Leading Nursing Excellence Through a System Magnet® Program Director Council.

American Nurses Credentialing Center Magnet® designation is prestigious to healthcare institutions. Setting the expectation for all hospitals within a system to be Magnet designated is a lofty but achievable goal. Nursing leaders at the University of Pittsburgh Medical Center set organization-wide designation as a goal in 2010. A robust system-wide Magnet Program Directors Council facilitated this effort by standardizing practices and supporting members through the journey.

The impact and perception of nursing certification in pediatric nursing.

Nursing certification is an assessment and formal recognition of specialized knowledge, and is awarded through achievement of standards identified by a nursing specialty (Niebuhr & Biel, 2007). This recognition is a method of not only assessing competency, but knowledge and skills, and has been linked to an increase in patient satisfaction and nurse retention (Kleinpell, 2009). For these reasons, a heightened focus has been on identifying the value of nursing certification and outcomes related to patient care. This study explored nurse perception of certification and measured response to a high fidelity simulated scenario by certified and non-certified pediatric nurses to a deteriorating patient through simulation and self-assessment.

Monitoring of hemostatic status in four patients being treated with recombinant factor VIIa.

Recombinant Factor VIIa (rVIIa) is a potent hemostatic agent for the management of refractory bleeding in patients with Factor VII deficiency or Factor VIII inhibitors. While the current recommended dose is usually effective, the most appropriate dose remains a subject of debate. Since factor VII levels and shortening of the pro-thrombin time do not appear to correlate with response, an appropriate laboratory marker of clinical response has not been identified. In this article we report changes noted in thrombin generation, platelet function and clot structure in blood from patients treated with rVIIa. Thrombin generation was assessed via a thrombin generation time (TGT) assay using a Hemodyne HAS instrument. Changes in clot structure were assessed as changes in clot elastic modulus in the HAS, changes in maximum amplitude in the TEG and changes in maximum clot firmness in the ROTEG. The cases presented confirmed improvement in thrombin generation with administration of rVIIa. The cases also illustrate that: a) in the factor VII deficient patient, 25% of the 90 microg/kg dose is sufficient to totally correct the defect, b) patients with high level factor VIII inhibitors may require significantly more than the recommended dose of 90 microg/kg, c) thrombin generation may not be completely corrected despite dramatic shortening of the prothrombin time, and d) increasing rVIIa doses does not by itself ensure improved thrombin generation.

Nursing portfolio study: the use in annual performance reviews.

Professional portfolios allow staff to document their participation in areas of education, certification, shared governance councils, national nursing organizations, and community outreach. In this study, nurses tracked their professional development in a virtual electronic portfolio. A preperception/postperception questionnaire for both staff and unit directors revealed that nursing portfolios proved to be a valuable tool during annual performance reviews to acknowledge accomplishments and encourage continued professional growth of individual direct-care staff nurses.