At the turn of the 21st century, the Institute of Medicine (IOM) issued the report, To err is human: Building a safer health system, which estimated that from 44,000 to as many as 98,000 unnecessary patient deaths occurred annually in United States hospitals as a result of preventable errors caused by health care workers. In fact, according to the report, preventable medical errors exceeded deaths from motor vehicle accidents, breast cancer, and acquired immunodeficiency syndrome.
Effects of the professional practice model
Since the report was issued, health care facilities have been striving to improve care and keep patients safe. Hospital-acquired conditions (HACs), a group of conditions that have been identified as reasonably preventable by the Centers for Medicare and Medicaid Services, have gained much attention. These conditions not only jeopardize patient safety, but have financial implications for the facility and the health care system.
Nursing’s impact; not always positive
Three of the top ten HACs, stage III and IV pressure ulcers, patient falls, and catheter-associated urinary tract infections, have a direct link to nursing care. They equate to an estimated 77% of the total annual cost of all HACs combined. That’s a pretty significant negative impact on patient safety and quality, as well as health care costs. Could this negative impact be related to the lack of an established professional practice model?
A look at the professional practice model
A professional practice model explains how nurses interact with patients to achieve optimal health outcomes by:
- Defining patient care goals
- Implementing evidence-based care strategies
- Evaluating the responses to the provided care.
Although nursing literature suggests that a professional practice model positively impacts patient outcomes, there’s little evidence to suggest that institutions are practicing with a professional practice model that has been tested for outcomes.
In one combined retrospective prospective research study spanning six years, conducted in two acute care facilities in a health care system (Deaconess Hospital, Inc., Evansville, Indiana, and Deaconess Gateway in Newburgh, Indiana), data were collected from 2,395 staff nurses on 15 inpatient units. Statistical significance was reached for nursing and patient outcomes on two hospital campuses, indicating a positive correlation between the initiation of a professional practice and improved nurse and patient outcomes.
Campus one demonstrated a significant decrease in pressure ulcers and an increase in patient satisfaction scores. High correlations existed between patient satisfaction and quality of care. A high correlation existed between registered nurse turnover and patient falls. Campus two showed a significant increase in patient satisfaction scores, which also correlated with quality of care. On campus two, strong correlations existed between nursing autonomy, decision-making, and job enjoyment.
The professional practice model used in the Deaconess study describes how nurses exercise professional autonomy. It provides a clear understanding of their role with patients and families. It also makes nurses accountable for evidence-based practice and outcomes that are derived through multidisciplinary collaboration. Moreover it requires that care be delivered in a caring and healing environment.
The Deaconess study demonstrates that a professional practice model can positively impact nurse and patient outcomes. So, what are the next steps to improving outcomes using a professional practice model?
- Engage nurses in developing, implementing, and evaluating a professional practice model that positively impacts outcomes.
- Sustain the professional practice model by securing commitment from key stakeholders, providing continuing education for all staff, and financially backing the endeavor.