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Volume 6 • No. 3 July 2010

An Official Publication of the Illinois Nurses Association The Voice of Illinois Nursing for more than 100 Years

Quarterly circulation approximately 187,000 to all RNs, LPNs, and Student Nurses in Illinois.

The Illinois Nurses Associationwww.illinoisnurses.com

Harriet Fulmer,1st President

of the IllinoisNurses Association

SSince 1901, the Illinois Nurses Associationhas been the leader in advancingprofessional nursing and remains thelargest and most influential nursingorganization in Illinois.

INA extends our respect to the Universityof Chicago Medical Center (UCMC) nursesand their right to choose the NationalNurses United (NNU) as their collectivebargaining agent.

Know that as the longstanding voice ofnurses in the state of Illinois for over 100years, our offices are always open to youon all matters which are nursing relatedand which we shall continue to share andfight for in common.

The Illinois Nurses Association remainsthe ONLY voice for ALL nurses in the Stateof Illinois.

In Solidarity,

Application on page 14

Join Illinois Nurses Association Today!

Page 2 July 2010 The Illinois Nurse

Silence Is AcceptancePam Robbins BSN, RN

INA President

The Illinois General Assembly passed HB 6065, “Care of Students with Diabetes Act” and is currently awaiting the Governor’s signature. This bill may have passed both the House and Senate, but not without opposition from the “Coalition for Safe Healthcare for School Children.” Some parts of this bill, if passed, may lower the standard of care for Illinois’ most vulnerable school children—those children diagnosed with Type I Diabetes that are too young to self-administer. However, HB 6065 does mandate that children who can self-manage their care must be allowed to do so, carry all equipment needed to test and administer Insulin, and, therefore, bring Illinois into compliance with federal law. The Coalition feels this is a good thing!

INA’s commitment to advocacy for safe care provided by the appropriate person, the realities of budget cuts to schools, the nursing shortage, and compliance with the Nurse Practice Act were key points during discussions surrounding this legislative proposal. Supporters and many legislators, touted the shortage of school nurses and therefore, the parent’s obligation to go to the school to administer medication and monitor their child’s condition as rationale to allow unlicensed, unregulated, designated diabetic care aides to manage the care (including calculation of and administration of Insulin) of those unable to do so themselves (typically the very young or those with other limiting factors).

The Coalition is a good example of how organizations can work together on specific issues affecting the public safety, as in this case, young school children with a diagnosis of Type I Diabetes. Members of the Coalition include: INA, the Illinois Association of School Nurses, Illinois Society for Advanced Practice Nursing, Illinois Association of Nurse Anesthetists, Illinois Academy of Family Physicians, Illinois Chapter American Academy of Pediatrics, Campaign for Better Health Care, Illinois Education Association, Illinois Federation of Teachers, Chicago Teachers Union, Illinois AFL-CIO, and the Illinois Fire Chiefs. Together we were a formidable block of opposition to one section of the proposal: Insulin calculation and administration without formalized education or regulation. But, success was not ours. It is, however, not over. The Governor has until early August to sign the bill into law.

President Pamela Robbins, BSN, RN: [email protected] First Vice President Mildred Taylor, BSN, RN: [email protected] Vice President Roosevelt Gallion, M.Ed, BSN, RN: [email protected] Queen Gallien-Patterson, RN: [email protected] Sharon Zandell, RN: [email protected]

Board of Directors: Cheryl Anema: [email protected] Mary Bortolotti, RN: [email protected] Pam Brown: [email protected] Dan Fraczkowski: [email protected] Paula Kagan: [email protected] Karen Kelly, EdD, RN, CNE-BC: [email protected] Pamela J. Para RN, MPH, CPHRM, ARM, FASHRM: [email protected] Ruby P. Reese RN PhD Bonnie Salvetti: [email protected] Gloria Simon: [email protected] Krystal Spivey: [email protected] Joe Williams: [email protected] Terri L. Williams RN: [email protected]

District Presidents 1 Roosevelt Gallion: [email protected] 2 Mary Bortolotti: [email protected] 3 Thelma Warner: [email protected] 5 Royanne Shultz: [email protected] 8 Ann O’Sullivan: [email protected] 9 Terri Williams: [email protected] 10 Jane Bruker: [email protected] 13 Janet Lynch: [email protected] 14 Martha McDonald: [email protected] 15 Eunice Mumm: [email protected] 17 Ann Smith: [email protected] 18 Acting President Alma Labunski: [email protected] 20 Cheryl Anema: [email protected] 21 Sandra Webb Booker: [email protected]

E & GW Commission Sandra D. Robinson, Chair: [email protected] Linda Briggs: [email protected] Sandy Fischer: [email protected] LaGretta Green: [email protected] Judith K. Hopkins: [email protected]

Local Unit Chairpersons/Co-Chairs City of Chicago: Denise Andrews, Nellie Lacy RC-23 State of Illinois: Lee Goehl Co-Chair Bill Schubert St. Joseph: Marlene Murphy and Chris Daly Union Health Services: Sophie Heldak University of Illinois: Marcia Hymon (D20), Julianne Moore

ILLINOIS NURSES ASSOCIATIONPresident’s Message

Pam Robbins

What can you do? Remaining silent is to accept how this potential change will impact the children in Illinois schools today and how it could serve as the tipping point to change the way healthcare is delivered in the future. I ask that you do not remain silent. Never underestimate the power of the grassroots effort to make positive change. Grassroots? You!

How? Get involved… join INA! Membership provides up-to-the minute knowledge of legislative proposals such as this. Our Government Relations Program gives voice to advocate for patient safety, public health initiatives affecting patient care and protecting nursing practice.

What’s next? The Coalition will be sending official letters to the Governor urging him to amendatory veto HB 6065 to remove calculation and administration of Insulin from the bill. I invite you, as a nurse expert on safe healthcare practices to send a respectful letter to: The Honorable Governor Patrick Quinn, James R. Thompson Center, Suite 16-100, 100 West Randolph, Chicago, Illinois, 60601-3220.

Deciding to remain silent is the same as acceptance….the choice is up to you!

REFERENCES:www.ilga.gov search HB 6065 for full language “Care of Students

with Diabetes Act”PROFESSIONS AND OCCUPATIONS (225 ILCS 65/50-75) Nurse Practice Act.

Nursing delegation.(a) For the purposes of this Section:“Delegation” means transferring to an individual the authority to

perform a selected nursing activity or task, in a selected situation.“Nursing activity” means any work requiring the use of knowledge

acquired by completion of an approved program for licensure, including advanced education, continuing education, and experience as a licensed practical nurse or professional nurse, as defined by the Department by rule.

“Task” means work not requiring nursing knowledge, judgment, or decision-making, as defined by the Department by rule.

(b) Nursing shall be practiced by licensed practical nurses, registered professional nurses, and advanced practice nurses. In the delivery of nursing care, nurses work with many other licensed professionals and other persons. An advanced practice nurse may delegate to registered professional nurses, licensed practical nurses, and others persons.

(c) A registered professional nurse shall not delegate any nursing activity requiring the specialized knowledge, judgment, and skill of a licensed nurse to an unlicensed person, including medication administration. A registered professional nurse may delegate nursing activities to other registered professional nurses or licensed practical nurses.

A registered nurse may delegate tasks to other licensed and unlicensed persons. A licensed practical nurse who has been delegated a nursing activity shall not re-delegate the nursing activity. A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation.

(Source: P.A. 95-639, eff. 10-5-07.)Illinois School Code “TITLE 23: EDUCATION AND CULTURAL

RESOURCES, SUBTITLE A: EDUCATION, CHAPTER I: STATE BOARD OF EDUCATION, SUBCHAPTER a: PUBLIC SCHOOL RECOGNITION which states “The duty to provide professional nursing services as defined in “The Illinois Nursing Act” shall not be included among the functions assigned to any school district personnel not covered by the job description required for school nurses.”

