Building a Center for Nursing Excellence Using a Role-Based Model for Accountability and Outcomes

The impetus to create the Center for Nursing Excellence in a southwest region hospital system coincided with new nursing leadership and a newly merged health network comprised of five hospitals. In order to align with the core tenets of Magnet® (ANCC, 2013), a feature of all five hospitals, and to provide access to resources for all nurses at all levels in all areas of nursing, a strategy was needed to bring together the key pillars of professional nursing practice, education, research and innovation. The new Network Chief Clinical Officer established the vision for the Center and pulled together the leadership team to make this vision a reality.

The Center was created on the philosophy of promoting a nursing environment that is as humanistic and compassionate as it is scientifically and technologically sophisticated (adapted from Arnold P. Gold Foundation, 2013). This is achieved through research and education of best practice at all levels, and by collaboration with a broad range of partners who are experts in today’s issues, and addressing tomorrow’s solutions through research to ensure the best information is available to support diverse populations and their health.

A role-based practice model (O’Rourke & White, 2011) was adopted as a framework the Center’s strategic plan and activities of the Center. A key tenet of the model is to promote better outcomes through ownership and accountability for practice at the managerial and clinical level. Within keeping of the Institute of Medicine Report, The Future of Nursing (2011) a long term goal of The Center is to make a global impact on transformative evidence-based practice, professional role development, education, research, and continual Magnet® readiness. The structure of the Center was designed to make the role-based model operational by hiring a diverse team of experts to lead and collaborate using an interdisciplinary and interprofessional approach to healthcare, based on the main investigative elements: patient outcomes, population health, and a well prepared healthcare workforce. 

The Center staff includes a network director for each area, including practice, education, research, outcomes and Magnet. Under the direction of an Associate Vice President, this team of directors actively engage with relevant work groups, clinical and managerial, to link accountability and ownership of practice across all levels of the network. Key strategies for the Center include: the Director of Nursing Practice investigating and helping to standardize policy to ensure a model driven approach; the Director of Research providing population data to ensure a patient-centered approach based on precise patient profiles; the Director of Nursing Education ensuring educational activities are consistent across the network, and the Director of Nursing Outcomes working with nurses to make sure they understand their professional role obligation to measure and monitor outcomes and learn how to actively engage in the process. In this sense, the executive leadership owns accountability for The Center as a vital structure to the network, while each director owns accountability for supporting the themes of their expertise.  None of this is possible without close alignment with a well-defined shared governance system that helps make the key professional concept of control of practice a reality. The Center provides vital support for the development of the Councils as they increase their knowledge and skill related to governance and decision-making practice. A shared governance approach requires a flat organizational structure as this increases likelihood that nurses at all levels will be actively engaged in transformational change and the development and implementation of best practices.

Strong academic-practice partnerships have been formed resulting in joint appointments, a distinguished scholar in residence program, and shared teaching and mentoring responsibilities for staff and students at all levels (Baccalaureate to Postdoctoral).  In addition, interprofessional and interdisciplinary research, both fundamental and applied are being fostered through The Center as well as a scientific-educational exchange with a Sister City in Kenya. All outcomes are monitored, reported and disseminated from the Center via various means, including through shared governance councils, a website, newsletters, forums and huddles.