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PubMed2005

Magnet demographic data: creating a system to streamline the process.

The benefits of Magnet status are well documented. However, the challenges of completing the Magnet application can overextend an organization's data collection processes and systems. The authors discuss the driving forces behind development of Step One, a cost-effective on-line system alternative to manual demographic data collection. The article presents an overview of staff's role in system development and rollout and describes improvements in efficiency, accuracy, and satisfaction from data collection to final American Nurse Credentialing Center report generation.

Benchmarking↗
PubMed2006

A road map for creating a Magnet work environment.

OBJECTIVE: The authors examine the relationship between working environment and the developmental level of the workforce, against the backdrop of the American Nurses Credentialing Center Magnet Recognition Program, to provide a road map for creating a positive work environment. BACKGROUND: With the daily demands on nurse managers, there is a need to identify focused strategies to achieve a Magnetized, high-performing work environment. METHODS: The American Nursing Association Magnet survey was administered to nurses at a large healthcare system. Patient units at each hospital were categorized as reactive, responsive, proactive, or high performing. Similar categories of units across all 6 hospitals were analyzed. Analysis of variance was performed on each Force of Magnetism by developmental level. RESULTS: Mean scores measuring the Forces of Magnetism were statistically significant between reactive and responsive units. Likewise, mean scores between responsive and proactive units were also statistically significant. Between reactive and responsive units, there were 3 statistically significant forces of Magnetism: organizational structure, management style, and interdisciplinary relations. These are labeled primary priority forces. Between responsive and proactive units, there were 6 statistically significant forces of Magnetism labeled secondary priority forces: policies and programs; professional models of care; quality of care; consultation and resources; autonomy; and interdisciplinary relations. CONCLUSIONS: Nursing staff perceive the "Magnetism" of the work environment differently, depending on the developmental level of the unit. Nurse managers with reactive units should focus on the 3 Forces of Magnetism identified as the primary priority forces, in order to help develop their unit to the next level of responsive. Once a responsive level has been achieved, the next 6 forces should be addressed.

Data Collection↗
PubMed1999

Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference.

OBJECTIVE: To assemble an international panel of experts to develop consensus recommendations on selected important issues on the use of ultrasonography (US) in trauma care. SETTING: R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Md. The conference was held on December 4, 1997. PARTICIPANTS: A committee of two co-directors and eight faculty members, in the disciplines of surgery and emergency medicine, representing four nations. Each faculty member had made significant contributions to the current understanding of US in trauma. RESULTS: Six broad topics felt to be controversial or to have wide variation in practice were discussed using the ad hoc process: (1) US nomenclature and technique; (2) US for organ-specific injury; (3) US scoring systems; (4) the meaning of positive and negative US studies; (5) US credentialing issues; and (6) future applications of US. Consensus recommendations were made when unanimous agreement was reached. Majority viewpoints and minority opinions are presented for unresolved issues. CONCLUSION: The consensus conference process fostered an international sharing of ideas. Continued communication is needed to advance the science and technology of US in trauma care.

Certification↗
PubMed1999

Use of an Objective Structured Clinical Examination (OSCE) for the assessment of physician performance in the ultrasound evaluation of trauma.

BACKGROUND: A reliable means of assessing physician competency in performing ultrasound (US) is critical for training and credentialing. Objective Structured Clinical Examinations (OSCE) have been used successfully to assess clinical competency in other areas of surgical education but have not been applied previously to trauma ultrasound training. The objectives of this study were to assess physician performance in the focused abdominal sonography in trauma (FAST) examination by using a specifically designed OSCE, and to determine whether the OSCE detects differences in two determinants of competency (knowledge acquisition and clinical interpretation skills). METHODS: Eighty-two physicians in surgery (n = 49) and emergency medicine (n = 33) at a Level I trauma center were evaluated. All participated in a FAST course consisting of didactic sessions on US physics, indications, and technique, FAST examination videos, and a hands-on session with human models. The OSCE consisted of two parts: written examination that assessed factual knowledge, and videotape of real-time US examinations that assessed interpretation skills. The OSCE was administered before and after the FAST course. RESULTS: Significant improvements in postcourse OSCE scores were observed for factual knowledge (52.5 +/- 2.0 vs. 87.5 +/- 1.1, p < 0.001) and interpretation skills (27.2 +/- 1.4 vs. 62.9 +/- 1.3, p < 0.007). Scores for US interpretation were significantly lower than those for factual knowledge at both precourse (27.2 +/- 1.4 vs. 52.5 - 2.0, p < 0.001) and postcourse (62.9 +/- 1.3 vs. 87.5 +/- 1.1, p < 0.01). No performance differences were observed between surgeons and emergency medicine physicians and no effect of training level on test scores was observed. CONCLUSION: Knowledge acquisition and US interpretation skills can be assessed reliably with a specifically designed OSCE. Although both skills improved after participation in a FAST course, US interpretation scores were consistently lower than those for factual knowledge. This study supports the use of the objective structured clinical examination in both the design of ultrasound teaching programs and the assessment of physician competency.

