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Background: The strategic nursing plan for a large Midwestern health care system includes achievement of the American Nurses Credentialing Center's Magnet ® recognition for all their hospitals. This study explored the barriers to and perceived value of certification among nurses employed by the same health care system across eight facilities in a metropolitan region. One of these facilities holds Magnet ® recognition., Method: Subjects were recruited by direct email to collect demographic data and complete a barrier to certification survey and the Perceived Value of Certification Tool-12., Results: There were statistically significant differences in the perception that lack of institutional support is a barrier to certification both in aggregate and when comparing the Magnet ® hospital with the others., Conclusion: As an initial exploration into barriers and perceived value, this study provides data for this health care system to plan strategies to promote certification. This study also serves as an exemplar for other organizations considering evaluation of certification barriers and value among their nursing staff. [ J Contin Educ Nurs. 2023;54(12):567-573.] .

Objective: The Certified Flight Registered Nurse (CFRN) credential independently validates a registered nurse's advanced knowledge, skills, and abilities in the unique specialty of flight nursing. Introduced in 1993 and celebrating its 30th anniversary in July 2023, the CFRN is held by over 5,500 registered nurses. The purpose of the 2022 CFRN pulse survey was to better understand the ways CFRN-certified registered nurses value this national flight nursing specialty credential. The CFRN survey is a companion to the 2022 Certified Transport Registered Nurse pulse survey, which focused on the Certified Transport Registered Nurse critical care ground transport nursing credential., Methods: The Board of Certification for Emergency Nursing e-mailed individuals in its database of CFRN credential holders and asked them to respond to a 14-question online survey between October 17, 2022, and November 8, 2022. Participation in the survey was voluntary. Of the 5,275 verified CFRN holders who received the survey, 992 responded, for a response rate of 18.8%. The survey instrument included discrete field and open-ended questions. Data were deidentified for analysis, and institutional review board exemption was received. Counts and percentages were reported, and descriptive statistics were used., Results: The highest percentage of flight nurses who responded have more than 10 years of experience in flight nursing (35.3%) and are employed by a stand-alone transport program (42.7%). Flight nurses reported they spent a mean of 70% of their work hours transporting via rotor wing aircraft, with a predominantly adult patient population. The top perceived benefits of being a CFRN-certified nurse were a sense of accomplishment and pride (90.7%) followed by flight physiology knowledge (85.4%), flight nursing clinical knowledge (83.4%), and confidence as a flight nurse (80.6%)., Conclusion: The 2022 CFRN pulse survey identified current CFRN demographics, practice environments including transport percentage by mode and patient population types, and perceived benefits of the CFRN credential. The findings suggest CFRNs are very experienced, provide care for patients across the age continuum, and perceive multiple intrinsic and extrinsic benefits of CFRN certification, all of which are essential to safe, evidence-based advanced nursing practice in the unique, complex, autonomous, and dynamic flight environment., (Copyright © 2023 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe differences in perioperative RN job satisfaction by specialty certification status., Design: A retrospective, exploratory, cross-sectional design., Methods: We conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified., Findings: Twelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses., Conclusions: As job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses., (Copyright © 2022 American Society of PeriAnesthesia Nurses. All rights reserved.)

