The practice of infusion nursing encompasses many levels of knowledge and expertise. A credentialed infusion nurse is highly qualified to provide infusion care across the patient care continuum and to participate in benchmarking efforts related to infusion nursing and patient outcomes. The role of this nursing specialist is defined in institutional policy and procedure, often based upon established Standards of Practice and consistent with the Nurse Practice Act. While the role may vary across clinical settings, the primary responsibility is to ensure quality infusion care regardless of the setting in which care is delivered. Expertise, clinical competence, credentials—these are the hallmarks of the infusion nurse.

The infusion nurse is a specialist and a generalist; the generalist could not be considered a specialist. One’s basic nursing education prepares one to become a nursing generalist.

The infusion nurse is accountable for the defined scope of practice based on the following:

Administration of safe, high-quality infusion therapy today depends on a collaborative and positive practice environment in which many members of the health care team play a key role. The nurse, in particular, plays a primary role in collaborating with other health care providers to maintain an infusion and to protect the patient from the hazards and complications associated with routine infusion (IV) therapy. Policies regarding the responsibilities of a staff nurse in relation to therapy vary significantly among health care institutions and are often influenced by the presence or absence of a full-service infusion team. In reality, many medical-surgical nurses are involved in the delivery of infusion care and have expanded their base of knowledge to prepare for the Infusion Nurses Credentialing Examination. An essential component of the collaborative practice setting is the flexibility of the infusion nurse in adapting to changing institutional environments. Expanded roles might include mentor, knowledge sharer, Magnet team member, advocate, and researcher. The global role of the infusion nurse is addressed in this chapter.

Research findings show that an infusion nursing team enhances the level of care that an organization provides. To ensure that the team approach provides safe IV care, the role of the team and the delineation of responsibilities must be part of the orientation program and ongoing education for all nurses. Specialized teams of infusion nurses provide clinical expertise and cost-effective care. In the ideal setting, registered nurses with clinical and theoretic expertise should be responsible for administering infusion therapy. This improves the quality of patient care because specialized nurses, freed from other responsibilities, can focus their attention on developing a high standard of performance. Such nurses, aware of the inherent risks of therapy, are vigilant and meticulous in performing and maintaining IV
therapy. Their advanced skills promote trauma-free venipuncture, conserve veins for future use, and reduce routine complications. The knowledge, skills, and abilities of these specialized nurses ensure patient safety.

Benefits of an IV team include reduction in complications related to peripheral IV administration, reduction in catheter-related bloodstream infections, increased patient satisfaction, timely completion of therapies, enhanced level of clinical expertise, utilization of state-of-the-art technology, reduction in patient length of stay, potential revenue generation, and early assessment and identification of vascular access needs.

In August 2002, in a publication by the CDC entitled “Guidelines for the Prevention of Intravascular Catheter-Related Infections,” where dedicated IV teams were recommended, the authors noted that specialized IV teams have shown unequivocal evidence in reducing the number of catheter-related bloodstream infections and associated complications and costs. Reports spanning decades have consistently demonstrated that risk of infection declines with standardization of aseptic care and that insertion and maintenance of central access catheters by inexperienced staff might increase the risk of catheter colonization and central line bloodstream infections.

With the majority of acute care patients receiving infusion therapy throughout the course of a hospitalization, the infusion nurse has become an integral part of the nursing process for each patient entrusted to his/her care. Once considered a technical function, the practice of infusion therapy is now recognized as a clinical specialty requiring the knowledge, skills, and abilities to offer sound assessment and interventions within the patient’s plan of care.

Today’s patient care models demand optimum utilization of resources, control of costs, and high quality; this is the ideal practice environment for the infusion nurse specialist who can offer comprehensive care with a high degree of safety. Even the most complex cases may be handled by the infusion specialist in an alternative care or home setting. Infusion nursing teams succeed in those institutions in which their value is recognized and appreciated. The Infusion Nurses Society published a white paper entitled Infusion Teams in Acute Care Hospitals: Call for a Business Approach (INS, 2013). Within this important document, the society emphasizes the three-tiered approach to hospital-based infusion care. No single model of service delivery works in all organizations.

In lieu of a full-service infusion team, the health care facility may use the services of one or more IV nurse specialists as a limited-service team or as resource personnel. The team may function within certain clinical units, or within given hours.

Although the coverage is not complete, it does provide for consistent, quality care by infusion nurses but leaves primary responsibility related to infusion care to staff nurses during the hours when there is no team coverage and sometimes during peak hours. In these situations, the infusion specialist may serve as educator, clinician, or team leader to a number of integrated health care organizations or home care agencies.

The role for the infusion nurse specialist is continually evolving. Changes in clinical practice and in the practice setting direct this process (Lozins Miller, 1998).

The infusion nurse specialist has a unique responsibility and opportunity to mentor others. This responsibility transcends the entire organization as well as members of the infusion nursing team. This is especially important when new staff is involved in the delivery of infusion care. Raising the bar and setting the standard are key responsibilities of the infusion specialist. Considerations for potential mentors may be found in Box 3-1.

One of the challenges of knowledge management is that of convincing people to share their knowledge. Why should people give up their hard-won knowledge when it is one of their key sources of personal advantage? In some organizations, sharing is natural. In others, the old dictum, knowledge is power, reigns. In this chapter, we explore some of the barriers and offer some pointers in overcoming them. The infusion nurse is a knowledge expert with a broad spectrum of knowledge to be shared with others.

