Infusion Survey #1: Visual Report Prepared by Ben Pratt on behalf of Professor Ben Dunford

Respondent Demographics* 1760 Total Respondents Average Age Average years of infusion experience 75.6% Clinically Active 69% Work in Hospitals *While this summary contains many analyses of data from ANN members alone, these demographics represent all respondents. This slide represents the basic demographics of all nurses who participated in survey #1. In total, 1760 nurses started our survey, and 1209 completed the survey entirely (68.64% completion rate among those who responded). Respondents represented 49 of the 50 United States, 5 of the 10 Canadian Provinces, and 8 different countries. As noted on the slide, while there will be sections of data in which total responses are compared to responses solely from those from ANN, the demographics noted here represent the average demographics of all respondents. If you would like these basic demographics for ANN respondents, please e-mail me and I would be happy to send them to you.

Who Performs infusion tasks? Our first research question was “Who performs infusion tasks in contemporary healthcare organizations?”

Infusion Assessments/Prep These percentages are derived from responses given to an item asking who typically performs infusion assessments and preparation in the respondent’s organization. Note that percentages on the left are provided by all respondents, while percentages on the right represent reports from members.

Infusion Insertion (“Sticks”) This item represents vascular access insertion as an infusion task (commonly called a “stick” in infusion nursing terms).

Infusion Administration “Infusion administration” refers to the administering of medications, solutions, nutrients, blood or blood components via infusion lines.

Monitoring and Patient Follow Up “Monitoring” includes both the monitoring of infusion materials, as well as the monitoring of the infusion access site. Survey #2 will differentiate between these two types of monitoring.

Infusion Dressing changes

Flushing and Locking Lines

Infusion Device Removal

Changes in Infusion Practice over the last ten years Our second research question was “How has the nature of infusion work changed over the last ten years?”

Reported changes in infusion task-work These charts show how many respondents indicated a change over the last ten years in who performs these seven infusion tasks. Based on our full group of respondents, responsibilities over vascular access have changed the most over the last ten years, with responsibilities for dressing changes, the removal of infusion devices, and pre-infusion assessment/preparation having also changed extensively over the last ten years.

Direction of changes in task-work A 0.1 change on this scale represents reports from 10% of respondents that an infusion task has been reassigned from one occupational level to another—either up or down the “occupational ladder”—during the last 10 years. (For example, the -.51 score for vascular access means that 51% percent of respondents indicated that the task had been reassigned one full level down the occupational scale over the last 10 years) Occupational Levels 7-Physician 6-Physician’s Asst. 5-Nurse Practitioner 4-Infusion Team 3-Other type of Inf. Team (Vascular Access) 2-Individual RN 1-Individual LPN/LVN We wanted to get a better feel for the directionality of the infusion changes noted by our respondents, we invited them to share who had been responsible for these infusion tasks before the change had occurred. We then took averages of all responses and—using zero as a starting point for all of the infusion tasks—measured the amount of divergence between who used to perform the tasks, and who now performs the infusion tasks. The meaning of scale values is described above the graphic. Divergence in the scale is oriented by the amount of change reported along seven occupational groups, which were predetermined and ordered with help from the leadership of four of the five nursing organizations represented in this survey, and can be found to the left of the graphic. While assessment/prep, vascular access, flushing/locking infusion lines, and infusion device removal have all reportedly been moved “down the occupational ladder,” so to speak, infusion administration, monitoring, and dressing changes have all reportedly been moved “up the occupational ladder” to some extent.

Reduction/Disbanding of Infusion Teams

30.9% Of respondents indicate that infusion teams have been disbanded or reduced in their place of work. 11.4% Nearly one-third of all respondents, and a little more than one-tenth of ANN respondents, indicated that infusion teams in their organizations have, at some point, been disbanded or reduced. Of ANN respondents indicate that infusion teams have been disbanded or reduced in their place of work.

Reasons When asked why those teams had been disbanded or reduced, respondents overwhelmingly attributed it to cost-reduction, as well as a sign of insufficient organizational resources. For respondents from ANN, there was also a group of respondents that felt that individual nurses perform infusions just as well as infusion teams.

