Alternative Learning Center students! “Here I was at the Mayo Clinic, the No. 1 ranked hospital in the world, and they were telling me the strengths that I brought to their organization.” The RN, who is also Mayo’s Rapid Response Team Nurse and chairs two committees (in her spare time), flatly informed the 2022 class: “It is not a secret that when you go to an ALC school, sometimes people view you as being a bad kid, an outcast, or not smart enough to make it in a traditional high school. I am here to tell you: That is false.”
The 2008 Ivan Sand grad can speak from experience: “Through the many leaders that I have worked with throughout the years, I have come to realize that one of the greatest predictors of success is your perception of yourself. I am here to tell you all today, as you graduate from Ivan Sand Community School that you are not an outcast, you are not a bad kid, and you are not the many things society has made you believe about yourself. But in fact, you are a class of potential leaders.”
After stressing the importance of assessing yourself on your own terms and not those imposed on you by others, the RN told the class of future leaders to write down their short-term and long-term goals,” and determine what they need to do to achieve them. Then, with a hat tip toward the Mayo onboarding process, Stulac added, “I would also recommend identifying your own personality type, and the strengths that each of you carries individually.”
And never assume defeat. Her sister, Stulac says, “is one of the smartest people I know.” ALC students learn early that “Life is messy.” After all, “Not all of you come from traditional families. Many of you are working to help support your families. Opportunities are not given equally to each person. But the feeling that you get when you achieve your goals, having overcome those barriers, is worth the hard work and worth the bad days — because you will have many bad days. Success does not come free; you must work hard for it.”
With her NP sister’s example in mind, as she concluded Stulac reminded them, “Your success is not only your own but the people who look up to you. I know that some of the greatest leaders are here among us tonight, and I am so excited for you and the impact that you will make on the world that we live in, and what you will achieve!”
A good message for all graduates to live by. Fort the full story on the graduation ceremony, see here.
The Beacon Award for Excellence lauds hospital units that employ evidence-based practices to improve patient and family outcomes. The award provides gold, silver and bronze levels of recognition to hospital units that exemplify excellence in professional practice, patient care and outcomes. Recognition is for a three-year term.
AACN President Beth Wathen, MSN, RN, CCRN-K, praises the exemplary efforts of the unit teams who achieved the Beacon Award for Excellence.
“Meaningful recognition takes on even greater relevance and importance as we continue to meet the challenges of the COVID-19 pandemic,” she said. “Being recognized as a Beacon unit underscores these teams’ ongoing commitment to providing safe, patient-centered and evidence-based care to patients and families. This achievement is a tremendous honor to those who have worked so hard to achieve excellence in patient care and positive patient outcomes.”
Recipients of a gold-level Beacon Award demonstrate staff-driven excellence in sustained unit performance and improved patient outcomes that exceed national benchmarks. Silver-level recipients demonstrate continual learning and effective systems to achieve optimal patient care. Bronze-level awardees demonstrate success in developing, deploying and integrating unit-based performance criteria for optimal outcomes.
In all, 58 units received gold-level Beacon awards, the program’s highest distinction. Among the 2021 recipients, University of California Davis Health System in Sacramento and University of North Carolina (UNC) Medical Center each had four units recognized with gold-level awards, with a fifth unit at UNC earning a silver-level award. St. Elizabeth Healthcare in Edgewood, Kentucky, had three units earn gold-level awards.
Children’s Hospital Los Angeles had four units recognized with Beacon awards in 2021, with two gold-level awards and two silver-level awards. VCU Health System in Virginia, Rush University Medical Center in Chicago and MetroHealth Medical Center in Cleveland, each had two units receive gold-level awards and a third unit was recognized with a silver-level award.
The medical intensive care unit (MICU) at ChristianaCare, Newark, Delaware, becomes the first unit in the United States to renew its Beacon Award for the fifth consecutive three-year cycle, earning gold-level recognition in 2021. In addition, two other units at ChristianaCare were recognized with silver-level awards.
“Through their relentless and uncompromising pursuit to deliver care that is nonpareil, the nurses of ChristianaCare’s MICU have become the paragon of what our profession can accomplish,” said Ric Cuming, EdD, MSN, RN, NEA-BC, FAAN, ChristianaCare’s chief nurse executive and ChristianaCare HomeHealth’s president. “The success that our ChristianaCare MICU has trailblazed, even in the face of this pandemic and continuously elevating benchmarks, also has catalyzed our health system’s other intensive care units to achieve unprecedented gains in safety and quality that have been recognized with the AACN’s Beacon award, the touchstone by which all critical care nursing excellence and quality are measured.”
