EP1 Clinical nurses are involved in the development, implementation, and evaluation of the professional practice model.
New applicants: Provide a description, with supporting evidence, of the development of the nursing professional practice model and how clinical nurses were involved.
BACKGROUND AND PURPOSE
Through a gap analysis using the 2008 Magnet application manual as framework for building a culture of nursing excellence, Homestead Hospital’s nursing team identified the need to develop a Professional Practice Model (PPM) as foundation for nursing practice. New Magnet Project Director (MPD) Julie David, ARNP, attended the 2009 national Magnet conference in Louisville, Kentucky, to learn about the journey and PPM development. She guided the nursing service department in its PPM voyage.
After returning from the conference, David conducted an extensive literature review on PPM development and looked at other organization’s models. In consultation with Chief Nursing Officer (CNO) and Vice President Gail Gordon, RN, she decided the method that would best fit the organizational culture and structure would be the formation of a focus group consisting of RNs across all levels to develop the initial PPM draft. The recruitment of the PPM task force members transpired during the first 3 months of 2010. This task force would be composed of the CNO, nurse leaders, nurse managers, nurse supervisors, nurse educators, research specialist and clinical nurses. David also had a vision of having a team overseeing the steps in the Magnet journey and proposed to Gordon naming the taskforce Magnet Steering Council (MSC). In this way, the group will continue to meet even after the PPM is developed in order to assist the MPD in troubleshooting opportunity areas in the journey, action planning and developing the application timelines.
METHODS AND APPROACH
PPM Development
MSC first met in April 2010 for 3.5 hours. The group engaged the expertise of Internal Consultant Anita Lymburner, RN to facilitate its initial brainstorming session. She explained to the group the Magnet model and the essential components of the PPM. She asked them to provide descriptors for each of the components. She also invited them to think of Homestead Hospital’s and the community’s unique characteristics in order to develop a PPM that will resonate with the nursing staff and be reflective of the organization’s personality. The team came up with some unified themes and these words became the early favorites: “quality, holistic, professional development, evidence-based practice (EBP), teamwork, patient/family, care and safety.” MSC continued to meet every other week for the next 3 months. They worked on the PPM overarching concept, decided what its components would consist of and refined the descriptors for each component. Although a corporate nursing vision statement already existed, the team recognized the need to integrate into the PPM a Homestead Hospital-specific nursing mission statement to articulate the nursing staff’s purpose. (EP1 01 MSC meeting minutes April-July 2010 and Sign-in Sheet).
The group used the Royal Poinciana tree as the inspiration for the PPM design because of its flamboyant canopy that was prevalent in the locale and provided shelter from the heat during the summer months. It also portrayed the agricultural neighborhood where the hospital is located. After several sessions of brainstorming and fine-tuning of words and concepts, MSC invited Graphics Designer, Kristi Desjardins, to the 7/19/10 meeting. The team explained to her first-hand their ideas for the graphical representation. The PPM underwent several iterations. (EP1 02 PPM Versions)
PARTICIPANTS
Clinical Nurse Involvement
The Magnet Steering Council consisted of clinical nurses who were standing members. There were also ad-hoc members who participated only in the PPM development sessions.
Name/Credentials |
Years RN / Years Specialty Experience |
Title |
Department |
Role in the Team |
Rosa Filomeno MSN, RN, CMSRN |
20 years RN /10 years specialty |
Clinical Nurse |
3 South |
MSC Standing Member |
Lois Johnson, RN, CMSRN |
38 years RN / 20 years specialty |
Clinical Nurse then. Promoted to Patient Care Supervisor |
MS4 |
MSC Standing Member |
Aracely Olvera, BSN, RN, CMSRN |
11 years RN/ 8 years specialty |
Clinical Nurse then. Promoted to Clinical Nurse Educator |
MS5 |
MSC Ad-Hoc Member |
Evelyn Quinones, RN |
16 years RN/ 2 years specialty |
Clinical Nurse then. Transferred to Case Management. |
Surgical Services |
MSC Ad-Hoc Member |
After MSC was satisfied with the initial draft, they wanted to get input from nurses across the hospital, including clinical nurses. They utilized the shared governance structure, both the hospital-wide and Unit Practice Councils (UPC), in circulating the PPM draft and garnering feedback. In early August 2010, David presented the draft to the Nurse Governance Council (NGC) since it is composed of nurses across all levels – CNO, nurse leaders, nurse managers, hospital-wide council chairs and UPC chairs. She asked the managers to discuss the PPM in the staff meetings. She also asked the chairs to introduce the PPM draft and solicit feedback from the nurses during their respective council meetings in August. The UPC Chairs asked their UPC council members to present the PPM using the communication tree and to send any feedback via email to the MPD.
The nursing staff received the PPM draft positively. There were a few minor suggestions. Below is an excerpt of one of the comments.
“I got good feedback from the UPC regarding the two documents you sent me. The only suggestion I heard, was to add an “emphasis on continuing education” to one of the branches on the tree. “
Donna Fuentes, RN
HH MS3/3South
UPC Chair-Interim
The MSC members reevaluated the PPM based on the comments received from the nurses. They also wanted to assess if nurses could actually relate to the model. Along with the Magnet Ambassadors, they went around and showed the PPM to different RNs and asked how they exemplified the PPM components in their practice. About half of them were not able to articulate clearly what the components meant to them and their nursing practice. They realized that the 1-2 word descriptors used to describe each component (represented by the branches) were not adequate in explaining its scope and intent. This observation was further validated by ANCC Consultant Julia Aucoin, RN, who visited the organization in February 2012 to conduct a second gap analysis. She commented that our current model is not intuitive enough and recommended on clarifying it more. Thereafter, MSC decided to remove the 2-word descriptors. In their place, they developed statements for each component that conveyed concisely its meaning and intent. Each statement started with the word “we” to express the nursing service department’s collective intent. By doing so, it eliminated the need to develop a separate companion document to explain the PPM. MSC also decided to incorporate the nursing vision and mission statement within the model.
