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Nursing Professional Practice Model

Nursing Practice Model Image

Patient Care Delivery

Commitment to Caring:

UNC Hospitals' "Commitment to Caring" is the foundation for the successes we now enjoy as well as the achievements we hope to reach in future years. To reach our goal of becoming the nation's leading public academic medical center, we focus on the foundational aspects, or "pillars," of our work.

The five pillars we have identified for UNC Hospitals are: People, Quality & Service, Growth, Value, and Innovation.

Swanson's Caring Theory:

The foundation of our patient care delivery model is based upon the theory developed by Dr. Kristen Swanson (1991). Swanson Caring Theory is built on five caring processes:

  • 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.

Relationship-Based Care Delivery Model:

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 influence our success.

Carolina Care:

"Carolina Care" is a part of UNC Hospitals' Commitment to Caring framework, and our care delivery model. It is also our unique brand of customer service designed to enhance our patients' and families' hospital experience. "Carolina Care" is a set of behaviors and practices that are linked to Swanson caring processes. All patients at UNC Hospitals receive "Carolina Care". The care and service we provide our patients is inter-professional, inter-departmental, and collaborative by nature, and "Carolina Care" involves departments and staff members across our organization.

Evidence-Based/Outcomes Driven Care:

Evidence-based practice promotes the collection, interpretation, and integration of valid, important and applicable patient-reported, clinician-observed, and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgments and facilitate cost-effective care. Outcomes are specific and measurable to identify and collect demonstrated achievement of a goal. Outcomes driven practice provides direction for patient satisfaction, clinical quality, safety and staff engagement, and guides continuous improvement.

Accreditation Standards:

UNC Hospitals meets all standards of governing regulatory agencies (such as the Joint Commission and the North Carolina Division of Health Service Regulation) and is accredited by the Joint Commission.

Meeting and Exceeding Magnet Standards:

Magnet designation nationally recognizes healthcare organizations providing a work environment that supports the delivery of excellent nursing and patient care. Magnet organizations have demonstrated fewer patient complications, lower mortality rates, and higher patient satisfaction. UNC Hospitals successfully attained its first Magnet designation in October of 2010 and was re-designated in September 2015. Our goal is to continue to not only meet these requirements, but to exceed the Magnet standards in our practice.


Leadership

Shared-Governance Council:

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."

The Shared Governance model at UNC Hospitals is based on a councilor format, comprised of five nursing councils (Quality, Research, Professional Development, Professional Practice, and Diversity), with a reporting relationship to the Executive Council, chaired by the Chief Nursing Officer. Each Council has a defined mission, purpose, and set of bylaws.

Resource-driven Care:

UNC Hospitals (UNCH) is committed to caring for the people of North Carolina regardless of ability to pay. Because the hospital is a public institution, UNCH has an especially high level of responsibility and accountability for stewardship of resources. As a very large and integral part of this organization, nursing strives to provide the most efficacious care in the most cost-effective manner through evidence-based practice and careful use of human and material resources. The resources conserved through this stewardship are invested in supporting care for more patients in need.

Hiring for Excellence:

Hiring for Excellence is an initiative with the purpose of providing a structured, replicable approach to interviewing. The goals of Hiring for Excellence are to help managers hire and retain people who:

  • Are the right fit for the position and the organization
  • Have a commitment to caring and a sense of importance for the work that they are hired to do
  • Help to create and sustain a culture of extraordinary service and operational excellence
  • Commit themselves to making UNC Hospitals the nation's leading public academic health care system

CNO Advocacy:

The Chief Nursing Officer advocates for the Division of Nursing across all levels of the organization. It is through her advocacy with the Senior Executive team that we have accomplished the following:

  • significant gains and sustainment in patient and employee satisfaction
  • improvement in patient outcome metrics
  • adoption of nurse-driven protocols 
  • increased resources for quality improvement and research initiatives for nurses
  • on-site Nursing Assistant II educational program
  • achievement of Magnet status designation and re-designation

These are a few examples of how the CNO's advocacy has improved patient care and strengthened the professional nursing work environment at UNC Hospitals.

