Differentiated Group Professional Practice: Evaluation of a Nursing Care Delivery System

ORIGINAL PROPOSAL ABSTRACT:
OVERVIEW: This proposed project is designed to test the effectiveness of a unit-based professional practice model on nurse satisfaction, nurse resources, quality of care, and fiscal outcomes. The purpose of this study is to implement and evaluate Differentiated Group Professional Practice (DGPP) in nursing. DGPP is an integrated model with three major components: group governance, differentiated care delivery, and shared values in a culture of excellence. Group governance entails four subcomponents directed toward creating a participatory nursing group practice at the unit level. The subcomponents are: participative unit management, shared decision-making through staff bylaws, peer review, and a professional salary structure. Differentiated care delivery consists of three subcomponents: differentiated registered nurse (RN) practice, the use of nurse extenders, and primary case management. Shared values in a culture of excellence includes three subcomponents: quality of care, support for entrepreneurship, and internal and external recognition. The implementation of this literature-based professional practice model is expected to strengthen the professional environment and to increase nurse satisfaction with practice. Increased nurse satisfaction is hypothesized to increase nurse resources. This, in turn, is hypothesized to increase quality of care while decreasing or maintaining the level of fiscal resources. The demonstration of this project is anticipated to last one year for which time funding is requested. The following two years are planned for longitudinal data collection to test the sustainment of the DGPP Model. Additional funding from other sources will be sought for the following two years. The DGPP Model will be demonstrated on two test units and two comparison units at Tripler Army Medical Center (TAMC). Data to test the research model will be analyzed using causal modeling and multiple regression statistics. SPECIFIC AIMS: The primary purpose of this project is to test the effectiveness of a unit-based Differentiated Group Professional Practice (DGPP) Model on professional practice, nurse satisfaction, nurse resources, quality of care, and fiscal outcomes. The specific aims are to: (1) replicate the DGPP Model in a military setting (original study jointly funded by the National Center for Nursing Research and the Division of Nursing to demonstrate the DGPP Model in hospital nurses practicing in Arizona).