From Blank Canvas to Masterwork: Creating a Professional Practice Model at a Magnet Hospital

Purpose: Professional practice models (PPMs) are significant to the foundation of our nursing practice, roles, positive outcomes, and excellence in care delivery across the continuum of health. The ANCC Magnet Standards of Excellence and expectations provide a framework for professional nursing practice and healthy work environments, and were the driving forces behind this project. Often, PPMs are imposed by standard models or casually generated. The purpose of this study was to engage nurses in the creation of a professional practice model. The research question was: How do registered nurses (RNs) in an acute care hospital conceptualize their professional practice?

Theoretical Framework: The theoretical framework used in this study was The ANCC Magnet Standards of Excellence (2014).

Methods: The research method for this study was qualitative inquiry utilizing descriptive qualitative. Twelve (nine initial and four verification) focus groups were conducted to explore and allow for deep understanding of the RNs values and beliefs about their professional practice.

Data Analysis: Data were analyzed using constant-comparative analysis to code the data, and identify categories, domains, and sub-domains.

Results: The 92 participants represented diverse roles and practice settings. Four domains were identified including: caring, knowing, navigating, and leading. The nurses were able to articulate the results with examples of the domains in their current practice.

Conclusion: Caring, knowing, navigating, and leading clearly described how RNs conceptualized their professional practice.

Caring was defined as the essence of nursing through an affective (emotional) demonstration of commitment to patients and families. Caring included sub-domains of a holistic approach, affirmation, connection, time, and trust.

Knowing was the art and science of nursing, an essential attribute to the success of nurses and the safe delivery of patient care. Knowing was the translation of embodied knowledge into evidence-based clinical decisions, actions, and scholarship. Knowing included sub-domains of “big picture”, competence, critical thinking, intuition, lifelong-learning, and nursing as a profession.

Navigating characterized the nurse’s role on the team, guiding patients and team members through the complexities of the health care experience. It was the nurse having the ultimate responsibility and accountability for establishing the link between all health care team members to navigate on behalf of patients. Navigating sub-domains included advocacy, communication, hub, “making a difference”, “master of all trades”, support, teamwork, and time.

Leading was organizing people and processes. Organizational and community leadership was charting new directions and having a vast sphere of influence on patients, families, and the nursing profession. Leading included sub-domains of affirmation, global vision, making a difference, nurses as professionals, respect, and support.

In this study, the nurses told us who they were, their identity, what they did, their roles, and how they envisioned nursing should be practiced in their institution. The results of this study were aligned with the internationally recognized ANCC Magnet Model, ANA Standards, Future of Nursing Initiative, and institution’s mission, vision, and values.

Application of rigorous research methods to create a PPM constituted an innovative strategy to advance the science of nursing and give a voice to the nurses at our institution. The future direction of this project includes the evaluation of the integration of the PPM into daily practice and its impact on outcomes.