Aspirus Wausau Hospital

Collaborative Practice

In the summer of 2003, nurses adopted a shared decision-making model called Collaborative Practice. This model, based on decades of research that demonstrates a high correlation between nursing accountability and patient outcomes, had been customized over the course of the previous year. The steering team, composed primarily of staff nurses themselves, spent months working with a national consultant who is also the founder of nursing shared decision-making.  
 
Since 2003, Aspirus Wausau Hospital nursing staff have continued to exercise their accountability for their practice through the hospital wide and unit based nursing councils. These councils, composed of and led by staff nurses, make the decisions that shape nursing practice in response to changing patient needs, new nursing research, advancing technology, and regulatory mandates.  
 
The primary tenet of Collaborative Practice is that the bedside nursing staff are accountable for their practice because they are best qualified to identify their patients’ needs and are invested in how the work is accomplished. By educating themselves in professional practice standards, education and research theory, and quality management paradigms, staff nurses participate in a council structure that allows them to combine these with their first-hand understanding of patient needs in order to shape nursing care.

At both hospital and unit levels, nurses make decisions that define nursing practice, ensure staff competence & continued learning, incorporate meaningful research, and constantly seek to improve the resulting quality of care. With irrevocable autonomy, authority, and control of their professional practice, staff nurses determine the methods by which they carry out their collective mission in response to dynamics in patient needs, technologies, and fiscal boundaries.
 
In Collaborative Practice, the role of the nursing directors and managers is to provide the fiscal, human, and system resources required to enable the staff nurses to succeed. The department leaders do not lead the councils.  Rather they coach the staff nurses to be excellent leaders and facilitators themselves.
 
There are seven hospital-wide councils: Practice, Quality, Education, Research, Advanced Practice, Leadership, and Coordinating. The members of these councils represent nurses in all areas of the hospital, bringing to the meetings the collective voice of the nursing staff.  Decisions are made by consensus, to promote successful implementation and real change.

Although not every nursing staff member can serve on a council or task force simultaneously, each participates in Collaborative Practice and is accountable to identify issues, contribute to solutions, and promote positive change.

Council Structure 

Practice Council

• Each nursing unit has a practice council that defines and manages issues related to clinical practice within that area.

• House Wide Practice Council defines and maintains the Nursing Philosophy and Model of care at Aspirus Wausau Hospital.

• Develops and implements Standards of Care by recognizing obstacles and approving/writing policies and procedures.

• Maintains effective clinical documentation system.

• Establishes and maintains career advancement program.

• Establishes unit specific competencies.

Quality Council

• Responsible for overseeing and providing the framework for Process Improvement and monitoring.

• Meets monthly to review data on scorecard for trends.

• Facilitates activities related to continuous improvement of nursing care and performance of the nursing care provider.

• Monitors effectiveness of established practices.

• Communicates opportunities to improve.

Education Council

• Performs educational needs assessment for the nursing organization.

• Develops annual plan for nursing continuing education and general in-services.

• Develops and maintains system for nursing orientation.

• Develops and maintains system that defines competencies required for each level of nursing staff.

• Sets appropriate number of CEU’s required for nursing.

• Administers Nursing education budget.

• Coordinates communication for nursing organization with Newsletter and Nursing Forums.

• Coordinates Nursing Celebrations.

Research

• Promotes evidence-based practice.

• Builds a nursing research program.

• Educates staff on evidence-based practice and the use of research material.

• Understands the elements of basic research and assists nurses in developing a knowledge base in the same.

• Serves as a link between the IRC and nursing.

• Serves as a clearinghouse for nursing research projects.

• Directs and assists nursing staff with publishing.

Advanced Practice Council

• Provides vision and leadership to advance the professional practice of nursing at Aspirus Wausau Hospital

• Promotes expert nursing practice

• Coordinates and manages the care of specific disease populations

• Implements evidence based practice at the bedside

• Actively involved in the Aspirus Tobacco Dependence Treatment Program that is working with a multidisciplinary team to assist with smoking cessation interventions for the inpatient tobacco user. 

Leadership Council

• Organizes and manages the resources of the nursing organization at Aspirus Wausau Hospital.

• Develops an environment that promotes and advances the practice of professional nursing at Aspirus Wausau Hospital.

• Actualizes the initiatives outlined in the nursing strategic plan for the organization.

• Defines, manages and improves the mechanisms to provide materials and the environment essential to nursing operations.

• Ensures the provision of human resources to meet applicable standards in delivering nursing care.

• Ensures collaboration between nursing and other disciplines.

• Ensures processes are in place to hold staff accountable to practice within the nursing model and policies/protocols.

Coordinating Council

• Coordinates, integrates, and facilitates Collaborative Practice.

• Develops the strategic plan for nursing at Aspirus Wausau Hospital.

• Resolves accountability conflicts between councils.

• Manages evolution of Collaborative Practice design.