A . K . Blakey : J Extra Corpor Technol 2024 , 56 , 185 – 190 187
maintaining at least 90 % of the criteria required for promotion to that level [ 16 ].
Discussion Application of findings to create a perfusionist PAM
Using the findings from the literature review , this discussion will be separated into the following categories : Institutional support , gauging perfusionist interest , PAM committee and application process , level and promotion criteria , and follow-up metrics .
Institutional support
Identifying the stakeholders affected by a PAM is an essential first step [ 15 ]. Implementing a PAM will be costly , so administrative and clinical leaders must agree it is a good investment [ 12 , 13 ]. For example , a PAM is typically signified by a salary increase when promoted from one level to another , ranging from 5 % to 30 %, depending on the level acquired [ 4 , 13 , 15 ]. Leaders should be able to estimate the additional cost of PAM implementation based on their employees ’ salaries . There are costs associated with high turnover and the hiring process , including indirect costs that may not be obvious [ 17 ]. PAM implementation in other healthcare fields has been shown to reduce staff turnover , so a connection can be made that a PAM may be in the best financial interest of the healthcare organization [ 4 , 13 ]. Looking past the financial considerations , hospital leaders may find value in increased academic standing from more publications due to PAM implementation [ 13 ].
Gauging perfusionist interest
McComiskey et al . surveyed APPs during the PAM planning phase to get their opinions on a PAM for their institution [ 4 ]. A similar survey can be conducted among perfusionist staff . Ideally , the survey will assess job satisfaction and whether perfusionists desire a PAM to promote career advancement . The feasibility of such a survey should be reasonable , considering the small size of most perfusion departments . According to a survey , the size of a perfusionist team can range from 1 to 37 , but most respondents came from a team with only three perfusionists [ 3 ].
PAM review committee and application process
Establishing a committee with decision-making authority concerning the approval or denial of the promotion is recommended . For example , McComiskey et al . describe the committee for an APP PAM as having members of the CNS , NP , PA , and CRNA teams [ 4 ]. Additionally , supervisors and peers of the applying team members were not allowed to participate . While not mentioning restrictions on who can review an application , Warman et al . describe a committee for a nursing clinical ladder , which comprises nurses who have advanced to either level II or level III of their ladder [ 10 ].
It is important to note that APP and nursing programs at institutions are much larger than most perfusion departments . For example , the study by Warman et al . describes a health system where 3,000 nurses are employed [ 10 ]. Similarly , McComiskey et al . state that their health system employs 300 APPs [ 4 ]. With the small number of perfusionists employed in a health system , it is not feasible for a perfusionist PAM committee to not allow peers or supervisors to review a PAM application without excluding perfusionists entirely from the process . Depending on the scope and reporting structure of perfusion departments within a health system , including a perfusionist leader from both adult and pediatrics , a cardiac surgeon , a cardiac anesthesiologist , and an administrator on thePAMcommitteemaybereasonable .
Applications for advancement should be standardized . The applicant should submit to the committee a CV , letters of recommendation , the level at which they intend to apply , and supporting documents [ 16 ]. Additionally , application windows are a reasonable addition to the process . For example , McComsikey et al . describe their application process as opening every six months for a two-week window [ 4 ]. Following this two-week window , a two-week review process is conducted , during which the applicants are either approved or denied promotion .
Level and promotion criteria
Level definition , point system , and experience requirement . Evidence supports the use of between three and five levels where clinicians can be promoted , each supporting the first level as an entry-level position [ 4 , 10 , 12 , 15 ]. Similarly , the literature review supports placing experience requirements on each level [ 4 , 10 , 12 , 15 ]. Additionally , a point system where applicants obtain points toward promotion by completing activities within specific categories is frequently described in the literature [ 10 , 15 ]. Table 1 displays the experience and points required to progress through the levels . The proposed perfusionist PAM will consist of four levels : Perfusionist I , II , III , and IV . The required experience level will be three , five , and seven years of experience for levels II , III , and IV , respectively . Perfusionist I requires no experience as it is an entry-level position .
Point categories , activities , and quantities . When referring to points accumulated as part of the promotion process , the accrual should be limited to points acquired within the past 24 months [ 15 ]. The perfusionist PAM categories and associated activities and points are listed in Table 2 . The following categories were created : Leadership , Clinical Excellence , Education , and Service . The number of points awarded was determined by the work by Boyd et al . as well as the opinion of this author [ 15 ].
Leadership . Six activities are included within the leadership category . The literature review supports being a member of a professional organization , a member of an institutional committee / task force , and having a leadership role in a professional organization as categorical points [ 4 , 10 , 15 ]. Warman et al . included attending a leadership development course , while Boyd et al . and McComiskey et al . also included being an active member in department initiatives and other activities with prior approval [ 4 , 10 , 15 ].
Clinical Excellence . Seven activities are included within the clinical excellence category . Boyd et al . support the addition of skills workshop participation , while Warman et al . and