Carolina Nursing Professional Practice Model
Our Brand of Care Delivery:
Carolina Care is a part of UNC Health’s Organizational Values and is our unique brand of customer service designed to enhance our patients’ and families’ experience.
All patients and families at UNC Hospitals receive Carolina Care.
Carolina Care means:
- We care holistically about patients and each other.
- It is our privilege to serve the people of North Carolina.
- We demonstrate kindness and compassion with every interaction.
Our Model of Care Delivery:
Our brand of care delivery, Carolina Care, demonstrates our care delivery model: Relationship Based Care:
- At UNC Hospitals we believe building strong relationships between the nurse and the patient/family is essential to our success in providing exceptional and compassionate care.
- It is this therapeutic and consistent relationship that provides the foundation for our work with patients and families to collaboratively manage care and achieve outstanding outcomes.
- We also recognize relationships with colleagues and with self as essential components of our care delivery system.
- These relationships contribute to the context of a healthy work environment and directly influence the relationships we build with our patients and their families and thus our success.
Our Theoretical Foundation to Care:
The foundation of our care delivery model is based upon the Swanson’s Caring Theory developed by Dr. Kristen Swanson (1991), which is built upon five caring processes:
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- Knowing and understanding the experience of the patient and family.
- Being with and in the moment with the patient.
- Doing for patients as they would do for themselves if it were at all possible.
- Enabling the capacity of the patient to care for themselves and their family.
- Maintaining belief and sustaining faith that the patient can face a transition and move forward with their lives.
Our Elements to Support the Best Clinical Practice:
To achieve the best possible outcomes for our patients we utilize:
- Research to generate new evidence.
- Evidence-Based Practice to apply the evidence to nursing practice.
- A Quality Improvement methodology to identify gaps, implement improvement strategies and continuously improve.
- Innovative Thinking to explore new possibilities.
Nurses at UNC Hospitals are supported in this work through resources in our Center for Nursing Excellence, such as:
- Nursing Scientists
- Nursing Quality Improvement Coaches
- Clinical Nurse Education Specialists & Nurse Educators
Nursing Shared Governance
Shared governance at UNC Hospitals is defined as "The decision-making model which affords the professional nurse autonomy. It empowers the nursing staff to contribute collectively to the processes related to nursing practice and the nursing work environment.”
Additionally, a Coordinating Council exists to provide support, leadership, oversight and direction to all nursing councils.
The bylaws include a defined mission and purpose for each council.
To strengthen the voice of the direct-care teammate as well as the flow of communication, Nursing Shared Governance at UNC Hospitals occurs monthly during our ‘Shared Governance Day’. It is a day-long event each month where direct care teammates from inpatient and ambulatory care areas will meet to inform nursing decision-making, obtain information to share with their own unit/care teams, and perform council work. Instead of having six different days each month in which the shared governance councils meet, all the councils meet on the same day.
Chief Nursing Officer Advocacy & Nursing Influence at the Highest Levels
Jacci Harden Jacobs, DHAc, MHA, MBA, BSN, RN, NE-BC, Chief Nursing Officer and Vice President, of the hospital is a member of the Medical Center Executive Committee, chaired by Janet Hadar, MSN, MBA, FACHE, President of UNC Hospitals and Dr. Mark Gwynne, Interim President, UNC Faculty Physicians, as well as the Medical Center Leadership Committee, also chaired by Ms. Hadar. The CNO is a voting member of the Medical Staff Executive Committee, co-leads the Quality & Clinical Oversight Committee with the Chief Medical Officer and Chief Quality Officer, and co-leads the Quality subcommittee of the UNC Hospital board in collaboration with the Chief Quality Officer. Additionally, Jacobs is a member of the CNO Roundtable and IT Clinical Workgroup (CLIWog) for the UNC Health System.
In these forums, Jacobs represents the nursing and clinical team, patients and families, serving to advocate at the highest levels of organizational discussion and decision-making.
The CNO supports nurses at all levels participating in local, service line, hospital-wide and system-wide groups, committees and projects. Some of this work is highlighted in our Carolina Nursing Annual Reports, monthly Shared Governance Days, annual Quality Expos, as well as local, regional, and national forums in which nurses and nurse leaders are supported to attend and present.
Nurses Working in Unique Roles to Advance Patient Care and Organizational Outcomes
Nurses at UNC Hospitals are supported in working in unique and expanded roles to advance patient care and organizational outcomes Examples of these nurses include:
- A clinical coordinator leading the Chest Pain Center
- A program manager and clinical coordinator leading the Comprehensive Stroke Program
- A program manager and clinical coordinator leading the Adult and Pediatric Trauma Programs
- Nurses working as Central Venous Access Device Liaisons
- Nurses working as part of a Certified Wound Ostomy and Continence (CWOWN) Consult Team
- Nurses working as part of a Certified Diabetes Care and Education Specialists
Advanced Practice Provider Center
The primary purpose of the Advanced Practice Provider (APP) Center is to provide support, guide, and recognize existing and emerging practices of Advanced Practice Providers.