Infusion teams: Miscellaneous information 79% of all respondents say infusion teams are a good idea 46.51% work in facilities with an infusion team 8.2 Average FTE on infusion teams 77 Respondents reported more than 1 infusion team in organization While 79% of all respondents indicated that they believe infusion teams are a good idea, only 46.51% indicated that the organizations in which they work have an infusion team. Those who reported having and infusion team in their organization indicated that the team had, on average, 8.2 FTE dedicated to it. Additionally, 77 of the total respondents indicated that their organizations had more than one infusion team.

organizations with and without infusion teams: Nurse Perceptions and effects

Support and Independence Social support represents the amount of support which nurses report receiving from colleagues in their place of work. Psychological safety refers to the level to which nurses’ feel safe to learn new skills and report errors without fear of retribution within their place of work. Autonomy refers to the level of freedom nurses have in making decisions regarding how to accomplish work tasks. Among the combined responses of all respondents from the five nursing associations, the difference in these organization-level characteristics are statistically significant, meaning that the scores reported among respondents that work in an organization with an infusion team are higher than the scores of respondents who work in an organization without an infusion team, and that these differences in scores are larger than we would expect on the basis of chance. Among ANN respondents, however, those from organizations without infusion teams reported higher levels of social support and autonomy than those from organizations with an infusion team. However, these differences are small and are not statistically significant, meaning we can’t rule out attributing the differences in these scores to chance. While ANN respondents from organizations which have infusion teams report slightly higher levels of psychological safety than respondents from organizations that do not have infusion teams, again, the differences are not statistically significant and, therefore, we cannot rule out attributing these differences to chance alone.

Trust and Satisfaction Organizational Trust refers to the amount of trust an employee feels in the organization in which she/he works. Satisfaction refers to the amount of satisfaction which an employee feels in her/his job. While differences in organizational trust and satisfaction scores between organizations with and without infusion teams is statistically significant among respondents from the total combined sample, the small differences in organizational trust and satisfaction are not statistically significant among respondents from ANN.

Perceived Resources and Burnout Resources for infusions refer to respondents’ perceptions of the adequacy of infusion related resources in their places of work. Burnout refers to the amount of burnout which nurses are currently experiencing in their work, while intent to turnover refers to respondents’ intent to leave the organization for other opportunities in work or life. While the differences in scores between respondents with infusion teams in their organizations and their counterparts which work in organizations without infusion teams are (once again) statistically significant for the pool of all respondents, differences in resources for infusions are not statistically significant between ANN respondents with an infusion team in the organization in which they work and those without a team in their organization. Furthermore, burnout and intent to turnover differences between the two groups of ANN respondents are, likewise, not statistically significant.

Perceived safety and quality Safety improvement refers to the amount of improvement which respondents perceive their organizations have made regarding safety in the last year. Safety comparison refers to respondents’ perceptions of safety characteristics in their places of work, compared with what they know about peer institutions in their industry. Finally, organization comparison is a scale that allows respondents to compare a number of their organizations’ practices (safety or otherwise) with those of peer/competing organizations. Differences noted between hospitals with and without an infusion team are statistically significant for the full group of respondents. For respondents from ANN, differences in safety improvement are not statistically significant. However, ANN respondents from organizations with infusion teams indicate that their organizations compare more favorably against peer institutions in organizational practices and safety than ANN respondents from organizations without infusion teams. The differences in safety comparison and organizational comparison scores between the two groups are statistically significant (p < .05), meaning that those differences are greater than we would expect on the basis of chance.

Implications As hospital data becomes available later this year, we will be able to match responses from survey #1 to objective, infusion-related safety scores for the facilities which are represented in the survey. However, in the meantime, we asked the nurses to compare the safety practices in their organizations with those of peer organizations, and this comparison serves as our primary safety measure until objective safety numbers are available.

psychological safety: a Mediating link Nurse Comparison of Organizational Safety Presence of Infusion Team The presence of an infusion team is associated with a 4% increase in nurse psych. safety scores. A 1-unit increase in psych. safety scores is associated with a .36 unit increase in perceptions of organizational safety The survey data suggest that the negative relationship between the presence of an infusion team and nurses’ perceptions of organizational safety are mediated by nurses’ feelings of psychological safety (i.e. feeling able to take learning-related risks and report errors at work without fear of retribution). The presence of an infusion team is associated with a 3.4% increase in nurse perceptions of safety in the organization in which they work, as compared with safety in peer institutions.

takeaways Decreased use of infusion teams Increased reliance on bedside nurses Infusion teams affect key nurse outcomes

Next Steps Publication of Findings from Survey #1 Finalization of Survey #2 Draws on findings from survey #1 New opportunity for collaboration More specific and refined survey A shorter survey!