Professional Nursing Practice Model
Ideally, students would have the opportunity to learn in a nursing home that supports professional nursing practice and promotes a professional nursing practice environment. Use the following guidelines to evaluate a professional nursing practice environment in a nursing home. Click each to learn more.
RN practice is based on specialized knowledge.
Examples of this guideline include RNs holding ANCC certification in geriatric nursing or perhaps certification in wound and ostomy care, palliative care, rehabilitation, or nursing administration. Further, RNs would be regularly engaged in professional development either through continuing education or furthering their academic credentials. RNs would be supported by the organization to ensure that they remain competent and have opportunities for professional development.
RNs lead assisting staff (nursing assistants and licensed practical nurses) in the delivery of care and are accountable for the nursing care delegated to assisting staff.
By licensure and scope of practice, RNs are accountable for the care delegated to assisting staff. Nursing care delivery systems would support the coordination, assessment, care planning, and evaluation responsibilities of the RN. RNs would likely have a significant role in guiding and evaluating daily care assignments, communicating with assisting nursing staff, conducting comprehensive assessments and leading the care planning process, and coordinating the resident’s care and care plan with members of the nursing and interdisciplinary care team. Assisting staff would have access to RNs on all shifts, seven days per week. An example of a care delivery model that facilitates the accountable role of the RN would be having RNs in the facility serve as case managers for groups of residents (~20-25); ensuring that all residents have a RN case manager or care coordinator.
RNs have the licensed authority to define scope of nursing practice and standards of care that will be used to evaluate quality of nursing practice, qualifications of nursing staff, and knowledge needed by all nursing staff to deliver care.
Given the accountability of RNs, they need to be involved in determining the qualifications of assisting staff and should be involved in the selection of those staff. By virtue of delegating care and supervising the care provided, RNs should provide recommendations on the staff development needs for assisting staff. The standards of care to guide nursing practice should be deliberately considered by the RNs in the organization, including the application and evaluation of the standards of care. One could expect that the RNs have regular meetings to address professional nursing practice in the organization. A major satisfier for registered nurses is having control over their practice; this guideline supports such control.
RNs are accountable for the quality of care and quality improvement.
RNs should be engaged in regular monitoring of quality care and in quality improvement initiatives. This activity should link to the organization’s quality improvement goals and activities. However, the ‘nurse sensitive quality indicators’ are the responsibility of professional nurses, and efforts to improve ‘nurse sensitive quality outcomes’ is the RN’s priority. Evidence of such activities might include:
- RNs conducting audits and analyzing results of audits to ensure adherence to nursing standards
- Regular monitoring and evaluating nurse sensitive quality indicators (e.g. fall rates, pressure ulcer rates)
- At least one active nursing quality improvement project targeted to a quality area identified by RNs as needing improvement.
RNs are accountable for the translation and dissemination of new and existing knowledge for quality care.
This guideline is about using evidence (research) in practice. All nursing assessments and interventions for nursing home residents should be based on the most current research. Evidence of this occurring would include the use of evidence-based assessment instruments and clinical practice guidelines. Several websites provide access to evidence-based, geriatric-focused assessment instruments and clinical practice guidelines:
Question for reflection...
If you are currently using a nursing home for a student clinical experience, analyze the role of the RN in the nursing home using the five guidelines.