Clinical Competence↗
PubMed1975

Practice characteristics and quality of primary medical care: the doctor-patient relationship.

Physician and practice characterisitics were reviewed in relation to the quality of the doctor-patient relationship in primary medical care. This relationship was defined in terms of communication between physicians and patients, patient satisfaction with care, and physician awareness of patient concerns. The study subjects were mothers of infants and pregnant women, identified from the offices of a random sample of primary care physicians is a single community. The patients of 49 physicians, 363 pregnant women and the mothers of 523 infants were the subjects of the study. When controlled for patient characteristics, communication was better for pediatricians with mothers of infants and for obstetricians with pregnant women as compared with other physicians. Mothers of infants were more highly satisfied with care provided by residency-trained physicians; pregnant women were more satisfied with non-Board certified physicians. Physician awareness of patient concerns presented a mixed pattern of associations with several physicians and practice characteristics. These findings suggest that physician credentials are not consistently associated with the three identified dimensions of the doctor-patient relationship.

Adult↗
PubMed1991

Physician referrals and the medical market place.

Factors determining the extent to which physicians obtain new patients through referrals are examined. A more thorough understanding of physician referral patterns can help to explain how competitive forces function in this market and how physician characteristics and credentials affect individual performance. Referral networks promote entry by young physicians into both primary and nonprimary care medical markets. Nevertheless, there are marked differences in referral patterns between primary care and nonprimary care providers. For instance, referrals are directly related to the degree of market competition and board-certification status among primary care physicians but not among nonprimary care specialists. Membership in a group practice is related to significantly more referral activity among nonprimary care physicians but not among primary care providers. No significant differences were found in referral patterns by physician sex. Although foreign medical graduates (FMGs) receive proportionately fewer referrals than do U.S. medical graduates, the differences are not large. While earlier research suggests that the returns to board certification are higher for female physicians, the present study finds little evidence that board certification is particularly helpful to either female physicians or to FMGs in terms of obtaining patients on referral.

Certification↗
PubMedDate not supplied

Advanced practice in maternal/child nursing: history, current status, and thoughts about the future.

Advanced practice nursing has undergone dramatic growth and change in during the past quarter century. Specialization in maternal/child health started with hospital-developed postlicensure programs which evolved into formal master's level programs. The first nurse-practitioner program in pediatrics was begun in 1965 at the University of Colorado. The last 25 years has seen an increase in clinical specialization and in advanced practice roles within the specialties. The growth of credentials and types of certification available have provided opportunities for nurses, but have also created confusion for consumers and other health care professionals. Current challenges facing advanced practice nurses include issues related to legal authority for scope of practice, direct reimbursement for services, and prescriptive authority. The current health care climate provides challenges and opportunities for nurses in advanced practice.

Adolescent↗
PubMed2002

How do we pass NP autonomy legislation?

NP practice autonomy means prescribing medication and treatment based on graduate nursing education and credentials, without physician supervision. NP advancement and optimal professional practice depends on autonomy. NP researchers conducted a study to describe legislative initiatives in states where NPs practice and prescribe autonomously. This article outlines the strategies NPs used to pass autonomy legislation in South Carolina. NPs in other states can use these strategies to pursue autonomy legislation.

Legislation, Nursing↗
PubMedDate not supplied

Celebrating certification in nursing: forces of magnetism in action.

Professional certification in nursing is a measure of distinctive nursing practice. The rise in consumerism in the face of a compelling nursing shortage and the profession's movement to elevate nursing as a career option has given prominence to the value of certification in nursing. The value of certification is not only significant for nursing practice rather the focus on professional certification is also essential to meet multiple standards within the American Nurses Credentialing Center's Magnet Recognition Program for excellence in nursing services. This article describes one hospital's success with a critical care nurse certification drive. The article identifies ways in which an organization can take elements of a professional certification drive to show-case the forces of magnetism and to provide evidence that a Magnet-aspiring organization meets required Magnet standards.

