Need for Infusion Nurses on the Rise
By Debra Wood, RN, contributor
Several factors—including changes to reimbursement rules and the trend toward more outpatient care—have been increasing the demand for infusion nurses. These professionals are particularly skilled in inserting and caring for short-term IV lines and implanted devices, assessing for signs of infection or other problems, and educating patients about their infusion device’s proper care.
The demand for infusion nurses has increased due to factors including changes in reimbursement regulations and more outpatient care.
Starting in October 2008, the Centers for Medicare and Medicaid Services (CMS) will stop paying for care associated with several preventable hospital-acquired conditions, including catheter-associated bloodstream infections. That will increase the demand for infusion nurses’ skills in assisting with catheter insertion and maintaining those lines in order to prevent infections, according to Mary Alexander, RN, CRNI(r), CAE, chief executive officer of the Infusion Nurses Society based in Norwood, Massachusetts. The society has close to 6,000 members throughout the United States, and more than half have obtained certification in the field.
The Centers for Disease Control and Prevention (CDC) has documented the benefits of using infusion nurses. Their publication, Guidelines for the Prevention of Intravascular Catheter-Related Infections, issued in August 2002, stated, "Specialized IV teams have shown unequivocal effectiveness in reducing the incidence of catheter-related infections and associated complications and costs."
Mary Alexander, RN, CRNI(r), CAE, chief executive officer of the Infusion Nurses Society, said changes to Medicare reimbursement will spur additional demand for infusion nurses.
Alexander explained, "Because [special teams] have the expertise, they are able to do the job correctly the first time and identify the potential for complications and intervene quickly, so the patient doesn’t end up with problems, particularly infections."
At Mercy Medical Center in Baltimore, Maryland, an infusion nurse performs all dressing changes and flushes on central lines and peripherally inserted central catheter (PICC) lines. The infusion nurses also start IV lines and draw blood, when the staff nurses do not succeed with the venipuncture, and insert bedside PICC lines.
"There’s a growing need for this, especially with the popularity of PICC lines," said Donna McCoy, RN, an IV therapist at Mercy. "They are safer and have a low infection rate and higher patient satisfaction."
Despite the success of infusion nurses, most hospitals in Michigan have downsized their IV teams and rely solely on bedside nurses, reported Nancy Bagnall-Trick, RN, CRNI, a Michigan nurse with Teleflex Medical and past president of the Great Lakes Chapter of the Infusion Nurses Society. Re-establishing these specialized teams could be a costly investment.
"Every nurse that delivers IV therapy or starts an IV is an infusion nurse, and the challenge to that is the bedside nurse has so many concerns," Bagnall-Trick said.
Today’s shorter hospital stays have pushed much infusion care to the outpatient or community setting. Alexander also reported that more infusion care is taking place in nursing homes.
"It’s a win-win situation for everyone," said Mary McCray, RN, clinical coordinator at Methodist Dallas Medical Center in Texas. She explains that patients may continue working while receiving their outpatient therapy, and it is more cost effective than keeping the patients in the hospital for an infusion.
Mary McCray, RN, noted a demand for outpatient infusion services, something she feels is beneficial for the patient and the health system.
"There is a need for more nurses with experience in oncology and infusion," added Denene Prophet-Williams, RN, MBA, MLA, NE-BC, nursing director for infusion services at The Methodist Hospital System in Houston. She indicated the need will primarily come from the outpatient arena as more treatments move out of the hospital, and patients appreciate that convenience.
LaShawn Ireland, RN, BSN, an infusion nurse at the Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, also reports an increased demand for outpatient infusion services.
"We want to keep patients and families out of the hospital as much as we can, and are doing more outpatient [procedures] and scheduling home health care for [overnight] hydration," Ireland said.
Ireland, who has held her position for 18 years, said she loves working with children and establishing long-term relationships with patients and their families. She has cared for some of the same children for years, such as those receiving transfusions due to sickle cell anemia.
"Nurses have a passion for it," Alexander added. Outpatient infusion centers typically operate weekdays, perhaps into the evening, but not overnight. The work is fast paced, but less physically taxing than working on an inpatient unit, with less lifting of patients.
The nurses infuse medications, chemotherapy, fluids, blood products and parenteral nutrition. They manage epidural catheters, central line ports, PICC lines and subcutaneous and intraocceous infusions.
Most infusion nurses pick up their skills on the job. They can get additional information from the Infusion Nurses Society, which publishes standards of practice related to infusion treatment. Bagnall-Trick said hospitals often base their IV policies and procedures on those standards.
Infusion-based therapy may last for hours, weeks or years. At each visit the infusion nurses assess the patient, check the infusion site for signs of infection and monitor for side effects.
"We also do teaching," McCray said. This can include instructing patients in the proper care of a line or helping them recognize the symptoms of infection or possible side effects from a medication.
"I have the best job in the world, because I love patient contact," McCray continued. "It can be very rewarding. You are able to help patients in the last part of their recovery phase."
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