The Power of Nurse Preceptors to Influence Practice Related to Central Line-Associated Bloodstream Infections

Abstract

(41st Biennial Convention) Background: The Joint Commission issued a National Patient Safety Goal for prevention of central line-associated bloodstream infections (CLABSI). The Centers for Disease Control and Prevention report 250,000 cases of CLABSI annually in the United States (US) with a cost of $25,000 per episode and a mortality rate of 12%. In our study examining behavioral intention to utilize best practice disinfection techniques when "scrubbing the hub," we found that nurse peers exerted the greatest influence over this crucial element in prevention of CLABSI. Methods: Based upon these findings, conversations were conducted with 37 staff nurse preceptors. Goals included: 1) to appreciate their powerful influence over nursing practice; 2) to validate comprehension of hospital policies related to central line care and maintenance; and 3) to discover obstacles to best practice implementation. Results: Complex patient care has placed myriad demands on nurses' time, often resulting in frustration with multi-tasking which can lead to sub-optimal best practice implementation. Inadequate time for retrieval, appraisal and translation of best practice information and delays in dissemination of policy updates were also perceived negatively. Positive perceptions included a desire to enhance patient outcomes through sharing of stories, and a willingness to offer and receive feedback as members of a high reliability organization. Preceptors expressed appreciation for having a voice in the organization. Implications: Preceptors should have opportunities to develop skills in time management and priority setting for the prevention of CLABSI. Sharing patient stories about CLABSI creates a connection between data and real life persons with whom the nurse has developed therapeutic relationships. This capitalizes on the caring nature of the nurse-patient bond and produces a nursing value system based in the affective learning domain. Organizational leaders should explore opportunities for direct care providers to engage in meaningful discourse about optimal best practices for CLABSI prevention.