Although not widely discussed, this area of nursing is of crucial importance in improving the quality of health care. Within the next few years both the aging population and the increase in the number of potential patients accessing the health care system means that more than ever the organization of nursing services will be a vital part of that inevitable change.
The professional nursing model (PNM) goes by many names, professional practice model, practice model etc. Although numerically in few discussions and research, and references date back to the mid 1990s its importance is recognized by individual institutions for example the University of Maryland or programs such as the Magnet accreditation program. The components of PNM receive more attention.
Nursing is a profession and as such it is worthwhile to take a look at those components of PNM. For by looking at history much can be learned that will enable a better future. A change in how nursing care is provided in health care organizations results in higher quality health care.
PNM is composed of 5 elements. The first are professional values, the second professional relationships, the third patient care delivery systems. The fourth is recognition and compensation. The fifth component enables the preceding 4 and that is management approach and structure. This article is a brief overview of these five elements which are interdependent and build on or detract from each other.
The foundation of nursing values is patient centered care. Any nursing duties aim is to increase health and healing through decreasing risk and prevention. At the same time patient is encouraged to be independent and nurses provide care that maintains the patient’s dignity through a compassionate attitude. To quote: “As a nurse, you bring to the situation that which is uniquely nursing—caring, teaching, advocating, and interpreting for the patient and family.”
Another nursing value is lifelong learning through ongoing professional development and continuing education. Management practices can assist nurses in continual learning, for example by making opportunities available on site or financial reimbursement or time off to attend courses.
Professional relationships are manifested in the interdisciplinary team. This approach creates high quality health care. Interdisciplinary collaboration allow for every team members’ input and expertise that contribute to a sum bigger than its parts. Interdisciplinary collaboration is facilitated by effective skillful communication that is open and constructive. Interdisciplinary teams share responsibility and accountability for medical outcomes. As one nurse said:
”The team owns the quality of care and the process of providing it.” “Sharing information, the results of decisions, and learning from one another is as important as an individual’s competence.”
In PNM nurse create and have control over nursing practice in the patient care delivery system. Nurses need to be in charge of work design and work flow, since they are the professionals involved in the majority of patient care. It is important they have input into the design of the unit or workplace, for instance being on a committee that buys equipment for effective care. A key part of patient care is clinical autonomy, where nurses are free to use their knowledge and judgment for each patient situation or needs. Interdependent decision making and evidence based practice support clinical autonomy. Clinical autonomy will be uniquely defined for each health care setting.
“you can and are expected to practice autonomously on this unit. You can use all your skills and make decisions independently or by working collaboratively with physicians, therapists and others.”
The management structure will also be a determining factor in how effective a PNM is in a particular setting. Management must be supportive of the PNM and its components. A participatory management philosophy will enable nurses input on practice standards, or policies. If front line workers feel they have access to power and can influence outcome that leads to increased job satisfaction and more engagement.
Shared governance is also a structure that supports PNM. Shared governance has many names. It can be defined as a configuration of councils and committees that provides a formal structure that ensures nurses have responsibility, rights, and power to control nursing practice. Shared governance can extend the influence and input of all nurses on staff and can also empower bedside staff. Shared governance must not be in name only, to carry it out productively best management practices must be applied.
Recognition and compensation are also part of the PNM. Recognition does not need to be formal:
“why did I come to work here? Because of the nurse manager. When she interviewed me she asked what kind of support I would need from her. The openness of her question impressed me, so I told her. She said she could meet my expectations. Not try to or maybe, but that she could. Our manager is so respectful of the nurses, of our knowledge and what we do. Daily her words and actions show she believes each of us is valuable. At meetings she is the one that reminds us that what nurses know is different but just as important as doctors’ knowledge. She has earned my trust and respect, I know I have earned hers.
As well, a clear understanding of how nurses can advance and acquire new knowledge is necessary. Career ladders are an example of an advancement structure. Adoption of the PNM can be encouraged by formally including aspects of it in promotion criteria.
Knowledge, skills and personal attributes become competence which are translated into effective nursing. The consequences of that sequence are all positive. Medical outcomes are better, nurses professional self image improves, job satisfaction decreases turnover.
The combination of structures, processes, and values that make up PNM are initiated by nurses, are nurse designed, implemented, and sustained over time. The successful PNM has the ability to transform health care and the professionals involved.
- Research in Gerontological Nursing Vol 1 No 3 2008 p 217-219
http://www.umm.edu/nursing/nppm.htm
http://ccn.aacnjournals.org/content/29/3/77.full#content-block
http://ccn.aacnjournals.org/content/28/6/58.full
http://hartfordign.org/uploads/File/issue_culture_change/Culture_Change_Background_Beck.pdf
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