Objective: The certified transport registered nurse (CTRN) credential independently validates a registered nurse's advanced knowledge, skills, and abilities in critical care ground transport nursing. After multiple years of mostly modest growth, the number of CTRNs surged in 2020 and 2021 and continues to post strong growth into 2022. The aim of the 2022 Certified Transport Registered Nurse Pulse Survey was to better understand the ways in which CTRN-certified registered nurses value this national ground transport specialty credential and gain insight into factors that may have contributed to the recent surge in CTRN certification., Methods: The Board of Certification for Emergency Nursing e-mailed individuals in its database of CTRN credential holders and invited them to complete an 11-question online survey between March 15 and March 28, 2022. Participation in the survey was voluntary. Sixty-three of 297 verified CTRN holders who received the survey responded for a response rate of 21.2%. The survey instrument included discrete field and open-ended questions. Data were deidentified for analysis, and institutional review board exemption was received. Descriptive statistics were used, and counts and percentages are reported., Results: The highest percentage of respondents (42.9%) have 10 or more years of experience in ground transport nursing, and nearly half (46%) are employed by a stand-alone transport program. Forty-three percent of all respondents reported that ground transport makes up at least 50% of their current role, whereas one third (33.3%) indicated they do ground transport 100% of the time. Critical thinking (87.5%) in the ground transport environment, confidence as a ground transport nurse (87.5%), and a sense of accomplishment and pride (94.6%) were the top 3 perceived benefits of being a CTRN-certified nurse., Conclusion: The 2022 CTRN pulse survey identified current CTRN demographics, practice environments, and perceived benefits of the CTRN credential. The findings suggest CTRNs are highly experienced and perceive multiple intrinsic and extrinsic benefits of CTRN certification, many of which are essential to safe, evidence-based nursing practice in the autonomous, complex, and dynamic ground transport environment., (Copyright © 2022 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Registered nurses are core members of critical care ground transport teams because of their education, experience, and scope of practice. Advances in medicine, technology, and equipment, combined with regionalization of specialized care and, most recently, the coronavirus disease 2019 pandemic, necessitate that transport nurses possess specialized knowledge, skills, and abilities. National specialty certification in ground transport nursing via the Certified Transport Registered Nurse (CTRN) offers registered nurses a process to validate their expertise. The most recent transport nursing role delineation study, which was conducted by the Board of Certification for Emergency Nursingin 2019, provided the foundation for the revised CTRN examination content outline, which is now separate from the Certified Flight Registered Nurse (CFRN) content outline. In this article, we provide a brief history of the specialty of ground transport nursing; details on the CTRN examination blueprint; and a composite patient case report to illustrate the ground-specific role, expertise, and contributions of the CTRN in delivering the highest level of patient care during ground transport., (Copyright © 2021 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Abstract: Advanced practice registered nurse (APRN) programs are challenged to provide clinical learning experiences that prepare graduates with the full continuum of expected competencies. Preparing the APRN in academia, in terms of didactic and clinical application for novice entry, is often a vexing balance between board certification preparedness and the actualities of clinical practice. This article presents an innovative strategy to examine the perplexing reflective question often asked by educators: Does the current approach for simulation development prepare our APRN students sufficiently for entry into practice, and is it current to what is occurring in practice?, Competing Interests: The authors have declared no conflict of interest., (Copyright © 2021 National League for Nursing.)

Professional certifications for nurses lead to improved patient satisfaction, fewer adverse events, and reduced nurse turnover rates. This study describes an initiative to increase professional certification at the medical-surgical service of an academic medical center. The solid organ transplant unit had a certification rate of 2%. Three registered nurses developed Certification Circle, which focused on the process of earning certification rather than a traditional knowledge-based review course, to increase the number of certified nurses on the unit. Clinical nurses conducted a prospective pilot study that used a pre-/posttest study design with convenience sampling for medical-surgical nurses. Participants were evaluated on their knowledge and confidence in taking the certification examination. Seven nurses earned certification, increasing the rate of certified nurses from one certified nurse to eight, a rate increase of 700%. Although the sample size was small, the dramatic increase in the certification rate shows that this initiative was a success. [ J Contin Educ Nurs. 2021;52(10):468-470.] .