The Illinois Nurse July 2010 Page 3

Illinois Nurses Association/Illinois Nurses Foundation

105 W. Adams, Suite 2101 911 S. Second Street Chicago, IL 60603 Springfield, IL 62704 312/419-2900 217/523-0783 Fax: 312/419-2920 Fax: 217/523-0838

www.illinoisnurses.com

Executive Director: Susan Swart, MS, RN: Ext. 229, [email protected] Financial Officer: Rick Roche: Ext. 230, [email protected] Executive Director: Sharon Canariato, MSN, MBA, RN, Ext. 235 [email protected] of Marketing and Member Services: Deb Weiderman, MS, RN, Ext. 232 [email protected] Director, Continuing Education: Kemi Ani, Ext. 240 [email protected]&GW Staff Attorney: Alice Johnson, Ext. 239, [email protected]&GW Staff Specialists: Rick Lezu, 217-523-0783 [email protected] Ray Scavone, Ext. 245, [email protected] Pam Brunton, Ext. 224 [email protected]&GW Coordinator: Rhonda Perkins, Ext. 223 [email protected], Springfield Staci Moore, 217-523-0783 [email protected] Accountant: Toni Fox, Ext. 243 [email protected]

Editorial Committee Theresa Adelman, RN Cheryl Anema, PhD, RN Margaret Kraft, RN, PhD Alma Labunski, EdD, MS, RN, Chair Linda Olson, PhD, RN Lisa Anderson Shaw DPH, MA, MSN Mary Shoemaker, PhD, BS, MS, RN

The Illinois Nurse is published quarterly (4 issues yearly) by the Illinois Nurses Association, 105 W. Adams, Suite 2101, Chicago, IL 60603.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. INA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Illinois Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. INA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of INA or those of the national or local associations.

ILLINOIS NURSES ASSOCIATION Executive Director’s NotesSusan Swart, MS, RN

Executive Director Illinois Nurses Association

On May 19th and 20th, the nurses employed at the University of Chicago Medical Center voted to align themselves with the National Nurses United. The Illinois Nurses Association respects the decision of these nurses. Our office remains open for them on all matters related to nursing as we move forward in our common fight to advocate for safe patient care and improved working environments for the registered nurses of Illinois.

The leaders of our organization have been focusing on defining a plan to move beyond this and forging a solid future for our members. These plans include a

Susan Swart

focus on internal restructuring and a re-orientation for all members. We have been working to develop processes to simplify our communication to members. By fall, we will be introducing a new user friendly website and member database. Our new database and website will allow for online member updates and renewals and offer a simple way for members to remain current on committee work and local unit updates.

Our Chicago office has been busy reorganizing and restructuring to better utilize the members resources. We believe this restructuring will allow INA to be more responsive to the needs of the members and help to identify better means to advocate for all nurses in Illinois.

The most important message I wish to send to our members and to all nurses throughout Illinois is one of “resilience.” Change is never easy but we are faced with an opportunity to redefine our focus and propel us into a NEW direction with the member’s voice as the center of our mission. The Illinois Nurses Association has proudly advocated for ALL nurses since 1901 and for the next one hundred years will continue to be the voice for ALL NURSES throughout the state.

Practice Corner

by Sharon Canariato

Nothing touches your heart more than seeing a nurse behave in a caring manner towards her patient. The feeling between the two is almost palpable. But I have to ask a tough question, where is our caring towards one another? Why are nurses so mean to one another? Caring is the basis of nursing practice, how can we hurt one another?

It is a common problem. Most nurses have encountered nurse aggression in the health care setting. Very often hostility between nurses is

“Why Are We Unkind to One Another?”passive—aggressive and difficult to identify. Meanness can be overt or covert in nature, but is always extremely hurtful. Nurses typically do not recognize the tremendous impact these behaviors have on one another. These acts leave others feeling wounded and victimized.

There are many theories as to why nurses treat one another in this manner. Some feel the long history of power imbalance in patient care is the root issue. While others feel the behavior stems from nurses belief they lack influence. When people feel powerless, they can be aggressive. Regardless of the cause, the problem fails to unite nurses but further divides them. Think of the power nurses would have should we remain united!

The best solution to this problem is discussion. Talking it out is the answer. Nurses must refuse to allow this type of behavior to continue and must address it whenever it occurs. We must stop allowing mistreatment of our fellow nurses and instead speak up.

Sharon Canariato


Educational Advancement of Registered Nurses in Illinois Summit: Pondering Questions

by Donna A. Redding, PhD, RN-CNEMemorial Medical Center

Over 200 nurses from across Illinois attended the “Educational Advancement of Registered Nurses in Illinois” Summit sponsored by the Illinois Nurses Association on April 20, 2010. The interactive event was held at Heartland Community College in Normal, IL. Many questions were generated based on thoughtful presentations, and the event set the stage for a follow-up session to seek answers.

Keynote Address: BSN-in-10 implicationsThe day began at 10:50 am with a keynote address by

Claire Murray from NYONE. She described New York’s effort to enact legislation in 2004-2005 that would require all RNs to achieve a Bachelor of Science degree in nursing by ten years after completion of an associate degree in nursing. The proposed legislation moved through the Higher Education Committee of the General Assembly, then to the whole legislature. The bill has not yet passed.

The bill was based on Linda Aikens’ research supporting the advantages of having baccalaureate-prepared nurses providing direct patient care. Aikens maintains that BSN-prepared nurses remain in their positions longer and are more satisfied with their jobs than ADN-prepared RNs, and that a greater percentage of RN staff is associated with stronger patient outcomes. Benefits include a decrease in surgical deaths, hospital acquired pressure ulcers, length of stay, mortality related to heart failure, and RN turnover. A 2003 survey of New York RNs in which 67% of respondents said they’d complete their BSN if they could do their education over again spurred action among supporters of the bill.

The bill is future oriented. Nurses who graduated prior to the passing of the bill will not be negatively affected. They would retain their RN license through a grandfathering process. The bill is not trail-blazing. New Jersey and Michigan legislatures are considering similar legislation. Nurses in Canada, Europe, Australia, Thailand and the Philippines must have a BSN for entry into professional practice.

Ms. Murray described the nursing faculty shortage situation in New York. She also cited difficulties persuading RNs to return to school for further education following graduation. Given the existence of 47 RN-to-BSN programs in New York, there is the capacity for 5000 students.

National Council of State Boards of Nursing:Activity Across the Nation

Nancy Spector, representing the National Council of State Boards of Nursing, followed with a presentation on work throughout the US to transform professional nursing education. California has formulated the Institute for Nursing and Healthcare, to support new graduate RNs who are unable to find a position with practice/

education partnerships to maintain nursing skills. There is a statewide plan to build capacity into nursing programs, provide financial support, initiate new programs, and decrease nursing faculty shortages. The goal is to improve nursing education completion rates to 85%.

North Dakota has instituted a Nurse Faculty Intern program to encourage Master’s prepared RNs to consider a nurse educator position. In Oregon, ADN and BSN faculty agree that the BSN is the preferred end degree for staff nurses. They share a curriculum, and ADN students are automatically enrolled in BSN completion, with 50% continuing to graduation. Students are precepted by BSN-prepared nurses.

In several states, hospitals provide dedicated education units to support nursing education. These are inpatient units that are designed to be educational environments. This addresses the need for meaningful patient care experiences for all nursing students.

North Carolina and Louisiana have established partnerships between academic institutions and clinical facilities allowing RNs to work as clinical faculty and as staff nurses in joint positions. Missouri has enacted the Clinical Faculty Academy as preparation for staff nurses enrolled in graduate school to serve as clinical faculty. This initiative is being viewed in other states as well.

Nineteen states, including Illinois, are considering the BSN-in-10 proposal.

Illinois Center for Nursing: The State of Nursing in IllinoisMichele Bromberg, Illinois Nursing Act Coordinator,

reported statistics on the present supply and demand of the RN workforce. There are approximately 130,000 RNs employed in Illinois. After onboarding an anticipated 4410 nurses this year, an overall shortfall of 2215 will remain. The majority of RNs work in hospitals, More than 63% are over the age of 46. 25% are over the age of 55. 16% intend to retire in the next five years, and 53% are eligible for retirement within the next 15 years.

There are over 7000 students enrolled in pre-licensure nursing programs across the state. 56% attend ADN curricula, and 44% attend BSN programs. There are four entry-level MSN programs, eight accelerated BSN programs, and 31 BSN completion programs. 63% of nursing faculty are age 45-60, and 8% are age 61 or older. Nurse educators’ salary is approximately 65% of that of the average industry based MSN salary. There are currently more than 20 vacant faculty positions in the state.

The need for increased clinical experience capacity persists. Alternatives including evening and weekend rotations and simulation experiences are increasing.

Illinois RN-to-BSN ProgramsAnn O’Sullivan, Assistant Dean at Blessing-Reiman

College of Nursing in Quincy, gave a summary of the nature of BSN completion programs across the state. Of the total of 31, six are in public colleges and 25 are in private colleges. Tuition averages at $432 per credit hour.

The number of nursing credit hours required ranges from 21-52, with an average of 33. Six programs are totally online, eight have online and classroom experiences, and seven have no online elements. On average, two clinical practica are required, usually in leadership and community health venues.

