Core Practice Principles

Professional Practice Model

Introduction

NYU Hospital for Joint Diseases (NYUHJD) uses the Relationship-Based Care Model. We focus on three fundamental relationships as the cornerstones of healthcare delivery: (1) the care provider’s relationship with patients and families, (2) the care provider’s relationship with self, and (3) the care provider’s relationship with colleagues.

Description: SCHEMATICabc (2)

NYUHJD’s Relationship-Based Care Professional Practice Model (PPM) has four pillars:

  • Primary Nursing as a delivery system for nursing care,
  • A shared management/governance structure for shared decision making,
  • Collaborative practice for improving professional working relationships and communication across disciplines, and
  • A recognition/reward development program for rewarding and recognizing excellence in nursing.

Our beliefs and values organize patient care around the needs and priorities of the patients and their families; nursing; professionalism; and a healthful work environment. The model also represents and magnifies our commitment to the Hospital’s mission, vision, and the core values of Performance, Respect, Integrity, Diversity, and Excellence.

Care Delivery

Principle I: Responsibility for Relationship and Decision Making

  • The Primary Nurse is a registered nurse who is responsible for establishing a relationship and an individualized plan of care with the patient for a defined period of time.
  • This nurse is accountable for planning, coordinating, delivering, and evaluating the patient's care, and for effectively transferring that accountability if the patient is moved off the unit.
  • The patient and family are able to identify their Primary Nurse by name and understand that she/he is responsible for planning and coordinating their care.
  • The Primary Nurse is responsible for communicating the plan of care to other members of the health care team.
  • The Associate Nurse is a registered nurse who cares for the patient in the absence of the Primary Nurse….on other shifts or days off. The Associate Nurse follows the plan of care developed with the patient and left by the Primary Nurse.

Principle II: Responsibility for Work allocation and patient assignments

  • A professional practice model is a patient-centered care delivery system where assignments match the skills of the caregiver with the needs of the patient.
  • Registered nurses have the authority to determine the kind and amount of nursing care a patient will receive, the activities of care that require the expertise of a registered nurse and the activities of care that can be delegated to other members of the health care team utilizing principles of effective delegation.
  • Work is allocated and delegated based on scope of the role, and the knowledge and skill of the caregiver.
  • The care team of registered nurses, licensed practical nurses, nursing assistants, and others will support and maximize one another's contribution.
  • Overall, increased continuity and consistency will be achieved in the assignment process.

Principle III: Communication Between Members of the Healthcare Team

  • Primary Nurses proactively provide information to others who need it and seek information from those who have it.
  • Patients and families experience cooperation among all members of the health care team. Members of the healthcare team treat the patients and each other with dignity, respect and sensitivity.
  • Consistency in care and continuity in relationships of members of the health care team is maximized.

Principle IV: Management

  • Managers lead through and support the changes in care delivery and support professional practice and care teams.
  • Managers lead, support, role model, coach and mentor staff by articulating expectations and by using situational leadership to promote the growth and development of staff in three competency domains: clinical/technical, communication/relationship management and critical thinking.
  • Managers lead to create an environment in which healthy relationships thrive.
  • Mangers facilitate an environment of shared-decision making.

Principles Related to Practice Environments

Principle V: Process Improvements

  • Work processes will be simplified and barriers to care will be removed so that patients and families have what they need in a timely and responsive fashion…each time. Unit Staff and manager responsibility for changes will be clearly differentiated.

Principle VI: Caring, Healing Milieu

  • Patient care will be provided in an environment that is therapeutic. Specifically, patient care practices will be attentive to the mind, body, and spirit: the patient will experience a relationship with the responsible nurse; and patients and families will be actively involved in managing their care as facilitated by the nurse, physician, and other members of the health care team.
  • Caring, healing practices will be visible in practitioner relationships, clinical practices and the physical setting.

Professional Relationship

Collaborative practice is the model used to facilitate interprofessional communication and shared decision-making.  Through this process we improve patient outcomes.  Several councils and committees have been established to facilitate and promote a collaborative practice environment and they include:

  • Interdisciplinary Rounds
  • Joint Operations Council
  • Patient Satisfaction Committee
  • Pediatric Operations Meeting
  • Peer to Peer Relationship
  • Periopertaive Council Meeting
  • Rehab Team Meeting
  • Spine Operations Council

Management and Governance

The shared decision making structure recognizes participation from all members of the nursing staff. Each council is clearly identified and oper­ates within the defined roles and responsibilities. Strategies, projects or processes proposed by councils, taskforces or subcommittees are research and evidence-based driven.

Recognition, Reward and Development

Recognition

Reward

Development

A rich variety of continuing educational resources exist at NYUHJD.  These resources provide the structures and processes for designing and implementing continuing education programs for nurses at all levels as described below.

Aspiring Nurse Leaders Institute. This offsite (usually held in another State) three-day workshop is offered by the America Organization of Nurse Executives (AONE).  The workshop concentrates on the many facets of nursing leadership such as managing people and a nursing unit, dealing with colleagues’ behaviors, nurses/physician relationships, reflective practice and shared governance.  Newly appointed middle management staff is encouraged to participate in this program.  Participants are compensated for all costs associated with attending the program.     

Essentials of Nurse Manager Orientation This is web-based program provided by the  American Association of Critical Care Nurses (AACN).  It is a self-paced interactive program that concentrates on three primary leadership domains: (1) the science of managing the business, (2) the art of leading the people and (3) the leader within, creating the leader in yourself.  The complete program offers 40 contact hours of continuing nursing education credits (CNE).  The Essentials of Nurse manager Orientation program is offered to both newly hired and tenured middle management nursing personnel.  The program can be accessed anytime online.  On an annual basis since 2008, NYUHJD contracts for ten users with AACC.  The enrollees have one year to complete the program.     

Leadership at the Point of Care is a three day workshop that is provided through the Creative Healthcare Management Company.  This onsite instructor led program focuses on what it will take to achieve leadership at the point of care.  Topics include leader as a person, leader as a colleague, leader as a professional and how to manage change.  Leadership at the Point of Care is offered once to twice per year. 

Leading an Empowered Organization is a three day program that is provided by the Creative Healthcare Management Company.  During this onsite instructor led program three-day program, novice and experienced leaders alike deepen their understanding of leadership. The workshop provides a conceptual framework for leadership, practical skills and an opportunity to develop those skills. Participants also learn how to help their staff develop problem solving, relationship and risk taking skills.  This program is offered periodically as needed.

Leadership Development Series addresses a variety of current healthcare issues.  Each topic is approximately once every six weeks and is one hour long.  It is opened to nursing leadership and staff nurses alike. 

Operating Room Training

PACU Training Program

Primary Nursing Workshop is a two-day workshop that concentrates on implementing and sustaining primary nursing.  This program targets staff nurses and leadership staff.

Recognition:
Nursing Spectrum, 1199 Nurse of Distinction, Internal (hospital wide, unit-based)

Reward:
Certification, Preceptor, PDM

Development:
OR, PACU Residency Programs, Tuition Reimbursement Programs, Continuing Education/Development Offerings, NYSNA Provider Unit, EPB/Research