Differentiated Group Professional Practice

ORIGINAL PROPOSAL ABSTRACT:
Few studies have examined the effects of nursing practice models on patient outcomes. In fact, previous research on patient outcomes rarely included variables representing the organization of nursing services. Despite this paucity of empirical evidence, many hospitals are implementing various models of nursing practice using work redesign or nurse extenders. In response to this, the National Center for Nursing Research and the Division of Nursing has funded two research demonstration projects in New York and Arizona. The Arizona project, Differentiated Group Professional Practice (DGPP), 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 the DGPP Model in a military health care setting. DGPP is an integrated model with three 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 entreprenuership, 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 occurred during Year One of funding from the TriService Research Award. Year Two will be used to strengthen the DGPP Model in demonstration units and to begin longitudinal data collection to test the sustainment of the DGPP Model. The DGPP Model is being 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.