NURS 623 Week 3 Professional Practice Model Paper Example

Professional Practice Model Paper: Building a Shared Governance and Relationship-Based Practice Model for a 220-Bed Community Hospital

Introduction

Hospitals often ask nurses to deliver excellent care while giving them little say in how that care is organized, staffed or improved. A professional practice model is the structure meant to close that gap. Roussel (2018) describes professional practice models as frameworks that define how nurses practice, collaborate, communicate and grow, aligning nursing's values with the organization's mission and giving nurses authority over their own practice. The American Nurses Association (2016) likewise expects nurse administrators to create environments in which nurses have a voice in decisions that affect their practice. This paper defines the components of a professional practice model, designs a model for a composite community hospital, reviews recent evidence on what such models achieve, and sets out how a nurse administrator would implement and evaluate it.

Components of a Professional Practice Model

Most professional practice models share five components. The first is a set of values that describe what nursing in the organization stands for. The second is a pattern of professional relationships, including how nurses relate to patients, families and colleagues in other disciplines. The third is a governance structure through which nurses share decisions. The fourth is a care delivery system, the way work is organized at the bedside. The fifth is a system of professional development and recognition that rewards growth and excellence. A model is strong when these components fit together, so that, for example, a value of accountability is supported by a governance structure that gives nurses real authority and a care delivery system that assigns them clear responsibility.

The Setting

The composite hospital is a 220-bed nonprofit community hospital with 480 registered nurses, no Magnet or Pathway designation, and first-year nurse turnover of 26%. Nurses in exit interviews describe feeling that decisions about their practice are made without them. The chief nursing officer wants a professional practice model that will strengthen nurses' voice, improve retention and support a future application for Pathway to Excellence designation.

The Proposed Model

Values

The model's values are dignity, accountability, partnership and growth. Each value is defined in a sentence that staff helped write, so that the values describe the hospital's nursing rather than an imported slogan.

Professional Relationships: Relationship-Based Care

The model adopts relationship-based care as its framework for professional relationships, emphasizing three relationships: with patients and families, with colleagues and with oneself. In practice, this means a primary nurse or care team for each patient during the stay, bedside shift report that includes the patient, and attention to nurses' own well-being as part of the model rather than an afterthought.

Governance: Shared Governance Through Unit Practice Councils

Each inpatient unit will have a unit practice council of staff nurses, with the manager serving as an advisor rather than as the chair of the group. Councils make decisions on unit practice issues, such as handoff processes and patient education, within limits agreed with leadership. A hospital-wide coordinating council of council chairs and nursing leaders addresses issues that cross units, and practice, quality and professional development councils report to it. Shared governance gives the model its credibility, because a practice model that nurses cannot change is only a poster on the wall.

Care Delivery

The care delivery system pairs a registered nurse with a nursing assistant in a team for each group of patients, with charge nurses who carry a reduced assignment so they can support the team. Assignments preserve continuity, so that a patient sees the same nurse on consecutive days when possible.

Professional Development and Recognition

A clinical ladder rewards nurses for expertise, education, certification and leadership, including council work, with pay differentials for each level. A recognition program highlights examples of each value, nominated by peers and patients.

What the Evidence Shows

Recent studies support the central place of shared governance in the model. Jans et al. (2026) followed the introduction of unit practice councils on four inpatient units of a Dutch academic hospital over twelve months. Nurse engagement and the nurse practice environment improved modestly across all staff, with larger improvements among council members, and while evidence-based practice implementation did not change for the whole sample, council members who took part at both measurements showed a large increase. The councils were also well embedded in routine practice by the end of the year. These findings suggest that councils benefit the nurses most involved in them, which argues for rotating council membership so that more nurses share the benefit.

Shared governance also appears to affect retention through empowerment. In a survey of 313 nurses in an integrated care system, Aquino-Maneja et al. (2026) found that nurses' perceptions of shared governance predicted their intention to leave, with psychological empowerment partly explaining that relationship, and the two together accounting for 24% of the variance in turnover intention. For the composite hospital, where first-year turnover is high, this finding connects the model directly to its most pressing problem.

Models that strengthen the practice environment are also associated with patient outcomes. A regional health system that pursued Magnet designation across 15 hospitals using high-reliability strategies found that the sites achieving designation had significantly lower falls with injury and lower infection and pressure injury rates than non-designated sites (McGinnis et al., 2024). A national study found that hospitals with Pathway to Excellence designation maintained patient satisfaction better than other hospitals during the pandemic, after accounting for hospital characteristics (Yu et al., 2025). These studies are observational and cannot show that the practice model alone caused the outcomes, but they are consistent with the model's aims.

Leadership behavior matters to whether such models succeed. A short servant leadership scale recently built and tested with nurse leaders in Magnet hospitals is organized around the Magnet model's own components (Hall & O'Malley, 2026), reflecting the expectation that leaders in strong practice environments serve and develop staff. The composite hospital's managers would complete leadership development aligned with that expectation.

