Lahey Clinic Professional Practice Model
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The Lahey Clinic (LC) Professional Practice Model (PPM) was developed, implemented, and evaluated based on the Massachusetts Nurse Practice Act: Massachusetts General Laws Chapter 112, Sections 74-81, "Registration of Nurses"; the Code of Massachusetts Rules and Regulations Governing Nursing Practice CMR 244; and the American Nurses Association (ANA) Standards of Nursing Practice: 6 Standards of Practice and 9 Standards of Professional Performance.
The model was developed after extensive review of the literature incorporating the theoretical framework of "Theory of Caring," by Kristen M. Swanson, RN, PhD, FAAN and "The Novice to Expert" model by Patricia Benner, PhD, RN, FAAN, FRCN and utilizing work from Hoffart and Wood (1996), Wolf and Greenhouse (2007), and Relationship Based Care: A Model for Transforming Practice, Koloroutis (2004). The incorporation of LC's organizational core values of compassion and openness, unsurpassed expertise, and a drive for continuous learning and improvement, and LC's guiding principles of respect, caring, teamwork, excellence, and commitment to personal best informed the development of the model, as it did the Nursing Department's Mission, Vision, and Philosophy.
Patient-focused care is the LC Professional Practice Model which places the patient at the center of all concerns. The patient is the authority for care received and the core of nursing practice is the caring relationship with the patient. This relationship informs and guides nursing practice.
Components of Our Professional Practice Model
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The PPM at LC is comprised of five components:
- Core Values
- Professional Relationships
- Patient Care Delivery Model
- Recognition and Reward
- Leadership/Governance Structure
The Nursing Vision, Mission and Philosophy
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Nursing Vision
As leaders in practice and partners in patient focused care, nurses at Lahey Clinic are recognized for their expertise and compassion in providing care to patients, families and the communities we serve. We strive for safety, excellence and quality patient outcomes by engaging in evidence based research, innovation and system improvements that support our professional practice environment.
Nursing Mission
In keeping with the philosophy and values of Lahey Clinic, our mission focuses on the unique needs of each patient and family. We are committed to providing superior patient care through a team-based approach, teaching tomorrow's healthcare leaders and advancing nursing using evidence based knowledge and innovative research.
Philosophy of Nursing
At Lahey Clinic, Nursing is an integral part of the organizational operation.
- We believe that the profession of Nursing is both an art and science responding to the human condition.
- The Lahey Clinic Model for Nursing supports the concept of patient-focused care recognizing that each individual is a unique person with varying health care requirements throughout life
- The Department of Nursing is committed to facilitating the progression of the patient through our healthcare system practicing a multi-disciplinary approach
- Swanson's Middle Range Theory of Caring and Benner's Novice-to-Expert skills acquisition model serve as the theoretical framework for Lahey Clinic Nursing's Professional Practice Model.
- Our Professional Practice Model supports our commitment to providing the highest quality of care to patients and families by cultivating a caring, healing, protective environment, achieved and maintained through our Nursing Governance Structure.
- As the foundation for this commitment to patient care and professional practice, Lahey Clinic nurses follow:
- The Lahey Clinic Guiding Principles
- The Massachusetts Nurse Practice Act
- ANA Nurses Code of Ethics
- Scope and Standards of Nursing Practice and for Nurse Administrators
- Ambulatory Care Nursing Administration and Practice Standards
- Nursing Social Policy Statement
- ANA Bill of Rights for Registered Nurses
- ANA Principles of Delegation
- ANA Principles of Documentation
- ANA Principles of Staffing
Nursing Governance Structure
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Shared Governance Model
The Nursing Shared Governance Model is the vehicle that guides and drives the
operational, professional, educational, and research process for nursing practice at LC. The structure has continued to evolve since the year 2000 to include councils for decision making based upon internal and external forces that impact nursing practice. Under the direction of the CNO, nurses from all areas in LC are encouraged to participate in the governance process for all nurses to have a voice and a venue to actively participate in nursing practice.
