Professional Practice in Nursing: A Framework

Ensuring that nurses can practise according to the philosophical underpinnings of their profession is recognized as an important factor in job satisfaction and is therefore a key element of retention and recruitment of the nursing workforce. Creating a culture of excellence requires making explicit a set of values and performance expectations to which all nurses can subscribe and that influences practice behaviours. The vice president and chief nursing officer of a large health region in Western Canada therefore sought to establish a foundation for building such a culture of excellence, through the creation of a mission, vision and Professional Practice Framework for the region’s nurses. The author describes the development of the nursing Professional Practice Framework for this health region, presents the results of a participatory approach to promoting nurses’ ownership of the model and discusses plans for assessing the impact of the framework on nurses’ practice and patient care. Professional Practice in Nursing: A Framework Francine Girard, RN, BN, MN, PhD Senior Vice President, Professional Practice and Research Chief Nursing Officer Calgary Health Region Calgary, AB Noreen Linton, RN, BN, MN Director, Chief Nursing Portfolio Calgary Health Region Calgary, AB Jeanne Besner, RN, PhD Director, Research Initiatives in Nursing and Health Calgary Health Region Calgary, AB Nursing Leadership On-line Exclusive • June 2005 2 The past decade in healthcare has been characterized by hospital restructuring, with mergers of previously independent organizations and their associated cultures into larger, regionalized entities. Concurrently, cutbacks due to fiscal constraints during the 1990s contributed to heavy workloads, long hours and reported difficulty by nurses in carrying out their professional roles (Baumann et al. 2001). Recognizing the importance of practice environments that conform to the philosophy of care held by the nursing profession (Baumann et al. 2001), many organizations have developed professional practice models to guide nursing care delivery, with the goal of empowering the nursing workforce and improving the quality of patient care (London Health Sciences Centre 2004; Ottawa Hospital 2004; University Health Network 2004). The newly appointed vice president and chief nursing officer (CNO) of the Calgary Health Region (“the Region”) requested that the Regional Nursing Council begin work on developing a Professional Practice Framework for nursing. A task force was struck, with a mandate to complete a first draft of the framework by Nursing Week (May 2003). This paper describes the process used to solicit input into the development of the framework and presents results of the participatory approach to obtaining ownership of the model by nurses. It concludes with a brief commentary on plans for assessing the impact of the framework on nurses’ practice and on patient care. Literature Support Ensuring that nurses can practise according to the philosophical underpinnings of their profession is recognized as an important factor in job satisfaction and hence is critical to retention and recruitment of the nursing workforce (Baumann et al. 2001). Employers share responsibility with nurses, professional associations and others for promoting environments that support quality professional practice (Canadian Nurses Association 2001). Achieving high-quality healthcare requires that we make explicit the expectations related to professional nursing practice (Ferguson-Pare et al. 2002). Nurses’ effectiveness in achieving the outcomes for which they are accountable is inextricably tied to the extent to which they can exercise control over the delivery of care for which they are responsible (Hoffart and Woods 1996). Professional practice models generally address nurses’ need for autonomy and accountability and are considered important to organizational empowerment of nurses and to the creation of effective work teams (Spence Laschinger and Havens 1996). A set of values and performance expectations to which all nurses can subscribe and that influences practice behaviours is essential to creating a culture of excellence (Kramer 1990). Achieving excellence in nursing practice was the aim in development of the Calgary Health Region Professional Practice Framework. Development of the Framework One of the first priorities of the vice president and CNO of the Calgary Health Region was to develop a vision for nursing in the Region. Through the development of this vision, it became apparent that a mission for nursing was also essential. As this work progressed, an evident need emerged to establish a definition of professional practice and a guideline or framework that nurses could utilize on a daily basis to achieve the vision and mission of nursing in the Region. This foundational work is described in Figure 1. The mission and vision formed the foundation on which development of the Professional Practice Framework was based. An important first step was to articulate clearly, in concise terms, the meaning of “professional nursing practice. ” Consultation with nurses in the Region provided the substance from which the following definition was crafted: Professional nursing practice is a commitment to compassion, caring and strong ethical values; continuous development of self and others; accountability and responsibility for insightful practice; demonstrating a spirit of collaboration and flexibility. One of the main concerns of the task force mandated with the development of the Professional Practice Framework was that all nurses be given the opportunity for involvement in its development. Hence, a participatory approach was used to solicit nurses’ input. A number of focus groups were held, which were offered at different times of the day on various days of the week and at various sites across the Region. Subsequent to analysis of the focus group data, questionnaires to validate the focus group findings were distributed in hard copy at all regional sites and simultaneously placed on the internal website to increase access for nurses in the Region and to invite them to complete the survey. Purpose and Objectives The purpose of the focus groups was to obtain nurses’ views about the defining elements of professional nursing practice within the Region. Three questions were asked of participants in the focus groups, only the first of which is addressed in this paper: Professional Practice in Nursing: A Framework 3 Figure 1. Vision and mission for nursing, Calgary Health Region Our vision for nursing: Excellent healthcare through professional nursing practice. Nursing mission: We are committed to professional nursing practice that promotes quality, family-centred care and efficient and effective delivery of integrated services provided in collaboration with community partners and members of the multidisciplinary healthcare team.