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Background: Many variables contribute to the success of nursing students and new nurses in their transition to practice. Clinical orientation and training usually falls to staff nurse preceptors. Inherent in this dynamic is the assumption that staff nurses are prepared and able to assume this responsibility. Ideal characteristics and attributes of preceptor competency have not been conclusively defined., Method: This qualitative study explored the defining attributes of preceptor role competency as described by preceptors who attended one of 44 continuing education preceptor academies over 9 years in Missouri., Results: Analysis revealed that communication, expertise, flexibility, evaluation skills, and patience are among the most important competencies of nurse preceptors., Conclusion: Understanding role expectations would benefit both preceptors and nurse educators who select, train, and support nurse preceptors. Identification of essential preceptor competencies can inform preceptor preparation courses and identify needs for continuing education of preceptors. J Contin Educ Nurs. 2018;49(5):233-240., (Copyright 2018, SLACK Incorporated.)

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.

The use of pentobarbital-induced coma to manage intractable increased intracranial pressure remains a viable option in the acutely brain-injured patient. In a retrospective review of 15 patients with a variety of neurological injuries at our institution, it was found that aggressive management of respiratory, hemodynamic, metabolic and neurological status was required with the use of pentobarbital coma. A scoring system to determine the amount of interventions and nursing care required was used in the review. The Therapeutic Intervention Scoring System (TISS) demonstrated that with the acuity of illness, there were predictably increased interventions. As a method for quantifying the amount of care in this group of individuals, scoring of the interventions before, during, and after barbiturate coma was assessed. The findings demonstrated a significant difference in the scoring. Mean scores were: pre-treatment = 31.8, s.d. = 7.5; during = 41.7, s.d. = 2.0; post-treatment = 36.4, s.d. = 5.2, p < 0.01. Further modifications of the TISS to include current neuroscience therapies, such as the monitoring of cerebral oxygen extraction by jugular bulb catheterization, may increase the utility of the TISS.