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An Unprecedented Transplant Nursing Consensus Conference:
Exploring Practice, Making Future Recommendations

Berni Coleman, PhD, ACNP-BC
Immediate Past Chair, NHSAH Council

bernice colemanOn April 12, 2011 at the International Society of Heart and Lung Transplantation (ISHLT) Annual Meeting and Scientific Sessions in San Diego, California, an unprecedented consensus conference occurred, titled, Crucial Conversations in Thoracic Transplant Nursing. This conference was sponsored by the ISHLT and Cedars-Sinai Medical Center Heart Institute, Los Angeles, California. The conference was chaired by Berni Coleman (USA), with co-chairs Nancy Blumenthal (USA), Judy Currey (Australia), Fabienne Dobbels (Belgium) and Angela Velleca (USA), in conjunction with conference advisors John Dark, MD (United Kingdom) and Jon Kobashigawa, MD (USA).

The conversations that occurred addressed many of the recurrent questions which have been discussed over the years by members of the Nursing Health Science and Allied Health council membership (NHSAH). How often have transplant nurses (coordinators, advance practice nurses and managers) discussed staffing mix and ratios, professional educational requirements, roles and responsibilities? One often wonders what colleagues from other programs are doing. How do they manage workloads, clinical responsibilities, and further education? How are their programs staffed? How are the coordinator and Advanced Practice Nurse roles within the context of a transplant program integrated? Importantly, do they also feel the pressures of balancing work, home and profession? Are these same questions being pondered in other countries?

Seventy-seven highly experienced transplant nurses were invited to the Transplant Nursing Consensus Conference from a combination of small, medium and large transplant programs across the globe. Attendants of the conference represented 12 countries; Australia, Austria, Belgium, Canada, Germany, Italy, Japan, New Zealand, Norway, Spain, United Kingdom and United States. Nurses were asked to complete an online survey prior to the conference; 57% responded. The conference format consisted of State of the Science talks on key issues, followed by presentations of Models of Care at various sized transplant centers representative of programs in Australia, Germany, United Kingdom and United States. An international mix of participants began afternoon discussions in four small groups to prepare for the final discussion in late afternoon. The aim was to reach a consensus on issues central to transplant nursing practice.

Connie Williams, PhD, RN, FAAN, presented the morning session on Education, License & Certification—Setting Standards for Transplant Nursing. Her remarks were anchored in the Institute of Medicine, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing: Leading Change and Advancing Health. Dr Williams applied the key messages of this report to Transplant Nursing. The issues she explored included: how will nurses practice to the full extent of their education and training; how will nurses achieve higher level of education in transplant nursing; how will transplant nurses achieve the recommendation of 80 percent baccalaureate degrees by 2020; and what should be the entry level of education for transplant coordinators and Advance Practice Nurses?

Kathy Grady APN, PhD, FAAN, discussed the topic, Recruitment and Retention Strategies for Maintenance of Quality Transplant Nursing Staff. She presented literature on factors that affect transplant coordinators' recruitment and retention, nurse staffing and quality patient care. Dr. Grady pointed out the impact of the tension related to blurred boundaries in nursing and lack of standardized educational preparations. Two perspectives on the impact of blurred nursing boundaries were presented. Cathy Murks Ph.D., ANP-BC, described the challenges of ill-defined nursing boundaries in the United States. She presented a model visually describing the overlap between the registered nurses, nurse practitioners, clinical nurse specialists and physician assistants working in transplantation. The focus of this talk teased out the drivers that contribute to the overlap of roles and responsibilities of transplant clinicians. A European perspective on nursing roles and responsibilities in transplantation was presented by Christiane Kugler, Ph.D. The presenter interviewed nurses (clinical nurses, advance practice nurses and recipient nurse coordinators) from 10 centers representative of Belgium, Germany, Italy, The Netherlands and United Kingdom. Across these countries, respondents reported lack of clarity in transplant nursing role definition. Outside of the United States, it seems our colleagues also feel that there is need for consensus regarding licensure, educational preparation and scope of practice.

To round out the morning talks, a presentation by Linda Ohler MSN, RN, CCTC, FAAN discussed Staffing Benchmarks: What is the Optimal Composition of a Transplant Program? Reviews of current transplant models for inpatient and outpatient total hours of nursing for patient care were discussed. The pros and cons of current staffing models were outlined. In the end, the presenter recommendations were: 1) Standardize the role definitions of transplant staff; 2) Develop strategies to link staffing to outcomes; and 3) Develop centralized systems to collect data to validate / benchmark staffing data for transplant centers.

After a provocative morning of discussions, participants retreated to small groups to discuss issues such as:

  • What are the minimal core competencies of heart/lung transplant nurse professionals?
  • What should be the minimal academic level for entry into transplant nursing?
  • What roles should RNs, NPs or PAs perform for a transplant program?
  • What is the optimal transplant professional staffing level?
  • What strategies are needed to improve recruitment and retention of heart/lung nurse professionals?
  • What are our recommendations for future research?

A consensus paper will be published. If you are intrigued to hear the results of the survey, data will be presented at the Annual NHSAH Council meeting in Prague, April 2012, which is another good reason to attend the ISHLT Annual Meeting and Scientific Sessions!

Disclosure Statement: The author has no conflicts of interest to disclose.