The investment to support and obtain board certification demonstrates a nurse leader's commitment to their staff, the organization, and the communities they serve. It is important for nurse leaders to appreciate how organizational support of board certification can positively impact patient care and to be advocates for funding to support board certification for their staff. This month's Magnet® Perspectives column discusses the empirical evidence, as well as the professional value of certification., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Increased demand for nurses and improved technology have increased the development and popularity of online education programs over the past two decades; however, the online format has revealed numerous pedagogical and implementation challenges. One primary challenge is the lack of structural design standards across all courses in the program. The lack of standardization is linked to decreased student outcomes, satisfaction, and retention. The Quality Matters course design rubric and program certification provide a methodical process to standardize the format of all courses in an online education program. The Quality Matters course rubric is designed to increase student and faculty engagement and reduce variability in course design. At the current university, the application of Quality Matters processes and standards was first trialed with a few individual courses. Following the trial, faculty and administration decided to begin the process of seeking Quality Matters certification for the entire registered nurse-bachelor of science in nursing program. This article describes the process of attaining Quality Matters program certification for an online registered nurse-bachelor of science in nursing program. The nursing process and the Human Performance Technology evaluation model were used as appraisal frameworks guiding this program's QM certification process., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To explore how registered nurses (certified, noncertified, and managers) value certification as determined by the Perceived Value of Certification Tool, review the psychometric properties of the instrument, and ascertain the benefits and barriers to nursing specialty certification., Design: Systematic review (without meta-analysis) of 18 studies representing 26,534 registered nurses., Methods: Rigorous processes were used to minimize bias; to identify, appraise, and synthesize studies to explore how registered nurses value certification; and to ascertain the benefits and barriers to nursing specialty certification. Psychometric properties of the Perceived Value of Certification Tool were also reviewed and evaluated. Methods and results are presented in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines., Findings: All studies included in the review were cross-sectional studies with observational, descriptive designs published between 2003 and 2019. The average study participant was a 49-year-old Caucasian woman with a bachelor of science in nursing degree and 20 years of experience working as a staff nurse in a hospital. In accordance with the results reported in all studies included in the systematic review, the highest level of agreement and strong agreement occurred with the intrinsic value statements of enhances feeling of personal accomplishment (n = 16,697; 97.8%), provides personal satisfaction (n = 16,607; 92.7%), and validates specialized knowledge (n = 16,697; 97%). The lowest levels of agreement and strong agreement occurred with the extrinsic value statements of promotes recognition from employers (n = 16,607; 78.6%), increases consumer confidence (n = 16,607; 73.3%), and increases salary (n = 16,607; 41.9%)., Conclusions: The vigorous statistical work completed on the developmental study for the instrument conducted in 2003 has yet to be duplicated in the multiple studies published subsequently. The chiefly descriptive studies detailed in this systematic review are of limited usefulness in guiding future research. The Perceived Value of Certification Tool has proven useful in stimulating interest; however, a revision of the instrument is now required to promote research and patient outcome studies regarding the self-perceived value of certification in nursing specialties., Clinical Relevance: This report systematically reviews 18 studies that have used the Perceived Value of Certification Tool, a tool that has been widely used since 2003, to measure the perceptions of registered nurses regarding specialty certification. This review provides evidence that the instrument has potential for expanded use in patient outcomes studies and should be revised to better serve the needs of researchers., (© 2020 Sigma Theta Tau International.)

Objective: To define and describe the current psychiatric mental health registered nursing (PMHN) workforce providing care for persons with mental health and substance use conditions, evaluate sources of data relevant to this workforce, identify additional data needs, and discuss areas for action and further investigation., Method: This article uses currently available data, much of it unpublished, to describe the current PMHN workforce., Results: The available data indicate that PMHNs represent the second largest group of behavioral health professionals in the United States. As is true of the overall nursing workforce, PMHNs are aging, overwhelming female, and largely Caucasian, although the PMHN workforce is becoming more diverse as younger nurses enter the field. PMHNs are largely employed in the mental health specialty sector, and specifically in institutional settings. Similar to other behavioral health professionals, a significant shortage of PMHNs exists in rural areas. Because of data limitations and difficulty accessing the best available data on the PMHN workforce, it is often overlooked or mischaracterized in published research and government reports on the behavioral health workforce., Conclusions: Although PMHNs are one of the largest groups in the behavioral health workforce, they are largely invisible in the psychiatric literature. Psychiatric nursing must correct misperceptions about the significance of the PMHN workforce and increase awareness of its importance among government agencies, large health care organizations, and within the broader nursing profession.

