SPECIALTY SECTION: Crtical Care
Their Biggest Fan

By Karla A. Knight, RN, MSN
September 20, 2004

Kathleen McCauley , RN, PhD, FAAN, is the newly elected president of the American Association of Critical-Care Nurses (AACN). During her yearlong term, she plans to travel around the country and encourage AACN members to “Live Their Contribution,” the theme she has adopted for her presidency. McCauley explained her theme and shared AACN’s vision in a recent interview with Nursing Spectrum, which publishes NurseWeek.

You are an associate professor of cardiovascular nursing at the University of Pennsylvania. You’re doing research on improved outcomes for patients who receive an advanced practice nurse intervention before discharge. You are a clinical nurse specialist at the Hospital of the University of Pennsylvania (HUP). And now you’re AACN president. How do you manage all of your roles?

You can’t become president of AACN without having serious conversations with your superiors at your day job. I needed to speak with the dean at the nursing school, my division chair, and my CNO at the hospital. From every one of them, I heard, “You go. This is fabulous.”

I’ve been given a tremendous amount of support from the school of nursing, so I can still teach and cochair the Curriculum Committee. Victoria Rich, RN, PhD, chief nursing officer at HUP, has been supportive in helping me think about how to be most effective in the time that I can give to my clinical role. AACN has an experienced staff that has been a wonderful support to me. I don’t think my husband realizes yet just how much I’ll be away, though.

What’s it like being the president of an organization that represents 65,000 critical care and progressive care nurses?

It’s wonderful. I was recently invited to speak to the Kerry-Edwards campaign in Washington, D.C. They wanted to hear from us. It was wonderful to have that voice. I know that I would not have been personally invited had I not been president of AACN. Because we are such a strong organization, I felt well-prepared to speak to what our members would say if they were in the room. I’ve been given a great opportunity to speak on behalf of AACN.

What is at the core of AACN?

It’s a big organization, and it’s a strong one. Several years ago, AACN had the potential for being pulled in too many directions and spread too thin. We made the decision then that AACN was going to be invested in the education of its members — and that’s always what we’re going to be about. We invest our energy in making sure that we have the best products and educational programs available to our members. We’ve developed the Electronic Critical Care Orientation (ECCO) program and are working on an electronic basic dysrhythmia course as well.

We know the way of the future is not to educate nurses the way I taught nurses in the critical care course at my hospital: Standing up five afternoons a week in ECG courses saying, “This is a P-wave.” The new generation of nurses learns well at their own pace using computer animation. We want to make sure we’re ahead of the education curve. But beyond education, we know our members need us to be a voice for them. They have told us that our focus on staffing, healthy work environments, and end-of-life care are right on target.

Staffing and ratios are huge issues, organizationally and legislatively. What is AACN’s position?

We’ve done a lot of thinking about new models, better collaboration with other team members, better use of support staff, and better use of technology. That’s all tied into how to use staff effectively and how to be a voice against mandatory overtime. Our feeling about ratios is that it is a limited view of the problem.

Ratios do not take into consideration the needs of the patient or the expertise of the nurse. AACN proposes a much higher-level model of matching patient needs with nurse competencies. It’s called the Synergy Model, and it’s much more intellectually congruent with what patients really need. (See “AACN Model Creates Synergy” [ www.aacn.org ])

The theme of your presidency is “Live Your Contribution.” How do you see members implementing this theme?

I knew that I wanted this to be my theme when I was president-elect. My theme involves being passionate about the contribution you make. It’s looking for opportunities to be engaged, to not be passive, to not be a punch-the-time-clock type of person, but instead to ask, “How am I going to make a contribution?”

Nurses should ask themselves: “Because I was there today, what happened? What was different that, had it been my day off, my patients and families would not have received? What was my individual contribution?”

The feedback I’ve received on the theme has been strong. It’s time for this theme. People are ready for it, and they’re excited about it.

How do you plan to stay in touch with AACN members?

Like my predecessor, Dorrie Fontaine [RN, DNSc, FAAN, dean of academic programs at the University of California, San Francisco], I want this to become a dialogue. When I write my president’s column every month, I’ll add my e-mail address to it. Of course, I can’t have a dialogue with 65,000 members, but I do want to be connected with our members.

When I speak at chapters around the country, I want to be able to go to their critical care units and thank the nurses for their contributions. It’s a way to make AACN personal, and I really want members to feel supported by their professional organization.

You mentioned the importance of retaining nurses in critical care. How does AACN plan to address this issue?

AACN gives out a Beacon Award recognizing excellence in intensive care and progressive care environments. The award recognizes evidence-based practice, healthy work environments, and excellent educational preparation. We believe, like Magnet, that the journey gets you to be a better place to work. We want thousands of units [to win Beacon Awards].

We also are helping nurses to remain in their positions by speaking out against disrespectful communication by physicians. We are pulling together research on healthy work environments. We’re working with other nursing organizations and industry to find ways to prevent nurses from being injured and to help our nurses do their work more effectively.

One of the goals for AACN is to become the undisputed leader of acute and critical care nursing in the U.S. How do you propose to do that? There’s a lot of competition for RNs’ time and money.

Right now, the universe of potential critical care nurses numbers about 400,000. We have started redefining ourselves as the organization for progressive care nurses, as well. These nurses take care of very sick patients on telemetry and step-down units. No one was really addressing their needs. If we look at the nurses who are affiliating with us without being members, we have CCRN-certified nurses who are not members.

We have nurses who spend a lot of money on our products, but don’t join AACN. We have started thinking more broadly about the people we influence, maybe thinking in terms of an affiliation rather than those who carry a membership card. We need to ask what these people need and how we can connect with them. That way, we don’t get hung up on whether they’re paying membership dues.

We are starting to think much more inclusively. If we become the organization for these folks, it’s very powerful. The work we’re doing with physician groups is part of this. We want people to say, “If AACN is not at the table, then something’s missing.”We want to be so visible that when anyone wants to know anything about critical care nursing, AACN is the organization to turn to.

We have to have data to be an undisputed leader, so we are investing a lot of our energy in finding out what our members need and how they practice.

It’s clear that you bring extensive skills and experiences to the role of president of AACN. What do you hope to take away from your year as president?

I’m going to be a different person as of June 30. I came to the board at AACN with a pretty good skill set even before I became president. I had been the undergraduate dean at the University of Pennsylvania, but I think in this position, I’m going to learn even more about how effective leadership happens.

AACN’s CEO [Wanda Johanson, RN, MN], the president-elect [Debbie Brinker, RN, CNS, MS, MS, CCRN], and I talk to each other on the phone at least every two weeks. Hearing Wanda’s insights about leading an organization and learning how she does things is going to be incredibly helpful to me.

I can bring everything I’m learning right back to my students and my colleagues in practice. My students are getting a very different class now that I can get the national picture. My bosses also realize that I’m going to bring back a knowledge base that I didn’t have before this experience. The benefits of this role are much bigger than I expected. I think I understand the relationships and the partnerships among board members and some of the key AACN staff much more now.

Karla A. Knight, RN, MSN, is a contributing writer for Nursing Spectrum, which publishes NurseWeek.