What Does Professionalism As A Advanced Practice Registered Nurse Mean

Abstract

Ensuring that nurses tin can practise according to the philosophical underpinnings of their profession is recognized every bit an important factor in task satisfaction and is therefore a key chemical element of retention and recruitment of the nursing workforce. Creating a culture of excellence requires making explicit a ready of values and operation expectations to which all nurses can subscribe and that influences practise behaviours. The vice president and primary nursing officer of a large wellness region in Western Canada therefore sought to establish a foundation for edifice such a culture of excellence, through the creation of a mission, vision and Professional Exercise 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 affect of the framework on nurses' practice and patient care.

The past decade in healthcare has been characterized by hospital restructuring, with mergers of previously contained 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 accept developed professional practise 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 primary 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 past 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 tin practise according to the philosophical underpinnings of their profession is recognized equally an of import cistron in chore satisfaction and hence is disquisitional to memory and recruitment of the nursing workforce (Baumann et al. 2001). Employers share responsibleness with nurses, professional associations and others for promoting environments that support quality professional practice (Canadian Nurses Association 2001). Achieving loftier-quality healthcare requires that nosotros 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 tin can exercise control over the delivery of care for which they are responsible (Hoffart and Forest 1996). Professional practice models by and large address nurses' need for autonomy and accountability and are considered important to organizational empowerment of nurses and to the creation of constructive piece of work teams (Spence Laschinger and Havens 1996). A set of values and operation expectations to which all nurses can subscribe and that influences practice behaviours is essential to creating a civilisation of excellence (Kramer 1990). Achieving excellence in nursing practice was the aim in development of the Calgary Health Region Professional person Practice Framework.

Development of the Framework

One of the beginning priorities of the vice president and CNO of the Calgary Wellness Region was to develop a vision for nursing in the Region. Through the evolution of this vision, it became apparent that a mission for nursing was as well essential. As this work progressed, an evident demand emerged to establish a definition of professional practice and a guideline or framework that nurses could utilize on a daily basis to reach the vision and mission of nursing in the Region. This foundational work is described in Effigy ane.

Figure ane. Vision and mission for nursing, Calgary Wellness Region

Our vision for nursing:
Excellent healthcare through professional nursing practice.

Nursing mission:
We are committed to professional nursing exercise that promotes quality, family-centred care and efficient and constructive delivery of integrated services provided in collaboration with community partners and members of the multidisciplinary healthcare team.

The mission and vision formed the foundation on which evolution of the Professional Practice Framework was based. An important first step was to articulate clearly, in concise terms, the significant of "professional person nursing practice." Consultation with nurses in the Region provided the substance from which the following definition was crafted:

Professional person nursing practice is a commitment to compassion, caring and strong ethical values; continuous evolution of self and others; accountability and responsibleness for insightful practice; demonstrating a spirit of collaboration and flexibility.

One of the main concerns of the job force mandated with the development of the Professional Practice Framework was that all nurses be given the opportunity for interest 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 24-hour interval on diverse 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 increment 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 virtually the defining elements of professional nursing practice inside the Region. Three questions were asked of participants in the focus groups, merely the outset of which is addressed in this newspaper:

How would you describe an exemplary "professional" nurse?
In light of those attributes, what do you think is the current status of professional nursing practice in the Calgary Wellness Region?
What can the Region exercise to support and promote professional nursing do?

Methodology and Limitations

Eighteen focus groups were held from early January to late February 2002, with a total of 156 participants in omnipresence. Three of these focus groups were considered "expert" groups, two with the Regional Nursing Council and one with representatives of the clinical nurse educators. The remaining 15 groups were composed of nurses (primarily registered nurses, with a few licensed practical nurses) working in a multifariousness of practice settings (east.g., home care, public health, astute intendance) and sites (hospitals and community-based offices or clinics).

All focus groups were moderated by one of two facilitators who were employees of the Region. Group discussions were either audiotaped and later transcribed, or summarized directly onto a laptop figurer by one of the group moderators. Subsequent to the focus groups, a questionnaire was constructed and a Region-wide survey conducted with nurses to validate the components of the Professional Do Framework. Statements on the questionnaire were derived from the themes that had emerged during focus group consultations. These included 8 statements focusing on the fine art of nursing, eight related to competence, eight dealing with attributes of practice and 10 with personal commitment. A total of 482 respondents returned a completed questionnaire. Consistently, respondents indicated high agreement with the statements on the questionnaire, confirming that the elements of the framework that had emerged from the focus groups resonated with the larger sample of nurses in the Region.

