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reducing healthcare-received conditions (HACs), equivalent to health center-bought drive injuries (HAPIs) and catheter-linked urinary tract infections (CAUTIs), is a crucial strategy for improving affected person consequences and decreasing costs in acute care hospitals. both hostile hobbies are a part of US healthcare coverage and patient security initiatives, together with the centers for Medicare & Medicaid services (CMS) nonpayment to hospitals for the additional charge of treating these events.1
a lot of patients receiving care in acute care facilities in the u.s. enhance HAPIs; the annual estimated charge of HAPI care is $9.1 billion to $eleven.6 billion.2 Bergquist-Beringer and colleagues3 pronounced a 3.6% HAPI rate among all surveyed inpatients and seven.9% among these in danger. sufferers who strengthen HAPIs experience pain, have lessen health-related nice of lifestyles, and are more likely to die all over a health center stay.2–four
Urinary tract infections are essentially the most average medical institution-obtained infection and about 80% are catheter-associated.5 Lo and associates5 reported that the every day chance of acquiring a urinary tract an infection varies from three% to 7% when an indwelling catheter is in region. despite the fact the charge per case of CAUTI, starting from $862 to $1007,6 is low relative to other HACs, the full financial burden for hospitals due to nonreimbursement is titanic.7 other fees of CAUTI, such as patient discomfort, restrained activities of day by day living, loss of dignity, advantage for venous thromboembolism, and HAPI, have not been quantified.7
WOC certified nurses are prepared to enrich the degree and exceptional of care (acute and rehabilitative) for people with selected problems of the integumentary, genitourinary, and gastrointestinal programs.eight WOC licensed nurses are RNs who're credentialed with the aid of the Wound, Ostomy, and Continence Nursing Certification Board in 1 or extra forte areas of wound, ostomy and continence care. however facts exists in stories using huge samples in regards to the effectiveness of WOC licensed nurses in enhancing home healthcare results (including urinary incontinence and drive accidents) at each the individual affected person care9,10 and agency9 degree, little is general in regards to the relationship between WOC certified nurses and HACs in acute care hospitals.
the use of a huge pattern of acute care hospitals from the countrywide Database of Nursing first-rate symptoms (NDNQI), their study aims had been to (1) investigate the numbers and types of WOC certified nurses employed in NDNQI hospitals, (2) evaluate the traits of NDNQI hospitals that do and do not employ WOC certified nurses, (three) describe HAPI rates and HAPI risk and prevention interventions in NDNQI hospitals that do and don't make use of WOC nurses with wound care uniqueness certification, (four) determine the affiliation between WOC nurses with wound care uniqueness certification and HAPI fees, (5) describe CAUTI quotes in NDNQI hospitals that do and do not make use of WOC nurses with continence and/or ostomy care strong point certification, and (6) verify the affiliation between nurses with continence and/or ostomy care distinctiveness certification and CAUTI fees. For this study, they covered WOC nurses with here distinctiveness certifications: CWOCN (licensed wound, ostomy and continence nurse), CWCN (licensed wound care nurse), CWON (certified wound ostomy nurse), CCCN (licensed continence care nurse), and COCN (certified ostomy care nurse). COCNs had been blanketed in the look at because they can also have been the only WOC licensed nurse in a hospital. HAPI prevention interventions protected epidermis evaluation, redistribution surface use, repositioning, nutritional aid, and moisture management. sanatorium-acquired power damage and CAUTI rates blanketed the whole HAPI fee, HAPI stage 2 and higher fee, HAPI levels three and four fee, and the total CAUTI expense.
For applications of this study, they assumed that WOC licensed nurses have an impact on nursing interventions and affected person consequences via a number of mechanisms.9,11 This assumption is in keeping with their provision of direct care, schooling, and session to patients.9 additionally, they supply consultation and route to non-WOC licensed nurses.11 They also can be involved in constructing strategies, guidelines, and protocols for affected person care, as well as choose supplies, beds, and so on.9strategies
Our study became a descriptive comparative design the usage of retrospective analyses of records from the NDNQI from 2012 to 2013. All analyses had been at the sanatorium level. examine techniques were reviewed and accredited via the institutional evaluate board at the school of Kansas medical core.pattern
there have been 3 look at samples (desk 1). sample 1 comprised NDNQI hospitals (n = 928 hospitals) that participated within the 2012 NDNQI Registered Nurse (RN) Survey that blanketed strong point certification facts. Registered nurses were eligible to finished the survey if they labored on the unit improved than 3 months and spent 50% or greater time in direct care. agency and contract RNs had been excluded from taking the survey. facts from sample 1 have been used to assess aims 1 and a pair of, which concentrated on hospitals that do or don't make use of WOC specialty certified nurses.
sample 2 (n = 674 hospitals) was a subset of sample 1; it comprised hospitals that suggested HAPI and nurse staffing information. simplest unit types that routinely report HAPI facts have been blanketed in their analyses; they had been important care, step-down, medical, surgical, and clinical-surgical units. data from pattern 2 have been used to reply aims 3 and 4, which focused on HAPIs.
pattern three (n = 494), additionally a subset of pattern 1, comprised hospitals that mentioned CAUTI and nurse staffing information. inside these hospitals, handiest unit varieties that routinely file CAUTI data have been blanketed: important care, step-down, scientific, surgical, and scientific-surgical mixed. statistics from pattern three were used to answer goals 5 and 6, which concentrated on CAUTI.look at Measures uniqueness Certification
As noted prior to now, their source for specialty certification information was the 2012 NDNQI RN Survey. Registered nurses self-suggested specialty certifications from a listing of seventy six certifications, clustered in 19 country wide certification courses. as a result of their analyses have been at the sanatorium level, they measured CWOCN, CWCN, CWON, CCCN, and COCN as a count number of the number of nurses conserving each and every respective certification within the medical institution. table 1 summarizes certain certifications protected in the analysis of each study purpose.
