Development and Implementation of
Professional Practice Model
In 2011, Mary Washington Healthcare’s (MWHC) professional development
program was evaluated; 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.
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. 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)
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
2. A variety of required classes established for advancement
- 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?
- Example: Describe your unit/organizational project and how it has provided
value to your unit.
- Example: Describe your teaching activities and what was taught.
New Knowledge, Innovations, & Improvements
- Example: Describe your leadership role in outcome activities, such as a
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.
Since 2015, there have been 62 successful Level I to Level II advancements
and 22 Level II to Level III advancements.
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.
ACE PNPB development was supported by the 2015 -2106 Shared Governance
Chairs, Co-Chairs and Facilitators, Human Resources, and the Executive Board.
- 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