The Department of Nursing Practice



The Department of Nursing Practice

Application of the Model to Clinical Practice

Responsibility for maintaining the patient/family and nursing focused dimensions of the Strong Nursing Model rests with individual staff and the leadership and management groups of the hospital. Input into organization-wide decision-making is facilitated through the Department of Nursing’s monthly Professional Nursing Council (PNC), the weekly meetings of the Nursing Leadership Council, the twice weekly meetings of the Nursing Practice Executive Council (NPEC), and the inclusion of nursing representatives in unit, department, and hospital-wide decision-making committees.

The Chief Nursing Officer, the Associate Directors of each of the services, and each of the patient care unit Nurse Managers and Nurse Leaders are responsible for oversight of care delivery processes and for assuring that the work environment supports the delivery of excellent care. Support services in the Department of Nursing (e.g. education, recruitment, research) provide the assistance needed to maintain the social, technical, system, and competency components of the model.

Nursing Practice standards and expectations for staff and manager performance are guided by the components of the model. Orientation and continuing education programs reinforce the importance of each of the components of the model and encourage the creativity, collaboration, expert practice, and informed decision-making that are essential elements of its success.

Individual unit approaches to the delivery of care to patients and families are guided by the underlying tenets of the Nursing Practice Model. Flexibility is evident, however, in the ways in which the structure of the care delivery process is operationalized. For example, the makeup of the unit nursing team is determined by the specialized needs and acuity of the patients and the unit’s demands. In the inpatient areas, a nurse manager oversees the management of the unit and is aided by one or more nurse leaders. The nurse leaders assist in the organization and accomplishment of daily activities, the implementation of strategic initiatives, and the assurance of quality care. Nurse leaders in several areas also assume responsibility for the oversight of the unit’s orientation and continuing professional development programs and for facilitating quality improvement activities. In the outpatient areas, a nurse manager or nurse leader oversees nursing care.

Regular interdisciplinary care delivery rounds are held on each of the patient care units. These are coordinated and overseen by the nurse manager, nurse leader, or care coordinator for the unit. During these rounds, current and projected needs of patients are reviewed, with specific plans developed for action. Patient and family conferences with care providers are scheduled as needed, with daily nurse-patient interactions reinforcing the patient’s and family’s inclusion in care delivery decision-making.

In keeping with the Professional Practice Model’s focus on knowledge generation and evidence-based practice (EBP), the continuous review of nursing care delivery on patient, unit, and organizational outcomes is an expected behavior of all nursing staff. This process is facilitated through individual annual performance review, unit-based and service-based quality improvement initiatives, and participation in small and large-scale research projects. Staff are encouraged to use the findings from these assessments to identify new and evidence-based approaches to individual, unit, and hospital performance improvement. These findings also are used to develop educational programs and competency expectations that support the achievement of clinically competent (expert) nursing staff and leaders.

The nursing staff of the hospital’s inpatient units is composed of registered nurses (RNs), licensed practical nurses (LPNs), patient care technicians (PCTs), and unit secretaries (US), all of whom report to the nurse manager of the unit. RNs are responsible for the management of patient care and the oversight of LPN and PCT performance. A nursing care coordinator works collaboratively with nursing, medicine, social work, and other health provider staff to assure continuity of care and effective discharge planning. Other expert staff such as safety/infection control nurses and advanced practice nurses also are present to support and promote excellence in patient care. Patient care assignments are made in consideration of patient condition and staff nurse experience and learning need. New staff are assigned to a unit preceptor who is responsible for assuring that hospital, service, and unit performance competencies are met and that care delivery assignment is consistent with stage of learning and learning needs. Nursing mix in the outpatient areas is determined according to unit size and patient need.

In keeping with the Practice Model’s focus on recognition and reward for education and expert practice, RNs at SMH are eligible for advancement through the hospital’s Clinical Advancement System (CAS). This career ladder allows for the progression of expert nurses whose skills and contributions are evidenced in their increasing levels of responsibility and accountability. Nurses at the most advanced levels assume responsibility for precepting new staff, for overseeing and participating in unit, service, and hospital projects, and for assisting with the hospital’s strategic planning and research activities. Criteria for advancement and maintenance of appointment at advanced levels are consistent with the Practice Model’s systems and professional proficiency components.

Application of the Model to the Management of Nursing Practice

The nursing management group at SMH is responsible for creating an environment in which the tenets of the Professional Practice Model are fully appreciated and implemented. The managers also assure that the programs and processes of the Department of Nursing are consistent with the vision and the mission of the hospital and medical center. In addition, the management group consistently role models and reinforces the components of the model and facilitates the attainment of the resources needed to support the model’s actualization.

In support of the model’s focus on continuous learning, informed decision-making, expert practice and collaborative decision-making, the nursing management group works to maintain their own level of expertise and to facilitate the continuous learning of others. Each of the services and departments in nursing uses a participative decision-making process, with shared governance structures that reinforce and support the overall PNC approach.

Advancement and performance review criteria for nursing management positions also reinforce the components of the Professional Practice Model and specify the levels of expertise required for each of these positions. In the case of the management group, however, the focus shifts from direct patient care delivery to the systems and organizational environment levels of practice.

References:

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McClure, M., Poulin, M., & Sovie, M.D. (1983). Magnet hospitals: Attraction and retention of professional nurses. Kansas City, MO: American Academy of Nurses.

Mick, D. J., & Ackerman, M. H. (2000). Advanced practice nursing role delineation in acute and critical care: Application of the Strong Model of Advanced Practice. Heart & Lung, 29, 211-221.

Pasmore, W. A. (1988). Designing effective organizations. The sociotechnical systems perspective. New York: John Wiley & Sons.

Senge, P.M. (1990). The fifth discipline. The art & practice of the learning organization. New York: Doubleday Currency.

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