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.
© Strong Memorial Hospital, Department of Nursing Practice
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
© Strong Memorial Hospital, Department of Nursing Practice
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 decisionmaking, 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.
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© Strong Memorial Hospital, Department of Nursing Practice
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© Strong Memorial Hospital, Department of Nursing Practice