Introduction: Strategic recruitment, preparation, distribution, and retention of US midwives requires a solid body of knowledge about midwives' education and workforce experiences. Although half of US midwifery education programs currently require or prefer prior registered nurse (RN) employment, data are lacking about whether and how these criteria influence efforts to scale up the workforce to meet reproductive care workforce shortages and maldistributions., Methods: This cross-sectional research used an online survey, developed using the framework of Social Cognitive Career Theory. Early-career midwives were contacted through the American College of Nurse-Midwives electronic mailing list and social media during the fall of 2016. Statistical analysis allowed for linkage of data related to the following constructs: personal characteristics, prior RN employment, educational experiences, employment situations, career perceptions, and future plans., Results: All participants (N = 244) were certified nurse-midwives. Compared with those without prior RN employment, midwives with prior RN employment were more likely to enroll part-time in distance programs and complete single majors or degrees. During enrollment, the 2 groups experienced the same degree of mentorship and cultural support and were similarly likely to attend 30 births and to pass the certification examination on first attempt. In the workforce, those with prior RN employment were 6 years older and more likely to work full-time. The 2 groups demonstrated no significant differences in their career perspectives or future career plans., Discussion: Despite anecdotal concerns about training midwives who lack RN work experience, an individual without prior RN employment offers the workforce an employee who completes midwifery education at a younger age, may be educated more quickly, and is more likely to have earned a dual major or degree. Those with prior RN employment are more likely to work full-time. Both groups may offer benefits to education and the workforce., (© 2018 by the American College of Nurse-Midwives.)

A growing and ageing haemophilia treatment centre (HTC) population, as well as a glaring shortage of adult haematologists available for the clinical management of persons with haemophilia (PWH), has resulted in significant care gaps in the United States. In response, various advanced practice registered nurse (APRN)-based models have been adopted across the country to counteract a deficit in haematologist resources for adult PWH. These models in the management of PWH have demonstrated competency and efficiency in the care of patients with haemophilia, offering a viable solution in areas where haematologist resources are limited and assure quality care provision, most notably in rural areas. The available literature indicates equivalence in terms of clinical outcomes, patient satisfaction and elements of healthcare service utilization. With continued support in current clinical guidelines and institutional contributions in the form of residency and fellowship programmes, the robust successes of APRN models for the clinical management of PWH can be maintained and expanded well into the foreseeable future., (© 2018 John Wiley & Sons Ltd.)

The introduction in 2016 of the Nursing and Midwifery Council revalidation process, which involves several standardised steps, has represented a major change for UK nurses and midwives, and is now a compulsory requirement of reregistration. This article presents preliminary results of a survey about revalidation, undertaken in June 2016 at Oxleas NHS Foundation Trust, Dartford, focusing on how nurses and midwives feel about the process. The article considers the effect of different variables, including pay band, seniority and directorate, on nurses' and midwives' perceptions of revalidation, and suggests it is regarded more positively by senior, more experienced staff than by those who are less experienced., Competing Interests: None declared, (©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Since 1 April 2016, UK nurses and midwives have been required to undertake revalidation to maintain their registration with the Nursing and Midwifery Council. This article reports the results of a service evaluation to identify the revalidation preparation experiences of nurses and midwives at University College London Hospitals NHS Foundation Trust (UCLH). Findings suggest that the revalidation preparation process at UCLH supports staff to seek opportunities continually for practice feedback, reflect on their everyday experiences and link their learning to ongoing professional development.

Challenges of the current health system in the United States call for collaboration of health care professionals, careful utilization of resources, and greater efficiency of system processes. Innovations to the delivery of care include the introduction of the clinical nurse leader role to provide leadership at the point of care, where it is needed most. Clinical nurse leaders have demonstrated their ability to address needed changes and implement improvements in processes that impact the efficiency and quality of patient care across the continuum and in a variety of settings, including critical care. This article describes the role of the certified clinical nurse leader, their education and skill set, and outlines outcomes that have been realized by their efforts. Specific examples of how clinical nurse leaders impact critical care nursing are discussed.

