PURPOSE:

To outline the nursing clinical practice model at Pomona Valley Hospital

POLICY:

Professional Nursing Practice at PVHMC is reflective of our Hospital Mission
Statement and the Nursing Department Vision Statement.

1. Mission Statement: PVHMC is a not for profit regional Medical Center dedicated to providing high quality, cost effective health care services to residents of the greater Pomona Valley. The Medical Center offers a full range of services from local primary acute care to highly specialized regional services. Selection of all services is based upon community need, availability of financing, and the organization’s technical ability to provide high quality results. Basic to our mission is our commitment to continuously strive to improve the status of health by reaching out and serving the needs of our diverse ethnic, religious, and cultural community.Support the retention and recruitment of skilled nurses at the bedside
2. Nursing Department Vision Statement: “Nursing at Pomona Valley Hospital Medical Center is the spirit and practice of caring for patients and families
   through knowledge, expertise, and compassion in a safe environment”. 

In addition, the Shared Governance vision, the nursing professional practice model, and the hospital’s CHANGE Values have been incorporated into the performance criteria guiding nursing practice.

1. We believe that clinical practice is the core of professional nursing.
2. The professional role of the nurse includes clinical knowledge, decision-making, advocacy, caring, leadership, consultation, research, and collaboration.
3. The professional nurse assumes accountability for his/her own practice.
4. The nurse is accountable to the clinical services in which he/she practices, to the organization in which the nurse is employed, and to the patient for the outcomes of care provided. The power of this commitment has driven nursing at PVHMC to adopt a model that will enhance the growth and development of professional nursing practice.
5. Our professional development clinical levels model is based in part on Dr. Patricia Benner’s work, Novice to Expert and was developed by a taskforce of practicing clinicians representing each service. After a review of the literature, clinical guidelines for four levels of nursing practice were clearly delineated. Through the shared governance process, the councils then categorized the clinical guideline competency statements into four domains. The domains with definitions specific to Pomona Valley Hospital Medical Center are:

• Collaboration: The process whereby the Interprofessional healthcare team plans and practices together as colleagues working interdependently within the boundaries of their scope of practice;
  fostering open communication, mutual respect, and shared decision making to achieve quality patient-centered care.
• Caring/Patient Advocacy: Recognizing the patient or designee as the source of control and full partner in providing compassionate, age specific and culturally appropriate care with respect for the patient’s preferences, values, and needs.
• Clinical Knowledge/Decision Making: The Registered Nurse is accountable to recognize the health and quality of life needs of patients, families, and community and to collaborate with them to
  achieve mutually agreed upon goals. The Registered Nurse utilizes his/her specialized skills and scientific knowledge to design, collaborate, and integrate care that binds together all resources in a
  goal oriented movement toward health.
• Informatics and Technology: Integration of nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice.

The four levels of practice identified are as follows:

• Clinical Level I (Novice to Advance Beginner): Independently plans and implements care, but may need guidance when setting priorities. A nurse at this stage is beginning to integrate technical skills and theoretical knowledge to meet the needs of the patient and family. Lacks clinical experience. Focus is on the pieces of a situation rather than on the whole. This nurse recognizes his/her limitations and seeks assistance as appropriate. Begins to assume basic leadership responsibilities.
• Clinical Level II (Competent): Plans and sets goals to demonstrate a holistic approach to caring for the patients/families. Mobilizes resources to meet the individualized needs of the patients/families.
  More reflective on how illness impacts the patient. Sees relationships among the various aspects of the situation. Assumes leadership at the unit level. Demonstrates mastery of technical skills and integrates clinical knowledge by demonstrating critical thinking.
• Clinical Level III (Proficient): Are experienced, confident clinicians who are considered proficient in their practice. These RN’s are expected to be efficient and flexible, demonstrate excellent communication, and collaboration skills, and demonstrate proficiency in managing planned and unplanned events.
• Clinical Level IV (Expert): Possesses an intuitive grasp of clinical situations that reflect comprehensive knowledge and experience. Is recognized as a resource, leader and problem solver. Grasps the whole situation and is skilled in a complex environment. Seeks out challenges and shares expertise with others. Demonstrates advanced clinical knowledge of patient population and exemplifies professional practice.

As Professional Nursing Practice at PVHMC continues to grow, so will our opportunities to recognize meaningful and professional practice. It is through the articulation of nursing practice that our roles in patient care are validated and defined. Unique and consistent relationships begin to evolve. The care that is provided in response to those relationships is where the professional fulfillment truly lies. It is our hope that through the Professional Development Model and clinical accountability this gratifying experience can be realized for all.

Basic Requirements for All Levels:

1. Current and valid license as a Registered Nurse in the State of California.
2. Knowledge of theory, technique, and practice of professional nursing.
3. Spends more than 50% of the time at the bedside.
4. Self-assessments are required at all levels.
5. All Clinical Level advancement takes place between the individual and Nursing leadership.