Ann’s suggestions included common information on nursing program Web sites to be more consumer friendly. She recommended a comprehensive assessment of statewide capacity for BSN completion students. Data is needed on potential numbers of BSN completion students to project needs for nursing programs. A standardized articulation agreement between ADN and BSN programs would facilitate matriculation.

BSN as the Level of Education for Nursing Practice: Illinois Association of Colleges of Nursing

Maria Connolly, as the immediate past president of the IACN, stirred lively debate with her presentation on the American Association of Colleges of Nursing position statement that the baccalaureate degree in nursing is the minimal preparation for professional practice. She defined the current healthcare situation as nursing’s window of opportunity, as primary care likely will be left to professional nursing. She cited groups including Magnet hospitals that preferentially hire BSN prepared nurses. She compared academic requirements for entry into practice between nursing and other healthcare professions; all have consistently higher requirements than nursing. She described the IACN’s comprehensive nursing education plan to connect baccalaureate and higher degree programs and community colleges to build on the community college base of nursing education.

Janet Lynch (at microphone), INA District Presidents Chair and Dean of Health Professions at Sauk Valley Community College.

Educational Advancement continued on page 5


AD Nursing Education PerspectiveCindy Maske, Catherine Miller and Debra Jezuit

expressed the views of community college nursing faculty regarding the BSN in 10 proposal. As a group, Illinois community college nursing faculty support the BSN for nursing practice, but do not support legislating the BSN in 10 years after graduation. It is the intent of community colleges to partner with BSN programs in nursing education. AND programs have distinctive characteristics: non-traditional students; teaching/learning support; and an entry-level RN education with excellent outcomes at an affordable cost. AD nurse educators support patient-centered care, inter-professional teams, evidence-based practice, patient safety, clinical reasoning and critical thinking, quality improvement, cultural sensitivity, and professionalism. AD graduates mirror BSN graduates in demonstration of the Essentials of Baccalaureate Nursing Education. There is no apparent differentiation in readiness as measured by the 36 core competencies.

Suggested alternatives to the BSN in 10 legislation include articulation agreements between AD and BSN sites, support for accelerated BSN and second-degree nursing programs, offering the BSN at community colleges, and a standardized statewide nursing curriculum. Three states currently provide the BSN at community colleges: Florida, Nevada, and Washington. The Illinois Articulation Initiative is addressing standardizing articulation agreements among Illinois institutions.

IONL Nursing Education PerspectiveSusan Campbell facilitated a spirited discussion about

challenges for minorities and socially disadvantaged students in nursing education. Based on a description of the American Organization of Nursing Executives guiding principles for nursing, Susan emphasized the need for nursing educational preparation to be at the baccalaureate level. This would prepare the nurse of the future to function as an equal partner, collaborator and manager of the complex patient care journey. Much discussion was generated regarding barriers to access to baccalaureate nursing education by people of color and people with limited resources.

Northern Illinois University Partnership InitiativeBrigid Lusk shared the story of NIU’s Nursing

Expansion Grant, a $1 million initiative to expand both generic and BSN completion programs at NIU. She and faculty found that RN students were unhappy in their curricula and resentful of feeling pressured to return to school for degree completion. NIU’s RN-to-BSN program is now only offered at community colleges, which creates diverse cohorts and captures ADN graduates early after graduation. Courses will be offered at Wilbur Wright Community College in Chicago if HRSA grant support is acquired. This would enable ADN graduates to move directly into BSN completion.

A New Design for Nursing EducationMarcia Maurer represented Southern Illinois University-

Edwardsville and Sheri Banovic represented Lewis & Clark Community College in leading a creative discussion of differentiated roles for ADN and BSN graduates in nursing practice. Historical review revealed that the Goldmark Report from 1923 recommended that nursing education be established in universities. They opined that the National Council of State Boards of Nursing needs to

decide if we’ll continue to have one licensure examination for three different types of nursing curricula. Marcia and Sheri proposed curriculum for a Professional Registered Adult Nurse Generalist, a restricted-practice role for nurses. They described a four-semester/one summer plan of study which would enable graduates to sit for a new type of licensure exam. Practice after graduation would be restricted to adult med/surg, gerontology, ED and ICU nursing environments. Open discussion emphasized the need for further study and definition of this proposal and an evaluation of the need of a restricted-practice role in nursing.

Next StepsCertainly discussions will continue, as the content

of the Summit generated multitudes of questions and an array of opinions and ideas. Mutual respect and a sense of entrepreneurship will lead us further into seeking best outcomes for nurses and for our patients.

Educational Advancement continued from page 4

Maria Connolly, Dean of the College of Nursing and Allied Health at the University of St. Francis.

Pam Brown (at podium), INA Board of Directors and President at Blessing-Reiman College of Nursing and Therese Burch, Dean of St. Anthony College of Nursing.


Cook County Treasurer Maria Pappas presents an “Award of Excellence” to the Illinois Nurses Association (INA). Accepting on behalf of the INA is Pamela Robbins, president (3rd from right), and other INA members. Nurses across Cook County were recognized in a reception in Pappas’ office in honor of National Nurses Week. From left: Diane Walton, Darcie J. Brazel, Gloria Simon, Treasurer Pappas, Pamela Robbins, Deb Weiderman and Evelyn Collier-Dixon.


Attention All INA Members!We are seeking mentors—individuals who would be willing to contact a new graduate RN and establish a professional mentoring relationship. We are seeking RN’s in all practice settings and areas. Expectations for mentors would include:

• Communicatingwithmenteesatleastonceamonthovera1yearperiod of time.

• PromotinginvolvementinINA

• Invitingmentorstodistrictmeetings/INAeventswheneverpossible

• Meetingwiththementeepersonallyforcoffeeor lunchforasocialsetting (whenever possible and if mentor / mentee desire such a contact). This activity is recommended as it could be beneficial, allowing the mentor/mentee to experience a face to connect with a name.

The INA Board of Directors has approved the mentoring program and guidelines set forth.

Goals of the program are to help new graduate nurses advance themselves professionally further their base of knowledge, expand professional opportunities, and allow new graduates to discover the opportunities they have in the profession. The program seeks to be flexible, professional, and valuableto the members, as well as mentors who are providing their insight and expertise.

We are introducing the mentoring program and making it available to new graduate RN’s joining INA this Summer.

Questions—email Dan Fraczkowski, at [email protected]


The Proposed Rules for the Nurse Practice Act as Provided by the Illinois Department of Financial and Professional Regulation

by Mary C. Shoemaker, Ph.D., R.N.

The Illinois Department of Financial and Professional Regulation is the overseer for many professions, of which nursing is one of the professions under the Department. Advanced Practice Nurses, Registered Professional Nurses, and Licensed Practical Nurses are licensed and work under the Nursing and Advanced Practice Nursing Act.

The function of the Nursing and Advanced Practice Nursing Act is to protect the public from harm. This Act begins with a definition of terms that are used throughout the Act. The Act identifies what each of the nurses in their specified nursing roles is allowed to perform or what is allowed to be delegated to another person. It also identifies what needs to be in the nursing curriculum and what the faculty qualifications are to be for the various levels of nurses. Other areas include unethical or unprofessional conduct, being an impaired nurse, and information on criminal history record.

Along with the Nursing and Advanced Practice Nursing Act are the Rules relating to the Act. When Rules or the Nursing and Advanced Practice Nursing Act are changed, the changed documents are published in the Illinois Register for 45 days. Individuals have the opportunity to review the Rules or the Act and submit written comments back to the Department. At the end of 45 days, the comments are reviewed with changes being made as appropriate to the area. The Proposed Rule changes were submitted to the Illinois Register on October 2, 2009 with the comment period ending on November 16, 2009.

The Proposed Rules indicated several changes that will be occurring in nursing. The Advanced Practice Nurses and the Registered Professional Nurses will renew their licenses in the even-numbered years, and Licensed Practical Nurses will renew theirs in the odd-numbered years. The renewals are for two years, and according to the Proposed Rules is $40 per year for Advanced Practice Nurses, and $30 per year for Registered Professional Nurses and Licensed Practical Nurses (Section 1300.30 Fees, Section b). The licenses expire on May 31 of the even-numbered years for Advanced Practice Nurses (Section 1300.40 Renewals, Section a) and Registered Professional Nurses (Section 1300.40 Renewals, Section b), and on January 31 of the odd-numbered years for Licensed Practical Nurses(Section 1300.40 Renewals, Section c).

Along with the renewals are requirements to complete continuing education hours as noted in the Rules.

All Advanced Practice Nurses shall complete 50 hours of approved continuing education per 2 year license renewal cycle. Completion of the 50 hours . . . shall satisfy the continuing education requirements for renewal of a register professional nurse license. An APN holding more than one APN license is required to complete 50 hours of continuing education total per license renewal period (Section 1300.130 Continuing Education, Section a1C).