For all other country wide area of expertise certifications, they used the count number of clinic RNs protecting certifications that had been in a strong point enviornment of nursing follow and were granted by country wide approved nursing certification classes.12 All licensed nurses were blanketed within the count number. every licensed RN changed into counted best as soon as, despite how many certifications the nurse held. Excluded certifications and credentials on the NDNQI RN survey had been (a) certifications granted by means of multidisciplinary groups now not restricted to nursing; (b) supplier-based expertise, certifications, or different credentials; or (c) lessons similar to superior cardiac lifestyles support and trauma nurse core path, or (d) no longer direct care related.HAPI and CAUTI outcomes
each the NDNQI HAPI and CAUTI measures have been counseled by means of the national great discussion board (NQF) as country wide consensus measures and have met the rigorous NQF dimension criteria of significance, reliability and validity, usability, and feasibility.13 NDNQI power harm records are gathered quarterly the usage of a 1-day point-in-time patient evaluation. clinic-acquired pressure accidents are identified by knowledgeable group of workers participants as these obtained after admission to the facility. NDNQI defines quarterly prices as the number of patients with HAPI divided through the number of surveyed sufferers, times one hundred. facts on pressure damage risk and prevention are gathered throughout the identical 1-day evaluation but by chart evaluation. This facts set contains skin and drive harm chance assessment on admission (sure, no), possibility evaluation 24 hours or less before the survey (sure, no), and risk reputation (in danger, not at risk). For these in danger, prevention measures encompass usual epidermis evaluation, pressure redistribution surface use, repositioning, nutritional support, and moisture administration throughout the 24-hour duration previous the survey (yes, not yes). evidence for the reliability of NDNQI statistics assortment methods on pressure injury identification, origination, drive damage chance, and prevention has been based.14–16
NDNQI makes use of the centers for disorder handle and Prevention's countrywide health defense community standard definitions for CAUTI.17,18 CAUTI fees are calculated because the variety of infections per a thousand catheter days.manage Variables
Unit structure features included as control variables have been mean RN tenure on the unit and the nursing care hours variable of RN hours per affected person day (RNHPPD). The NDNQI nursing care hours variables are NQF counseled and are supported through massive validity and reliability proof.19,20 They additionally protected the health center structure attribute of yank Nurses Credentialing middle Magnet attention software popularity (Magnet, applicant, now not Magnet) as a manage variable.NDNQI facts great
A web page coordinator at each and every NDNQI health center is liable for amassing and submitting statistics or overseeing the technique of facts submission in accordance with NDNQI definitions and protocols. The web site coordinator and each person collecting or reporting statistics should acquire practicing about the NDNQI information assortment instructions and flow assessments on essential elements with excessive accuracy. For the RN survey, site coordinators use an in depth, standardized records assortment protocol and timeline. All information, together with RN survey statistics, are entered directly into a relaxed, password-included NDNQI internet web page with embedded nice handle aspects. for instance, the web site doesn't allow described out-of-latitude or illogical information to be saved. information are also subjected to wide excellent audits by NDNQI body of workers. confer with Boyle and colleagues11 for more targeted description of NDNQI records excellent.statistics preparation
Three evaluation files have been developed. the first file became for pattern 1 (addressing goals 1 and a pair of); it consisted of merged statistics from the NDNQI RN Survey and hospital demographic qualities. sample 2 (addressing goals 3 and 4) and pattern 3 (addressing aims 5 and 6) info consisted of merged facts from the RN Survey and NDNQI clinical statistics on HAPIs or CAUTI, respectively. clinic qualities and staffing statistics additionally were merged into samples 2 and three info. All info have been checked for mistakes and corrected as necessary by NDNQI analytic team of workers.
Unit-degree records have been annualized and aggregated to the hospital level for evaluation. sanatorium-received power damage information had been accumulated quarterly and CAUTI information had been accrued month-to-month, whereas the RN survey become conducted annually. Hospitals elected a single month wherein to take the survey. therefore, to make sure the clinical facts have been consequent to the RN survey, the first quarter or month of HAPI or CAUTI statistics turned into the same month of the RN Survey. as an instance, if a sanatorium performed its annual RN survey in April of 2012, CAUTI statistics from April 2012 to March 2013 had been annualized and matched to survey data. thus all hospitals have a full year of clinical information following the RN survey information.
most effective hospitals that reported 3 of four quarters of HAPI facts and 9 of 365 days of CAUTI information have been covered. These records have been annualized by way of summing the numerator (eg, the variety of sufferers with HAPI) for the 12 months and dividing by means of the summed denominator (e.g., the variety of sufferers assessed) for the yr. once the information had been annualized, the unit-degree information for outcomes and staffing measures have been aggregated to the health center level and possibility-stratified through adjusting for unit-type ameliorations. First, quotes for a unit were standardized by way of unit type by way of subtracting the regular expense for instruments of that category and dividing by way of the unit classification common deviation to create a z-score. The ensuing unit-stage z-ratings then were weighted through the exposure variable (the variety of patients assessed for pressure injuries and gadget days for CAUTI). the brand new unit-degree ratings then have been averaged to create clinic-level ratings. at last, the hospital-stage combination z-rankings have been transformed returned to the original metric (eg, CAUTI fee per one thousand affected person days) for easier analytic interpretation.facts evaluation
All analyses have been performed using SAS version 9.4; P values ≤ 0.05 have been deemed statistically tremendous. Descriptive statistics had been generated to summarize hospital characteristics, the number of WOC licensed nurses by way of uniqueness, HAPI assessment and prevention intervention charges, HAPI costs, and CAUTI quotes. Descriptive data and χ2 analyses were used to examine qualities of hospitals that do and do not make use of WOC certified nurses.
analysis of covariance (ANCOVA) fashions had been used to test associations between the effect variables (HAPI charges, HAPI interventions, and CAUTI rates) and WOC nurse certifications in hospitals. different health facility and RN staffing qualities that can also influence prices of HAPI or CAUTI had been protected as manage variables: usual patient risk for force accidents, RNHPPD, RN unit tenure, and clinic Magnet repute.consequences
desk 2 shows specific sanatorium qualities of the 3 samples; characteristics have been followed to be similar across all 3 samples. The usual health facility in each and every sample become a prevalent health facility, non-Magnet, no longer-for-income, nonteaching, dimension fewer than 300 beds, determined in a metropolitan area of 50,000 population or extra, and with a medium case-mix index.Numbers and types of WOC certified Nurses Employed in NDNQI Hospitals
300 forty of the 928 sample hospitals (36.6%) employed WOC certified nurses; the average variety of WOC certified nurses employed became 2.27 ± 2.06 (mean ± SD, range 1-15). many of the employed WOC certified nurses had been CWOCNs (1.70 ± 1.forty per hospital, latitude 1-10), whereas CCCNs have been fewest in number (1.10 ± 0.30, latitude 1-2). table 3 displays the number of WOC licensed nurses by using specialty.assessment of NDNQI Hospitals That Do and don't make use of WOC licensed Nurses
Hospitals employing WOC licensed nurses have been more prone to be a standard clinic (χ2 = 38.fifty five; P = .001), have Magnet Designation (χ2 = 57.32; P = .001), be an educational scientific core (χ2 = 12.72; P = .002), be determined in a metropolitan area with a population greater than 50,000 (χ2 = 16.33; P = .001), have a mattress measurement ≥ 300 (χ2 = a hundred and twenty.07, P = .001), have a excessive case-combine index (χ2 = 22.15; P = .001), and employ at least 100 other country wide uniqueness certified nurses (other than WOC certification) (χ2 = 156.90; P = .001). also, hospitals using WOC certified nurses had been less likely to be owned through a for-profit entity (χ2 = 19.35; P = .001). See the Supplemental Digital content (http://hyperlinks.lww.com/JWOCN/A39) for additional aspect.HAPI fees, possibility assessment, and Prevention
Hospitals that employed CWOCN, CWCN, and CWONs had lower complete (M = 2.eighty one% ± three.92%), stage 2 and better (M = 2.sixteen% ± 2.eighty four%), and levels three and 4 (M = 0.27± 0.sixty nine%) HAPI fees than hospitals that didn't make use of CWOCN, CWCN, and CWONs (M = three.28% ± 5.forty nine%, M = 2.39% ± three.60%, M = 0.51% ± 2.12%, respectively; desk 4). in a similar fashion, hospitals using CWOCN, CWCN, and CWONs had somewhat larger costs of force damage chance and epidermis evaluation on admission (M = ninety five.fifty eight% ± sixteen.seventy one%, M = ninety five.forty three% ± 18.01%, respectively) than hospitals no longer using CWOCN, CWCN, and CWONs (M = ninety four.15% ± 21.24%, M = ninety three.13% ± 24.sixty two%, respectively; desk 5). In distinction, hospitals using CWOCN, CWCN, and CWONs had a bit of decrease rates of power damage possibility assessment in the closing 24 hours (M = ninety three.21% ± 35.00%) than hospitals no longer using CWOCN, CWCN, and CWONs (M = 95.10% ± 17.eighty one) (desk 5). All force harm intervention (dermis evaluation, redistribution surface use, repositioning, dietary guide, and moisture administration) implementation quotes were bigger in hospitals employing CWOCN, CWCN, and CWONs than in hospitals not employing CWOCN, CWCN, and CWONs.