Respondent Profile

Almost all respondents to the survey were registered nurses (RNs). A majority (44%) held a baccalaureate caste in nursing, closely followed by diploma-prepared nurses (40%). A small number of respondents (9%) were prepared at the graduate level. Only 2% of respondents were licensed applied nurses (LPNs) and 3% were registered psychiatric nurses (RPNs). The proportion of LPN and RPN respondents was only slightly less than their proportional numbers in the full nursing staff mix of the Region at the fourth dimension the survey was conducted. More than one-half the respondents (51%) worked in acute care settings. Public health (11%), ambulatory care (10%) and home care settings (ten%) were equally represented, followed closely by mental wellness (8%). But 3% of respondents held administrative positions. Three-quarters (74%) of respondents had ten or more years' feel in nursing, compared to only 3% with less than 1 year in nursing exercise. Respondents with 1 to four (11%) or five to nine (11%) years' experience were every bit represented.

Discussion of Results

From focus group comments and their subsequent validation through the quantitative survey, a typhoon Professional person Practice Framework was presented for consideration and farther evolution by the Regional Nursing Council. The components that follow were derived from nurses' input.

The fine art of nursing

Professional nursing exercise is grounded in the art of nursing, described as taking a holistic, customer-centred focus; being caring and ethical in interactions with patients, families and colleagues; having above-average interpersonal skills; and making sound judgments based on experience and knowledge, thus averting potential bug.

2. Competence

Professional person practice demands competence in relation to cognition and technical skills. This requires non simply a broad base of knowledge, but also depth of knowledge in a chosen expanse of practice, a desire and ability to continue developing that noesis base and to share it with others and critical thinking in conclusion-making.

iii. Attributes of Exercise

Professional practice reflects a item approach to one's work, with collaboration by far the most salient characteristic. Professional person nursing exercise ways working in partnership with other nurses and health professionals in providing client care, being highly organized in managing activities and time, having the ability to manage many complex tasks simultaneously, working apart as appropriate and having an open up mind and nonjudgmental style.

4. Personal commitment

In describing this element of professional person exercise, respondents referred to the importance of having confidence in one's abilities and taking responsibleness for one's actions, including having a sound agreement of the boundaries and limitations of nursing practice. Having a balanced lifestyle and supporting the advancement of the profession were besides considered important characteristics of a professional nurse.

Approval of the Framework

Later on several months of consultations with nurses across the Region, give-and-take at Regional Nursing Council and numerous revisions, the final draft of the Professional Do Framework was approved by Nursing Council and distributed during Nurses Week 2003. The Professional Nursing Practice Framework for the Calgary Health Region is depicted in Figure 2.

The framework is congruent with the values of the Calgary Wellness Region (Honesty, Integrity, Dignity, Trust, Respect, Responsiveness, Creativity and Learning). Information technology reflects elements that are common to other professional exercise frameworks described in the literature (Behrend et al. 1986; Hannah and Shamian 1992 ; Hoffart and Woods 1996; Joy and Malay 1992; University Health Network 2003). The framework reinforces the prerequisites for the promotion of safe, competent and ethical nursing exercise that are inherent in the standards of do and code of deport of the Alberta Clan of Registered Nurses (AARN), the professional body that regulates the practice of registered nurses in the province.

The framework was illustrated in a pamphlet distributed to all nurses in the Region during Nurses Week. Incorporated in the pamphlet was a pocket card summarizing the elements of the framework, providing a quick reference and enhancing the likelihood that the framework would be utilized on a solar day-to-day basis as a guide to practice.

The framework logo depicted in Figure ii was designed by i of the members of Regional Nursing Council (Sharon Witt) and is an expression of her belief that the nurse'south cap has traditionally been an important symbol of professionalism in nursing.

Implementation of the Framework

Once the Professional Practice Framework was developed, information technology was important that it "come up alive" for all nurses practising in the Region. Numerous sessions were held (some using telehealth technology) to familiarize nursing staff with the framework when information technology was first launched, and introduction to the framework is at present routinely incorporated into the orientation of all new nurses who join the Region. The framework too guides the development of preceptors and charge nurses.

The major elements of the framework have been linked to the expected RN, LPN and RPN competencies articulated in job descriptions, and application of the framework in exercise is at present incorporated into nurses' ongoing professional development and continuing education plans. A clinical mentorship program based on the competencies associated with professional do in the Region is under development, as is a position paper on patient rubber and professional person nursing practice.