Benchmarking↗
PubMedDate not supplied

Comparison of native versus nonnative English-speaking nurses on critical thinking assessments at entry and exit.

Diversity of language among healthcare employees and nursing students is growing as diversity increases among the general population. Institutions have begun to develop systems to accommodate diversity and to assimilate workers. One barrier to nonnative English-speaking nurse hires may be posed by readiness for the licensure exam and the critical thinking assessments that are now an expected outcome of nursing programs, and act as a gatekeeper to graduation and to employment. To assist in preparing for high-stakes testing, the Assessment Technologies Institute Critical Thinking Assessment was developed in compliance with credentialing bodies' educational outcomes criteria. This pilot study of 209 nursing students was designed to reveal any possible language bias that might act as a barrier to nonnative English speakers. Nursing students were entered as whole classes to the study to control for selection bias. A sample representative of national nursing enrollment was obtained from 21 universities, with 192 (92%) native English-speaking students and 17 (8%) nonnative English speakers participating in the study. All students were given the Assessment Technologies Institute Critical Thinking Assessment at entry and exit to their nursing program. Average scores on entry were 66% for nonnative speakers and 72% for native speakers. At exit, the nonnative speakers had closed the gap in academic outcomes. They had an average score of 72% compared to 73% for native speakers. The study found that the slight differences between the native and nonnative speakers on 2 exit outcome measures-National Council licensure examination (NCLEX-RN) pass rates and Critical Thinking Assessment-were not statistically significant, demonstrating that nonnative English speakers achieved parity with native English-speaking peers on the Critical Thinking Assessment tool, which is often believed to be related to employment readiness.

Bias↗
PubMed2002

The magnetic pull.

In this third of an ongoing series of articles, discover the major attributes of organizations that earn Magnet status through The Magnet Nursing Services Recognition Program for Excellence in Nursing Services of the American Nurses Credentialing Center.

Awards and Prizes↗
PubMed2002

The magnetic pull.

In this fourth of an ongoing series of articles, discover the major attributes of organizations that earn Magnet status through The Magnet Nursing Services Recognition Program for Excellence in Nursing Services of the American Nurses Credentialing Center.

Awards and Prizes↗
PubMed2004

Personal digital assistant use in Florida obstetrics and gynecology residency programs.

OBJECTIVES: Improvements in electronic technologies have resulted in affordable, smaller computers that operate at faster speeds. The personal digital assistant (PDA) is a tool that has the potential to enhance residency education by allowing residents immediate access to an abundance of information. This article assesses the current use of this tool at obstetrics and gynecology residency programs in the state of Florida. METHODS: The authors conducted a statewide survey addressing the general question: is the PDA useful in an obstetrics and gynecology residency training program? Specifically, the authors asked residents how much time was perceived to be saved weekly with the use of this tool, and in what aspect of their training use of this tool was most helpful. RESULTS: At the survey's close, five of seven programs had returned the survey for evaluation. These five institutions included both university- and community-based residency programs. Forty percent of obstetrics and gynecology residents at these programs responded to this questionnaire. Resident responses to the survey revealed that most of the perceived benefit was in maintaining procedural statistics logs, pharmacology reference manuals, and personal clinical protocols. Most responses revealed that only minimal time savings (<2 h/wk) were gained with using this tool. However, many residents felt they were not using this tool to its maximum potential. Nearly 90% of those who responded felt that the PDA should be available at residency programs and anticipated using it after completing residency. CONCLUSIONS: This study posed the question of PDA usefulness at obstetric and gynecology residency programs in the state of Florida. Although not all programs provided their residents with a PDA, 95% of the respondents revealed that they owned one of these tools. Experience at the authors' institution revealed high expectations for the potential uses of a PDA. Although many residents were not using this tool to its full potential, a PDA tutorial session could educate residents on the many applications available for PDAs, including applications to maintain on-call schedules and sign-out lists, statistics and procedure logs for credentialing and board certification, electronic billing, and electronic prescriptions.

Academic Medical Centers↗
PubMedDate not supplied

A regional comparison of cardiac rehabilitation personnel. Adherence to the 1995 American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines by Staff Position.