desk 5affiliation Between Wound Care certified Nurses and HAPI charges
Three ANCOVA models had been fitted to HAPI prices: total HAPI fee, rate of HAPIs stage 2 and better, and cost of tiers three and four HAPIs (desk 6). the full HAPI rate model and the stage 2 and higher HAPI rate model were gigantic however had small usual r 2 values; handiest 4% to six% of the variance changed into defined in either model (F = four.38, P < .01, r 2 = 0.04; F = 6.41, P < .01, r 2 = 0.06, respectively). in the total HAPI expense and stage 2 and better HAPI expense models, the best massive predictors of HAPI fee had been the covariates affected person risk (total HAPI model, F = 9.19, P < .01; HAPI ≥stage 2, F = 21.sixty four, P < .01) and clinic Magnet status (total HAPI model, F = 4.sixty four, P = .01; HAPI ≥stage 2, F = 4.94, P < .01). in the mannequin for the expense of stages 3 and 4 HAPIs, CWOCN, CWCN, and CWONs have been drastically linked to reduce occurances of ranges three and four HAPIs (F = three.88, P = .05). patient possibility additionally was enormously concerning tiers three and 4 HAPI fees (F = 6.25, P = .01). however, the basic model become nonsignificant (F = 2.03, P = .06, r 2 = 0.02).CAUTI fees and affiliation Between Continence Care licensed Nurses and CAUTI fees
table 4 displays CAUTI quotes in hospitals that do and do not make use of CWOCN, CCCN, COCNs. Hospitals using CWOCN, CCCN, and COCNs had just a little better prices of CAUTI (M = 2.15 ± 2.26 per one thousand equipment days) than hospitals no longer employing CWOCN, CCCN, COCNs (M = 1.eighty five ± 2.eighty per a thousand device days). The median CAUTI rate also become greater in hospitals using CWOCN, CCCN, and COCNs (1.sixty four per a thousand machine days) than hospitals not employing CWOCN, CCCN, and COCNs (0.83 per a thousand equipment days).
The ANCOVA model inspecting the impact of CWOCN, CCCN, and COCNs on CAUTI costs was nonsignificant (F = 0.86, P = .51, r 2 = 0.01) (table 6). further, none of the handle variables protected within the mannequin have been tremendously linked to CAUTI fees.discussion
Our study offers new abilities concerning WOC licensed nurse employment in acute care and the connection between WOC nurses with wound care distinctiveness certification (CWOCN, CWCN, and CWON) and HAPI quotes, as neatly as the relationship between WOC nurses with continence and/or ostomy care forte certification (CWOCN, CCCN, and COCN) and CAUTI quotes. Findings indicate that the employment of larger numbers of CWOCN, CWCN, and CWONs is linked to decreased HAPI quotes and greater force damage possibility assessment and prevention practices. Their consequences aid these of other reviews that concerned WOC licensed nurses in prevention programs to reduce HAPI quotes. for example, Bales and Padwojski21 reported lessen HAPI rates after expanding the variety of wound licensed nurse hours, amongst different concepts. Anderson and colleagues22 showed that wound certified nurse involvement in HAPI prevention reduced HAPI occurrence amongst intensive care unit (ICU) sufferers and elevated adherence to redistribution surface and repositioning interventions. Their findings extend these of Anderson and colleagues to more chiefly identify that hospitals using CWOCN, CWCN, and CWONs had fewer complete HAPIs, stage 2 and higher HAPIs, and HAPI tiers three and 4 than hospitals no longer employing CWOCN, CWCN, and CWONs. additionally, the implementation of epidermis evaluation, nutritional assist, and moisture management interventions as well as pressure redistribution surface use and repositioning was greater among hospitals using CWOCN, CWCN, and CWONs.
The three.08% common HAPI rate for critical care, step-down, scientific, surgical, and medical-surgical devices in their analyze was lessen than the 3.6% rate of HAPI amongst these devices present in 2010 NDNQI statistics evaluation.three results imply that the downward style in HAPI stated in old research23–25 continued via 2012 to 2013. In their examine, the ranges 3 and 4 HAPI cost among hospitals employing CWOCN, CWCN, and CWONs (0.27%) became nearly half the stage 3 and four HAPI cost of hospitals no longer employing CWOCN, CWCN, and CWONs (0.fifty one%), indicating a improvement of wound area of expertise certification on HAPI charges. ANCOVA modeling that managed for patient chance and RN and clinic components offers extra help for the function of CWOCN, CWCN, and CWONs in cutting back stages three and four HAPI building. Nonsignificance of the overall mannequin could be concerning the small number of stages 3 and four HAPI hobbies, which resulted in too little vigour to obtain statistical healthy and means that mannequin parameters should still be interpreted with warning.
affected person chance repute changed into vastly involving HAPI expense, even with stage. This finding is in line with other research that showed patients at risk for force injuries usually tend to purchase a force injury.3,26,27 as an example, Chen and associates26 discovered that the incidence of drive injury became 1.four% amongst acute care sufferers at no risk and 23.6% among sufferers at high risk for power damage. assessment of drive harm risk is carried out routinely in acute care settings to set up a prevention plan and provoke applicable interventions to ameliorate the possibility. In their analyze, just a little better quotes of prevention interventions were implemented for those at risk amongst hospitals employing CWOCN, CWCN, and CWONs relative to hospitals not employing these certified nurses, but the transformations have been more advantageous for drive damage redistribution floor use and nutritional aid. The CWOCN, CWCN, and CWONs in acute care practice are often chargeable for health facility policies and procedures concerning drive injury prevention including usage of power redistribution surfaces28 and may take part in organizational actions to maintain prevention follow. The particular function of these nurses in nutritional aid to evade HAPIs warrants further investigation.