The Center provides coordination and improved integration of Advanced Practice Providers across the inpatient and ambulatory settings at UNC Hospital and the surrounding community.
UNC Health For Me Pillars
“UNC Health For Me” is UNC Health’s leadership commitment to teammates from recruitment to retirement that includes ways we welcome, engage, develop, care for, include and value our teammates.
- Welcome Me: Create a positive and memorable experience for candidates and new teammates throughout the hiring process and beyond, welcoming them into UNC Health’s One Great Team and setting the tone for how teammates begin their journey at UNC Health.
- Engage Me: Nurture a sense of belonging and a strong cultural identity at UNC Health that makes teammates feel connected and cared for as part of One Great Team via consistent and transparent communications.
- Care for Me: Express that UNC Health’s Carolina Care encompasses teammates. UNC Health is supportive of teammates’ goals, both professional and personal; health & well-being, personal safety, respect and support are a priority.
- Include Me: Demonstrate that “It Starts with Me” is foundational to all pillars to continue building a community reflecting the patients we serve.
- Value Me: Foster a culture where teammates experience the holistic Carolina Care by feeling valued, recognized and equitably compensated for their contributions, as well as rewarded when they demonstrate outstanding performance of their work; total rewards and recognition are a priority.
- Develop Me: “Leading the Way” by focusing on teammates’ growth, development and overall experience, professionally and personally; training the next generation of health care leaders; and inspiring career mobility by offering learning and educational opportunities.
Carolina Nursing Annual Reports
- 2023
- 2021
- 2020
- 2019
- 2018
- 2016-2017
- 2015
- 2014
- 2013
Nurses at UNC Hospitals are Valued
Through the organizations ‘Value Me’ pillar, UNC Hospitals Nursing Leadership is committed to fostering a culture where teammates experience the holistic Carolina Care by feeling valued, recognized and equitably compensated for their contributions, as well as recognized when they demonstrate outstanding performance in their work. Through this pillar, our leaders also recognize that total rewards and recognition are a priority.
In addition to financial compensation and incentives, ‘Value Me’ is demonstrated in many ways, including but not limited to:
UNC Hospitals is committed to the ongoing professional development of our nursing staff. There are multiple opportunities to participate in the free educational offerings that are provided at our institution.
Nurses are supported through transitions to practice and new roles through structured offerings such as the New Graduate Nurse Residency, Nurse Manager Transitions to Practice, and Nursing Assistant II program.
An online-based, continuing education platform exists to support access to on-demand professional development and certification review courses that covers a variety of clinical and leadership topics.
Nurses are also supported in continuous professional development through specialty-related certification. Financial assistance is provided for certification and/or re-certification to eligible employees on a reimbursement basis. A ‘No Cost Certification’ program also exists through partnerships with certain specialty organizations to allow staff to test at no cost.
Nursing Professional Advancement System
The Nursing Professional Advancement System or Clinical Ladder is a 4-tiered performance-based career advancement system that provides a professional framework for developing, evaluating, promoting, and rewarding nurses who are direct caregivers. The four levels are based on Patricia Benner's novice-to-expert model (Benner, P. 1984. From Novice to Expert: Excellence and power in clinical nursing practice. Addison-Wesley Publishing Company).
Recognition Programs
Carolina Nursing, along with UNC Hospitals and UNC Health, offers multiple avenues of recognition for teammates. Examples of this include, but are not limited to:
- DAISY Award to recognize excellence in care for nurses
- PETAL Award to recognize excellence in care for assistive personnel
- Annual Nursing Staff Recognition Week Awards, “Nurse of the Year”, “Nurse Manager of the Year”, “Senior and Generational Excellence Nurse of the Year”
- Annual Emerging and Inspiring Nurse Leader Awards
- Nursing Leadership Challenge coin to provide spot recognition for individuals who provide outstanding performance is support of organizational values
- Electronic ‘high-five’ platform available for teammates and leaders to recognize each other through personalized notes of celebration and gratitude
Engagement Platform
Nurse Leaders have access to a unique online engagement platform to engage, recognize and retain teammates. This engagement platform promotes the UNC Health for Me pillars:
- Welcome Me: Automates new teammate check-ins and information for ‘favorite things’ questionnaire
- Develop Me: Tracks and supports professional goals and conversations
- Engage Me: Documents reminders and notes for one-on-one meetings in a central location
- Care for Me, Include Me and Value Me: Recognizes great work, personal accomplishments and career milestones
Organization
UNC Health Values
One Great Team:
- We are better together than we are apart.
- Our effective collaboration is key to providing quality care.
- We are committed to building an organizational culture that foster engagement, wellbeing, and belonging.
Carolina Care:
- We care holistically about patients and each other.
- It is our privilege to serve the people of North Carolina.
- We demonstrate kindness and compassion in every interaction.