Beginning May 31, 2012, all registered nurses shall complete 20 hours of approved continuing education per 2 year license renewal cycle (Section 1300.130 Continuing Education, Section a1B).

Beginning July 1, 2013, all licensed practical nurses shall complete 20 hours of approved continuing education per 2 year license renewal cycle (Section 1300.130 Continuing Education, Section a1A).

The hours of continuing education must be completed prior to the next renewal date. The renewal dates begin with Advanced Practice Nurses and Registered Professional Nurses in 2010 with the next renewal date of 2012. For the Licensed Practical Nurse the renewal date begins in 2011 with the next renewal date in 2013. Ways in which to get the continuing education are varied. They may be through workshops, seminars, higher education courses (need to be appropriate for the area of certification), published articles/papers, research projects, being a preceptor, or, other health discipline independent study modules, to name a few. Other ways of getting contact hours are by being a presenter or lecturer made to other health professionals.

The following table addresses the time equivalencies for the continuing education hours.

Verification occurs through certificates of attendance/completion. Credit may also be received if the nurse participates in a program or course that is offered or sponsored by an approved CE sponsor who meets the requirements (Section 1300.130 Continuing Education, Section b). The program/course needs to be offered or sponsored by an approved CE sponsor who meets the requirements noted in the Rules (Section 1300.130 Continuing Education, Section b1, and c).

The programs attended need to increase knowledge of material in a nurse’s specific area. At the end of the programs, evaluations must be done of the program and speakers (Section 1300.130 Continuing Education, Section b3). Waivers of the continuing education requirement may be given and include: extreme hardship; full time service men and women in the Armed Forces for the United States; an incapacitating illness with documentation from the physician; a physical inability to access the sites of these programs; and other circumstances approved by the Department ((Section 1300.130 Continuing Education, Section g1, 2, 6).

Access to these programs is varied. Nurses may elect to do the CEs in journals, The Illinois Nurse, Nursing Spectrum, or CE’s offered online, along with webinars, audio courses and podcasts. Courses may also be made known by mailings to the individual nurse. Specialty organizations may mail out flyers to nurses within that specialty. Presentations may be accepted as CEs if given at local nursing chapters, and state or national presentations to other nurses at professional organizations.

If nurses take courses to further their education in nursing, then, depending on the course, CEs may be accepted for the courses if they apply to the specific nurse’s area of expertise. Writing for publication in a professional journal or book may also be accepted as CEs.

The cost of the programs, membership, and courses vary depending on the length and the speakers. If nurses want to have their own copies of publications, take courses or have membership in professional organizations to receive

Time Equivalencies (CE = 1 contact hour)

1 contact hour 60 minutes

1 academic semester hour (cannot audit) 15 contact hours

1 academic quarter hour (cannot audit) 12.5 contact hours

1 CME (Continuing Medical Education) 1 contact hour

1 CNE (Continuing Nursing Education) 1 contact hour

1 AMA 1 contact hour

Presenter/lecturer presentations to health professionals 60 minutes = 5 CE hours(not for full time educators teaching as a part of theiremployment)

Author a paper 10 CE hours

Author a publication/article 10 CE hours

Dissertation 20 CE hours

Author a book chapter 20 CE hours

Research project (completed during renewal period) 20 CE hours

Preceptor to APN student (need documentation) 10 CE per academic semester or quarter (cannot get more than 20 CE hours in each renewal period)

Recertification exam in APN’s area of specialty 50 CE units

Section 1300.130 Continuing Education, Section a2, b

Mary C. Shoemaker

info on CE programs, many will do so in the future. Cost for these journals, courses, or memberships range from a few dollars to several hundred. Many employers will pay for part or all of the programs attended by nurses, but may have stipulations of the amount. The health care agencies may also have the ability to be providers of CEs.

Nurses who attend programs or use web sites will receive certification at the end of the program or the certificate will be mailed to the nurse. Nurses receive information on the status of their membership in organizations when the membership is due.

The establishment of rules saying that nurses, whether Licensed Practical Nurses, Registered Professional Nurses, or Advanced Practice Nurses, need to obtain CEs from this next renewal in 2010 to 2012 for Registered Professional Nurses and Advanced Practice Nurses and 2011 to 2013 for Licensed Practical Nurses perhaps makes many nurses unsure of their ability to obtain the CEs. Most of the nurses obtain that number of CEs or more in two years now. This may seem a challenge to nurses, but we have met many challenges face to face and succeeded. Nurses can do this and the requirement can make nurses much more up to date with what is going on in their specified fields. Overall, having to get CEs will ultimately benefit our patients, and healthcare is all about the patient. If you have questions regarding the need for more information, please go on the web site for the Illinois Department of Financial and Professional Regulations to: http://www.idfpr.com/dpr/WHO/nurs.asp.

**Dr. Shoemaker is the Associate Dean, Institutional Research Professor, Saint Francis Medical Center College of Nursing

ReferencesIllinois Department of Financial and Professional

Regulations. (2007). Illinois Nurse Practice Act. Retrieved March 4, 2010 from http://www.idfpr.com/dpr/WHO/nurs.asp

Illinois Department of Financial and Professional Regulations. (2010). Illinois Registered Professional Nurse Continuing Nursing Education Option Availability


Continuing Education OfferingHigh-Fidelity Manikin-Based Simulation Learning (HFMBSL)

For Registered Nurses in an Acute Care Settingby Melissa A.Burdi, MS, RN,

Debra L. Weiderman, MS, RN (INA member), and Libby A. Zamis, MS, RN

CE OFFERING1.0 CONTACT HOURS---------------------------This offering expires in 2 years:June, 2012----------------------------------The goal of this continuing education offering is to provide information on Telemedicine and its implications to nursing practice. The objectives of this article are:1. Define High-Fidelity Minikin-Based Simulation

Learning2. Compare and Contrast HFMBSL as it relates to

critical thinking and nurse competency3. Identify strategies that justify the cost-benefit of

HFMBSL4. Summarize the value of HFMBSL as it relates to

patient safety.

High quality and safe nursing care are imperative attributes pertinent to the nursing workforce that compel nursing administrators to focus heavily on effective and efficient patient care processes to facilitate high-caliber outcomes. Leaders in the acute care setting are faced with constant challenges due to the continuous changes in today’s healthcare industry. Using creative technology, which promotes and sustains a high quality patient care environment, is one way many nursing leaders are attempting to address this need. Because of the level of patient acuity and the rapid advancements in technology, nursing administrators need to provide the most authentic patient situations possible for staff’s skill development and assessment, while ensuring the highest level of patient safety. One such way of balancing authenticity and safety is to utilize high-fidelity mannequin-based simulation for skill development and assessment.

Simulation technology has been used in the military and the airline industry for decades. It allows pilots to safely practice take-offs and landings as well as to manage potential emergency events with no risk to human life (Beyea & Kobokovich, 2004). The healthcare industry commenced using simulation technology when it realized the benefits in other industries. The University of Southern California (USC) created the first computerized patient simulator in 1967 and several companies have been attempting to perfect it since that time (Rogers, 2007). “A human patient simulator is a highly sophisticated, technologically advanced mannequin in adult, child, or infant size. These mannequins fully integrate with computer software that supports the development of preplanned scenarios that mimic a wide variety of clinical situations.” (Beyea & Kobokovich, para. 2).

High-fidelity mannequin-based simulation technology was adopted into the healthcare arena for the purpose of assessing the acquisition of knowledge (Martin, 2002), synthesis and applicability of material, and transferring the knowledge gained into a skill set at the patient’s bedside. World-wide, one-third of medical schools and hundreds of medical centers, colleges and universities use HFMBSL (Good, 2003). Over 356 simulation centers were established in the United States between the years of 1994-2005, and the top two simulation vendors sold over 4000 devices worldwide (Kyle & Murray, 2008). Nurse researchers and clinicians began using human patient simulation to develop competencies, provide interdisciplinary training (such as high-risk, low-volume events), and learn more about ways to increase patient safety (Beyea & Kobokovich, 2004).

Critical thinking has been researched for the last 20 years, however it remains an ambiguous concept that is difficult for clinicians to clearly define or measure. Critical thinking includes “questioning, analysis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity” (Riddell, 2007). Martin (2002) explains that the growing shortage in the nursing workforce requires nurses to have greater autonomy and have strong critical thinking skills. Martin also suggests that as the nurse’s scope expands the level and amount of critical thinking necessary to provide safe patient care increases as well.