The 1.ninety six% ordinary CAUTI price for crucial care, step-down, scientific, surgical, and medical-surgical devices in their study turned into similar to the yr 2010 CAUTI cost of 2.00% amongst these units found by means of Waters and colleagues25 and a bit of decrease than the CAUTI fee of two.19% stated by means of Saint and associates29 for ICUs and non-ICU units in late 2013. Their consequences may imply the CAUTI cost stabilized after the 10% downward style between 2008 and 2010 mentioned by means of Waters' community,25 however countrywide statistics exhibit that CAUTI costs rose 6% from 2009 to 2013.30 In their study, the suggest CAUTI price amongst hospitals employing CWOCN, CCCN, and COCNs (2.15) became higher than the CAUTI fee in hospitals no longer using these nurses (1.85). ANCOVA modeling that managed for affected person risk and RN and clinic elements showed no affiliation between the use of CWOCN, CCCN, and COCNs and reduce CAUTI prices. Nonsignificance of the basic model could be concerning the small number of CAUTI events and small number of CWOCN, CCCN, and COCNs employed, which resulted in too little vigour to achieve statistical healthy.
distinctive care suppliers are worried in CAUTI prevention and monitoring, together with first-line RNs, infection handle nurses and officers, and physicians. however, WOC nurses with continence care distinctiveness certification are an excellent resource concerning care of indwelling urinary catheters, and they are smartly placed to provide useful input into CAUTI prevention courses.28,31,32 CWOCN and CCCNs are certainly certified for bladder evaluation and prioritizing interventions in accordance with evaluation findings (eg, interventions about comprehensive bladder emptying, urinary retention, and incontinence), which might be vital in combating CAUTI.31,32 further, CWOCN and CCCNs can work with nursing staff to put into effect the proof-based American Nurses association (ANA) CAUTI Prevention device for acute care settings.32 Developed in collaboration with the CMS Partnership for sufferers through a technical professional panel of nurses, the ANA CAUTI Prevention tool recommends session with forte nurses including nurses certified in wound, ostomy, and continence care to decrease CAUTI charges. within one clinic system, CWOCNs have collaborated with infection prevention nurses and nurse educators to implement the tool and pronounced a metamorphosis in culture around indwelling urinary catheter insertion at the pilot health facility.32
best 36.6% (n = 340) of the examine NDNQI hospitals employed CWOCN, CWCN, CWON, CCCN, and COCNs. The finding is staggering given countrywide focal point on reducing HAPI and CAUTI charges. besides the fact that children, smaller hospitals can also have shared a WOC certified nurse or contracted with an out of doors enterprise for their service when needed. A 2012 survey carried out with the aid of the Wound, Ostomy and Continence Nurses (WOCN) Society confirmed that sixty one.5% of WOCNs are employed in the acute care environment.33 In their look at, NDNQI hospitals that employed WOC licensed nurses employed 2 on usual and at the least 1 health center employed 15 WOC licensed nurses. CCCNs were employed in the smallest number (2.three%) through taking part hospitals. therefore, examination of the barriers to using WOC certified nurses, and CCCNs in specific, is warranted. The role of COCNs in CAUTI for patients with an indwelling urethral catheter (urethral or suprapubic), urostomy, or nephrostomy tube is not smartly delineated but ostomy nurse scope of practice comprises combating periostomal/stomal problems.30 additional research is needed to verify WOC certified nurse follow in hospitals that make use of them. for instance, how lots of the function of CWOCNs and CCCNs is committed to CAUTI prevention and protocols? Future reviews also should consist of affected person-level facts on urinary diversions as well as UIC and investigate COCN follow regarding CAUTI in the acute care atmosphere. in addition, research is needed to determine the role of CCCNs in CAUTI prevention.obstacles
Hospitals electively be a part of NDNQI and don't seem to be consultant of the normal US health center population.34 in particular NDNQI is overrepresentative of gigantic facilities, and it's underrepresentative of small hospitals. despite the fact about half of US hospitals have fewer than a hundred beds, only one-quarter of NDNQI hospitals are of that size. They covered handiest these hospitals that completed the RN Survey in 2012, which is set half of NDNQI hospitals. further, they included most effective 5 unit kinds (essential care, step-down, scientific, surgical, and medical-surgical mixed) that routinely compile nurse staffing, HAPI, and CAUTI statistics. within these unit forms, no longer all bring together nurse staffing, HAPI, or CAUTI records, so these gadgets had been not blanketed in the analyze. for this reason, results can also not be generalizable to other hospitals.
