Foreword

This issue of Critical Care Nursing Quarterly broaches some topics that are very important to the profession of nursing as well as to the specialty of critical care. As critical care nurses, we carry a very heavy responsibility of caring for the “sickest of the sick.”We do so in a fast-paced environment that requires us to be intelligent critical (fast) thinkers, with skillful (quick) hands that do not hurry (because that is when mistakes are made) while maintaining a sense of genuine caring about what we are doing and patients for whom we are caring. Professional development and empowerment not only explores ways for us to be more accountable to those we are caring for and improve patient care outcomes in a more cost-effective manner but also offers suggestions for innovatively training nurse leaders and mentoring young nurses. In critical care, technology abounds, the healthcare delivery system is constantly changing, and healthcare reform is upon us. Skees explains why we have a professional and ethical responsibility to seek continuing education in her article “Continuing Education: A Bridge in Critical Care Nursing.”She embraces lifelong learning as a way of increasing one’s knowledge base and broadening one’s critical thinking acumen. Continuing education units assist critical care nurses in maintaining necessary skills for their work environment and can enrich their contribution to healthcare. There is power in learning and that power can lead to less delay in bringing evidence-based practice (EBP) to the bedside and improving patient outcomes. Skees takes note of the challenging obstacles that nurses face in continuing their education and/or obtaining continuing education credits and offers suggestions to assist in achieving continuing education goals. As critical care nurses, we all want to provide our patients with safe, high-quality patient care and positive clinical outcomes. Research has shown that this happens most effectively through the swift implementation and maintenance of EBP. Tuite and George emphasize this in their article “The Role of the CNS in Facilitating EBP Within a University Setting.”They look at the importance of advanced practice nurses, specifically the clinical nurse specialist (CNS), in leading multidisciplinary team committees and facilitating the implementation and sustaining of EBP to improve patient outcomes. They emphasize how vital the role of the CNS can be in bridging the gap between medicine and nursing. As a CNS chair shares committee leadership with a physician cochair and is also accompanied by a nurse administrator meeting attendee to reinforce the value of the committee’s work, the CNS is empowered to facilitate change in practice. This can be accomplished by the CNS facilitating and assisting in the transfer of some of the decision making of the hospital leaders to those individuals who perform the day-to-day care in the critical care units—the critical care staff nurses. Tuite and George give examples of how their facility has improved intensive care unit (ICU) ventilation-acquired pneumonia (VAP) prevention rates and compliance with the sedation interruption protocol through CNS initiative development, EBP implementation, and tracking of staff compliance with EBP guidelines. In the article “Trauma VAP SWAT Team: A Rapid Response to Infection Prevention,”Laux et al demonstrate a commitment to excellence and quality as well as an improvement in VAP prevention rates in their facility’s 5 ICUs. Through the utilization of a rapid cycle quality improvement model using “plan, do, study, act” components, a group consisting of the unit’s advanced practice nurse, clinical nurse educator, and the nurse director investigated their problem of rising VAP rates. They then performed a detailed analysis of best practice interventions and implemented an action that would prove to be highly effective in reducing VAP as well as easily track for compliance. Their process involved both bedsideand unit-based research. With the assistance of the facility’s medical director of patient care and safety, their efforts empowered the critical care bedside nurses and respiratory therapists to make a difference in their work. As a result, the facility is now experiencing their lowest VAP rates in more than 4 years (in all 5 of their ICUs)! It is no secret that critical care nurse managers face many demands in their role. They are often