Development and Implementation of
Professional Practice Model

Background

In 2011, Mary Washington Healthcare’s (MWHC) professional development program was evaluated, including continuing nursing education, specialty certification, scholarship and tuition reimbursement program and the clinical advancement program (CAP). Through this evaluation, CAP was viewed as being stagnant; hence the further development of a new nursing professional practice advancement program was developed.

MWHC was being responsive to the Virginia Action Coalition and Future of Nursing Campaign for Action and the 8 recommendations to advance the practice of nursing. These recommendations became a clear and consistent pathway to advance the practice of nursing within our health system.

Introduction

In the development of the new Professional Practice Model, we evaluated nursing from all perspectives, and a Strategic Workforce Planning (SWP) Committee was formed to develop and align professional development strategies with the Institute of Medicine and Future of Nursing report. Based on the initial gap analysis, three subcommittees from the SWP Committee were identified to fulfill critical gaps; Professional Nursing Practice, On-Boarding, and Bachelor of Science in Nursing (BSN)-Recruitment. The Professional Nursing Practice Subcommittee was tasked with developing a professional nursing practice advancement program. A leadership team was formed and led by Kelly McDonough, DNP.

The development of the professional nursing practice model began early in 2013, after networking with another Magnet hospital that had a proven successful professional nursing practice program and had also successfully infused the Magnet core competencies into nursing practice. In December 2013, the chairs and co-chairs of the Shared Governance Councils were given a presentation on the vision of the professional nursing practice program. This completely nurse-led shared governance group would re-envision the program as an innovative staff leadership program to meet our organizational mission and vision with the strategic goal to retain and develop our bedside nurses.

Establishment of a Professional Nursing Practice Board

The Professional Nurse Practice Board (PNPB) is the body which governs the professional nursing practice program known as ACE (Advancing Clinical Excellence). The Board is comprised of 20 clinical nurses who represent all areas of the hospital. Being a member of this board carries a great deal of responsibility, for those selected serve as ambassadors for nursing and adhere to the highest level of ethical standards. Members who serve on this Board have received an appointment by the Chief Nursing Officer (CNO) and it is viewed as a privilege. Nursing Executive Committee (NEC) liaisons aid the Chair of the PNPB in governance.

This nurse-led PNPB promotes a highly educated workforce and drives succession planning. The theoretical foundation for ACE was adapted from Patricia Benner’s framework, American Nurses Association® National Standards of Practice and Magnet components. Every clinical nurse who practices at the bedside is an ACE member; this excludes advance practice nurses or those holding specialty roles. Every clinical registered nurse (RN) has a job description, job code and classification as a Level 1 Novice, Level 2 Competent, Level 3 Advanced, Proficient, or Level 4 Expert. There are educational essentials and evidence-based performance improvement requirements for advancement and maintenance for each level.

Advancing Clinical Excellence (ACE)

1. Development of practice standards

• Four categories of practice standards within each competency level.
• The categories of practice standards are principles from the Magnet Recognition Program.
• Each category contains subcategories based on American Nurses Association (ANA) standards.

2. A variety of required classes established for advancement

Classes include:

• Preceptor Workshop
• Introduction of Evidence-Based Practice
• Introduction to Nursing Research
• Introduction to Lean
• Performance Improvement – PDCA
• Introduction to Process Maps
• 5S Visual Management
• Growing as a Clinical Leader

3. Required components of e-portfolio

Exemplary Professional Practice

• Example: How have you grown as a professional nurse?

Transformational Leadership

• Example: Describe your unit/organizational project and how it has provided value to your unit.

Structural Empowerment

• Example: Describe your teaching activities and what was taught.

New Knowledge, Innovations, & Improvements

• Example: Describe your leadership role in outcome activities, such as a QI project.

4. E-portfolio submission

• The portfolio is to be submitted digitally.
• You will present your portfolio to members of the Professional Nurse Practice Board.
• No more than 10-minute presentation.
• Additional 5 minutes for questions.

Results

Since 2015, there have been 62 successful Level I to Level II advancements and 22 Level II to Level III advancements.

Advancements

Conclusion

This is the logo, designed by nurses with the assistance of marketing, to represent ACE caring and professionalism at MWHC.

The adoption of the ACE process has been slow but steady. The requirements of BSN and Certification have prevented individuals from advancing but there has been an increase in our BSN completion rate signifying interest in professional growth.

MWHC made an organizational goal of every unit increasing certification by one per year. This goal has been exceeded in several units with NICU having 100% certification.

Advancing Clinical Excellence (ACE) is our professional practice model which is essential to strengthening nursing professionalism and enhancing job satisfaction at MWHC. ACE is a structure to support nurse empowerment; nurses who have control of their practice are linked to high-quality patient outcomes. MWHC is investing in a model that ensures the nurses’ role in clinical practice and quality care decisions that is strong, innovative, collaborative and evidence-based.

Acknowledgements

ACE PNPB development was supported by the 2015 -2106 Shared Governance Chairs, Co-Chairs and Facilitators, Human Resources, and the Executive Board.

Contact Information

• Mary Jane Bowles, DNP, RN, CCRN, CNS-BC, Mary Washington Hospital, 540.741.4170
• Kelly McDonough, DNP, RN, CENP, Mary Washington Hospital, 540.741.1559
• Debra Marinari, MSN, RN, NE-BC, Stafford Hospital, 540.741.9120