Nurses Drive Success in ECMO Care
The many roles of nurses who are integral to the care of patients on ECMO are described.
Nurses are crucial in providing comprehensive care for patients on extracorporeal membrane oxygenation (ECMO). They significantly improve outcomes and cost efficiency through diverse roles, such as primary RNs, ECMO specialists, coordinators and leads.
“Nursing Roles in Extracorporeal Membrane Oxygenation,” in AJN: American Journal of Nursing, highlights the contributions of nurses in the increasing use of ECMO for patients with severe respiratory and cardiac failure when conventional therapies aren’t effective. The article examines ECMO training and staffing models, the potential cost savings of RN-run models and the novel role of an ECMO lead.
An overview of nursing roles and responsibilities:
ECMO specialist: Manages the ECMO circuit, prevents and handles emergencies, and documents patient and circuit parameters
Primary RN: Provides advanced ICU care, conducts assessments, develops care plans and collaborates with the ECMO specialist on cannulation care, anticoagulation, ventilator management, transport and therapy
ECMO coordinator: Oversees staff training, equipment maintenance and data collection; might maintain ECMO specialist competencies, manage policies and guidelines, oversee quality improvement projects and evaluate resources
ECMO nurse practitioner: Assists during ECMO procedures, acts as a liaison for multidisciplinary teams and attends daily rounds; might explain procedures to patients or decision makers, obtain consent and assist with bedside procedures
ECMO clinical nurse specialist: Provides clinical nursing leadership through care coordination, teaching, mentoring and facilitating multidisciplinary care; might develop and provide ECMO education
ECMO lead: Serves as a clinical resource for primary RNs and ECMO specialists, extending the ECMO coordinator’s role. May attend multidisciplinary rounds, champion ECMO mobility, facilitate procedures outside the ICU, assist with procedures and conduct safety rounds.
AACN provides a list of books, sessions and other resources regarding ECMO care. “Troubleshooting for the Empowered ECMO Nurse,” an AACN blog, describes how critical care nurses are uniquely positioned to recognize and address clinical problems related to ECMO circuits and escalate concerns within the healthcare team. An ECMO micro-credential and an ECMO clinical resource page are also available.
AHRQ Releases MRSA Prevention Toolkit
The toolkit has three sections: key strategies for prevention, comprehensive unit-based safety programs and program implementation.
The Agency for Healthcare Research and Quality (AHRQ) released a toolkit for MRSA prevention for ICUs and non-ICUs to improve practices and reducing infection rates.
“MRSA Prevention Toolkit: ICUs & Non-ICUs,” an AHRQ webpage, notes that the AHRQ Safety Program for MRSA Prevention employs best evidence and frontline clinical experiences to aid units and facilities. “The program collaborated with clinicians, frontline staff, surgeons, educators, researchers, hospitals, and long-term care centers to establish comprehensive and sustainable programs to address MRSA prevention from multiple angles,” the article adds.
The Toolkits for MRSA Prevention have three sections: key strategies for prevention, comprehensive unit-based safety programs (CUSPs) and program implementation. Developed from a five-year national project, the kit provides background material on MRSA sources and transmission, and an information sheet for patients and families. “The goal of these toolkits is to assist staff and leadership in improving infection prevention practices and ultimately reduce MRSA rates in their units and facilities.”
Using interactive graphics and a wide range of tools and educational materials, including presentations, videos and facilitator guides, each section provides clinicians with extensive resources to review and implement. The four key strategies – decolonization, decontamination, preventing person-based transmission, and preventing device- and procedure-related infections – highlight areas for intervention and improvement. Resources include fundamental best practices that apply to all the strategies.
The CUSP resource webpage offers extensive materials based on a framework that “starts with the frontline staff and focuses on promoting changes in thinking and behavior to reduce preventable harm.” Units do not need an existing CUSP team or experience with the framework to use the materials effectively.
The program implementation kit includes downloadable resources designed for a holistic approach, gap analysis tools at unit and hospital levels, and a monthly team checkup tool. Additional toolkits covering surgical services and long-term care settings will be released later in 2025.
Optimizing Interfacility Transport for Cardiac Arrest
The statement provides evidence to assess clinical characteristics, evaluate hospital resources and coordinate transport.
The American Heart Association offers new guidance to improve interfacility transport (IFT) for patients experiencing out-of-hospital cardiac arrest, with the goal of minimizing complications and enhancing outcomes.
“Management of Patients With Cardiac Arrest Requiring Interfacility Transport: A Scientific Statement From the American Heart Association,” in Circulation, emphasizes that despite limited guidance, receiving centers rely on emergency department professionals at transferring hospitals to make crucial postresuscitation care decisions that can affect the efficacy of future treatment.
The statement provides evidence regarding important factors such as assessing clinical characteristics, evaluating hospital resources and coordinating IFT logistics, while identifying gaps in knowledge and highlighting areas for additional research.
Transfer protocols and best practices are detailed for various aspects of care:
- Levels and modalities of IFT services: Ground or aeromedical transport should be based on patients’ needs, the skills and experience of IFT professionals, travel distance and time-dependent interventions.
- Patient’s stability for transfer: To mitigate IFT risks, ensure pretransport coordination and patient selection, assessing the risk of deterioration against potential benefits at the receiving facility.
- Airway and vascular management: Advanced airway devices and stable vascular access should be in place before transport. Clinicians who conduct IFT must have the skills to place a backup airway or obtain additional vascular access if needed.
- Ventilator management: Transport teams require expertise in ventilator and sedation management and medical oversight for complex cases. They should also be familiar with the features and limitations of transport ventilators.
