Contrast-enhanced ultrasonography (CEUS) is an imaging modality that shows promise in the detection and characterization of renal masses, as well as treatment through CEUS-guided percutaneous radiofrequency ablation. These techniques may be especially valuable in challenging patients who cannot tolerate traditional contrast agents, such as those with diminished renal function, and those who cannot tolerate more invasive surgical treatment. The following case report details an incidence of renal cell carcinoma in a renal transplant patient whose tumor was diagnosed with CEU and successfully treated with CEUS-guided percutaneous RFA.

Purpose: The purpose of this project was to delineate the clinical nurse specialist (CNS) from other nursing roles within this academic medical center with the goal of (1) aligning role responsibilities with core competencies, (2) categorizing role-specific activities using a productivity spreadsheet, and (3) disseminating role-sensitive outcomes. Description of Project: The Donabedian model was used to evaluate the recently added CNS position and ensure the position aligned with professionally established role responsibilities and practice expectations. Using CNS competencies and standards of practice, the job description was restructured. A process for tracking productivity was developed, and outcomes reporting method was selected. Outcome: Changes to the job description resulted in 88% of the job description being reflective of CNS competencies and standards of practice. With this new process, collective role-specific work increased from 36% to 95%. Outcomes were identified from 4 frequently performed role-specific activities. Conclusion: The CNS role was successfully established and differentiated from other nursing roles by redesigning the job description, documenting role-specific activities, and capturing role-sensitive outcomes. Success was captured and disseminated using a year-end report, resulting in a positive response from hospital leadership and a recognized need for current and additional CNSs.

OBJECTIVE The purpose of this study was to determine chief nursing officer (CNO) perspectives on how to sustain the infrastructure required for successful American Nurses Credentialing Center (ANCC) Magnet® redesignation. BACKGROUND American Nurses Credentialing Center Magnet designation is a prestigious achievement reflective of years of dedication, innovation, mentoring, and leadership support. As challenging as the initial attainment of Magnet status can be, sustaining the success and becoming redesignated is considered even more difficult by many CNOs. However, there have been no published reports indicating how to be successful in Magnet redesignation. METHOD A grounded theory qualitative approach was used, and data were collected through telephone interviews with CNOs who had successfully attained at least 1 redesignation. RESULTS Fourteen CNOs participated; data were organized into 6 themes and 15 subthemes describing the critical elements for Magnet redesignation. CONCLUSION Relationships among the 6 themes and subthemes are theorized in the form of a wheel with 6 spokes. When “set in motion,” the wheel gathers momentum and all of the model elements become coalesced into the organizational ethos.

Bundles are composed of individually established practices supported by research that, when combined, structure patient care. Implementing bundles improves patient outcomes. The ABCDEF initiative is an example of a bundled approach that improves outcomes of critically ill patients that are related to the likelihood of hospital death within 7 days, delirium and coma days, physical restraint use, intensive care unit readmission, and discharge disposition, with outcomes being proportional to the number of appropriate components performed. The purpose of this quality improvement project was to implement practice integration as an educational strategy to increase nursing knowledge of complex topics and, specifically, components of the ABCDEF bundle. Nurses’ knowledge of all the BDE components of the ABCDEF bundle increased after implementing practice integration. Findings from this project support the use of resources to implement practice integration as an educational strategy for comprehensive concepts, specifically the BDE components of the ABCDEF bundle.