Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended.

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Advocacy describes the act of pleading for, supporting, and active espousal. It implies taking action to achieve a goal on behalf of oneself or another. In nursing, the patient's wishes often serve as the impetus for advocacy. Perioperative nurses function as advocates and accept responsibility to safe-guard the rights of surgical patients. This article describes historical aspects of and conceptual problems in nursing advocacy, and it presents case studies that demonstrate advocacy by the perioperative nurse.

It is traditionally assumed that licensure of healthcare professionals means that they are minimally competent. Many nursing specialty organizations offer examinations and other processes for certification, suggesting that certification is associated with continued competency. Can standardized examination for certification and continuing education for recertification ensure continued competency? Continuing education and testing provide a limited picture of an individual's knowledge and/or skill acquisition in a limited area at one point in time. However, portfolios promote critical thinking, self-assessment, and individual accountability. A portfolio is a portable mechanism for evaluating competencies that may otherwise be difficult to assess. This article summarizes some of the literature addressing portfolios, including aspects of portfolio development process, the value of portfolios versus continuing education for competency assessment, evidence associated with portfolio usage, and suggestions for organizing nursing portfolios.