AACNManifest a philosophy of clinical care emphasizing quality, safety, interdisciplinary collaboration, continuity of care, and professional accountability.
- Does the organization have a written philosophy and mission statement that reflect an emphasis on quality, safety, interdisciplinary collaboration, continuity of care, and professional nursing accountability?
- Does the organization have committees with nursing representation that provide input into policy development and operational management of issues related to quality of care, safety, continuity of care, patient-staff ratios, and clinical outcomes?
- Does the organization have a formal mechanism for quality assurance that includes criteria to assess whether nursing practice is based on the most current research evidence?
- What is the nurse-to-patient ratio? What support staff are available on the unit to assist nurses?
- Request a copy of the job description(s) of the registered nurse.
- How does the organization hold professional nurses accountable for high quality practice?
- Does the annual performance evaluation have explicit criteria related to level of practice expertise?
- Are there differentiated practice levels or roles for nursing congruent with differences in educational preparation, certification, and other advanced preparation in nursing (i.e. continuing education)?
- Does the organization have differentiated pay scales that recognize role distinctions and educational preparation among staff nurses?
- Does the organization recognize professional role distinctions among all disciplines by title on nametags, etc?
- Does the organization utilize clinical nurse specialists, nurse practitioners, nurse scientists and/or educators to support and enhance the work of staff nurses in clinical care?
- What are the key responsibilities/accountabilities of the top nurse executive? (Request a copy of the job description.)
- Request a copy of the organizational chart of the governing body and hospital structure to determine:
- Where is the top nursing voice in the organizational chart?
- Where are nurses represented in key committees and activities of governance? - Request a copy of the organizational chart of the patient care/nursing services:
- What is the chain of command?
- What resources and functions fall under the domain of the nurse executive?
- What professional development, educational, and research functions are included in nursing services? Empower nurses' participation in clinical decision-making and organization of clinical care systems.- Do nurses control decisions directly related to nursing practice and delivery of nursing care, such as staffing, nursing quality improvement, and peer review?
- Do nurses have input into the systems, equipment, and environment of care?
- How is nurse staffing addressed in the hospital plan of care? (Request a copy of the hospital plan of care.)
- Request a copy of the unit/department plan of care to determine:
- What is the specific patient population and nature of nursing care on this unit?
- What issues are evident in the performance improvement plans for this department?
- What role is defined for nursing staff in the unit plan? - Request a copy of the policy/procedure regarding the patient classification system to determine:
- How are nurses involved in establishing and monitoring the workload measurement system?
- How does this system influence daily staffing?
- Request a copy of the hospital performance improvement plan to determine:
- Is the role of nursing evident?
- What are the key issues reflected in this overall hospital plan?
- Are bachelor's prepared graduates distinguished from other nursing personnel in terms of:
- Employment responsibilities?
- Opportunities for advancement and promotion?
- Initial pay schedule or salary? If yes, what are the differences? - What rewards based on educational preparation are available?
- How are clinical competencies and professional contributions evaluated?
- How does this evaluation relate to the promotion process?
- Does the evaluation of clinical advancement, competencies, and professional contributions include consideration of:
- Patient satisfaction?
- Self-initiated education?
- Dissemination of clinical information, e.g. nursing rounds, case presentations, articles?
- Improvement of clinical outcomes and efficiency?
- Evidence-based practice?
- Ability to delegate to and guide non-bachelor's prepared nursing staff?
- Serving as mentor, consultant, or preceptor to students and recent graduates?
- Demonstrated ability to work in an interdisciplinary context?
- Leadership role in institutional self-governance and practice committees? - How are nurses recognized for meeting the professional practice criteria listed above, e.g. public acknowledgement, salary increases, time release, additional education, support to attend conferences, etc.?
- How do peers, patients, and supervisors provide input into the review process?
- Request a copy of procedures or information regarding the performance evaluation process and any clinical advancement system:
- Is peer review included in this process?
- What are salary increases based on?
- What resources are committed to the ongoing professional development of nurses, i.e. tuition, continuing education, and certification?
- How much is budgeted annually per staff nurse for attendance at professional development activities?
- Do you provide tuition reimbursement for nursing course work completed towards obtaining the next higher degree?
- Is there an internship or its equivalent in your institution for bachelor's degree nursing students?
- Is there an internship or mentorship program to prepare nurses for clinical leadership positions?
- Do the graduates who have completed an internship program in your institution as students start at a higher pay scale/salary than those who have not?
- What are the opportunities for promotion within the clinical practice model?
- What types of incentive programs exist for licensed practical nurses and other non-nurse health care personnel who wish to pursue registered nurse education?
- Do you use case managers or their equivalent in your institution and what is the minimal nursing education required for that role?
- What are the opportunities for my own professional growth? What can I learn here and how would employment here facilitate my career goals?
- How is the quality of patient care and safety reviewed?
- Who is involved in this process? Is it a peer review process?
- Do nursing units or departments of the practice setting have interdisciplinary or shared leadership models?
- Does the practice setting have interdisciplinary standing committees for peer review, patient safety, quality care, or disease state management?
- Does an interdisciplinary team participate in the process for quality improvement and review of patient care errors?
- Does the practice setting offer clinical practice privileges to advanced practice nurses and other health care providers as part of the medical staff bylaws and credentialing system?
- Are nursing units or departments of the practice setting organized from a discipline-centered perspective or from a patient-centered perspective?
- Do nurses from the practice setting refer to other members of the patient care team when discussing their role or work?
- Do nursing units or departments of the practice setting hold routine interdisciplinary care planning sessions?
- What collaborative, interdisciplinary articles, books or research reports have been published by clinicians from the practice setting?
- Does this institution utilize an electronic patient care documentation system? If yes, who has access to this system and who inputs information? If a patient goes to a unit/department outside of this building, do the staff in that unit/department have access to the system?
- Do nurses have electronic access to clinical nursing and health care knowledge and research results, including Web access? Is this access available on nursing units or departments of the practice setting?
- Does the practice setting allocate budgeted resources for new equipment and patient care technology? Do clinical care providers have routine opportunities to provide input to the budget planning process?
- What clinical information system, including patient care documentation, does the practice setting use? Is the system integrated throughout all or most clinical departments?
- Do nurses feel that their practice is supported by up-to-date clinical care technology?
- What continuing nursing education programs are in place to help nurses and other providers assimilate new technologies and information systems?
Patient satisfaction scores (preferably percentile ranking)
Employee satisfaction scores
Average tenure of nursing staff
Education mix of nursing staff
Percentage of registry/travelers used Copyright © 2000 by the American Association of Colleges of Nursing. All rights reserved. Please direct comments and suggestions to webmaster@aacn.nche.edu. American Association of Colleges of Nursing One Dupont Circle, NW, Suite 530 Washington, DC 20036 Phone: (202) 463-6930 - Fax: (202) 785-8320
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