Regimented vital signs (VS) assessment for all emergency patients is a common practice in many US emergency departments despite the paucity of evidence supporting its utility. Nurse attitude may be a factor that maintains this ritualized practice. Understanding the relationship between attitudes, practices, and nurse demographic factors may be the first step to challenging this ritual in order to implement evidence-based practices. A 20-item questionnaire was developed to assess emergency nurse attitudes and practices related to VS. A convenience sample of emergency nurses from the mid-Atlantic region of the United States was used. Eighty-one emergency nurses participated. Results demonstrated wide variations in VS practice and attitudes, though some strongly held attitudes are inconsistent with the literature. Certification in emergency nursing had significant associations with beliefs that nurses' clinical judgment should be the determinant for VS frequency (p < .05) and that triage VS are not an accurate representation of patient condition (p < .05). The practice of assessing the patient first and reviewing VS after was also associated with certification (p < .05). This study begins to address emergency nurse attitudes and practices of VS so that evidence-based changes can be implemented and further research on VS frequency conducted. It also demonstrates the relationship between specialty certification and evidence-supported attitudes and practices., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

TWO MONTHS ago, the Nursing and Midwifery Council launched a revalidation model that all nurses and midwives in the UK will have to undertake to maintain their registration.

AT THE beginning of this month, the first nurses to use the new revalidation system will have completed their applications to maintain their registration. By April 2019, every nurse and midwife in the UK will have gone through the process.

Under the new system of revalidation, nurses and midwives are required to complete a number of activities before renewal of their registration every three years. This article reports on the experiences of one pilot site that tested the proposed system.

All UK nurses and midwives will be required to perform revalidation as part of their registration process, from April 2016. This entails a pre-determined number of practice hours and study time, reflection on practice, obtaining feedback on individual performance and confirmation of these achievements by a third party source. This article describes the actions nurses and midwives can take to fulfil their revalidation requirements. It also discusses how to prepare for the forthcoming changes and what the nurse and midwife need to consider to perform successful revalidation. By completing the time out activities included with this article, reflecting on your practice and submitting your work for continuing professional development credits, you will be working towards creating a revalidation portfolio, in accordance with Nursing and Midwifery Council guidelines.

A huge revalidation pilot at Aneurin Bevan Health Board in Wales – more than 800 staff embarked on the process in February – has delivered important lessons for other organisations and individual registrants about what to expect when they begin the process.

Objective: The purpose of this study was to examine the relationship between nursing job satisfaction and healthcare-associated infections (HAIs) in adult critical care., Methods: Multilevel modelling was used to examine the relationship between nursing job satisfaction and two HAIs, ventilator-associated pneumonia (VAP) and central-line associated bloodstream infections (CLABSI)., Results: Units with nurses that reported satisfaction with organisational policies were associated with a 6.08 decrease in VAP (p=0.013) and units with nurses reporting favourable perception of task requirements were associated with a 7.02 decrease in VAP (.014). Positive perception of organisational policies was associated with lower rates of CLABSI (p=0.002). Unexpected findings include a positive relationship between perception of pay and autonomy and CLABSI as well as perception of interactions and VAP. Units with a higher proportion of Critical Care Registered Nurse (CCRN) certified nurses were associated with lower rates of both CLABSI (p<0.001) and VAP (p=0.037)., Conclusion: This study provides preliminary evidence to support the relationship between nursing job satisfaction and HAIs in critical care, although some relationships were counterintuitive. A secondary finding included significant relationships between CCRN certified nurses and HAIs., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Revalidation replaces the current triennial self-declaration system of maintaining nurse registration. It involves a third-party affirmation process designed to improve public and patient confidence that nurses remain up to date by undertaking relevant professional development activities. While revalidation is ultimately the responsibility of individual nurses, senior nurses have an important facilitating role in ensuring that registrants can remain on the register and so continue to practise. This article outlines, from a practical perspective, the senior nurse's role and responsibilities in supporting registrants through each stage of the revalidation process.

AS A participant in the revalidation pilot at Guy's and St Thomas' NHS Foundation Trust, I began the process by registering online at the Nursing and Midwifery Council (NMC) website.

