FORCE 5Professional Models of Care

Models of care are used that give nurses the responsibility and authority for the provision of patient care. Nurses are accountable for their own practice and are the coordinators of care.

EXECUTIVE SUMMARY FORCE 5: PROFESSIONAL MODELS OF CARE Models of care are used that give nurses the responsibility and authority for the provision of patient care. Nurses are accountable for their own practice and are the coordinators of care.

The Massachusetts General Hospital Patient Care Services’ Professional Practice Model

(PPM) serves as the blueprint for the delivery of exceptional nursing care. Developed and launched

in 1996 and revised in 2007, this innovative practice model is comprised of nine inter-locking

components to ensure seamless, interdisciplinary, knowledge-based care to MGH patients and

families. These components include: patient centeredness, vision and values, standards of practice,

narrative culture, professional development, clinical recognition and advancement, collaborative

decision-making, research, and innovation and teamwork.

Patient Centeredness is the nucleus of the PPM, reflecting the expectation that superior

patient care requires nurses to be present to patients and families ⎯ to listen, to know, to advocate

for, throughout the healthcare experience. The Patient Care Delivery Model (PCDM) articulates a

state-of–the-art infrastructure for the delivery of patient care: interdisciplinary, patient- and family-

centered within a dynamic, internal health environment which is influenced by the sociopolitical and

professional dimensions of nursing practice. The ultimate authority, responsibility, and

accountability for the nursing care rendered rests with registered nurses. Examples of continuity of

care, system’s improvements and nurse staffing aligned with the PCDM are imbedded throughout

this Force.

Standards of practice are an equally important component of the Professional Practice Model.

They exist to define the scope of practice for the professional nurse and to ensure patients receive

the highest quality of care by providing scientific rationales to support practice. Along with multiple

professional practice standards, the two major documents that influence nursing practice at MGH

are the Massachusetts Nurse Practice Act and Massachusetts Board of Registration in Nursing rules

and regulations. These documents are incorporated into the PCDM through the department’s

nursing policies and procedures. While standards serve an essential role in guiding practice for the

novice nurse, they also guide behavior of more experienced staff nurses, reflecting the organization’s

culture towards care delivery.

As articulated above, the PPM provides the framework to deliver the highest, quality patient

care possible at MGH. Communication of the PPM, the PCDM as well as regulatory and

professional standards is essential and occurs through a number of different venues: the Department

of Nursing orientation, educational programs offered through The Norman Knight Nursing Center

for Clinical & Professional Development and unit-based activities led by Nursing Directors and

Clinical Nurse Specialists. Hospital publications, particularly Caring Headlines, reinforce the

information and reach a large audience.

If questions arise, opportunities also exist for nurses to explore these tenets of practice

through consults with internal or external nurse experts. To address more urgent practice needs,

clinical and reference materials are available as an alternative to staff through on-line access and in

the hospital’s Treadwell Library and the Blum Patient and Family Learning Center. Reference

manuals and professional standards are also available to all staff either in hard copy format and/or

on-line.

Competent, adequate, flexible staffing is essential to actualizing the components of the

Professional Practice Model. The MGH leadership recognizes the impact of nursing in achieving

high quality patient care and has a longstanding history of documenting nursing workload and

supporting the need for additional staff. The MGH Department of Nursing Direct Care Staffing

Guidelines summarize the multi-faceted dimensions involved in effective staffing. Staffing levels are

based on volume and acuity of patients (nursing workload) and factored for distribution of workload

over various time periods, experience and mix of staff, and logistical and support issues. Examples

in this Force describe direct care nurses influence in scheduling practices as well as descriptions of

unit scheduling operations and available monitoring reports.

TABLE OF CONTENTS Volume 4

Force 5: Professional Models of Care

Sources of Evidence 5.1

5.2

5.3

5.4

5.5

5.6

5.7

5.8

5.9

5.10

5.11

Pages 1-9

Pages 10-26

Pages 27-44

Pages 45-56

Pages 57-76

Pages 77-81

Pages 82-92

Pages 93-109

Pages 110-111

Pages 112-117

Pages 118-130