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Sense and Sensibilities: Finding Consensus in Adult Cardiothoracic Transplant Nursing

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Angela Velleca, RN, BSN, CCTC
Cedars Sinai Heart Institute
Los Angeles, CA, USA

In November 2014, a consensus document on nursing practice in Adult Heart and Lung Transplantation was published. This document stems from a global transplant nursing conference convened on April 12, 2011 involving members of the ISHLT Nursing, Health Science and Allied Health Council. This conference, which included nursing representatives from 12 countries and 4 continents, sought to define minimal recommendations for transplant nursing education and role responsibilities while also discussing retention strategies and models of care. Of the 77 attendees, 72% were transplant nurse coordinators, 15% were transplant nurse practitioners, 4% were nurse managers, and 6% were nurse researchers. The size of the transplant programs represented ranged from small to large, as defined by the United Network of Organ Sharing. Attendees completed a survey prior to the consensus conference. The survey centered on staffing levels, minimum core competencies, levels of education, roles and responsibilities, and areas of future research.

While education varies among transplant nursing professionals depending on country of origin, prior to this document, there were no consensus guidelines available on required education level, licensure, or certification for the transplant nursing specialty. Among the transplant nursing experts attending this conference, consensus was reached that a minimum of 2 years clinical nursing experience was required for all transplant coordinators, nurse managers, or advanced practice nurses. A baccalaureate degree in nursing is the minimum education level requirement for a transplant coordinator. Additionally, the attendees reached consensus that transplant coordinator-specific certification is recommended. Such certification does not exist in all countries and could not be mandated. Finally, in the area of education, consensus also agreed that transplant nurse practitioners, clinical nurse specialists, and transplant managers should hold at least a master's degree.

The cardiothoracic transplant coordinator role is critical to the success of transplant programs as well as quality patient outcomes. For this reason, the presence of a transplant nurse coordinator on the transplant team is mandated by the US Centers for Medicare and Medicaid Services. However, recruitment and retention strategies aimed at finding and keeping transplant nurse coordinators with this specialized skill set are lacking. Consensus was reached that strategies to retain transplant nurse coordinators include engaging donor call teams, mentoring programs, flexible hours, and support with career advancement.

While consensus was reached in the above mentioned areas, agreement on appropriate staffing levels for nursing within an adult cardiothoracic transplant program remained elusive. The contingency of experts convened for this task believed too many variables were left unanswered to reach conclusive staffing levels. Models of care vary widely across the continuum and such models affect staffing needs. No ambulatory care metric exists to gauge staffing levels and all current information is based on inpatient staffing ratios. Although not yet attainable, determining appropriate staffing levels for transplant nursing was deemed high priority by attendees.

Consensus was reached that future research should focus on the relationships between staffing levels, nurse education, and patient outcomes. To this end, a new survey has been developed and will be distributed to the ISHLT Nursing, Health Science and Allied Health Council in hopes of finding a path to consensus on these more difficult issues of staffing levels and models of care. The results of this survey will fuel discussions for future direction at a special Transplant Nursing Forum to be held in Nice, France, in tandem with the ISHLT Annual Meeting and Scientific Sessions. ■

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

1. Coleman B, Blumenthal N, Currey J, et al. Adult cardiothoracic transplant nursing: An ISHLT consensus document on the current adult nursing practice in heart and lung transplantation. 2014.

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