While changes in healthcare have been a long time coming, COVID-19 completely upended how we prepare new nurses, scale care for the acutely ill and those with chronic conditions, and ensure nurses have the necessary support — not only for their own well-being but for the safety of patients. Challenging times call for a more formalized, advanced clinical practice ability framework as an adjunct to hospitals' professional practice models.
During a recent webinar, titled, “Optimizing practice and outcomes using a Clinical Practice Ability Framework,” Wolters Kluwer Chief Nurse Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, and Wyndy Looney, MSN, RN, NPD-CPMP, National Accounts Executive, discussed the current state of the post-pandemic nursing workforce crisis, introducing a formalized professional practice model that can help facilitate optimal patient care and outcomes and, at the same time, nurse well-being.
“Going through the pandemic was probably the hardest three years of our nursing careers,” remarked Woods, noting that the response to the current workforce situation requires creative solutions that allow nurses to perform adaptive, evidence-informed decision-making, use clinical judgment to solve complex nursing and patient problems, and provide high-quality nursing care. “Many nurses are retired or have chosen to leave the nursing profession altogether. Studies show that our nursing students transitioning to practice are less prepared than they were four years ago. And nurses who remain at the bedside are tired, exhausted, and burned out, with many feeling they've lost their love for nursing and want to leave — but can't.” As a result, she emphasized that “patient outcomes nationally are suffering.”
Consider the facts. As of 2021, four of the five leading HAIs increased: catheter-associated urinary tract infections (CAUTI) rose 19%, central line-associated bloodstream infections (CLABSI) at 47%, ventilator-associated events at 47%, and methicillin-resistant Staphylococcus aureus (MRSA) at 14%. Clostridioides difficile (C. diff.) declined by 3% due to the prevailing care of viruses, including COVID-19, influenza, and respiratory syncytial virus or RSV.
The speakers noted that the Clinical Practice Ability Framework can provide an avenue to optimize practice, outcomes, and well-being for novice to expert nurses throughout the healthcare organization. While many organizations have a professional practice model in place, many do not have a model that clearly defines how they will develop clinical practice ability and competency within their workforce.
The case for an expanded practice model
Looney explained that a research method originally developed in China for master's degree nursing candidates was the impetus to design a new model for professional practice development. The concept focuses on developing clinical practice ability, which is defined as the ability to (1) perform adaptive, evidence-informed decision-making, (2) use clinical reasoning to solve complex nursing problems, and (3) provide high-quality nursing care in a clinical experience to solve a problem.
According to Looney, clinical practice ability and its relationship to competence must be interrelated to achieve the benefits of the model. “If a nurse has developed their clinical practice ability, they have the ability to be competent,” she said, defining nursing competence as an expected level of performance where knowledge, skills, abilities, and judgment are integrated in order to care for patients.
3 'nursing truths' that build the case for clinical practice ability
Woods shared several “nursing truths,” citing the following market study statistics on the nursing labor deficit:
- As the nursing shortage worsens, burnout is up by 37%. “By 2035, we'll need at least 13 million healthcare professionals globally,” she emphasized. “In the U.S., we’ll need between 200,000 and 450,000 nurses by 2045. Our latest information reveals that by 2027-2028 this number could be upwards of 800,000 and 900,000 nurses.”
- Nurses are dissatisfied with their work, and 52% want to leave the profession. “Only 40 percent of respondents are satisfied with being a registered nurse, down from 62 percent in 2018,” Woods said. “When we talk to nurses, their main reason for wanting to leave the bedside is not having what they consider to be safe staffing levels.”
- New graduate nurses aren't practice ready. “Based on Benner's Model, it takes two to three years for a new nurse graduate to become competent,” Woods explained. “We want them to become practice-ready, and we need to redefine the transition from novice to expert, ensuring that we're tailoring what they need to learn. New nurses who undertake nurse residency programs and are paired with a preceptor for six months to a year yield better retention rates than those without that experience.”
Components of the Clinical Practice Ability Framework
Looney explained that the Clinical Practice Ability Framework is built on a foundation of regulations, nursing's code of ethics, and other professional nursing practice models, including evidence-based practice and quality of care models (e.g., Magnet Recognition Program®). In its essence, this framework is supported by three pillars
- Coordinate with the intentional use of tools and resources to provide guardrails for safe practice.
- Cultivate planned and deliberate activities to support new staff, especially helping new nurses at the novice level to reach proficiency or new role transition, as well as those nurses and preceptors throughout the continuum of their careers.
- Accelerate structured empowerment, helping nursing staff achieve life-long learning and role advancement.
According to the co-presenters, implementing a Clinical Practice Ability Framework can help to foster a healthy and successful work environment while continuing investments in nursing workforce educational and professional growth, contributing to improved care delivery and better outcomes. “In a healthcare system, the most valuable asset is the nursing workforce who cares for the patients,” Woods stressed. “Patient outcomes are optimized if nurses are valued, have adequate resources, are properly trained, and feel safe in the care environment.”
