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A clinical teaching and evaluation tool was created to improve clinical judgment and diagnostic reasoning for Practical Nursing (PN) and Associate Degree in Nursing (ADN) students in preparation for the Next-Generation National Council Licensure Examination (NCLEX). Implementation of the PURPOSE tool offers a structured approach for nursing students to obtain and retain necessary clinical information in a variety of populations and settings. In addition, the PURPOSE tool provides all levels of faculty a consistent method to contribute to clinical evaluation. Integration of the PURPOSE tool at a large community college in the Southeast resulted in a 100% NCLEX pass rate for new stand-alone program PN graduates.

Nurses should protect the affected extremities of patients who have a permanent arteriovenous access for hemodialysis by avoiding blood pressure measurements and venipuncture on access extremities. National recommendations include labeling the affected extremity with an alert mechanism, such as a wristband, to notify patients and staff of arteriovenous access. A policy change was enacted at an academic medical center in the Southeast to identify restricted extremities with a pink "limb alert" wristband after review of national recommendations on hemodialysis access preservation, individual facility procedures, product cost-benefit analysis, and unit and system educational methods. Keeping simplicity, nursing workload, and flexibility at the forefront of implementation, evaluation, and process revision, an overall adherence rate of 84.2% was achieved three months after implementation of the policy.