Professional Nursing Practice Models
A professional nursing practice model (PNPM) provides the overall philosophy of how nursing in a healthcare organization upholds its role in achieving positive patient and staff outcomes. It serves as a framework for guiding and aligning clinical practice, education, administration, and research. A PNPM should involve nursing staff input, reflect the unique environment of the organization, be integrated throughout the nursing department, and be a foundation for patient care, as well as being evidence-based and theoretical. A PNPM has five subsystems: professional values, professional relationships, a care delivery model, management or governance, and professional recognition and rewards (Shirey, 2008). One of the 14 “Forces of Magnetism” in the nursing Magnet™ Recognition Program requires a healthcare organization to have a PNPM that considers patients’ unique needs, nursing skill level, and adequate resources to achieve desired outcomes. Aiken, Smith, and Lake (1994) found a strong relationship between lower Medicare mortality rates and nursing in Magnet™ hospitals, presumably due to the effect of greater autonomy of nurses on patient outcomes. Shared governance and career ladders are often components of a PNPM and reflect the tenets of the Magnet™ Recognition Program.
Although the terms nursing care delivery model and professional nursing practice model are often used interchangeably, they are not the same concept. Care delivery models focus on how care is structurally organized to facilitate nursing work and outcomes. It is one component of a professional nursing practice model (Shirey, 2008). A care delivery model answers five questions (Neisner & Raymond, 2002):
Who is responsible for making decisions about patient care?
How long does that person’s decision remain in effect?
How is work distributed among staff: by task or by patient?
How is patient care communication handled?
How is the whole unit managed?
Examples of Nursing Models
The traditional care delivery models are Total Patient Care/Private Duty Nurses (1890-1930), Functional Nursing (1940-1960), Team Nursing (1950-1960), Primary Nursing (1960s-1990s), and Patient-Centered Care (1990s). Each of these models had strengths and weaknesses. Many organizations have since developed their own care delivery models, which may incorporate components of one or more of these traditional models.
The Robert Wood Johnson Foundation issued a challenge of creating new models of individualized care that leverage new roles and technology at lower costs while preserving and improving patient quality, safety, and satisfaction (Joynt & Kimball, 2008). Partially in response to the RWJF challenge, the American Organization of Nurse Executives (AONE) developed Guiding Principles for Future Patient Care Delivery (2004). Among the assumptions of this position is that an organization must first define the work of the future, then the roles needed to do that work, then the educational requirements to prepare workers for those roles. Other assumptions include optimizing technology for patient safety, maximizing collaboration of multidisciplinary teams, using evidence-based practice and research to design the model, and using systems thinking. AONE emphatically states that health care cannot wait for a perfect solution; we must embrace revolutionary thinking and experiment with different models of care (AONE, 2004). The AONE Guiding Principles include the following:
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