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At Thunder Bay Regional Health Sciences Centre, we have been
striving to align ourselves with one Nursing Care Delivery
Model as a critical step to achieving excellence in nursing
care. To that end, we have developed a Nursing Care Delivery
Model that is based on a foundation of Nursing Professional
Practice and complimented by a Total Patient Care Nursing
Care Delivery System. Central to our model of Nursing Practice
is the caring relationship that exists between the patient
(family and significant other) and the Nurse.
A Nursing Professional Practice (NPP) foundation supports
professional nurses to achieve excellence in clinical practice
through the utilization of the nursing process to achieve
patient-focused goals. NPP promotes a dynamic work environment
that is supportive of highly professional performance, and
the synergistic relationship between the patient/significant
other and the Care Team Members in determining care needs,
and prioritizing care services and activities.
The Nursing Professional Practice approach empowers nurses
by fostering trust, mutual respect, self-confidence, autonomy,
initiative and innovation as nursing staff assume accountability
for their professional practice and in helping to shape their
work environment.
The Nursing Professional Practice concepts supporting our
Model of Nursing Clinical Practice at Thunder Bay Regional
Health Sciences Centre are as follows:
- patient centered caring
- the use of the Nursing Process to achieve patient focused goals
- the development of a supportive work environment
- promotion of collaborative and communicative continuity of care and care provider in the care plan
- facilitating the discharge planning process
- the effective utilization of available resources
- commitment to continuous learning, and healthy inquiry
- a focus on evidenced based and standards based practice decisions
- enhancing the professional practice of Registered Nurses (RN) and Registered Practical Nurses (RPN), in accordance with the College of Nurses (CNO) Professional Standards
Overall, our model serves to reflect the mission, vision
and values of Thunder Bay Regional Health Sciences Centre
in meeting the health care needs of the patients and families
that we serve.
Registered Nurses and Registered Practical Nurses work in a collaborative practice
that focuses on professional excellence, caring, respect and
collegiality, and professional accountability. Each nurse
is assigned a group of patients for whose care she/he is responsible
and accountable, but each nurse is also part of a partnership.
This partnership, or collaboration, ensures coverage for all
patients when the nurses assigned to them are unavailable,
and also provides ready access for nurse-to-nurse consultation
on clinical and workload issues. Patients benefit from care
that is well planned, holistic, consistent and coordinated.
We believe that a Nursing Professional Practice foundation is best complimented
by a Total Patient Care Delivery Model.
Total Patient Care means that a Professional Nurse is accountable to provide and coordinate the care of a patient or group of patients assigned to her/him during her/his working hours. This Model supports nursing care based on the needs of individual patients, their families and significant others
Accountability for Care Planning: A Professional Nurse (RN or RPN) is assigned and responsible for planning and providing all care (within the scope of practice guidelines) during the assigned shift. The RPN collaborates with the RN they are partnered with, to complete or modify the care plan.
Patient Assignments:
- Are made with an emphasis on continuity and consistency for patient care
- Are allocated and delegated based on the scope of practice, knowledge and skill of the Nurse, as well as each patient’s acuity, stability and predictability of outcomes
- Negotiation, collaboration and consultation among Nurses and with Managers are components of the assignment
Continuity:
Continuity is made possible through the patient centered care approach. Where possible, the same RN or RPN is assigned to care for the same patient.
Coordination:
The RN or RPN responsible for the patient, coordinates and is accountable for all patient care outcomes
Documentation:
The nurse providing care is accountable for documenting the care delivered. The responsible nurse documents the planned care and outcomes of the care delivered.
Nursing Process:
- The assigned RN is responsible for all of the nursing process for the assigned shift.
- The assigned RPN is responsible for all aspects of the nursing process for the assigned shift and also works in collaboration with the RN; they are partnered with, in the care planning process.
- All nurses have responsibility to communicate the care they have planned and delivered, using the established documentation process
- Documentation must also include the patient’s progress and outline the expected outcomes
Discharge Planning:
- Discharge planning is a shared responsibility of all nurses caring for the patient.
- Accurate and thorough documentation and care planning focusing on continuity is essential to communication and planning shift to shift
- RN’s and RPN’s work in collaboration to plan for patient outcomes
Professional Accountability:
RN’s and RPN’s are accountable for their own professional practice.
The RN/RPN relationship is one of collaboration and not supervision.
Cost Effectiveness:
High quality, cost-effective care is the result of RNs and RPNs working to their full scope of practice, at the right time and with the right patient.
Management:
Managers are leaders, facilitators, role-models, mentors and advocates for the Professional Nursing staff who provide care to patients, families and significant others
The Nursing Practice Team is an advisory body to the Chief Nursing Officer
of Thunder Bay Regional Health Sciences Centre and is comprised
of nursing representatives from the programs services and
nursing roles within TBRHSC. The Team provides a forum in
which practice-specific and patient care issues related to
nursing standards, professional development, policy and procedures
are discussed.
The Nursing Practice Team engages in collaborative discussion
and consultation with internal departments, individual patient
care units, educational institutions, and other external partners.
Nurses on the Nursing Practice Team benefit from becoming
more fully informed and involved in influencing and determining
nursing practice issues, developing leadership qualities,
and participating in advancing professional issues organization-wide.
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