Professional practice for the extended care environment: learning from one model and its implementation.
This article describes a model of professional nursing governance in an 800-bed long-term care facility and discusses the model's implications for nursing education. Seventy registered nurses, 330 ancillary staff, and 50 other health professionals provide care for about 100 residential, 350 intermediate, and 350 skilled nursing care patients in the facility. The governance model includes a registered nurse organization that determines all standards for nursing practice, policies governing practice, and nursing clinical programming. Each registered nurse has 24-hour, seven-days-a-week authority and accountability for a patient caseload. Average annual turnover of registered nurses is 5 per cent, and the average length of employment among the nurses is 7.5 years. Since the model was implemented, measures of patient welfare have increased. Experience with the governance model indicates that nursing education curricula need to increase students' (1) understanding of professional autonomy and accountability, (2) understanding of the role of nursing diagnoses and interventions to structure nursing knowledge, (3) skills of diagnostic and intervention reasoning, (4) consensus decision-making abilities, (5) knowledge of organizational structures and mechanisms for governance, and (6) mastery of technical intervention skills.
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D006801:Humans; D007318:Inservice Training; D008962:Models, Theoretical; D009736:Nursing Process / Q000458:organization & administration*; D011364:Professional Practice / Q000458:organization & administration*; D012866:Skilled Nursing Facilities