A number of states have adopted certification programs for community health workers (CHWs) to improve recognition of CHWs as members of health care teams, increase oversight, and to provide sustainable funding. There has been little research into the impact of state CHW certification on the diffusion and adoption of CHWs into existing health care systems. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. The study recruited RNs using a purposeful sampling method and used an online survey, which included the Team Climate Inventory (TCI), and compared the perceptions of team climate between the two groups. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n = 81) and those who work in states without CHW certification programs (n = 115). There was a statistically significant difference on one survey question regarding whether RNs believe state certification of CHWs improved the ability of their health care team to deliver quality care. More research is needed to assess impact of state certification of CHWs and other factors that influence the diffusion and adoption of CHWs into the current health care system.

Advancing Healthy and Socially Just Schools and Communities is a four-course graduate certificate program collaboratively developed by an interdisciplinary team comprised of faculty from the fields of Social Work and Education at a Canadian university. The aim of this program is to facilitate systems-level change through enhancing the knowledge and skills of graduate students from disciplines such as social work, education, and nursing who work with youth in schools and communities. The ultimate goal of this systems-level change is promotion of healthy youth relationships and prevention of violence. The topics for the four courses in the program include the following: promoting healthy relationships and preventing interpersonal violence, recognizing and counteracting oppression and structural violence, addressing trauma and building resilience, and fostering advocacy and community in the context of social justice. The development and pedagogy of the certificate program are described, along with findings from a pilot study designed to examine the utility and feasibility of the initial certificate offering. Experiences with the program to date highlight the potential for improvements in graduate students' attitudes, beliefs, and confidence regarding what constitutes violence and their role in responding to it.

The most important new trend in resumes is the employer-focused resume. Writing one is not difficult, but it requires a change in focus. The focus of this type of resume is on the needs of prospective employers. This new resume format allows applicants to describe to prospective employers what they can provide related to the employer's needs as opposed to a simple listing of their academic and work experiences without relation to the prospective new job. This article provides advanced practice nurses with sources to guide construction of informative text about their advanced practice nursing skills and competencies using language familiar to employers. Resumes and curriculum vitae formats are compared, and advice is provided on developing content for either format. Guidelines are provided about listing credentials, identifying clinical proficiencies from student clinical practicum, using qualification summaries rather than an objective statement, choosing references, and including essential components in a cover letter.

The aim of the study was to determine the effect of a portfolio-based professional development program on nurses' competence in a university hospital in Iran. A pre-test/post-test, controlled, quasi-experimental design was used. From the university hospital's 18 general wards, four wards were randomly selected. Two wards were randomly allocated as the experimental group (35 subjects) and two wards as the control group (38 subjects). Nurses in the experimental group participated in a 12-month portfolio-based professional development program and nurses in the control group participated in the routine professional development programs of their wards. The data were collected by the Nurse Competence Scale and were analyzed using descriptive statistics and independent and paired t-tests. After intervention, the average nurses' competence in the experimental group increased significantly (P < 0.001) but these changes in the control group were not significant (P = 0.08). This study shows that the professional portfolio is an effective tool for improving nurses' competence. The professional portfolios help nurses update their knowledge, skills, and competence towards their full role as nurses., (© 2012 Wiley Publishing Asia Pty Ltd.)

Background: Traditional top-down national regulation of internationally mobile doctors and nurses is fast being rendered obsolete by the speed of globalisation and digitisation. Here we propose a bottom-up system in which responsibility for hiring and accrediting overseas staff begins to be shared by medical employers, managers, and insurers., Discussion: In this model, professional Boards would retain authority for disciplinary proceedings in response to local complaints, but would lose their present power of veto over foreign practitioners recruited by employers who have independently evaluated and approved such candidates' ability. Evaluations of this kind could be facilitated by globally accessible National Registers of professional work and conduct. A decentralised system of this kind could also dispense with time-consuming national oversight of continuing professional education and license revalidation, which tasks could be replaced over time by tighter institutional audit supported by stronger powers to terminate underperforming employees., Summary: Market forces based on the reputation (and, hence, financial and political viability) of employers and institutions could continue to ensure patient safety in the future, while at the same time improving both national system efficiency and international professional mobility.