Nurse competence affects patient safety, outcomes, and quality of care. The American Nurses Association’s (ANA) scope and standards for nursing administrators, as it relates to this integrative review, include: identification of outcomes, evaluation, quality of care, and performance appraisal (American Nurses Association, 2004). “Nurse administrators … must be able to lead a group of healthcare workers, composed primarily of nurses, toward the best possible outcomes for patients and for the healthcare team” (Yoder-Wise & Kowalski, 2006, p. 4). The Institute of Medicine’s (IOM) definition of quality of care reflects the importance of attaining desired health outcomes (McGlynn, 1997).

Shi & Singh (2008), in their book Delivering Health Care in America, describe dimensions of quality as having a micro- and macroview. The microview of quality includes clinical aspects (caregiver skill level, processes, interventions, outcomes, and cost) and interpersonal aspects (caregiver’s demeanor, concern, and interactions which increase compliance and treatment success) (Shi & Singh). These microview aspects are reflected in del Bueno’s dimensions of competent performance in nursing (del Bueno, Weeks & Brown-Stewart, 1987). Thus, the foundation of the scope and standards for nursing administrators is to ensure that competent staff is at the bedside.

Leaders in the acute care setting are faced with constant challenges due to the continuous changes in today’s healthcare industry. “Patients are more acutely ill and have shorter lengths of stay, placing greater demands on nurses who must demonstrate competency in caring for increasingly complex patients in a continually changing healthcare environment” (Whelan, 2006, p. 198). The National Council for State Boards of Nursing (as cited in Tilley, 2008, p.59) define competency as, “the application of knowledge and the interpersonal, decision-making, and psychomotor skills expected for the practice role, within the context of public health.” Because of the level of patient acuity and the rapid advancements in technology, nursing administrators need to provide the most authentic patient situations possible for staff’s skill development and assessment, while ensuring the highest level of patient safety.

The challenge with HFMBSL is to link performance in this controlled environment with delivered quality care (Wayne, Didwania, Feinglass, Fudala, Barsuk, & McGaghie, 2008). Another challenge is justifying the high cost of purchasing a simulator. It must be used efficiently and effectively to produce an acceptable return on the facility’s investment (Murray & Schneider, 1997).

Simulation has been used in the aviation and military fields since the early 1900’s and in anesthesia training for several decades (Henrichs, B., Rule, A., Grady, M., & Wayne, E., 2002; Long, 2005). Resusci-Anne was the first simulation mannequin which was developed by Peter Safar and Asmund Laerdal in the early 1960s (Fritz, Gray, & Flanagan, 2008). The first computerized simulator was created in 1967 but was not widely used due to its prohibitive cost (Fritz et al., 2008).

Since the mid-1990’s companies have been producing high-fidelity simulators which have different levels of capabilities; all able to imitate reality but none able to duplicate it (Fritz et al.). Recently, simulation has been incorporated into health care education and has now been, “Firmly established as a crucial component of training” (Kneebone et al., 2006, p. 919). Simulation assists with bridging theory to practice (Beyea, Von Reyen, & Slattery, 2007; Hogg, Pirie, & Ker, 2006), promotes safe practice in professionals (Hogg et al.), focuses on the needs of the learner (Kneebone et al.), and allows for mastery of skills without placing patients in danger (Beyea & Kobokovich, 2004; Kneebone et al.).

Cost-Benefit/EffectivenessOne of the focus areas to achieving Magnet status is

the area of clinical research. HFMBSL allows for study in many areas such as response time and appropriateness of actions, assessing competency, and record-keeping during events, as well as effects of fatigue on performance, room design, equipment placement, and data acquisition (Murray & Schneider, 1997). As a result, this contributes to the cost effectiveness of purchasing the equipment.

“The indirect costs associated with nursing preceptorships and competency development may range from $3,000 to $12,000 per nurse. These costs reflect only

the nonproductivity associated with learning the job, not the selection or recruitment costs.” (del Bueno, Weeks, & Brown-Stewart, 1987, p. 21). Del Bueno, Weeks, & Brown-Stewart recommend designating an Assessment Center which includes simulation to help reduce these costs. They were able to reduce their nonproductivity costs by 20-35% after initial implementation of such a center. Del Bueno et al. asserts that if start up costs are around $100,000 the facility can recoup this quickly with a hiring plan that could include cross-training of at least 100 healthcare workers per year. A one-third reduction in orientation time to the Intensive Care Unit was noted after implementation of this program. The facility can also rent their space to smaller hospitals, making it more efficacious for both facilities.

Human Patient Simulators have significant costs attached to them. Initial cost to purchase a simulator can be up to $250,000 with additional annual maintenance costs of greater than $10,000. This does not include the cost of updating the equipment when technology changes (Block et al., 2003; Tuoriniemi & Schott-Baer, 2008; Binstadt, Walls, White, Nadel, Takayesu, Barker, et al., 2007). Operational costs may exceed $500 per hour when personnel costs are factored in (Murray & Schneider, 1997).

According to Murray & Schneider (1997) simulation is more cost effective if one considers the actual hours needed to achieve proficiency using actual patients. It takes clinicians considerably longer to achieve a knowledge base waiting for patients to present with certain diagnoses than if they were to use a simulation setting to replicate the scenario. Considering operating room cost at $1000 per hour with 13,500 cases per year, and assuming every procedure is prolonged by 30-60 minutes for teaching, the cost of learning becomes quite high (Murray). Also considered was the lack of travel needed to off-site training facilities and the ability to use the simulators at times convenient to employees (Weinstock, Kappus, Kleinman, Grenier, Hickey, & Burns, 2005).

Tuoriniemi et al. (2008) identified the high costs of creating a simulation laboratory which are estimated to be from $200,000 to $1.6 million, and states that it is time-consuming. The laboratory must have a dedicated space, actual equipment used on patient units, compressed air and gases, technical support, and expert staff to create realistic scenarios (Rothgeb, 2008).

In a Canadian simulation project Good (2003) reported a start-up costs of $665,000 which included renovations, the simulator, supplemental equipment, audio-visual electronics and oversight personnel. Good also cited first year operating costs of $167,250 reflecting staff salaries (70% of cost), simulator upgrades, and maintenance, and recommended these costs come from third party funding such as, donations, corporate sponsors, government programs and specific departments who will use the simulator. Iglesias-Vasquez, Rodriguez-Nunez, Penas-Penas, Sanchez-Santos, Cegarra-Garcia, & Barreiro-Diaz (2007) suggested that manufacturers make a concerted effort to produce human simulators at a more reasonable price which will, in turn, increase the implementation of these programs.

Nurses in administration need to be able to determine cost benefit and effectiveness in order to achieve desired outcomes for the least determined cost when evaluating annual budgets. The cost of technology may outweigh the benefits at times, but is necessary to remain current in the marketplace. In order for a facility to be top in the marketplace, it must be able to foster improvement and innovation and still make a profit. Finally, the nurse manager needs to justify a return on investment using cost benefit and effectiveness strategies (Finkler, 2001).

Critical ThinkingOral and written exams assess a clinician’s knowledge

base and ability to reason in a controlled environment without the demands of actual practice. In actuality, clinicians need to simultaneously apply their knowledge and cognitive abilities, use hands-on psychomotor skills, and work through complex interpersonal behaviors with team members (Gaba & Small, 1997). Murray and Schneider (1997) state that comprehension and knowledge acquisition are best taught in classrooms, but clinical training, which involves higher levels of cognition such as analysis and synthesis, are more thoroughly learned

HFMBSL continued on page 10


Continuing Education Offeringthrough realistic simulation. Problems can be repeated as the clinician considers various treatment options without the stress of ‘live’ patient encounters (Raemer & Barron, 1997).

Through programming, Human Patient Simulators can interact with clinicians like an actual patient thus promoting the application of critical thinking skills (Nehring & Lashley, 2004, Beyea & Kobokovich, 2004). Improvement in patient care occurs by allowing healthcare workers to make errors that do not harm a patient, providing repetition of rarely used skills, and exercising of teamwork skills to build collaborative abilities (Beyea & Kobokovich, 2004). Adverse events can be explored by allowing clinicians to role play and examine conditions, circumstances, and root causes in a practical setting. Concepts related to patient safety can be incorporated into the scenarios to provide clinicians an opportunity to concurrently learn these approaches as well as the clinical skills needed to support patient safety (Beyea & Kobokovich, 2004). Videotaping the sessions and debriefing afterwards becomes a powerful self-assessment tool as well (Gaba & Small, 1997).

Salas and Burke (2002, p. 120) suggest that “The level of simulation fidelity needed should be driven by the cognitive and behavioral requirements of the task and the level needed to support learning.” HFMBSL uses an event-based approach to training (EBAT) which relies on scenarios embedded with multiple events at differing time intervals. Experience through practice generates knowledge acquisition within meaningful contexts (Salas & Burke).