The NDNQI RN survey turned into the source of forte certification records. The certifications of CWOCN, CWCN, CWON, CCCN, and COCN have been protected within the 2012 NDNQI Survey. The survey did not include certifications granted by using multidisciplinary groups to these other than RNs. hence, credentials corresponding to licensed wound expert, certified wound care affiliate, and authorized wound professional healthcare professional have been not covered in their analysis. moreover, they have no idea what proportion of CWOCN, CWCN, CWON, CCCN, and COCNs in their analyze had been advanced follow nurses. last, the small variety of CCCNs in their analyze and the uncertainty of the position of CWOCN, CCCN, and COCNs versus infection manage nurses and officers in the study hospitals might also have influenced results.CONCLUSIONS
Our look at gives evidence that CWOCN, CWCN, and CWONs are a crucial factor in achieving stronger HAPI results in acute care settings. Hospitals employing CWOCN, CWCN, and CWONs have reduce quotes of complete HAPI, HAPI stage 2 or greater, and HAPI degrees three and 4 than hospitals now not employing these nurses. additionally, the implementation of epidermis assessment, dietary guide, and moisture administration interventions as well as pressure redistribution surface use and repositioning turned into bigger amongst hospitals using CWOCN, CWCN, and CWONs. WOC nurses with wound care strong point certification should be a part of health facility techniques to cut back HAPI prices. In contrast, they found no gigantic relationships between medical institution employment of CWOCN, CCCN, COCNs, and CAUTI charges. The role of CWOCN, CCCN, and COCN in CAUTI prevention warrants extra investigation.ACKNOWLEDGMENTS
The funding became supplied via the AACN Certification organization and American affiliation of essential-Care Nurses (AACN), American Board of Nursing Specialties, American Board of Certification for Gastroenterology Nurses, American Board of Neuroscience Nursing, American Board for Occupational fitness Nurses, American Board of Perianesthesia Nursing Certification, American corporation of Nurse Executives–Credentialing center, utilized size professionals, Board of Certification for Emergency Nursing, Canadian Nurses association Certification software, fort international, center for Nursing training and trying out, Citizen Advocacy core, Competency & Credentialing Institute, Infusion Nurses Certification organization, clinical-Surgical Nursing Certification Board, country wide Alliance of Wound Care Certification Board, national Board for Certification of Hospice and Palliative Nurses, countrywide Board of Certification and Recertification of Nurse Anesthetists, national Board for Certification of school Nurses, national Certification Board for Diabetes Educators, Nephrology Nursing Certification fee, Oncology Nursing Certification agency, Orthopaedic Nurses Certification Board, Pediatric Nursing Certification Board, knowledgeable Examination carrier, Rehabilitation Nursing Certification Board, and the Wound, Ostomy, and Continence Nursing Certification Board. The investigators conducted the analyze independently of the funders. The content is completely the responsibility of the authors and doesn't characterize professional views of the funders.REFERENCES 1. Medicare software. alterations to the medical institution inpatient potential charge systems and fiscal 12 months 2008 charges; closing rule. centers for Medicare and Medicaid features. https://http://www.cms.gov/Medicare/Medicare-payment-for-provider-payment/AcuteInpatientPPS/Downloads/CMS-1533-FC.pdf. published August 22, 2007. Accessed October 22, 2015. 2. Berlowitz D, Lukas CV, Parker V, et al fighting power ulcers in hospitals: a toolkit for bettering satisfactory of care. agency for Healthcare research and satisfactory. http://http://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/index.html. Accessed December 14, 2015. 3. Bergquist-Beringer S, Dong L, He J, Dunton N. drive ulcers and prevention among acute care hospitals within the u.s.. Jt Comm J Qual affected person Saf. 2013;39:404–414. four. Lyder CH, Wang Y, Metersky M, et al sanatorium-got drive ulcers: effects from the country wide Medicare patient protection Monitoring system look at. J Am Geriatr Soc. 2012;60:1603–1608. 5. Lo E, Nicolle L, Classen D, et al thoughts to avoid catheter-associated urinary tract infections in acute care hospitals. Infect manage Hosp Epidemiol. 2008;29:S41–S50. 6. Scott RD. The direct clinical fees of healthcare-linked infections in U.S. hospitals and the merits of prevention. centers for ailment control and Prevention. http://http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. published March 2009. Accessed November 18, 2015. 7. Saint S, Lipsky BA, Goold SD. Indwelling urinary catheters: a one-element restraint? Ann Intern Med. 2002;137:a hundred twenty five–127. eight. Wound, Ostomy, and Continence Nursing Certification Board. position statement: Entry stage Wound, Ostomy, and Continence Nurse training and Certification. https://http://www.wocncb.org/pdf/place-statements/WOCNCB_Position_Statement_WOC_entry_Level.pdf. posted 2008. Accessed October 22, 2015. 9. Westra BL, Bliss DZ, Savik k, Hou Y, Borchert A. Effectiveness of wound, ostomy and continence nurses on company-level wound and incontinence outcomes in domestic care. J Wound Ostomy Continence Nurs. 2013;40:25–33. 10. Bliss DZ, Westra BL, Savik k, Hou Y. Effectiveness of wound, ostomy and continence nurses on individual results in domestic fitness care.J Wound Ostomy Continence Nurs. 2013;forty:135–142. 11. Boyle DK, Cramer E, Potter C, Staggs VS. The impact of longitudinal alterations in RN area of expertise certification rates on total patient fall prices in acute care hospitals. Nurs Res. 2015;64:291–299. 12. Miller PA, Boyle DK. Nursing uniqueness certification: a measure of abilities. Nurs manipulate. 2008;39(10):10–sixteen. 13. countrywide best forum. Measure contrast standards. Washington, DC: national first-rate discussion board; 2008. http://http://www.qualityforum.org/doctors/measure_evaluation_criteria.aspx 14. Hart S, Bergquist S, Gajewski B, Dunton N. Reliability trying out of the country wide Database of Nursing quality indications power ulcer indicator. J Nurs Care Qual. 2006;21:256–265. 15. Bergquist-Beringer S, Gajewski B, Dunton N, Klaus S. The reliability of the countrywide Database of Nursing pleasant symptoms power ulcer indicator: a triangulation approach. J Nurs Care Qual. 2011;6(4):292–301. 16. Waugh SM, Bergquist-Beringer S. Inter-rater contract of force ulcer chance and prevention measures in the countrywide Database of Nursing high-quality symptoms® (NDNQI). Res Nurs health. 2016;39(3):164–174. 17. countrywide Healthcare security network guide: patient security component Protocols. centers for ailment control and Prevention. http://http://www.cdc.gov/ncidod/dhqp/pdf/nhsn/NHSN_Manual_PatientSafetyProtocol_CURRENT.pdf. published 2010. Accessed October 12, 2013. 18. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of fitness care–linked an infection and criteria for certain forms of infections in the acute care atmosphere. Am J an infection control. 2008;36(5):309–332. 19. Choi J, Boyle DK, Dunton NA. Standardized measure: NDNQI nursing care hours indicator. West J Nurs Res. 2014;36:one zero five–116. 20. Klaus S, Dunton N, Gajewski B, Potter C. Reliability of the nursing care hour measure: a descriptive analyze. Int J Nurs Stud. 2013;50:924–932. 21. Bales I, Padwojski A. attaining for the moon: reaching zero pressure ulcer prevalence. J Wound Care. 2009;18:137–one hundred forty four. 22. Anderson A, Guthrie PF, Kraft W, Reicks P, Skay C, Beal AL. regular power ulcer prevention bundle with WOC nurse support. J Wound Ostomy Continence Nurs. 2015;42(3):217–225. 23. Bergquist-Beringer S, Gajewski BJ, Davidson J. drive ulcer occurrence and incidence: report from the countrywide Database of Nursing first-rate warning signs® (NDNQI®). In: Pieper B, ed, with the countrywide force Ulcer Advisory Panel (NPUAP): power Ulcers: prevalence, Incidence, and Implications for the future. 2nd ed. Washington, DC: national pressure Ulcer Advisory Panel (NPUAP); 2012:one hundred seventy five–187. 24. He J, Staggs V, Bergquist-Beringer S, Dunton N. Unit-stage time developments and seasonality in the cost of sanatorium bought force ulcers in U.S. acute care hospitals. Res Nurs fitness. 2013;36:171–a hundred and eighty. 25. Waters TM, Daniels MA, Bazzoli GJ, et al effect of Medicare's nonpayment for medical institution-obtained circumstances: classes for future policy. JAMA Intern Med. 2015;175:347–354. 26. Chen HL, Cao YJ, Wang J, Huai BS. A retrospective evaluation of power ulcer incidence and modified Braden Scale rating risk classifications. Ostomy Wound manipulate. 2015;sixty one(9):26–30. 27. Park SH, Choi YK, Kang CB. Predictive validity of the Braden Scale for pressure ulcer chance in hospitalized patients. J Tissue Viability. 2015;24:102–113. 28. Janoski IM. Matching patient protection goals to the nursing area of expertise: the use of wound, ostomy, continence nursing functions. J Nurs Admin. 2010;40(1):26–31. 29. Saint S, Greene MT, Krein SL, et al A software to evade catheter-linked urinary tract an infection in acute care. N Engl J Med. 2016;374:2111–2119. 30. facilities for disease handle and Prevention. 2014 national and State Healthcare-linked Infections growth file. Atlanta, GA: centers for sickness handle and Prevention. http://http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-file.pdf. published March 2016. Accessed October 16, 2016. 31. WOCN Society. function of the wound, ostomy continence nurse or continence care nurse in continence care. J Wound Ostomy Continence Nurs. 2009;36:529–531. 32. Trevellini C. Operationalizing the ANA CAUTI prevention tool in acute care settings. Am Nurse these days. 2015;10(9):5–7. 33. WOCN Society. WOC Nursing revenue & productiveness Survey. Wound Ostomy and Continence Society. Mt Laurel, NJ: WOCN Society; 2012. 34. American medical institution affiliation. AHA Annual Survey DatabaseTM [database on CD-ROM]. Chicago, IL: American medical institution association; 2013. keywords:
Catheter-linked urinary tract infections; Healthcare nice warning signs; Healthcare-obtained conditions; health facility-received pressure injury; medical institution-obtained drive ulcer; distinctiveness certificationSupplemental Digital content material © 2017 by using the Wound, Ostomy and Continence Nurses Society. source
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MORRISTOWN – Morristown medical center has once once again earned The Joint fee’s Gold Seal of Approval® for its backbone surgery and Joint alternative (hip and knee) programs via demonstrating extremely good efficiency in pleasant The Joint commission’s country wide requisites for fitness care high-quality and protection in disorder-particular care. The certification award recognizes the Atlantic Orthopedic Institute of Morristown clinical core’s dedication to continuous compliance with The Joint commission’s state-of-the-paintings necessities in complete Joint replacement and backbone surgical procedure.
Morristown medical middle, part of Atlantic fitness equipment, underwent a rigorous on-web page overview on may additionally 22 and 23. A Joint fee expert evaluated the joint replacement and the backbone care courses for compliance with requisites of care particular to the wants of patients and families, including an infection prevention and control, leadership and medication administration.
"In achieving Joint fee certification, Morristown clinical middle has proven its dedication to the optimum level of look after its sufferers needing spinal surgery or joint alternative," says Jean latitude, M.S., R.N., C.P.H.Q. govt director, ailment-certain Care Certification, The Joint fee. “Certification is a voluntary process and that i commend Morristown for effectively accomplishing this challenge to elevate its general of care and instill self belief within the neighborhood it serves.”
"Joint fee accreditation acknowledges the tremendous funding they make in pleasant on a every day basis and helps create a culture of excellence,” says William Dowling, MD, chair, department of Orthopedics. “reaching Joint commission forte certification for the 4th time, for their firm, is a tremendous accomplishment and a huge step toward constantly improving the care they deliver.”
The Joint fee’s disease-particular Care Certification application, launched in 2002, is designed to consider clinical classes across the continuum of care. Certification requirements handle three core areas: compliance with consensus-primarily based national requirements; effective use of facts-based medical follow instructions to control and optimize care; and an prepared method to performance dimension and development actions.
centered in 1951, The Joint commission seeks to always increase fitness care for the general public, in collaboration with different stakeholders, by way of evaluating health care businesses and galvanizing them to excel in presenting secure and helpful care of the very best quality and value. The Joint commission evaluates and accredits more than 20,000 health care groups and classes within the united states, together with greater than 10,600 hospitals and residential care agencies, and more than 6,600 different health care companies that provide future care, behavioral fitness care, laboratory and ambulatory care services. The Joint commission additionally certifies more than 2,four hundred sickness-certain care classes comparable to stroke, coronary heart failure, joint substitute and stroke rehabilitation, and 400 fitness care staffing services. An impartial, not-for-income firm, The Joint fee is the nation's oldest and greatest specifications-surroundings and accrediting body in health care. study more in regards to the Joint commission at www.jointcommission.org.
About Morristown medical middle
Morristown clinical core, found in Morristown, NJ, is part of Atlantic fitness device, some of the biggest non-earnings fitness care methods in New Jersey. approved by way of The Joint commission, the clinic became recognized by using U.S. news & World record as a exact sanatorium nationwide for cardiology, coronary heart surgery, gynecology and geriatrics. Morristown scientific middle additionally ranked as a “most appropriate Regional health center” for cancer, diabetes & endocrinology, neurology and neurosurgery, orthopedics as well as gastroenterology & GI surgery, nephrology, pulmonology and urology. The branch of Orthopedics of Morristown scientific middle changed into lately recognized as #1 in the State of latest Jersey with the aid of an unbiased hospital contrast company. Morristown scientific center’s Gagnon Cardiovascular Institute performs greater cardiac surgeries than another health facility in New Jersey, placing its cardiac program in the correct two percent in the nation. Morristown scientific center is confirmed as a stage I Regional Trauma core with the aid of the American college of Surgeons and detailed a level II by the state of latest Jersey and turned into just re-specific a Magnet health center for Excellence in Nursing provider, the maximum level of consciousness by American Nurses Credentialing center for amenities that deliver acute care features, a big difference awarded to less than 5 % of U.S. hospitals. For more information, please seek advice from AtlanticHealth.org/Morristown.
Fewer medical graduates are applying for nephrology fellowship training, and i see this as a personnel disaster. nowadays, of greater than 400 fellowship positions across the nation, some forty% continue to be unfilled when in shape effects are introduced in December of each and every yr. more than half of training classes have had at the least one unfilled place. youngsters my nephrology software at the college of California Irvine has never had unfilled fits, this doesn't make me consider relieved about the challenge of attracting new doctors into nephrology. The personnel crisis in nephrology may have a domino effect on many features of patient care.
the united states has some 8000 grownup and 500 pediatric nephrologists who are engaged in patient care or connected positions. each and every year, some 300 to 400 young physicians finished nephrology practising and enter the market and a similar number of senior nephrologists retire. The annual median nephrologist earnings ranges from $one hundred eighty,000 to $240,000, which is not very distinct from usual internist revenue in this country but, accept as true with it or no longer, it's 50% to a hundred% lessen than the median salary of a nephrologist in Canada, even though it is higher than Germany, united kingdom, and Japan.
the rise of the hospitalist box and its surprisingly pricey revenue and work hours has affected subspecialty working towards in inner drugs. it is heartbreaking that many interior medicine residency graduates are inclined to effectively embark on a hospitalist position with none pastime in a subspecialty. In nephrology, revenues appear to have declined by means of 5%–10% or greater over the years. Many nephrology agencies are inclined to rent nurse practitioners (NPs) and health professional assistants (PAs) for such tasks as weekly dialysis medical institution rounds. This has doubtless resulted in diminished demand for nephrologists. lately i was shocked to be trained that the deepest practice group I used to work with has downsized from 20 to 22 nephrologists all the way down to 15 nephrologists and employed greater NPs and PAs.
with reference to a shortage of latest doctors entering nephrology, I agree with they now have reached the nadir. In coming years, they should see expanding pastime in nephrology. Ongoing increase in the dialysis population from enhanced patient survival will enhance nephrology job security and many hospitalists return to subspecialty follow—together with nephrology—after a few years of coaching gap.