Barriers to knowledge sharing abound, and include loss of power, fear from revelation, uncertainty (especially among new nurse members), a loss of recognition or reward (because they have shared their knowledge with others), personal or institutional culture, a difference between awareness and knowledge, and conflict of motives.

The key is awareness of the organization itself—by identifying and developing complementary ways to share the knowledge management and transfer within an organization. Best practices that result in excellence include processes, methods, and strategies; identifying and sharing best practices is a critical way of incorporating the knowledge of some into the work of many (Table 3-1).

The role of the knowledge sharer involves cultural change, cooperation, and commitment (David J. Skyrme, www.skyrme.com/updates/u64_f1.htm; Accessed October 5, 2005). According to Skyrme, culture change is never easy and takes time. But cultures can be
changed once the term culture is clearly defined. Culture is defined in many ways, such as “commonly held beliefs, attitudes, and values” and “the collective programming of the mind that distinguishes one group from another” and in many other ways that also embrace rituals, artifacts, and other trappings of the work environment. Cooperation is an essential component of knowledge sharing; we are both competitive and cooperative. In today’s complex world, we need help from others with whom we compete in order to achieve our goals.

And commitment is based on culture and cooperation. Organizations need to create a commitment to culture, to change, to challenge, to compete, and to cooperate. If, as is often the case, time pressure leads to poor knowledge sharing, then there must be a commitment to allow time for it to happen. Commitment to knowledge sharing must be demonstrated throughout the organization. It is inherent in the behaviors of infusion nurse specialists who consistently share knowledge with others even if it is not formally part of their job.

Wilson, Whitaker, and Whitford (2012) challenge us to look at the entrepreneurial and intrapreneurial roles of nurses in the health care reform era that we currently live in. These roles vary as per employment and practice setting yet reflect the nurse as an innovator. Innovation is providing affordable health care, access to health care, collaborative practice settings, and expanding “out of the box” thinking to global partners. Nurses are the “leaders of the pack” in designing innovation in patient care.

The Magnet Recognition Program recognizes health care organizations for quality patient care, nursing excellence, and innovations in professional nursing practice. Consumers rely on Magnet designation as the ultimate credential for high-quality nursing. Developed by the American Nurses Credentialing Center (ANCC), Magnet is the leading source of successful nursing practices and strategies worldwide. The program provides a vehicle for disseminating successful practices and strategies among nursing systems. To provide greater clarity and direction, as well as eliminate redundancy within the Forces of Magnetism, the latest model configures the 14 Forces of Magnetism into 5 Model Components. The simpler model reflects a greater focus on measuring outcomes and allows for more streamlined documentation, while retaining the 14 Forces as foundational to the program. Overarching the new Magnet Model Components is an acknowledgment of Global Issues in Nursing and Health Care. While not technically a Model Component, this category includes the various factors and challenges facing nursing and health care today (Box 3-2).

The Magnet Recognition Program is based on quality indicators and standards of nursing practice as defined in the American Nurses Association’s Scope and Standards for Nurse Administrators (2003). The Magnet designation process includes the appraisal of both qualitative and quantitative factors in nursing. (See Box 3-3 for the findings of independent research on magnet-designated facilities.)

Dr. Aiken and her team surveyed more than 26,250 RNs at 567 hospitals in California, Florida, New Jersey, and Pennsylvania. Of the hospitals involved, four had achieved Magnet recognition from the ANCC. Results show that the Magnet hospitals had not only a larger number of specialty-certified nurses but also a greater proportion of nurses with a BSN
degree or higher education. In addition, the number of patients per nurse in Magnet hospitals was significantly lower than in non-Magnet hospitals. Nurses in Magnet hospitals were 18% less likely to be dissatisfied, 13% less likely to have high levels of burnout, and much less likely to report intent to leave their current position.

Three decades of evidence showing superior outcomes for Magnet hospitals place this organizational innovation in a class of its own as best practice, which deserves the attention of hospital leaders, nurses, and the public (Aiken, 2012a, 2012b) (Table 3-2).

New research from Aiken shows that surgical patients cared for in ANCC Magnetrecognized hospitals have significantly lower odds of mortality and failure-to-rescue than those cared for in non-Magnet facilities. The findings appeared in the October 2012 issue of Medical Care, the official journal of the Medical Care section of the American Public Health Association. Dr. Aiken and her team analyzed linked data from 564 hospitals in California, Florida, Pennsylvania, and New Jersey. Of the hospitals involved, 56 had received Magnet recognition from the ANCC. Controlling for differences in nursing, hospital, and patient characteristics, the team found that surgical patients in Magnet hospitals had 14% lower odds of inpatient death within 30 days and 12% lower odds of failure-to-rescue, compared with similar patients in non-Magnet hospitals. Although Dr. Aiken has published previous studies documenting lower mortality rates in Magnet hospitals, this was the first time she and her team directly measured the work environment with a variety of indicators, including a survey of more than 100,000 nurses. Their findings reinforced that superior practice environments for nurses are the distinguishing factor between Magnet and non-Magnet hospitals and are key to better patient outcomes. The research was funded by the National Institute of Nursing Research of the National Institutes of Health (Table 3-3).