The Department of Nursing Practice



The Department of Nursing Practice

History of Professional Practice Model

Strong Memorial Hospital’s (SMH) nursing practice model is a directly descended from the original Magnet Hospital Framework, which was defined according to a pattern of characteristics observed in hospitals known for their ability to recruit and retain nurses during serious workforce shortages (McClure, Poulin & Sovie, 1986). The original description of the magnet framework was generated as an outgrowth of a study of 41 hospitals identified as “magnets” for nurses. Each of these hospitals was characterized by a high level of nurse autonomy, consistent evidence of nurse control over practice, effective communication between physicians and nurses, and the presence of a strong and visible nursing leader. Nurses practicing in magnet hospitals were satisfied with the work environment and reported a high likelihood of remaining employed. SMH was one of those original magnet hospitals.

When the next round of nursing shortage occurred during the late 1980s and early 1990s, SMH again served as a demonstration site for the testing of a professional practice model based on the Magnet Framework. In this case, an Enhanced Professional Practice Model (EPPM) defined and categorized the Magnet Framework components and targeted their implementation on medical and surgical units at SMH and two other hospitals. This multi-hospital research project was jointly funded by the Division of Nursing and the National Institute for Nursing Research and was the first ever to study the impact of a magnet hospital focused intervention on nurse and patient outcomes (Ingersoll, Schultz, Hoffart, & Ryan, 1996; Ingersoll, Schultz, Hoffart, & Ryan, 1997).

In the EPPM project, characteristics associated with magnet hospitals were categorized into five conceptual areas – control over practice, continuing education responsive to staff need, continuity of care delivery, collaborative practice, and compensation reflective of education and experience. Nurses from units that implemented this model reported higher levels of job satisfaction and more favorable perceptions of work group and nurse leader behavior (Ingersoll et al., 1996).

The five conceptual elements tested in the EPPM project remained in evidence at SMH as the model evolved over time. These “magnetizing” work environment characteristics have been present regardless of the type of care delivery model (primary or the more recent patient and family focused approach) in place.

Subsequent review and update of the model by a team of registered nurses (RNs), advanced practice nurses (APNs) and nurse managers (NMs) during the Summer of 2007 resulted in recommendations for revision of the graphic representation of the model, addition of the components of Benner’s (1982, 1984) professional advancement model, and incorporation of the 14 forces of magnetism.

References:

American Association of Colleges of Nursing. (2002). Hallmarks of the professional nursing practice environment. Journal of Professional Nursing, 18, 295-304.

Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402-407.

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley.

Benner, P. (1992). Uncovering the wonders of skilled practice by listening to nurses’ stories. Critical Care Nurse, 12, 82-89.

Benner, P., Tanner, C., & Chesla, C. (1992). From beginner to expert: gaining a differentiated clinical world in critical care nursing. Advances in Nursing Science, 14, 13-28.

Chisholm, R. F., & Ziegenfuss, J. T. (1986). A review of applications of the sociotechnical systems approach to health care organizations. Journal of Applied Behavioral Science, 22, 315-327.

Dreyfus, S., & Dreyfus, H. (1980). A 5-stage model of the mental activities involved in directed skill acquisition. University of California: Berkeley. Unpublished manuscript.

Happ, M. B. (1993). Sociotechnical systems theory. Analysis and application for nursing administration. Journal of Nursing Administration, 23(3), 47-54.

Ingersoll, G. L., Schultz, A. W., Hoffart, N., & Ryan, S. A. (1996). Effect of a professional practice model on perception of work group and satisfaction with job. Journal of Nursing Administration (Annual Research Issue), 26(5), 1-9.

Ingersoll, G. L., Schultz, A. W., Hoffart, N., & Ryan, S. A. (1997). A longitudinal study of the effect of a professional practice model on staff nurse satisfaction. In P. A. Stamps (Ed.), Nurses and work satisfaction: An index for measurement (2nd ed., pp. 111-117). Chicago: Health Administration Press.

Ingersoll, G. L., Merk, S., Kirsch, J., Hepworth, J. T., Williams, M., & Wagner, L. (2002). Patient focused redesign and employee perception of work environment. Nursing Economics, 20, 163-170, 187.

Kramer, M., & Schmalenberg, C.E. (2003). Magnet hospital staff nurses describe clinical autonomy. Nursing Outlook, 51, 13-19.

Laschinger, H.K.S., Shamian, J., & Thomson, D. (2001). Impact of magnet hospital characteristics on nurses’ perceptions of trust, burnout, quality of care, and work satisfaction. Nursing Economics, 19, 209-219.

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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