Efforts should be directed at making nephrology more appealing. This will also be executed by using strengthening sub-fellowships in kidney transplantation, glomerulonephritis, interventional nephrology, and even certification in dialysis therapy and recommendations (as in Japan). adding combined fellowships in crucial care, rheumatology, and endocrinology can lead to more triple board-licensed nephrologists. mixed medicine/pediatric residency graduates may still be inspired to agree with twin fellowships in nephrology for toddlers and adults to extend the pool of quadruple board-licensed nephrologists. together, they can make nephrology even more widely wide-spread than earlier than.
Kam Kalantar-Zadeh, MD, MPH, PhD Chief, Division of Nephrology & Hypertension, Professor of medicine, Pediatrics and Public health, institution of California Irvine faculty of medicine.
From the February 01, 2017 concern of Renal and Urology news
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Board of Nephrology Examiners Nursing and Technology (BONENT) Certified Median Salary by Job
DENVER, Sept. 11, 2017 /PRNewswire/ -- DaVita Kidney Care (NYSE: DVA), a division of DaVita Inc. (NYSE: DVA) and a leading provider of kidney care services, joins the American Nephrology Nurses' Association (ANNA) in celebrating the week of Sept. 10, 2017, as Nephrology Nurses Week.
Nephrology nurses in the U.S. provide life-saving care to nearly 600,000 end-stage renal disease patients every day. Nephrology Nurses Week was designed by the American Nephrology Nurses Association as a way to honor nurses who care for patients with kidney disease. Each year, the second full week of September is Nephrology Nurses Week.
"At DaVita Kidney Care, their nurses play a key role in assessing, educating and treating their 194,600 patients, and they could not provide quality care without them," said Mandy Hale, vice president of nursing at DaVita Kidney Care. "Our nurses give tirelessly of themselves to treat, care for and empower their patients through providing them education, care and compassion."
At DaVita, they strive to create a place of nursing excellence and advancement. Their nursing strategy involves a number of programs to support us in their goals to grow, engage and attract nurses. To celebrate nurses and ensure they have career opportunities, DaVita has begun reimbursing RNs for certain costs associated with Certified Dialysis Nurse (CDN) and Certified Nephrology Nurse (CNN) certifications. In addition, DaVita will reimburse teammates for certain prep materials and exam fees. All regular, active full- and part-time RNs are eligible for this program, even if not operating in a direct patient care RN role – this includes facility administrators and clinical support specialists.
Additionally, DaVita leaders hold nurse roundtable discussions where nurses across the country travel to Denver, Colo. to spend the day engaging in brainstorming and idea sharing regarding patient care and nursing. These ideas improve the care they deliver and nursing in general.
Nephrology nurses are uniquely positioned to improve patient care and are often involved in the design of specific nursing and patient care programs such as patient education and medication management.
We encourage their nurses to gain and share nursing knowledge through programs such as their LeaRN Challenge where nurses are nominated and selected to attend professional nursing conferences such as ANNA conferences and the Annual Dialysis Conference (ADC).
Nephrology Nurses Week was established in 2005 by ANNA to honor the devotion and commitment that nurses provide for patients with kidney disease. Being involved in caring for patients with kidney failure requires nurses to be highly attentive, driven and skilled.
To learn more about how to celebrate the work that nurses do for patients with kidney disease, visit AnnaNurse.org.
About DaVita Kidney Care DaVita Kidney Care is a division of DaVita Inc., a Fortune 500® company, that through its operating divisions provides a variety of health care services to patient populations throughout the United States and abroad. A leading provider of dialysis services in the United States, DaVita Kidney Care treats patients with chronic kidney failure and end stage renal disease. DaVita Kidney Care strives to improve patients' quality of life by innovating clinical care, and by offering integrated treatment plans, personalized care teams and convenient health-management services. As of June 30, 2017, DaVita Kidney Care operated or provided administrative services at 2,445 outpatient dialysis centers located in the United States serving approximately 194,600 patients. The company also operated 217 outpatient dialysis centers located in 11 countries outside the United States. DaVita Kidney Care supports numerous programs dedicated to creating positive, sustainable change in communities around the world. The company's leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu. For more information, please visit DaVita.com.
Contact InformationMedia:Kate Wilson Stabrawa 720-318-4080 Kate.email@example.com
SOURCE DaVita Kidney CareRelated Links
For Jana Van Haaften, shift work at a hospital just wasn't working. She needed something that would make mothering small children while working as a nurse more manageable.
Van Haaften found a career in caring for patients with kidney disease, or nephrology nursing. A nurse for 23 years, she is based at the South Minneapolis office of Kidney Specialists of Minnesota (kidney-mn.com).
Van Haaften especially enjoys the opportunity to work in a variety of dialysis centers and getting to know her dialysis patients, whom she sees regularly. "I know about their families; I know when their daughters are getting married and their grandkids are graduating," she said.