PURPOSE: The American Association of Cardiopulmonary Rehabilitation (AACVPR) established guidelines for cardiac rehabilitation (CR) personnel regarding educational degree attainment, licensure, and certification. New England hospital-based CR personnel were surveyed by staff position to determine their adherence to these guidelines. METHODS: The New England Hospital-Based CR Program Questionnaire was designed to obtain information regarding program characteristics and personnel credentialing. Initially, 117 program directors agreed to participate, and 108 returned completed questionnaires for a response rate of 92.3%. RESULTS: Of the CR programs surveyed, 41% were within hospitals containing 101 to 250 beds, whereas most of those providing inpatient (66.6%) and outpatient (82.4%) CR enrolled less than 200 patients annually. Overall, 40.7% of personnel (n = 450) by staff position reported that they met the minimum recommendations, whereas 7.0% (n = 470) met the preferred AACVPR recommendations. Registered nurses (n = 67) and physical therapists (n = 58) were most compliant with the minimum guidelines: 89.6% and 84.5%, respectively. In contrast, 10.9% of the program directors/coordinators (PD/C; n = 128) met the minimum qualifications, and 5.5% met the preferred AACVPR qualifications. Most PD/C had Advanced Cardiac Life Support Certification (84.4%), but few (18%) attained American College of Sports Medicine (ACSM) certification. CONCLUSIONS: Overall, compliance of New England hospital-based CR personnel with the AACVPR minimum/preferred guidelines for educational degree and certification was lacking, as was acquisition of ACSM certification. The effect of these findings on the future status of recommended and required CR personnel qualifications for hire merits attention.

Cardiac Rehabilitation↗
PubMedDate not supplied

Clinical Tips: The New Commission on Dietetic Registration/Professional Development Portfolio Process: You're in the Driver's Seat.

After more than 25 years of credentialing dietetic professionals, the Commission on Dietetic Registration is revising the format for logging continuing professional education. As of 2001, the new system will be phased in over 5 years. Each registered dietetic professional will now plan a course of continuing education to meet personal and professional growth needs. This is a very exciting process and one that has many asking questions of "why, how, when, and where." This article is designed to put a perspective on the new process.

Journal Article↗
PubMedDate not supplied

Identification of Molecular Targets and Biomarkers for Disease Resistance.

Discoveries about molecular targets for nutrients will unquestionably provide important clues into how best to optimize nutrition for an individual. The "Credentialing" of nutrients in terms of their influence on genetic and epigenetic events that bring about a desired phenotypic change is surely within the future of nutrition science.

Journal Article↗
PubMed2001

The use of volume standards in health services.

The ways in which volume standards are implemented by health services organizations are not clear. Therefore, the authors sought to evaluate the extent of use of volume standards, the purposes for which such standards were developed, and the sources of the standards in a sample of health services organizations. The authors found that volume standards were used widely by accrediting organizations, professional societies, and hospitals in their sample, but almost never by health maintenance organizations. Volume standards were used for ensuring adequate experience among residents, providing guidelines to residency programs, and privileging and credentialing physicians. Expert consensus appeared to be the usual source of volume standards.

Accreditation↗
PubMedDate not supplied

Practice analysis: techniques of head and neck surgeons and general surgeons performing thyroidectomy for cancer.

OBJECTIVE: Medical practice governance is made more challenging by the fact that many procedures may be performed by various medical or surgical specialties. Thyroid cancer surgery is performed by both physicians with general surgery (GS) and those with otolaryngology/head and neck surgery (HNS) credentials. Analyses describing differences in practice patterns between the 2 services have not been published previously. PATIENTS AND METHODS: The records of the Tumor Registry at the Naval Medical Center San Diego were reviewed for patients presenting with thyroid cancer between January 1, 1990, and December 31, 1999. The review included all patients undergoing partial or total thyroidectomy, and the operative techniques and complications were noted. RESULTS: Of the 178 patients who underwent thyroid cancer surgery in this period, charts were available for 136 (n = 87 HNS, n = 49 GS, 1 combined HNS/GS). There was no difference between the 2 services in terms of the percentage of patients undergoing lymph node sampling (P = 1.000), but each had different approaches to sampling techniques. Head and neck surgeons performed more total thyroidectomies (P < .001) and referred patients more frequently for postoperative radioiodine (P = .025); they resected 426 nodes in 32 patients (mean 13.3, median 6.5), of which 120 (28.2%) were positive. General surgeons resected 28 nodes in 11 patients (median 2.0, mean 2.6), of which 12 (42.8%) were positive (P = .009). Other variables were similar for services, including inpatient hospital days, estimated blood loss, number of patients with temporary hypoparathyroidism, and duration of hypocalcemia. CONCLUSION: In this cohort, otolaryngologists/head and neck surgeons and general surgeons have a significantly different approach with respect to lymph node sampling in the surgical therapy of thyroid cancer. Outcomes appear independent of technique.

California↗