A total of 34 hospitals had multiple units honored with an award in 2021, demonstrating excellence in caring for acutely and critically ill patients and their families. Memorial Hermann Hospital in Houston had the most units earn Beacon awards, with six units recognized with silver-level awards.
In all, 25 units at 13 New York hospitals attained Beacon status in 2021, the most for any state. Northwell Health had three units at North Shore University Hospital in Manhasset, New York, and two at its nearby Syosset Hospital receive Beacon awards. In Rochester, Highland Hospital, Rochester General Hospital an Unity Hospital Rochester Regional Health earned six Beacon awards, bringing the total for these area hospitals to 34 units currently recognized through the Beacon award program. Last year, University of Rochester Medical Center described its journey toward multiple Beacon awards in “The Beacon Collaborative: A Journey to Excellence,” published in the peer-reviewed journal Critical Care Nurse.
Learn more about the Beacon Award for Excellence, and read about one unit’s Beacon journey in Your Stories on the AACN website.
About the Beacon Award for Excellence: Established in 2003, AACN’s award recognizes top hospital units that meet standards of excellence in recruitment and retention; education, training and mentoring; research and evidence-based practice; patient outcomes; leadership and organizational ethics; and creation of a healthy work environment. Award criteria — which measure systems, outcomes and environments against evidence-based national criteria for excellence — provide a mechanism to initiate patient safety efforts. To learn more about the award, visit www.aacn.org/beacon or call 800-899-2226.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.
Short answer: yes, improving nurses’ work environment can even save lives. Surgical patients in hospitals with better nurse work environments were less likely to be admitted to an intensive care unit (ICU) and less likely to die, according to an analysis of nearly 270,000 patient records.
The researchers examined a large sample of Medicare beneficiaries undergoing general, orthopedic or vascular surgical procedures between January 2006 and October 2007. The cross-sectional study included 269,764 adult surgical patients in 453 hospitals.
They found that surgical patients in hospitals with good nurse work environments had 16% lower odds of ICU admission, 12% lower odds of in-hospital mortality, and 11% lower odds of dying within 30 days of hospital admission than patients in hospitals with mixed or poor nurse work environments. When they examined the joint outcome of either ICU admission or death within 30 days of hospital admission, they found 15% lower odds for either event for patients in hospitals with good nurse work environments.
Patients in the best nurse work environments had the lowest occurrence of ICU admission or 30-day mortality.
“A key difference between ICUs and lower acuity units is the staffing ratio of patients to nurses.”
“Hospitals with better nurse work environments may be better equipped to provide complex patient care in a lower acuity setting without compromising a patient’s odds of mortality,” Krupp said. “A key difference between ICUs and lower acuity units is the staffing ratio of patients to nurses. In the context of the COVID-19 pandemic, our findings suggest that a limiting factor in a hospital’s capacity to respond to the COVID-19 surges of critically ill patients is likely related to the quality of the nurse work environments prior to the pandemic. Fewer additional ICU beds may have been needed if hospitals had good nurse work environments prior to the pandemic, with enough nurses to safely care for patients in lower acuity settings.”
The research team used data from three sources: the Medicare Provider Analysis and Review, hospital characteristics from an American Hospital Association annual survey, and the RN4CAST survey of approximately 34,000 registered nurses at hospitals in California, Florida, New Jersey, and Pennsylvania. Hospitals were assigned unique individual identifiers to link them across the sources.
The nurse work environment was measured using the 31-item Practice Environment Scale of the Nursing Work Index, which is endorsed by the National Quality Forum. Hospitals were then categorized as good (top 25%), poor (bottom 25%) or mixed, which were the 50% between the high and low scales.
Patients in the best nurse work environments had the lowest occurrence of ICU admission or 30-day mortality. Patients in hospitals with poor nurse work environments had the highest occurrence.
Surgical patients in hospitals with good versus poor nurse work environments had 29% lower odds of being admitted to an ICU, 23% lower odds of in-hospital mortality, 21% lower odds of 30-day mortality, and 28% lower odds of being admitted to an ICU or experience 30-day mortality.
Admission to an ICU varied significantly by surgical group, with vascular surgical patients having the highest use of ICUs (47.4%), followed by general (18.2%) and orthopedic (5.9%).
Hospital characteristics, such as number of beds, teaching status, and technology capabilities, varied significantly. The analysis revealed that those with the best nurse work environments were nonteaching hospitals with more than 250 beds.
Listen to the Chapter Podcasts for Jonas and Kovner's Health Care Delivery in the United States
Gain a better understanding of the current state of the US health care system and how it might impact your work and life.