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

2. Respondent Demographics*
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 AMSN 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 AMSN, the demographics noted here represent the average demographics of all respondents. If you would like these basic demographics for AMSN respondents, please me and I would be happy to send them to you.

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

4. 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 AMSN members.

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

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

7. 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.

8. Infusion Dressing changes

9. Flushing and Locking Lines

10. Infusion Device Removal

11. 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?”

12. 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 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.

13. 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 visual scale.
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 on the left of this slide. 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.

14. Reduction/Disbanding of Infusion Teams

15. 30.9%
Of respondents indicate that infusion teams have been disbanded or reduced in their place of work.
28.8%
Nearly one-third of all respondents, and more than a quarter of AMSN respondents, indicated that infusion teams in their organizations have been disbanded or reduced.
Of AMSN respondents indicate that infusion teams have been disbanded or reduced in their place of work.

16. Reasons
When asked why those teams had been disbanded or reduced, respondents indicated that this was done primarily as a cost-reducing mechanisms, as well as a sign of insufficient organizational resources.

17. 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.

18. organizations with and without infusion teams: Nurse Perceptions and effects

19. Support and Independence
Social support represents the amount of support which nurses believe they receive 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 all respondents, the difference in these organization-level characteristics are statistically significant, meaning that they are greater than we would expect on the basis of chance. For AMSN members, however, differences in social support based on the presence or absence of an infusion team, is statistically significant (p < .05). The comparatively higher psychological safety and autonomy scores reported by AMSN respondents that work in facilities with an infusion team are only marginally statistically significant (p < .10).

20. Trust and Satisfaction
Organizational Trust refers to the amount of trust the employee feels in the organization in which she/he works. Satisfaction refers to the amount of satisfaction which the employee feels in her/his job. While the differences between organizations with and without infusion teams is statistically significant among all respondents, the slight differences in scores between AMSN respondents that work in facilities with an infusion team, compared with their counterparts that work in organizations without infusion teams, is not statistically significant.

21. 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 noted according to the presence/absence of infusion teams in the organization are once again statistically significant for the pool of all respondents, the slightly higher resources for infusions scores reported by AMSN respondents in organizations with infusion teams (compared with their counterparts in organizations without infusion teams) is only marginally significant (p < .10). Differences in burnout and intent to turnover scores between AMSN respondents from organizations with an infusion team and their counterparts in organizations without infusion teams are not statistically significant.

22. 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 of their places of work, in comparison with what they know about nearby peer institutions. 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. While differences noted between respondents from organizations with vs. without an infusion team are statistically significant for the full group of respondents, these differences are not statistically significant among respondents from AMSN.

23. 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.

24. psychological safety: a Mediating link
Nurse Comparisons 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 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 at work without fear of punishment).
The presence of an infusion team is associated with a 3.4% increase in nurse perceptions of safety (compared with peer institutions) in the organization in which they work.

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

26. Next Steps Publication of Findings from Survey #1
Finalization of Survey #2
Draws on findings from survey #1
Collaborative Opportunity
More specific and refined survey
A shorter survey!