Evaluation is a critical component of professional practice. Making time to reflect on models of care, employee practice, and patient outcomes is an important team function. We describe the process that clinical nurse leaders in our department used to evaluate our facility's professional practice model (PPM). The goal was to engage point-of-care nurses in the process and outcome of this evaluation. Ensuring buy-in from a variety of stakeholders was the key to success. Ultimately, large-scale changes to our PPM weren't needed; however, definitions of model components were refined to reflect nurses' actual views of their professional practice.
Where to start
Professionalism in nursing practice is a foundation of care delivery at Magnet(R) recognized hospitals. Literature from the 1990s about developing PPMs had a different focus than current practice.1,21,2 That focus was on nursing care delivery systems and the practice environment rather than a broader PPM designed to "illustrate the alignment and integration of nursing practice with the mission, vision, and values that nursing has adopted" as defined by the Magnet Recognition Program(R).3
More recently, the development and evaluation of the compass PPM has been described.4 The model was created by nurse leaders using the compass as a symbol of their journey toward a comprehensive PPM. Using focus groups with 12 nurse leaders, they created 20 questions to evaluate nurses' understanding and use of PPM components before and after implementation. Using the compass, nurses' ability to apply professional practice standards improved.
Our nursing PPM was developed to incorporate four essential concepts: communication, collaboration, clinical practice, and professional development. We evaluated the existing PPM at our facility to assure nurses at the point of care that these components still represented their personal and collective conceptualization of professional nursing practice at our institution.
We formed a 12-member volunteer workgroup from the department-level shared governance steering committee with the goal of creating an evaluation plan. We determined that the process needed to be efficient and timely, organizing three monthly meetings to accomplish our task. Both the process and outcome of our evaluation plan are detailed here to serve as a model for others.
Meeting 1: January 2014
Our first meeting established the group purpose, data collection process, and important outcomes. We discussed a variety of approaches and decided to use a modified Delphi technique.5 Classic Delphi studies include multiple rounds of questions that become more focused and targeted with each round. Because we were focused on evaluation of an existing model, we began with a single question designed to uncover nurses' ideas of professional practice and created a plan to assess respondents who were representative of the entire nursing department.
Representation on the committee was broad; thus, members were tasked with collecting data from their colleagues and strategically identifying nurse leaders to ensure inclusive representation. Nurse respondents were asked by committee members to identify three top aspects of their personal professional nursing practice: "What are three things that define your practice as a nurse?" We sought to categorize responses into one of the four PPM components, realizing that any uncategorized statements might prompt revision.
Members of the group ultimately collected statements from more than 80 nurses representing a wide variety of practice areas across inpatient and outpatient settings. The nurse respondents were clinical nurses, advanced practice nurses, case managers, and nursing leaders.
Meeting 2: February 2014
Between the first and second meeting, responses were sent to one committee member who organized them into five columns: one for each of the four PPM components (communication, collaboration, clinical practice, and professional development) and an "other" category. A total of 240 statements were included in the chart. This chart was distributed to the workgroup members before the meeting for review.
At the second meeting, we reviewed, discussed, and recategorized all statements as needed to determine their relationship to the existing PPM. Statements in the "other" category were of particular interest. Members of the group previewed each statement in this category and discussed how the statements did or didn't fit into one of the four PPM components. (For statement examples, see Table 1).
This process allowed us to determine if our PPM was inclusive or if it was missing any elements of professional nursing practice. Additionally, we were able to clearly articulate the aspects of our facility's professional nursing practice that are encompassed by the four PPM components.
Meeting 3: March 2014
We used the final group meeting to review the four components of the PPM to determine if they needed modification based on the data collected and categorized. We read all of the statements and reflected on how the existing definition of each component did or didn't include the ideas expressed by nurse respondents. As a result of this process, each component was updated and clarified. (See Table 2.)
Outcomes
Reports from the workgroup were presented at the shared governance steering committee meetings in February, March, and April 2014. Data as collected and categorized were available to all members of the larger group to review and provide feedback. The final report presented to the steering committee included recommendations for changes to PPM component definitions. The revised definitions were adopted by committee consensus following discussion.
The workgroup was also charged with developing a recommendation for ongoing periodic PPM evaluation. The group recommended a biyearly evaluation process. In alternating years, we recommended an evaluation of the PPM regarding nurses' familiarity with and use of the model in their professional practice.
To further embed the PPM into nursing practice, workgroup members revised nurse job descriptions utilizing the language and information collected during this process to align the revised PPM component definitions with nursing position documents. For example, in a similar 3-month evaluation process, job responsibility categories were changed to reflect the four revised PPM components.
Revision precision
Project success was ensured by directly engaging frontline nursing staff in the PPM evaluation process as data collectors and reviewers. Asking nurses at all levels of practice to provide feedback about their ideas of professional practice promotes inclusion, recognizes staff autonomy, and supports the principles of shared governance.
REFERENCES