Further elaboration of the framework will be ongoing. For example, use of the framework has exposed the need to analyze some of its terms, such every bit "insightful do." Using a process not unlike that which guided evolution of the Professional Practice Framework, input will again exist sought to ensure that a definition of insightful do is elaborated that will resonate with nurses in the Region.

Evaluation and Enquiry

Now that the Professional person Exercise Framework has been articulated, it volition exist of import to determine the effectiveness with which it is being implemented across the many sites and settings in this large regional health authority and measure its impact on practice and patient outcomes. Over the course of the next several years, specific implementation initiatives will be targeted for evaluation and enquiry. An overarching framework will exist developed to guide the evaluation of specific initiatives. Answers will be sought to such questions equally: What facilitated "internalization" of the Professional person Practice Framework? Did its implementation modify nursing practice on select units? Did changes in nursing practise affect the roles of other members of the healthcare squad? What difference, if any, did implementation of a Professional person Practice Framework make in job satisfaction and patient outcomes? What went well in implementing the framework? What could have been done differently?

Conclusion

The procedure of developing a Professional Practice Framework for the Calgary Wellness Region demanded considerable fourth dimension and effort on the function of a multitude of nurses. The resolve to reflect accurately the language of nurses in developing the framework was vital to defining professional person practice in a mode that promoted ownership of the terminal product past nurses in the Region. Information technology will now be important to examine the extent to which elaboration of this framework helps nurses achieve increased meaning and continually strive to attain college levels of excellence in their work. It is hoped that the development of an explicit model to guide practice will ultimately assistance nurses feel pride in their profession and value the tremendous contribution that they and nursing make to the healthcare arrangement.

Francine Girard, RN, BN, MN, PhD
Senior Vice President, Professional person Practice and Enquiry
Chief Nursing Officer
Calgary Health Region
Calgary, AB

Noreen Linton, RN, BN, MN
Manager, Principal Nursing Portfolio
Calgary Health Region
Calgary, AB

Jeanne Besner, RN, PhD
Director, Research Initiatives in Nursing and Health
Calgary Health Region
Calgary, AB

References

Baumann, A., L. O'Brien-Pallas, M. Armstrong-Stassen et al. 2001. Delivery and Care: The Benefits of a Salubrious Workplace for Nurses, Their Patients and the System. A Policy Synthesis. Ottawa: Canadian Health Services Inquiry Foundation. Retrieved May 3, 2005. < http://www.nlcahr.mun.ca/dwnlds/CHSRF_2001a.pdf >.

Behrend, B.J, D.A. Finch, C.A. Emerick and G. Scoble. 1986. "Articulating Professional Nursing Practice Behaviors." Journal of Nursing Administration sixteen(2): 20-24.

Canadian Nurses Association. 2001. Position Statement: Quality Professional Do Environments for Registered Nurses. Ottawa: Writer. Retrieved May 3, 2005. < http://www.cna-nurses.ca/CNA/documents/pdf /publications/PS53_Quality_Prof_Practice_ Env_RNs_Nov_2001_e.pdf >.

Ferguson-Pare, M., T. Closson and Southward. Tully. 2002. "Nursing Best Practise Guidelines: A Gift for Advancing Professional Do in Every Environs." Hospital Quarterly 5(iii): 66-68.

Hoffart, N. and C.Q. Woods. 1996. "Elements of a Nursing Professional Do Model." Periodical of Professional Nursing 12(half dozen): 354-64.

Joy, Fifty. and M. Malay. 1992. "Evaluation Instruments to Measure Professional Nursing Practice." Nursing Direction 23(7): 73-77.

Kramer, M. 1990. "The Magnet Hospitals: Excellence Revisited." Journal of Nursing Administration xx(9): 35-44.

Spence Laschinger, H.K. and D.S. Havens. 1996. "Staff Nurse Work Empowerment and Perceived Control Over Nursing Practice." In Due east.C. Hein, ed., Contemporary Leadership Beliefs: Selected Readings (5th ed., pp. 177-86). New York: Lippincott.

London Health Sciences Eye. 2004. "What Is a Professional person Practise Model?" Retrieved May 3, 2005. < http://www.lhsc.on.ca/nursing/nppmwhat.htm >.

The Ottawa Infirmary. 2004. "Nursing Professional Practice." Retrieved May 3, 2005. < http://www.ottawahospital.on.ca/hp/dept/ nursing/npp/index-e.asp >.

Academy Health Network. 2004. "Professional Practice Model." Retrieved May three, 2005. < http://www.uhn.ca/programs/nursing/ site/professional_practice >.

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