- Hemodynamic monitoring and antiarrhythmic management: The transport environment’s unique challenges, such as limited patient access and equipment, necessitate protocols for continuous ECG monitoring, performing 12-lead ECGs and communicating results to the receiving facility.
The statement also offers guidance for sedation, blood pressure and temperature control, metabolic management, equity, diversity and inclusion, and family communication. Many of these aspects can be handled through protocol-driven care.
Education on Autonomic Dysreflexia Can Help Prevent Severe Outcomes
Educating patients before discharge home includes personalized care plans to mitigate AD episodes.
Nurses who know early warning signs and interventions when a patient with a spinal cord injury (SCI) has autonomic dysreflexia (AD) can help prevent a severe outcome.
“Autonomic Dysreflexia in Spinal Cord Injuries,” in American Nurse, notes that early detection of potential AD episodes can include symptoms such as surging blood pressure. “With the right education and training, they [nurses] can effectively manage AD emergencies and significantly reduce the potential for catastrophic outcomes in patients with SCIs,” the article adds.
Patients with cervical injuries or thoracic injuries at T6 and above may be most prone to AD, while those with lumbar and sacral injuries have a generally lower risk. Negative stimuli can precipitate a rise in blood pressure caused by an overreaction from the autonomic nervous system, which can lead to a stroke, seizure or myocardial infarction if undetected.
Co-written by Pamela Bolton, past chair of AACN Certification Corporation board of directors, the article details a protocol that should begin at the first signs of an AD episode, including careful examination of the patient’s skin for wounds or other irritations that may be related to an episode. An indwelling urinary catheter with kinks or blockages or a bowel impaction can also lead to an AD episode.
Educating patients before discharge home should include personalized care plans that can mitigate these episodes and involve an interdisciplinary team. “This collective approach aims to empower patients and their families with the knowledge and skills they need to effectively manage AD and promote overall well-being.”
Because AD is a potentially life-threatening medical emergency, it “demands immediate attention and intervention. Nurses play a crucial role in recognizing and responding to AD.” If they keep “improving their knowledge and skills, nurses can make a significant difference in the lives of these patients and their families.”
AACN resources include an article on pharmacological treatment of patients with paroxysmal sympathetic hyperactivity.
Reducing Burnout to Improve Patient Outcomes
Nurse burnout was associated with decreased healthcare quality, safety and patient satisfaction.
A review of 85 studies involving 288,581 nurses finds that nurse burnout leads to diminished patient safety and quality of care, increased adverse events and lower patient satisfaction, regardless of demographics or work experience.
“Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis,” in JAMA Network Open, suggests that improving patient outcomes requires more system-level interventions to reduce burnout, which is characterized by emotional exhaustion, depersonalization and a diminished sense of personal accomplishment.
The analysis of studies from 1994 to 2024 included nurses from 5,322 hospitals in 32 countries. Findings reveal burnout-related compromised care, including lower safety climate and grades, more frequent nosocomial infections, patient falls and medication errors, incomplete care and reduced patient satisfaction.
However, a related summary in Becker’s Hospital Review notes that nurse burnout was not linked to patient mortality, frequency of patient abuse, complaints or pressure ulcers. In addition, “the association between burnout and lower patient safety was less significant” for nurses with a bachelor’s degree or higher.
The review indicates that most anti-burnout efforts focus on individual interventions, such as mindfulness or personal resilience training. However, many effective strategies are at the unit level, where nurses experience teamwork, a sense of community, professional development and recognition.
The U.S. Surgeon General and healthcare organizations have prioritized reducing burnout and initiatives that promote well-being. Congress has allocated over $100 million to enhance mental health, foster resilience and reduce stigma for healthcare professionals.
“Allocation of even more substantive funding, commensurate with the magnitude and adverse effects of health worker burnout, seems necessary to support research and implementation of evidence-based approaches to reduce clinician burnout,” the review notes.
AACN’s “Prioritizing Your Well-Being” webpage offers a range of resources on diverse aspects of health and wellness that could be useful during times of stress.
How to Address Implicit Bias
Addressing biased behavior requires ongoing effort and commitment.
Unconscious actions and decisions associated with implicit bias, even those that contradict conscious beliefs, can lead to negative outcomes for patients and require strategies that recognize and mitigate any harmful effects.
“Implicit Bias: More Than a Buzzword,” in American Nurse, notes that having biases becomes problematic when others are treated unfavorably based on those biases. Nurses may need guidance on being aware of unequal treatment and the tools to detect and remove biases. “Addressing biased behaviors requires ongoing effort, dedication and a commitment to continual improvement, practice and reflection,” the article notes.
The article addresses several harms associated with bias in healthcare, including systemic discrimination, poorer outcomes for marginalized individuals and inequitable access to care. Biased treatment based on factors such as race, gender, sexual orientation and age can lead to misdiagnosis, inadequate or inappropriate treatment and poorer health outcomes.
Using some case studies of nursing scenarios, the article demonstrates where implicit bias may emerge and how it impacts patient care through poor communication, delays in treatment and dismissed symptoms. The lessons from these cases can help nurses examine their own potential implicit biases and the consequences to patients, particularly marginalized individuals.
To address implicit bias, nurses can engage in self-reflection and undergo a learn-unlearn-relearn process of changing thoughts and behaviors through education, exposure and sharing knowledge with colleagues. “By engaging in open discussions and sharing insights, we can contribute to dismantling biases and promoting a more inclusive and equitable society,” the article adds.
AACN resources include a blog on preceptor training and development and a journal article on ethical behavior that helps address bias.
Protecting Nurses Against Workplace Violence
Workplace violence against nurses is on the rise. In her role, Jasmin Orange, an assistant nurse manager in a medical ICU, leads a committee working to mitigate workplace violence with tools and strategies to help maintain a safe environment.