David presented PPM Version 4 to NGC during the May 2011 meeting. She highlighted the changes that were made by MSC to clarify and simplify the model. NGC members received the changes favorably with no additional suggestions and approved it as the final PPM version. David also presented the plan for the initial education roll-out of the PPM to the nurses.
PPM Implementation
The Magnet Ambassadors Committee, consisting of clinical nurses from all nursing departments, took the task of rolling out the PPM to all of the nurses. They started the planning of the roll-out immediately in May 2011. They wanted to sponsor an activity that will herald the roll-out. So, the group decided to coordinate a story-telling contest since nurses love sharing stories. In this contest, nurses were asked to write a story that exemplified one of the branches of the PPM. ICU Clinical Nurse Maria Zolaica Paragas, RN and MS4 Patient Care Supervisor Lois Johnson, RN, won. Their prize was a grant to attend the 2011 Magnet conference in Baltimore, Maryland. The Magnet ambassadors introduced the PPM in September 2011, mainly through rolling cart, to afford one-on-one interaction and opportunity to ask questions. They kicked off the activity with an interactive board game and had nurses match different examples to the corresponding branches of the tree which was enlarged into a big poster. They rounded in all the nursing departments during various shifts and on different days for the entire month of September. For the nurses who they were not able to speak directly to, they handed out a literature on the PPM. They gave tree-shaped pens as gifts to all of the nursing staff. Through a combination of rolling cart rounding and handing out of literature, they were able to introduce the PPM to 98% of the nurses. In November of 2011, Katharine Kolcaba, RN, author of the Comfort Theory, came for a second site visit. She reinforced to the staff and the nurses the basic premises of her theory and its applications. The highlights of the visit included her keynote presentations which were rated highly by the staff; inauguration of the lactation lounge; and comfort huddles during which she conversed with staff about patient and employee comfort and asked them to pick an item from the comfort basket.
David through the Magnet Ambassadors coordinated several activities in the succeeding years that enabled visibility of the model and made it alive in the nurses’ day-to-day professional practice. In May 2012, the Magnet Designation department sponsored another Magnet poster, video and essay contest. This time around it was opened to all hospital employees to reinforce the philosophy that the journey to Magnet excellence involves everybody. The contest ran for 6 weeks and the theme was “What excellence means to me?” There were 3 entries for the essay and 1 entry for the video. The winners in each category were awarded a grant to go attend the 2012 Magnet Conference in Los Angeles, California. At the same time, Professional Development Council (PDC) Present Chair and Clinical Nurse Rosa Filomeno, RN, together with Clinical Learning Consultant Regina Russell, RN, facilitated a PPM discussion group for nurses. This session was particularly targeted towards clinical nurses. Its purpose was to provide nurses the opportunity to describe how they applied PPM to their individual practice. This also provided a method of evaluating the use, relevance and value that the nurses attributed to the PPM. Filomeno and Russell designed an interactive session using a PowerPoint presentation and table top activities with puzzle pieces. The nurses enjoyed the activity and were able to relate easily how they use the PPM in their daily practice by giving examples. They also enjoyed hearing different perspectives from their colleagues in other specialties. (EP1 03 PPM Discussion Group Completion Report)
Beginning in 2012 and thereafter, the PPM was a major consideration when developing the annual nursing strategic goal. The Nurse Governance Council (NGC) utilized the PPM in identifying priority areas for the nursing service department to focus on. Various shared governance council chairs utilize the PPM as a logo for their monthly meeting agenda promoting its visibility.
PPM Evaluation
In November 2014, NGC once again conducted its annual 1-day retreat to develop the FY15 nursing strategic goal. As in the previous years, Gordon invited nurses from across all levels to participate in this important exercise. Part of the day’s agenda was the PPM evaluation. David facilitated the activity. Prior to the discussion, she asked the participants to complete a survey on the PPMs relevance and importance to the FY14 nursing strategic goals and areas that needed modification and clarification. She used the survey results to guide her discussion. (EP1 04 PPM Survey) She methodically went over every PPM component and engaged the group in a brainstorming and dialogue. Through this process, the group arrived at a consensus that the PPM was still relevant and important to nursing practice. They further agreed that the PPM did not need any modification. It only needed clarification in certain areas in order to better reflect the realities impacting Homestead Hospital’s nursing practice environment. Thus, the group made suggestions to replace some of the words in the “Collaboration” and “Clinical Practice” components. (EP1 05 Nursing Strategic Retreat Minutes and Sign-in Sheet). The next steps would involve updating the PPM to reflect the changes and disseminating the revised version through the shared governance councils.
Summary
Nurses across all levels, including clinical nurses, utilize the PPM as their guide for nursing practice. It conveys their philosophy as professional nurses and highlights the aspects that are most important to them. They can relate to it because they had input in the development of the initial draft, approval of the final version and its evaluation. As their true north, they utilize the document in making decisions that impact nursing such as the nursing strategic goal and in reviewing professional nursing practice.
Summary of Attachments/Hyperlinks/Evidences
EP1 01 MSC meeting minutes April-July 2010 and Sign-in Sheet
EP1 02 PPM Versions
EP1 03 PPM Discussion Group Completion Report
EP1 04 PPM Survey
EP1 05 Nursing Strategic Retreat Minutes and Sign-in Sheet