Nursing Bylaws

Aspirus Wausau Hospital Wausau, Wisconsin Revised: 12/07, 12/08, 3/09

Aspirus Wausau Hospital

Nursing Bylaws
The Nursing Bylaws document was designed by professional nurses for professional nurses in an effort to recognize the impact nursing has on patient care at Aspirus Wausau Hospital (AWH) and within the Aspirus organization. This document is an affirmation that nursing excellence is the standard of care that is expected within the organization and the profession, and optimal patient outcomes are the goals we strive to meet. These goals can be met through professional accountability and ownership of the nursing profession. This comprehensive document strives to delineate the contributions that nursing has made to AWH, define the role of the professional nurse at AWH and identify those tools available to nurses in the pursuit of excellence.

Aspirus Wausau Hospital Nursing By-Laws

Table of Contents
Article I: Definitions Section 1. Purpose of Nursing Bylaws Section 2. Definition of the Registered Nurse... Section 3. Philosophy... Section 4. Values.. Section 5. Standards of Magnetism .. Standard 1. Transformational Leadership... Standard 2. Structural Empowerment.. Standard 3. Exemplary Professional Practice.. Standard 4. New Knowledge, Innovations, Improvements. Standard 5. Empirical Quality Outcomes. Section 6. Changes in Nursing Bylaws Article II. Roles Section 1. Role of the Professional Registered Nurse... Section 2. Nursing Care Delivery... Article III. Services of Nursing.. Section 1. Definition Section 2. Nursing Services. Article IV. Collaborative Practice. Section 1. Definition Section 2. Councils... Nursing Leadership Council Nursing Research Council... Nursing Practice Council. Nursing Education Council. Nursing Quality Council.. Advanced Practice Nursing Council... Nursing Coordinating Council Article V. Healthy Work Environment. Section 1. Definitions... Section 2. Standards Skilled Communication True Collaboration... Effective Decision Making... Appropriate Staffing Meaningful Recognition... Authentic Leadership... Article VI. Nurse Credentialing. Section 1: Definition Section 2. Background... Section 3. Vision and Philosophy... Section 4. Conceptual Framework. Section 5. Benefits Section 6. Goals Page 5 5 5 5 5 6 6 7 7 8 8 9 9 9 9 10 10 11 11 11 12 12 12 13 14 14 15 16 16 16 17 17 17 18 18 19 19 20 20 20 20 20 21 21

Section 7. Credentialing Components... Section 8. Performance Review.. Section 9. Mandatory Annual Education. Section 10. Continuing Education.. Section 11. Peer Evaluation Process.. Section 12. Clinical Advancement Program. Article VII. Nursing Ethics. Article VIII. Peer Review... Section 1. Definition and Purpose.. Section 2. Nursing Peer Review Utilization Policy... Article IX. Nursing Leadership.. Section 1. Role of Nurse Executive in Professional Organization... Section 2. Role of Management in the Nursing Department... Conclusion. References. Appendix A... Acknowledgment..