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CIPS [4 Certification Exam(s) ]
Cisco [318 Certification Exam(s) ]
Citrix [48 Certification Exam(s) ]
CIW [18 Certification Exam(s) ]
Cloudera [10 Certification Exam(s) ]
Cognos [19 Certification Exam(s) ]
College-Board [2 Certification Exam(s) ]
CompTIA [76 Certification Exam(s) ]
ComputerAssociates [6 Certification Exam(s) ]
Consultant [2 Certification Exam(s) ]
Counselor [4 Certification Exam(s) ]
CPP-Institute [4 Certification Exam(s) ]
CSP [1 Certification Exam(s) ]
CWNA [1 Certification Exam(s) ]
CWNP [13 Certification Exam(s) ]
CyberArk [1 Certification Exam(s) ]
Dassault [2 Certification Exam(s) ]
DELL [11 Certification Exam(s) ]
DMI [1 Certification Exam(s) ]
DRI [1 Certification Exam(s) ]
ECCouncil [22 Certification Exam(s) ]
ECDL [1 Certification Exam(s) ]
EMC [128 Certification Exam(s) ]
Enterasys [13 Certification Exam(s) ]
Ericsson [5 Certification Exam(s) ]
ESPA [1 Certification Exam(s) ]
Esri [2 Certification Exam(s) ]
ExamExpress [15 Certification Exam(s) ]
Exin [40 Certification Exam(s) ]
ExtremeNetworks [3 Certification Exam(s) ]
F5-Networks [20 Certification Exam(s) ]
FCTC [2 Certification Exam(s) ]
Filemaker [9 Certification Exam(s) ]
Financial [36 Certification Exam(s) ]
Food [4 Certification Exam(s) ]
Fortinet [14 Certification Exam(s) ]
Foundry [6 Certification Exam(s) ]
FSMTB [1 Certification Exam(s) ]
Fujitsu [2 Certification Exam(s) ]
GAQM [9 Certification Exam(s) ]
Genesys [4 Certification Exam(s) ]
GIAC [15 Certification Exam(s) ]
Google [4 Certification Exam(s) ]
GuidanceSoftware [2 Certification Exam(s) ]
H3C [1 Certification Exam(s) ]
HDI [9 Certification Exam(s) ]
Healthcare [3 Certification Exam(s) ]
HIPAA [2 Certification Exam(s) ]
Hitachi [30 Certification Exam(s) ]
Hortonworks [4 Certification Exam(s) ]
Hospitality [2 Certification Exam(s) ]
HP [752 Certification Exam(s) ]
HR [4 Certification Exam(s) ]
HRCI [1 Certification Exam(s) ]
Huawei [21 Certification Exam(s) ]
Hyperion [10 Certification Exam(s) ]
IAAP [1 Certification Exam(s) ]
IAHCSMM [1 Certification Exam(s) ]
IBM [1533 Certification Exam(s) ]
IBQH [1 Certification Exam(s) ]
ICAI [1 Certification Exam(s) ]
ICDL [6 Certification Exam(s) ]
IEEE [1 Certification Exam(s) ]
IELTS [1 Certification Exam(s) ]
IFPUG [1 Certification Exam(s) ]
IIA [3 Certification Exam(s) ]
IIBA [2 Certification Exam(s) ]
IISFA [1 Certification Exam(s) ]
Intel [2 Certification Exam(s) ]
IQN [1 Certification Exam(s) ]
IRS [1 Certification Exam(s) ]
ISA [1 Certification Exam(s) ]
ISACA [4 Certification Exam(s) ]
ISC2 [6 Certification Exam(s) ]
ISEB [24 Certification Exam(s) ]
Isilon [4 Certification Exam(s) ]
ISM [6 Certification Exam(s) ]
iSQI [7 Certification Exam(s) ]
ITEC [1 Certification Exam(s) ]
Juniper [65 Certification Exam(s) ]
LEED [1 Certification Exam(s) ]
Legato [5 Certification Exam(s) ]
Liferay [1 Certification Exam(s) ]
Logical-Operations [1 Certification Exam(s) ]
Lotus [66 Certification Exam(s) ]
LPI [24 Certification Exam(s) ]
LSI [3 Certification Exam(s) ]
Magento [3 Certification Exam(s) ]
Maintenance [2 Certification Exam(s) ]
McAfee [8 Certification Exam(s) ]
McData [3 Certification Exam(s) ]
Medical [68 Certification Exam(s) ]
Microsoft [375 Certification Exam(s) ]
Mile2 [3 Certification Exam(s) ]
Military [1 Certification Exam(s) ]
Misc [1 Certification Exam(s) ]
Motorola [7 Certification Exam(s) ]
mySQL [4 Certification Exam(s) ]
NBSTSA [1 Certification Exam(s) ]
NCEES [2 Certification Exam(s) ]
NCIDQ [1 Certification Exam(s) ]
NCLEX [3 Certification Exam(s) ]
Network-General [12 Certification Exam(s) ]
NetworkAppliance [39 Certification Exam(s) ]
NI [1 Certification Exam(s) ]
NIELIT [1 Certification Exam(s) ]
Nokia [6 Certification Exam(s) ]
Nortel [130 Certification Exam(s) ]
Novell [37 Certification Exam(s) ]
OMG [10 Certification Exam(s) ]
Oracle [282 Certification Exam(s) ]
P&C [2 Certification Exam(s) ]
Palo-Alto [4 Certification Exam(s) ]
PARCC [1 Certification Exam(s) ]
PayPal [1 Certification Exam(s) ]
Pegasystems [12 Certification Exam(s) ]
PEOPLECERT [4 Certification Exam(s) ]
PMI [15 Certification Exam(s) ]
Polycom [2 Certification Exam(s) ]
PostgreSQL-CE [1 Certification Exam(s) ]
Prince2 [6 Certification Exam(s) ]
PRMIA [1 Certification Exam(s) ]
PsychCorp [1 Certification Exam(s) ]
PTCB [2 Certification Exam(s) ]
QAI [1 Certification Exam(s) ]
QlikView [1 Certification Exam(s) ]
Quality-Assurance [7 Certification Exam(s) ]
RACC [1 Certification Exam(s) ]
Real Estate [1 Certification Exam(s) ]
Real-Estate [1 Certification Exam(s) ]
RedHat [8 Certification Exam(s) ]
RES [5 Certification Exam(s) ]
Riverbed [8 Certification Exam(s) ]
RSA [15 Certification Exam(s) ]
Sair [8 Certification Exam(s) ]
Salesforce [5 Certification Exam(s) ]
SANS [1 Certification Exam(s) ]
SAP [98 Certification Exam(s) ]
SASInstitute [15 Certification Exam(s) ]
SAT [1 Certification Exam(s) ]
SCO [10 Certification Exam(s) ]
SCP [6 Certification Exam(s) ]
SDI [3 Certification Exam(s) ]
See-Beyond [1 Certification Exam(s) ]
Siemens [1 Certification Exam(s) ]
Snia [7 Certification Exam(s) ]
SOA [15 Certification Exam(s) ]
Social-Work-Board [4 Certification Exam(s) ]
SpringSource [1 Certification Exam(s) ]
SUN [63 Certification Exam(s) ]
SUSE [1 Certification Exam(s) ]
Sybase [17 Certification Exam(s) ]
Symantec [135 Certification Exam(s) ]
Teacher-Certification [4 Certification Exam(s) ]
The-Open-Group [8 Certification Exam(s) ]
TIA [3 Certification Exam(s) ]
Tibco [18 Certification Exam(s) ]
Trainers [3 Certification Exam(s) ]
Trend [1 Certification Exam(s) ]
TruSecure [1 Certification Exam(s) ]
USMLE [1 Certification Exam(s) ]
VCE [6 Certification Exam(s) ]
Veeam [2 Certification Exam(s) ]
Veritas [33 Certification Exam(s) ]
Vmware [58 Certification Exam(s) ]
Wonderlic [2 Certification Exam(s) ]
Worldatwork [2 Certification Exam(s) ]
XML-Master [3 Certification Exam(s) ]
Zend [6 Certification Exam(s) ]
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