Furthermore, in 1979, the National Aeronautics and Space Administration (NASA) developed an educational curriculum known as Crew Resource Management (CRM) as a result of statistical analysis that linked aircraft crashes to pilots’ lack of teamwork, exercise in leadership, and critical thinking skills. CRM identifies 6 elements of performance that are crucial to the success of their program. These include: situational awareness, problem identification, decision making, workload distribution, time management, and conflict resolution. These concepts have been linked to the Relationship-Centered Care model in healthcare, where interactions between the patient and multidisciplinary team are essential to successful patient outcomes (Oriol, 2006).

Simulation has expanded its use to incorporate emergency medicine preparation, disaster training, and obstetrical training. According to the AHRQ (2008, Ch. 51, p. 8), “the versatility and adaptability of the technology provide a broad range of uses for the patient simulator,” and provides an alternative teaching methodology for bedside nurses in the acute care setting that fosters scenario based training in a controlled environment. This teaching methodology ultimately leads to enhanced critical thinking skills at the bedside and high quality patient care.

Psychomotor and Interpersonal CompetencyBefore competence can be assessed, learning on the part

of the performer needs to occur (Schmalenberg et al., 2008; Tilley, 2008; Wright, 2005). Malcolm Knowles, the father of adult learning (andragogy), drew upon John Dewey’s and Eduard Lindeman’s beliefs that adults’ education should be based on situations, experiences, and interests; as well as Confucius, Aristotle, Socrates, and Plato who believed learning was a process of active, engaging mental inquiry and experiential learning (Knowles, Holton, & Swanson, 2005). Knowles established six principles to adult learning: adults have (1) an intrinsic need to know, (2) self-responsibility, (3) a lifetime of experiences, (4) an innate readiness to learn, (5) a life-centered orientation to learning, (6) internal motivators (Rodgers, 2007). All six principles can be observed in the use of high-fidelity simulation (Rodgers).

In the 1980’s, The Joint Commission (formerly known as The Joint Commission on the Accreditation of Healthcare Organizations) set forth standards and guidelines for hospitals to assess the competence of nursing staff (Miller, 2007). Although competence is defined by Merriam-Webster as having adequate abilities (Merriam-Webster, 2008), Schmalenberg et al. (2008) found in interviews with 244 RNs, 105 managers, and 97 physicians in eight Magnet hospitals that competence is more than adequacy in skill, “… adequacy produces safe care, competency produces quality care” (p.56).

The following are the competency domains described by interviewees in order of frequency beginning with most frequently cited: (1) autonomous clinical decision making, (2) prioritizing and multitasking, (3) interpersonal competence, (4) technical skill competence, (5) knowledge competence, (6) quality of patient outcomes (Schmalenberg et al., p.57). These are closely related to the six domains of medical practice as identified by the Accreditation Council for Graduate Medical Education (Issenberg, McGaghie, Petrusa, Gordon, & Scalese, 2005) in which Miller (1990) proposed there are four levels to assess the medical learner: (1) knows, (2) knows how, (3) shows how, and (4) does.

Tilley’s (2008) concept analysis on competency in nursing reports the current, dominant method for assessing competence, after initial nursing licensure, is through traditional education. The IOM has determined there is little proof that this traditional approach has any effect on competency performance and health outcomes (Tilley). That is why del Bueno’s three dimensions of competence performance are so important. If a nurse performs a procedure correctly and critically thinks through what is occurring with the patient but is rude and condescending, the organization’s goals of high-quality, safe care and high patient satisfaction are not accomplished (Miller, 2007). The opposite is just as true where the nurse can be the nicest, most caring person the patient has ever dealt with, but the nurse fails to competently perform an assessment or procedure, again the organization’s goals are not attained (Miller, 2007). All three domains must be included to accurately and comprehensively assess competence. Authenticity during assessment of competence should be a high priority which simulation provides.

Throughout the literature it is reported that pilots, astronauts, military personnel, business executives, and nuclear power plant personnel all develop knowledge and skill by using simulation technology (Issenberg et al.). Shorter inpatient stays decrease opportunities for healthcare providers to practice their skills and advancements in technology necessitate innovative ways in educating staff and providing opportunities to safely practice techniques (Issenberg et al.) Ericsson and several colleagues identified principles that direct acquisition of skill expertise (Issenberg et al.). These principles focus on deliberate practice which entails: repetitive practice in cognitive and/or psychomotor skills, rigorous assessment, direct and specific feedback, and a controlled setting (Issenberg

et al.). Deliberate practice is required for acquisition and maintenance of expert performance of skills (Ericsson, 2008) which high-fidelity simulation provides. Results from the Best Evidence Medical Education (BEME) systematic review performed by Issenberg et al. showed that high-fidelity simulation facilitated effective learning when it provided feedback, repetitive practice, curriculum integration, range of difficulty and clinical variation, and a controlled environment. Thus, high-fidelity simulation provides deliberate practice which facilitates skill mastery.

“International reports such as the National Health Services, Institute of Medicine, and The Joint Commission convey that human factors such as communication and team work often play a major role in adverse events” (Guise et al., 2008). Simulation, especially when videotaped, provides an opportunity to reflect on conversations, interpretations, delegation, and even emotional responses in a safe environment. Guise et al. developed a tool, which their 2008 study showed was valid and reliable, objectively evaluating teamwork during simulations by using 15 items with in five conceptual domains. The five domains are: communication, situational awareness, decision making, role responsibility, and patient-friendliness (Guise et al.). Within these domains are the following items: orientation of new members, transparent thinking, directed communication, closed loop communication, resource allocations, target fixation, prioritization, role clarity, and performance as a leader/helper (Guise et al.).

Simulation has been incorporated into the nursing curriculum of many academic programs at undergraduate and graduate levels to facilitate and expand critical thinking and psychomotor skills along with assessing nursing competency. It also serves as a tool to bridge the gap between the academia and practice setting. Simulation has also recently gained a growing sense of popularity among global healthcare organizations as a result of various safety recommendations issued from the Institute of Medicine (IOM) and accreditation facilities.

In 1999, the IOM estimated that 44,000 deaths per year occur directly as a result of human error in medical care (To Err is Human: Building a Safer Health System, 1999). This data prompted the medical industry to develop innovative ways to reduce human error and to increase patient safety. As a result of the IOM findings, HFMBSL has been identified as an opportunity that will advance both critical thinking and psychomotor skills in a controlled environment without impacting patient safety at the bedside (Seong, L., Pardo, M., Gaba, D., Sowb, Y., Dicker, R., & Straus et. al, 2003). Therefore from an administrative perspective, it is essential for nursing organizations to possess a highly skilled nursing staff able to provide bedside care with a high standard of nursing competency. Simulation is an alternative teaching strategy that will facilitate this.

Nursing research of HFMBSL lags behind medicine, the armed forces and aviation. A sustained body of research is needed that explores the full potential of HFMBSL (Leigh, 2008). Included in this research should be cost-benefit/effectiveness analyses of HFMBSL technology. Facilities need to be able to identify the cost of doing business and how HFMBSL can impact gaps to improve overall organizational performance to meet their goals and objectives (Kyle & Murray, 2008). It is important to measure cost-benefit/effectiveness across different types of services to determine appropriate use of the investment. “Until an algebraic cost/return model can be built that can project the return on investment, it may suffice to point out that, intuitively, training performed in the OR/ED costs in the hundreds of dollars per minute, while simulation training costs in the tens of dollars per minute.” (Kyle & Murray, 2008)

Simulation activities have been proven to increase self-confidence (Jeffries, 2005). Feingold, et al. (2004) indicated that being able to make clinical decisions using HFMBSL increased confidence levels. Critical thinking has been measured and occurs as an outcome of HFMBSL (Jeffries, 2005). Using multilogic thinking, participants can work through positive and negative outcomes using HFMBSL that result in transfer of knowledge to the bedside (Kuhrik et al., 2008). HFMBSL provides the opportunity to practice and reinforce critical thinking (Feingold et al., 2004). Feingold, et al. (2004) studied transferability of competence to a real setting, including development of psychomotor skills, and found a positive correlation with HFMBSL.

M. Burdi, MS, RN and L. Zamis, MS, RN work in the education department of Central DuPage Hospital. D. Weiderman, MS, RN is Director, Marketing & Member Services for INA.