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Article I
Definitions Section 1: Purpose of Nursing Bylaws The purpose of nursing bylaws is to delineate the role of the registered nurse in the delivery of care at Aspirus to the community, in accordance with the Nurse Practice Act of the State of Wisconsin (Wisconsin Nurse Practice Act, 1999). These bylaws are based upon the tenet that nursing is a selfdirected and self-governing profession, which is accountable to the community in which the nurse serves. This community includes patients within Aspirus Wausau Hospital (AWH) as well as those in the community that AWH serves. The professional registered nurse will ensure the delivery of quality care using evidence-based practice while keeping the individual patients needs in mind. The professional registered nurse will encourage collaboration among nursing staff, physicians and other disciplines for the patients benefit. The professional nurse will foster learning, stimulate professional growth of the nursing staff and will promote nursing research. The professional will continuously seek information that improves patient care in an innovative and cost effective manner. AWH nurses continuously strive to achieve the mission with a passion for excellence and compassion for people. This pertains to all nurses at AWH that require a registered nurse license as part of their job description. Section 2: Definition of the Registered Nurse A Registered nurse is a person who practices professional nursing. Professional nursing means the performance for compensation of any act in the observation or care of the ill, injured or infirm, or for the maintenance of health or prevention of illness of others, which act requires substantial nursing skill, knowledge or training, or application of nursing principles based on biological, physical and social sciences, such as the observation and recording of symptoms and reactions, the execution of procedures and techniques in the treatment of the sick under the general or special supervision or direction of a physicianand the execution of general nursing procedures and techniques. (Taken from State of Wisconsin Department of Regulation and Licensing Code Book, 2006) Section 3: Nursing Philosophy In alignment with the AWH mission and vision, the AWH Nursing philosophy is Patients First Through Nursing Excellence and Compassionate Care. Nurses have adopted the view that health and illness states are an important aspect of the journey that involves patients and their families. This journey is traveled throughout their lives. Nursing assists patients and their families along the journey through the healthcare system via collaboration, integration and facilitation. The patient is the focus of this process and optimal patient outcomes are the goals. These goals are achieved through use of evidence-based practice and commitment to nursing excellence and the compassionate care provided. Nurses achieve excellence through professional accountability, use of research and application of research to improve the quality of care delivered to our patients. The nursing profession is advanced through professional accountability, research and application of evidence-based practice. This enhances the nursing care delivered at AWH. Nursing is empowered with the autonomy, authority and control to guide patients and their families through the healthcare system and the achievement of optimal patient outcomes. Section 4: Values AWH nurses endeavor to meet the organizational values as set forth below: Service we commit to: Treating our patients with compassion and respect for their human dignity, individual values and religious beliefs. Being responsive to the customers needs while making decisions that are based upon sound, ethical business principles and practices. Caring equally for all without regard to race, color, national origin, disability, age, religion, sex or any other basis prohibited by law.

 The provision of emergency services to the people of our community regardless of their ability to pay. Working together interdependently to serve our clients better. Community we commit to: Being a good corporate citizen. Community involvement and support through the Board of Directors, Volunteers and other support groups, which are of paramount importance to the success of AWH. Cooperative working relationships with other healthcare providers assuming a leadership role in facilitating the delivery of healthcare services in north and central Wisconsin. All Health Care Providers treated as valued partners. Recognizing the uniqueness of individuals and the strength realized when we work interdependently with deep respect for human dignity. Being preferred by our community of customers. Integrity we commit to: Accountability and ethical action deserving of the trust and confidence given to us by our community. Excellence in our treatment of employees and fostering a preferred work environment recognizing the value of employee leadership, cooperation and caring. The responsible use of resources. Honoring of commitments as individuals and as an organization. Improvement we commit to: Continuously striving to improve in everything we do. The understanding that both competition and cooperation can lead to improvement and increased value for our regional community. Leadership for improvement. Encouraging and providing an overall safe environment for our patients and staff. (Taken from policy #5603, Mission and Values of Aspirus Wausau Hospital, 2005) Section 5: Standards of Magnetism Professional nurses at the Magnet-designated AWH follow the tenet that professional nursing is self-governed and self-directed. This tenet can be delineated in the Standards of Magnetism, with supporting forces from the American Nurses Credentialing Center as listed below: Standard 1: Transformational Leadership Quality of Nursing Leadership Knowledgeable, strong, risk-taking nurse leaders follow a well articulated, strategic, and visionary philosophy in the day-to-day operations of the nursing services. Nursing leaders, at all levels of the organization, convey a strong sense of advocacy and support for the staff and for the patient. (The results of quality leadership are evident in nursing practice at the patients side.) Management Style Healthcare organization and nursing leaders create an environment supporting participation. Feedback is encouraged and valued and is incorporated from the staff at all levels of the organization. Nurses serving in leadership positions are visible, accessible, and committed to communicating effectively with staff.