Nursing Influence at Highest Levels:

Dr. Cathy Madigan, Chief Nursing Officer and Senior Vice President of the hospital is a member of the Hospital Executive Staff Committee, chaired by Mr. Gary Park, President of the hospital. She is a voting member of the Medical Staff Executive Committee as well as the Joint Conference Committee on Quality of the hospital board. In these forums, Dr. Madigan represents and speaks for the nursing team and patients at the highest levels of organizational debate and decision-making. Additionally Dr. Madigan serves as the Chair for the UNC Health Care System Chief Nursing Officer Council.


Compensation and Rewards

Professional Development:

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.  In addition to attending CE classes and on-site certification review courses, CE Direct is an online-based CE offering that covers most any clinical topic including certification review courses in specialty areas. Nursing staff can apply for tuition reimbursement to support educational opportunities, and reimbursement for professional certification and re-certification.

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 RNs 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).

Merit Based Performance Program (Taleo):

UNC Hospitals utilizes a merit based performance management program, of which Taleo is the Web-based online tool used in the "Evaluate Performance" phase of this process. The Taleo online performance review contains the institutional Core Behaviors and the job-specific functions for the employee based on job-class or unique position. The process promotes self and peer appraisal, individualized goal setting, encourages conversation about performance expectation, to assist in growth and development of nursing staff. In addition, it reinforces the organization's values and culture, quality of work/service, and UNC Health Care's Mission, Vision, & Values.

Employee Incentive Plan:

In addition to providing competitive market salaries and benefits, UNC Hospitals is fortunate to be able to provide an incentive compensation plan for all employees. The plan is based on meeting financial, quality, patient, and employee satisfaction performance goals as outlined at the beginning of each fiscal year.

Recognition Programs:

The Department of Nursing, along with UNC Hospitals, offers multiple avenues of staff recognition. In nursing, for example, these include the annual Nurses' Week service line "Nurse of the Year" and "Nurse Manager of the Year" awards, and the annual Aspiring and Inspiring Nurse Leader awards. Many departments and service lines recognize nursing staff monthly and quarterly has high performers, coupled with opportunities such as the electronic "High 5" program that give staff an opportunity to provide recognition to peers and other departments on an ongoing basis.


Professional Nursing Values

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 (2015) 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 (2015) 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.

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.

UNC Hospitals Nursing Mission, Vision, & Philosophy:

The mission of Nursing at UNC Hospitals is to be a leader in providing compassionate, quality care focusing on the unique needs of patients and their families.

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.

Research:

Nursing research is an integral part of nursing practice at UNC Hospitals. This research includes improvement science and both basic and applied research focused on understanding health and illness experiences to improve patient outcomes and nursing practice environments. The shared governance Research Council engages nurses at UNCH to generate, utilize, and disseminate nursing research while supporting and coordinating nursing research activities for both staff and students. Members serve as mentors to staff who are conducting research projects and assist to translate findings into practice.


Professional Relationships

Core Behaviors:

UNC Hospitals' "core behaviors" can be thought of as building blocks for long-term success. The core set of behaviors is universal throughout UNC Health Care System and applies to every employee. Expected behaviors are outlined for each of the following areas:

  • customer service
  • communication
  • patient and employee safety
  • ethics and professionalism
  • initiative and adaptation
  • stewardship
  • team work

"Just-Culture" Environment:

UNC Hospitals is an organization that practices a "just culture" environment, one in which we strive for a culture of safety that values learning, reporting, and fairness. In a "just culture" human error is recognized as unintentional and does not lead to disciplinary action. Error, blame, and disciplinary action are balances. Team members are encouraged to report events and information gained from these reports is used to make performance improvements in patient safety.

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 19 schools of nursing that include students from all levels of programs. UNCH offers clinical inpatient and outpatient sites for student experiences and our staff actively participates in precepting these students. 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." In addition, many members of our nursing leadership team hold academic appointments in the UNC-Chapel Hill School of Nursing.

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.