Nursing Governance Councils
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Unit Based Councils
The shared governance structure has evolved to include the Unit Based Practice Councils (UBPC) that includes the Nurse Practitioner Committee and Certified Registered Nurse Anesthetists. The Unit Based Practice Councils were integrated into the Shared Governance Structure in 2006. They meet regularly and identify opportunities for improvement in nursing practice in their respective units that enhance excellence in patient care. The Unit Based Practice Council structure is the essential process for staff nurse decision making in operational and professional practice issues at the unit level.
Central Councils
The following is a description of the 11 Shared Governance Central Councils and their functions. These councils include nursing staff from all areas in nursing and focus on processes for relationship building and mutual collaboration and the development and promotion of policies, guidelines, and standards of practice that enhance professional nursing practice and promote quality in patient care.
- Nursing Practice Coordination Council - The purpose of this council is to provide a forum for shared decision making in nursing practice and best practice initiatives across the organization by representatives from the UBCs and central shared governance councils. All councils will share best practices and solve nursing practice problems creating linkage across ambulatory and tertiary care.
- Clinical Practice Council - The purpose is to review all policies and nursing practice guidelines and insure that they conform to current standards of care, are evidenced-based, incorporate research and reflect interdisciplinary collaboration as appropriate.
- Ambulatory Clinical Practice Council - The purpose of this council is to review all ambulatory policies and practice guidelines and insure that they conform with current standards of care, are evidenced based, incorporate research and reflect interdisciplinary collaboration as appropriate.
- Nurse Physician Partnership Council - The purpose of this council is to create a partnership between nurses and physicians to jointly manager and problem-solve to provide a forum of shared ideas, discuss issues and disseminate new information that will enhance patient outcomes.
- Nursing Research Council - This council provides the scientific foundation for nursing practice, dedicated to the support of nursing research and evidence based practice at LC. The council's objectives include educating staff about the research process and evidence based practice, providing resources and research consultation that facilitate the conduct of nursing research, disseminating research findings from organization, local, and national meetings, and facilitating the use of research findings to improve patient care.
- Nursing Quality Safety Council - The purpose of this council is to review data related to quality and safety initiatives including National Patient Safety Goals, Core Measures, and FMEA results. This council makes recommendations that promote and maintain a nursing environment where the best practices in safety and quality are able to be provided for patient care.
- Patient Care Technology Council - This is a multidisciplinary council that facilitates the implementation of departmental and organization objectives related to technology to enhance patient care. This council develops guidelines and protocols for technology initiatives, ensures that clinical applications reflect standards of care and nursing practice and solicits input and feedback from end user.
- Professional & Educational Council - The purpose of this council is to facilitate a culture where learning is viewed as a life long process, which is essential to the growth and development of all nurses at LC. This council develops and reviews all staff education materials, the nursing practice guidelines, oversees the process of incorporating evidence based practice and nursing research into patient care practices and supports professional development through Pathways to Expertise and Certification.
- Coordination and Review Council - The purpose of this council is to review, revise and standardize job descriptions, streamline documentation, approve and revise clinical administrative policies as necessary for accurate nursing functions and process.
- Nursing Ethics Council - As voted by the Nursing Practice Coordinating and Review Council in February 2008. This council is designated as a central council where staff nurses participate in identifying strategies and educational initiatives to improve the staff nurse knowledge on ethical principles and problem-solving processes.
- Interdisciplinary Patient Care Leadership Council - The purpose is collaborative discussion and shared decision-making on operational patient care issues and updates on current patient care initiatives, including Joint Commission Readiness and a review of the status of initiatives related to the organization's strategic plan. This council is incorporated in the shared governance structure and allows collaboration with other disciplines who are invited to discuss organizational initiatives and strategies and seek broad nursing input for the most comprehensive approach to address patient care and operational concerns.