Anticipated Barriers

Three barriers are likely. The first is time. Council work takes nurses away from patient care, and on understaffed units managers may be reluctant to release them. The model addresses this by scheduling council meetings during paid, protected time and backfilling council members from the float pool, so that participation does not depend on a unit's census that day. The second barrier is skepticism. Nurses who have seen earlier initiatives fade may see councils as another program that will disappear. The best answer is early, visible results: each pilot council will choose one problem it can solve within three months, such as a handoff process or a supply issue, and its success will be shared across the hospital. The third barrier is the limits of authority. Councils cannot decide everything, and a council that recommends a change leadership cannot fund may conclude that shared governance is a pretense. The model therefore defines in writing which decisions councils make, which they recommend and which they are consulted on, and the chief nursing officer responds to every recommendation in writing within thirty days, explaining the decision and the reasons. Roussel (2018) notes that clarity about decision rights is one of the most important factors in whether shared governance succeeds, and this barrier is the one most often underestimated.

Implementation

Implementation would take eighteen months in three phases. In the first six months, the chief nursing officer would form a design team of staff nurses and managers to finalize the values and model diagram, train council chairs and managers in shared governance, and launch councils on four pilot units. In months seven through twelve, councils would expand to all inpatient units, the coordinating council would begin meeting, and relationship-based care education would be offered to all nursing staff. In the final six months, the clinical ladder and recognition program would be launched and the model reviewed. Roussel (2018) emphasizes that professional practice models succeed when they are developed with staff rather than delivered to them, and each phase includes staff in decisions.

Evaluation

The model would be evaluated with measures tied to its aims: first-year and overall nurse turnover; a practice environment survey at baseline and annually; nurse engagement; the proportion of nurses who have served on a council; and patient outcomes such as falls with injury and patient experience scores. Results would be reported to the coordinating council and the board each year. Because the hospital hopes to apply for Pathway to Excellence designation, the evaluation would also track the evidence that application requires, so that the model's progress and the designation work reinforce each other. A model that is evaluated only once tends to fade; one whose results are reported every year gives councils, managers and the board a shared reason to keep it alive, and it lets the hospital revise components that are not working instead of abandoning the model.

The Nurse Administrator's Role

The nurse administrator's role is to sponsor the model, protect resources for it and model the values it describes. That includes paying nurses for council time, honoring council decisions within agreed limits, and responding visibly to council recommendations. The ANA (2016) describes the nurse administrator as responsible for creating an environment that supports professional practice, and a professional practice model is one of the clearest ways to fulfill that responsibility.

A Biblical Perspective

Paul described the church as a body in which every member has a function and none can say to another, "I have no need of you" (English Standard Version Bible, 2001/2016, 1 Corinthians 12:21). A professional practice model built on shared governance expresses the same conviction in a hospital: decisions about nursing practice are better when the nurses who carry them out help make them.

Conclusion

A professional practice model gives nurses a defined voice in their practice and aligns the structures of nursing with its values. The model proposed for the composite community hospital combines shared governance through unit practice councils with relationship-based care, a team care delivery system and a clinical ladder. Recent evidence links shared governance to engagement, empowerment and lower turnover intention, and links strong practice environments to better patient outcomes. With careful implementation and evaluation led by a supportive nurse administrator, the model could help the hospital keep its nurses and serve its patients well.

References

American Nurses Association. (2016). Nursing administration: Scope and standards of practice (2nd ed.). Nursesbooks.org.

Aquino-Maneja, E., Searle Leach, L., Li, H., & McGinnis, J. (2026). Predictive relationships among nurses' perceptions of shared governance, psychological empowerment, and turnover intentions. Journal of Nursing Care Quality, 41(4), 370-378. https://doi.org/10.1097/NCQ.0000000000000949

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Hall, H., & O'Malley, P. (2026). Development and psychometric testing of an instrument to measure servant leadership behaviors in Magnet nurse leaders. Worldviews on Evidence-Based Nursing, 23(5), Article e70178. https://doi.org/10.1111/wvn.70178

Jans, M. M., Stallinga, H. A., Olvers, M. A., Ter Sluysen, J., de Brouwer, B. J., Finnema, E. J., de Vos, R., & Heemels, M. I. (2026). The impact of introducing unit practice councils on nurse engagement, the nurse practice environment and evidence-based practice: A longitudinal observational study. International Journal of Nursing Studies Advances, 11, Article 100584. https://doi.org/10.1016/j.ijnsa.2026.100584

McGinnis, J., Aquino-Maneja, E., Geloso, K., Zaragoza, C., Spicer, J., & Kawar, L. N. (2024). Regional transformation: An integrated system's approach to Magnet designation utilizing high-reliability organization implementation strategies. Journal of Nursing Care Quality, 39(4), 345-353. https://doi.org/10.1097/NCQ.0000000000000782

Roussel, L. (2018). Management and leadership for nurse administrators (8th ed.). Jones & Bartlett Learning.

Yu, H., Golinelli, D., Aiken, L. H., McHugh, M. D., & Brooks Carthon, J. M. (2025). The protective effect of Pathway to Excellence designation on patient satisfaction during the COVID-19 pandemic. International Journal for Quality in Health Care, 37(4). https://doi.org/10.1093/intqhc/mzaf096