HFMBSL continued from page 9

HFMBSL continued on page 11


Continuing Education OfferingHOW TO EARN

CONTINUING EDUCATION CREDIT

This course is 1.0 Contact Hours

1. Read the Continuing Education Article2. Take the test on the next page3. Complete the entire form

DEADLINEAnswer forms must be postmarked by

June 1, 2012

1. Mail or fax the completed answer form. Include processing fee as follows:

INA members—$7.50Non members—$15.00

Check or money order payable to INAor credit card information only

MAIL: Illinois Nurses AssociationAttn: Sharon Canariato 105 W. Adams, Suite 2101 Chicago, IL 60603

FAX: Credit Card Payments Only 312-419-2920

ACHIEVEMENT• Toearn1.0contacthoursofcontinuingeducation,

you must achieve a score of 75%• Ifyoudonotpassthetest,youmaytakeitagainat

no additional charge. • Certificatesindicatingsuccessfulcompletionofthis

offering will be emailed to you

ACCREDITATIONIllinois Nurses Association is an approved provider of continuing nursing education by the Georgia Nurses

Association, an accredited approver by the

American Nurses Credentialing Center’s Commissionon Accreditation.

Test Questions1. A human patient simulator is:

a. a highly sophisticated, technologically advanced mannequin in adult, child, or infant sizeb. can fully integrate with computer softwarec. supports the development of preplanned scenarios that mimic a wide variety of clinical situationsd. All of the above

2. Simulation technology has been used in the Military and Airline industry for decades.a. Trueb. False

3. Human patient simulation can be used to:a. develop competenciesb. provide interdisciplinary training in high-risk, low-volume eventsc. increase patient safety d. all of the above

4. Critical thinking includes all of the following except:a. Questioningb. Analysisc. Phone etiquetted. inductive and deductive reasoninge. creativity

5. It is difficult for nursing administrators to provide the most authentic patient situations possible for staff’s skill development and assessment because:a. Patients are more acutely ill and have shorter lengths of stay b. Rapid advancements in technology make it difficult to remain currentc. They are too busy with other projectsd. It takes clinicians considerably longer to achieve a knowledge base waiting for patients to present with certain diagnosese. All of the abovef. A, B, & D

6. Which of the following is true about HFMBSL?a. Simulation does not assist with bridging theory to practice b. Allows for mastery of skills without placing patients in dangerc. Does not promote safe practice in professionals d. Does not focus on the needs of the learner

7. Initial cost to purchase a simulator can be up to $250,000 with additional annual maintenance costs of greater than $10,000.a. Trueb. False

8. Improvement in patient care occurs by:a. Allowing healthcare workers to make errors that do not harm a patientb. Providing repetition of rarely used skillsc. Exercising of teamwork skills to build collaborative abilities d. Allowing clinicians to explore adverse events by allowing them to role play and examine conditionse. All of the above

9. Adult learning principles include all of the following except: a. Adults have an intrinsic need to knowb. Adult learners draw on a lifetime of experiencesc. Adult learners need frequent napsd. Adult learners have an innate readiness to learn

10. High-fidelity simulation facilitates effective learning when it:a. Allows for repetitive practiceb. Provides feedbackc. The curriculum integrates range of difficulty and clinical variationd. Uses a controlled environmente. None of the abovef. All of the above

(Submit entire form below for contact hours)

ANSWER FORMCE #24: HFMBSL: for RNs in Acute Care

Please circle the appropriate letter

1. A B C D2. A B 3. A B C D4. A B C D E5. A B C D E F6. A B C D7. A B8. A B C D E9. A B C D10. A B C D E F

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Learner achievement of objectives:1. Define High-Fidelity Minikin-Based Simulation Learning 5 4 3 2 12. Compare and Contrast HFMBSL as it relates to critical thinking and nurse competency 5 4 3 2 13. Identify strategies that justify the cost-benefit of HFMBSL 5 4 3 2 14. Summarize the value of HFMBSL as it relates to patient safety 5 4 3 2 1

How many minutes did it take you to read and complete this program? ___________________________________________________________

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Illinois Simulation Asset Mapping: Expanding Education Capacityby Linda Roberts, MS, RN

IDFPR, Manager Illinois Center for Nursing

BackgroundThere is a growing demand for healthcare professionals

in Illinois. Expanding educational capacity is vital to ensuring the supply of a well qualified and highly skilled workforce.

The Illinois Center for Nursing (ICN) was established in 2006, and is located within the Illinois Department of Financial and Professional Regulation (www.nursing.illinois.gov). The ICN is working with industry professionals and educational institutions to ensure that Illinois has a nursing workforce necessary to meet the demands of a growing and aging population. Regional stakeholders and State agency leaders have developed frameworks that focus on workforce transition points including expanding education program capacity.

In June 2008, the State of Illinois, along with eighteen other states, was chosen to participate in a national summit on nursing education capacity, sponsored by the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation.

The IDFPR/Illinois Center for Nursing was identified as primary lead in this project with support from the Metropolitan Chicago Healthcare Council (MCHC), mid-state Team Illinois members: Central Illinois Nursing Initiative (CINI) in Springfield, the Central Illinois Regional Collaborative Effort (CIRCLE) in Bloomington-Normal and Man-Tra-Con Corp./Connect SI in southern Illinois. The first step in the simulation action plan was to develop a survey to map current simulation laboratory capacity in Illinois.

In 2009 the ICN Advisory Board developed the survey to map clinical simulation labs in Illinois, the level of simulation in use, and the primary users of these facilities. Definitions of simulation were created and accompanied the survey. The survey and definitions were vetted with a convenience sample of nursing simulation lab experts.

Survey results show that there is a willingness to consider collaboration throughout the State of Illinois to develop a strong simulation program for health care professionals.

ObjectivesMap out clinical simulation lab space in the state of

Illinoisdentify ways programs are using simulation for

teachingIdentify resources facilities need to utilize

simulation laboratories for educationDetermine needs and collect data for potential

future collaboration and fundingDetermine areas in which health care institutions

and organizations are willing to consider collaboration on simulation education

MethodologyThe IDFPR/Illinois Center for Nursing (ICN), in

partnership with the Metropolitan Chicago Healthcare Council (MCHC), Illinois Hospital Association (IHA) and The Illinois HomeCare Council (IHCC) distributed an on-line survey of Illinois health care simulation labs in May, 2009. Over 124 Illinois Nursing Education Programs, 8

Medical Education Programs, 200 hospitals and 263 IHCC members within Illinois received the survey.

The ICN Advisory Board of Directors adapted definitions, primarily from the National League for Nursing (NLN), for distribution with the survey: simulation, low, medium and high fidelity simulation and standardized patient. Initially two separate surveys were developed, one for distribution to health care institutions, and one to educational institutions. These surveys were then vetted through a convenience group of Illinois nursing simulation lab experts. While working with MCHC, IHA, and IHCC, in part to facilitate survey participation, the questions were collapsed into one survey for on-line distribution.

FindingsOverall 150 Illinois institutions responded to the survey,

of which:• 65Responseswerefromnursingschools

• 34 two year schools of 46 total in Illinois• 26 four year schools of 30 total in Illinois

• 2LPNprograms• 2BSNcompletionprograms• 1Hospitalprogram• 9Medicalschoolcampusesrespondedtothesurvey.

Forty-six percent of the institutions acknowledged having a clinical simulation lab. 66.2% have conducted high fidelity programs, defined as the degree of realism or accuracy of the system used and simulations by M.A. Seropian (2004).

The majority of those responded showed a willingness to consider collaboration with other healthcare institutions or organizations with sharing and developing simulation scenarios, and developing professional staff.

ConclusionsResults indicate that there is interest in developing a

simulation consortium for expansion and coordination of healthcare simulation opportunities in Illinois with

hospitals, health institutions, nursing, medical and allied health schools. Therefore, next steps should include identifying best practices and funding resources to further facilitate and promote an interdisciplinary and collaborative alliance for leveraging the expansion of clinical simulation opportunities within the State of Illinois.

This alliance would not only be for the development of nursing education, it will be a resource for all healthcare programs in the state.

ReferencesJeffries, Pamela R. DNS, RN, FAAN., Rizzolo, Mary Anne,

Ed.D, RN, FAAN. (2006) Designing and Implementing Models for the Innovation Use of Simulation to Teach Nursing Care of Ill Adults and Children: A National, Multi-site, Multi-Method Study. Project Sponsors: National League Nursing and Laerdal Medical.

Illuminate. Asset Mapping Roadmap: A Guide to Assessing Regional Development Resources. (2007). Council on Competitiveness as prepared for the U.S. Department of Labor’s Employment and Training Administration.

NLN Bibliography on Simulation (with Annotations by Carol S. Coose, EdD, RN, CNE).

