Nursing at The Miriam Hospital

Professional Practice Model

The Miriam Hospital’s philosophy and definition of professional nursing is consistent with the RI State Nurse Practice Act. The Act states that “the practice of professional nursing is a dynamic process of assessment of an individual’s health status, identification of care needs, determination of health care goals with the individual and/or family participation, and the development of a plan of nursing to achieve these goals. Nursing actions, including teaching and counseling, are directed toward the promotion, maintenance and restoration of health and evaluation of the individual’s response to nursing actions and the medical regimen of care.

Our model of care is aligned with professional and accrediting agency standards and the hospital’s strategic plan and initiatives. The ANA’s Principles of Nurse Staffing are utilized in the allocation of nursing resources and in preparation of patient assignments. Considerations for continuity of care and nurse competencies are integrated into our Model of Care. Key tenets of this model include the following:

• Accountability/Engagement
  Our nurses serve in the role of coordinator of care, which is delivered with compassion and competence. Engagement is incorporated to further define the advocacy, moral agency, and vigilant engagement required for holistic care of the patient.

• Communication
  The RN is responsible to effectively communicate with the multidisciplinary team, in order to exchange information related to the patient’s care. The multidisciplinary team includes the patient, family and health care providers. Healthcare disciplines are consulted for their expertise. The RN is responsible to communicate with the patient and family, incorporating patient education and information in all aspects of their practice. RN to MD communication focuses on facilitation toward desired patient outcomes. Collaboration will provide continuity of care to patient/family, development of goals and evaluation of care outcomes. The staff nurses expressed that much valuable information and collegial exchanges were lost when silent report was instituted. The following are components of this tenet:

• Collaborative Practice
  The RN is responsible to ensure continuity of care involving coordination of all disciplines in arriving at an interdisciplinary plan of care for the patient. The RN facilitates the contributions of all disciplines toward optimal and realistic goals for the patient. Continuity of care will be maintained in assignment of patients. Processes and persons will be continuous and consistent in recognizing the holistic interrelationships that exist in the healthcare system.The RN will incorporate the multi-disciplines in addressing the diversity of each patient and recognize differences in the provision of each patient’s care.

• Control Over Professional Practice Environment.
  This tenet further defined and set guidelines for our unit council structure. From this group and the leadership group came the recommendation for a Unit Council Steering Committee. The RN will make judgments collectively to change policies, procedures, and clinical and administrative practice, with a focus on optimal patient outcomes. The vehicles through which staff institute change include unit councils, hospital wide committees with nurse representation, and collaboration with the Nurse Manager/CNO. Nurses have input and exert power and control in issues affecting nursing and patient care. Nurses are viewed as integral to the hospital’s ability to provide patient care services.
  
  Nurses contribute to the hospital’s positive presence through participation in collaborative partnerships with the community or personal involvement at the community, national or international level.

• Autonomy (individual decision making for the patient). Nurses are empowered to make independent clinical decisions, beyond usual standard of practice, within the scope of the Nurse Practice Act. Leaders foster an environment that encourages and recognizes autonomy in a non-punitive environment. Feedback on unsuccessful actions is constructive and is discussed for educational purposes and the measurement of patient outcomes.

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