Leading the Way:
- We make a difference by improving lives every day and training the next generation of health care leaders.
- Our research is changing the world.
- We provide innovative care.
It Starts with Me:
- Each of us takes ownership of, and accountability for, doing the right thing.
- We empower and trust each other to step up.
- We support each other and hold each other accountable in our work.
Carolina Nursing Vision:
I am a part of Carolina Nursing and:
- I have a voice in decisions that affect my work.
- I am an advocate and can keep my patients safe.
- I am supported in my own professional development and professional excellence.
- My and my teammates’ differences are embraced and respected.
- My leaders and teammates join me in prioritizing mental and physical well-being.
- My leaders and teammates stand up against bullying and incivility.
- I make a difference in the lives of others and I belong here.
State
North Carolina Nurse Practice Act:
- The practice of nursing is constantly evolving as new and changing technologies and therapies are introduced. The North Carolina Nursing Practice Act (August 2009), under which we practice at UNC Hospitals, defines and interprets scopes of practice for all levels of providers of nursing care.
National
ANA Scope & Standards of Practice
- As the professional organization representing nurses, the American Nurses Association (ANA) is responsible for defining the scope and standards of practice for all registered nurses. The ANA scope of practice statement included in Nursing: Scope and Standards of Practice (4th ed.) reflects the values and priorities of the profession, provides direction for professional nursing practice, and serves as a framework for the evaluation of this practice.
ANA Code of Ethics
The Guide to the Code of Ethics for Nurses (2nd ed.) was developed by the American Nurses Association (ANA) as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. The Code of Ethics for Nurses serves as a succinct statement of ethical obligations and duties of every individual who enters the profession. UNC Hospitals Nursing integrates the ANA Code of Ethics as our standard for nursing practice.
Professional Organizations
Professional nursing organizations, both at the national and local chapter levels, provide opportunities to share best practices and learn about new trends, education and technical advances that can inform practice. Nurses at UNC Hospitals are members of professional organizations at the local, state, national, and international levels, and are encouraged and supported to participate in leadership opportunities and promoting policy efforts. Membership in professional organizations is an important element in promotion within the nursing professional advancement ladder.
Relationship-based Caring & Healing Environment
Relationship-based care takes place in a caring, competent and healing environment organized around the needs and priorities of the patient and their families. At UNC Hospitals we recognize that healthy work relationships are an integral part of the caring and healing environment and that these positively impact patient outcomes.
A Workplace Safety Committee is dedicated to developing resources for staff safety and the promotion of workplace safety and prevention of workplace violence.
"Just-Culture" Environment
A Just Culture is a model that is foundational to providing quality, safe patient care. Using a Just Culture, UNC Hospitals and its teammates share accountability for safety and quality, learn from errors and mishaps, understand humans make mistakes, design systems to prevent errors, and treat people fairly when errors happen. Some examples of how Just Culture principles are reinforced include:
- Tiered Safety Huddles: Huddles sustain a Just Culture by providing an opportunity for care teams to learn about our errors and mishaps and the actions we are taking to build stronger systems. Huddles are an opportunity for participants to share concerns about risks in our system and identify opportunities for improvement.
- SAFE Reporting: Our Safety Awareness For Everyone (SAFE) system helps sustain a Just Culture by allowing the organization to learn from our errors and mishaps, to understand how mistakes and errors happen, and to make us safer by redesigning systems. Teams and units evaluate their SAFE report trends to identify opportunities for improvements and use the Just Culture algorithm to guide their review.
- TeamSTEPPS: TeamSTEPPS provides language and tools foundational to a Just Culture. Accountability for effective and efficient communication is shared among all team members; and the tools are designed to prevent errors by eliminating hierarchy during critical communication and standardizing how to share information to prevent miscommunication.
- Visual Management Boards: Visual Management Boards help sustain a Just Culture. Boards display problems we are addressing AND our analysis of how our system contributed to the problem. They share how the team is redesigning systems to prevent this problem from happening again AND how the individual can contribute to creating a stronger, safety system.
Academic Partnerships
UNC Hospitals (UNCH) is fortunate to be part of a health science complex comprised of schools of nursing, medicine, dentistry, pharmacy, and public health, and is affiliated with over 90 Schools of Nursing across the country that include students from all levels of programs.
UNCH offers clinical inpatient and outpatient sites for student experiences with our staff actively participating as preceptors.
UNC Health Care is a member of a regional clinical consortium whose mission is "to provide quality, comprehensive clinical experiences for the nursing students we serve."
Some of our direct-care nurses hold dual appointments between UNC hospitals as staff nurses and the UNC School of Nursing as clinical instructors to facilitate undergraduate education and training.
The Tarheel Academic Practice Partnership (TAPP) is a formalized collaborative partnership between UNC Health and UNC School of Nursing to advance nursing education, practice, research, and leadership consistent with the guiding principles outlined by the American Association of Colleges of Nursing (AACN).