Seropian, M.A., Brown, K., Gavilanes, J.S. & Driggers, B. (2004). Simulation: Not just a manikin. Journal of Nursing education, 43 (4), 164-169.

AcknowledgementsThe IDFPR/Illinois Center for Nursing (ICN) wishes to thank

the following associations: Oregon State Simulation Alliance, Texas Statewide Health Coordinating Council, Illinois Coalition of Skill Lab Coordinators (ICSAL) and individuals: Pam Jeffries, DNS, RN, FAAN, Associate Professor and Associate Dean of Undergraduate Programs, Indiana University; Cynthia Reese, PhD, RN, CNE, Lake Land Community College, Mattoon, IL; Carol Shinn, MS, RN Methodist College of Nursing, Peoria, IL; Suzanne Brown, RN, PhD and Theresa A. Hoadley, PhD, RN, TNS, St. Francis Medical Center College of Nursing, Peoria, IL; Pam Aitchison, RN, Center for Simulation Technology and Research, Highland, IL; for their guidance and expertise in initiating this project.

The Illinois Center for Nursing, in partnership with the Metropolitan Chicago Healthcare Council (MCHC), acknowledges the assistance of the Illinois Hospital Association (IHA), the Illinois HomeCare Council (IHCC), The University of Illinois College of Medicine (four campuses), Northwestern University Medical School, The Chicago Medical School, Rush Medical College of Rush University, The University of Chicago Pritzker School of Medicine, Chicago College of Osteopathic Medicine, Southern Illinois University School of Medicine, and Loyola University, Stritch School of Medicine, in the distribution of the on-line survey.

Illinois Center for Nursing Advisory Board: Chairperson Michele L. Bromberg, Susan Campbell, Kathryn E. Christiansen, Nancy Cutler, Linda Fahey, Donna L. Hartweg, Mary Lebold, Marcia Maurer, Donna Meyer, James Renneker, Maureen Shekleton and Deborah A. Terrell.


INA District NewsDistrict 2—First Recipient of

Scholarship

by Mary Bortolotti, INA D-2 President

Congratulations to Diana Cafi BSN, RN, CLCN for being the first recipient of the Illinois Nurses Association’s, District 2 scholarship of $500.00. She is presently a student at the University of Phoenix. She is pursuing a dual degree of Masters of Science in Nursing and a Masters of Health Administration. Diana believes that advancing one’s nursing education can empower nurses. We believe that Diana is a credit to nursing and an outstanding patient advocate. She is well thought of by her instructors, fellow students and co-workers. We wish her only the best in all her future endeavors.

Please stay tuned for the 2011 scholarship applications in a future issue of Illinois Nurse.

District 3—2010 Nursing EXPO A Great Success

by District 3 Board Members: Wealtha Helland, Thelma Warner, and Sharon Peterson

The first Nurses EXPO was started in 1981 by students and faculty of the BSN program at UIC in Rockford. EXPO was primarily the brain child of Carol Klint and 3 students—Rita Wolvan, Linda Schmit, and Pat Ritzman. These students were in their nursing leadership course. EXPO was envisioned as a way to get nurses together to have fun, learn, socialize, and care for each other away from the workplace. The first EXPO was held at Regents Hall at Rockford College in the spring of 1981. INA

District 3 provided the initial leadership and funding for EXPO. Later EXPO developed its own committee structure with a mixture of INA and non-INA nurses, budget, and processes but the link with INA is historical, financial and ongoing.

EXPO begins on Thursday evening with greetings from INA District 3 and the EXPO Chair. The highlight of the evening is the awarding of the INA District 3 scholarships and the nursing awards. INA District three provides four $1000.00 scholarships, one each in the following categories: Pre-licensure, BSN Completion, Masters level and PhD level. The scholarship recipients were Pre-Licensure Bonnie Grant, BSN completion Christopher Mills and Graduate Jennifer Blixt-Ward. The Excellence in Nursing Award had three winners Christine Anderson, Linnette Carter and Theresa Fritz. Distinguished Advocate for Nursing Award was presented to Julie Luetschwager. Additionally, six evidence-based posters were on display in the exhibit hall. The posters provided a reflection on some of the many wonderful projects going on in our nursing community. There is a Thursday evening key note speaker and the exhibits and poster presentations are available for viewing. EXPO continues on Friday with a morning and afternoon key note speaker, and several breakout sessions. Continuing education credits are available for all of the key note speeches and the breakout sessions.

For the past several years we have also collected food and money for the Rock River Valley Pantry. This year we collected 95 pounds of food and $28.00. The food was given out by the pantry to needy persons within 48 hours of the collection.

EXPO continues to fulfill the aspirations of its founders by serving thousands of nurses in our community. Next year’s event is already being planned. Please consider attending!

The Illinois Nurses Association Is Excited To Announce a New and

Improved CHART

Beginning in October, members of INA will once again receive a print version of the peer-reviewed journal CHART. In order to make CHART relevant to our members INA has devised a survey. Please follow the enclosed link or visit www.illinoisnurses.com to click on the link (INA homepage) and take a moment to answer a few brief questions. This will help us make CHART the journal YOU want to read!

https://www.surveymonkey.com/s/NF6YZDRWe are also looking for contributors, so dust off

your notebooks and send in your articles. Criteria for submission of articles can be found at www.illinoisnurses.com, About INA, Publications/Illinois Nurse.

What Do Illinois Nurses Value in a Nursing

Association?by Andrew Case, DePaul University Masters in

Nursing Student

Attention Illinois nurses. The Illinois Nurses Association (INA) would like to know what you value in a nursing association. With DePaul University graduate nursing student Andrew Case, INA is conducting a short research survey in order to answer this question. The results of this research will be shared with the INA and used to tailor the INA’s services to better meet the needs of Illinois nurses. This survey will only take 10 to 15 minutes to complete, and is open to all nurses living or working in Illinois.

Whether you are a member of the INA or not, the organization’s activities likely affect your nursing practice. In order to ensure that they are meeting the needs of Illinois nurses they need your feedback. Your participation is voluntary, and will go a long way in helping the INA achieve its goal of improving nursing practice and supporting nurses in Illinois. If you would like to participate in this survey, please visit the INA’s homepage at www.illinoisnurse.com and click on the link entitled, “What do Illinois nurses value in a nursing association survey?”

CEAU

by Kemi Ani, Associate DirectorContinuing Education

The Illinois Nurses Association has successfully applied for and retained its national accreditation status from the American Nurses Credentialing Center (ANCC) Accreditation Program. This status was initially achieved in 1974 by INA which is one of ANCC’s pioneering Approver Units.

WHAT DOES APPROVER STATUS MEAN?The INA Continuing Education Approver Unit (CEAU)

approves offerings for continuing nursing education (CNE) credits or contact hours that agencies or organizations provide to nurses. CNE activities with a minimum of 30 minutes of content are eligible for approval.

WHAT IS CONTINUING NURSING EDUCATION?Continuing nursing education is defined as “that

which involves professional learning activities designed to augment the basic knowledge, skills and attitudes of nurses and therefore enrich the nurses’ contributions to quality health care and their pursuit of professional career goals.” (i.e., the knowledge, skills and/or attitudes gained from continuing education activities can be applied regardless of the employer of the learner.)* An educational activity may be a traditional lecture-style presentation, teleconference, web-based opportunity such as a live webinar and independent study article in a nursing journal.

WHAT IS THE PROCESS?The application process is as follows:• Visit the Illinois Nurses Association website,

http://www.illinoisnurses.com and click on the “continuing education” tab on the left side.

• Click on the “Download Individual Activity CEDocuments” tab which will take you to the web page that includes the reference materials and application forms to be downloaded.

• It is important to first of all review the eligibilitycriteria.

• Each application is assessed by nursing peers todetermine that the individual activity meets the criteria for a two-year CNE recognition period.

• The applicant organization is provided with anapproval number for the certificates that it awards to the participants.

Once three individual activities are approved and at least one designated BSN RN planner is in place, an agency or organization may be eligible to apply to become an Approved Provider Unit. This three-year status is found to be very cost effective and time efficient. As an Approved Provider, the organization has achieved recognition to award CNE credits for unlimited continuing education offerings without requesting approval from INA for each activity.

ADDITIONAL INFORMATIONAdditional information is available when you can

contact the Continuing Education Approver Unit at the INA Chicago office, 312-419-2900 or [email protected].

The INA CEAU is committed to promoting and supporting quality continuing nursing education. This is particularly significant as the 2007 Nurse Practice Act mandates 20 continuing education hours for license renewals.

Congratulations to INA on this great achievement for nurses in the state of Illinois.

Illinois Nurses Association Maintains National Accreditation Status as a Continuing Nursing Education Approver