Standard 2: Structural Empowerment Organizational Structure Organizational structures are generally flat, rather than tall, and decentralized decision-making prevails. The organizational structure is dynamic and responsive to change. Strong nursing representation is evident in the organizational committee structure. Executive-level nursing leaders serve at the executive level of the organization. The Chief Nursing Officer typically reports directly to the Chief Executive Officer. The organization has a functioning and productive system of shared decision-making. Personnel Policies and Programs Salaries and benefits are competitive. Creative and flexible staffing models that support a safe and healthy work environment are used. Personnel policies are created with direct care nurse involvement. Significant opportunities for professional growth exist in administrative and clinical tracks. Personnel policies and programs support professional nursing practice, work/life balance, and the delivery of quality care. Community and the Healthcare Organization Relationships are established within and among all types of healthcare organizations and other community organizations, to develop strong partnerships that support improved client outcomes and the health of the communities they serve. Image of Nursing Other members of the healthcare team characterize the services provided by nurses as essential. Nurses are viewed as integral to the healthcare organizations ability to provide patient care. Nursing effectively influences system-wide processes. Professional Development The healthcare organization values and supports the personal and professional growth and development of staff. In addition to quality orientation and in-service education addressed in the section Nurses as Teachers, emphasis is placed on career development services. Programs that promote formal education, professional certification, and career development are evident. Competency-based clinical and leadership/management development is promoted and adequate human and fiscal resources for all professional development programs are provided. Standard 3: Exemplary Professional Practice Professional Models of Care There are models of care that give nurses the responsibility and authority for the provision of direct patient care. Nurses are accountable for their own practice as well as the coordination of care. The models of care (i.e., primary nursing, case management, family-centered, district, and holistic) provide for the continuity of care across the continuum. The models take into consideration patients unique needs and provide skilled nurses and adequate resources to accomplish desired outcomes.

Consultation and Resources The healthcare organization provides adequate resources, support, and opportunities for the utilization of experts, particularly advanced practice nurses. In addition, the organization promotes involvement of nurses in professional organizations and among peers in the community. Autonomy Autonomous nursing care is the ability of a nurse to assess and provide nursing actions as appropriate for patient care based on competence, professional expertise, and knowledge. The nurse is expected to practice autonomously, consistent with professional standards. Independent judgment is expected to be exercised within the context of interdisciplinary and multidisciplinary approaches to patient/resident/client care. Nurses as Teachers Professional nurses are involved in educational activities within the organization and community. Students from a variety of academic programs are welcomed and supported in the organization; contractual arrangements are mutually beneficial. There is a development and mentoring program for staff preceptors for all levels of students (including students, new graduates, experienced nurses, etc.). Staff in all positions serve as faculty and preceptors for students from a variety of academic programs. There is a patient education program that meets the diverse needs of patients in all of the care settings of the organization. Interdisciplinary Relationships Collaborative working relationships within and among the disciplines are valued. Mutual respect is based on the premise that all members of the healthcare team make essential and meaningful contributions in the achievement of clinical outcomes. Conflict management strategies are in place and are used effectively, when indicated. Standard 4: New Knowledge, Innovations, and Improvements Quality Improvement The organization has structures and processes for the measurement of quality and programs for improving the quality of care and services within the organization. Standard 5: Empirical Quality Outcomes Quality of Care Quality is the systematic driving force for nursing and the organization. Nurses serving in leadership positions are responsible for providing an environment that positively influences patient outcomes. There is a pervasive perception among nurses that they provide high-quality care to patients.

Section 6: Changes in Nursing Bylaws All professional nurses have the ability to make recommendations to Hospital-wide Coordinating Council for changes to this document. The understanding is that this document is a fluid document that will need to have periodic reviews and modifications to meet the changes within the organization and the nursing profession.

Article II Roles
Section 1: Role of the Professional Registered Nurse Professional nurses at AWH have roles that are outcome oriented in order to meet the needs of our patients, as noted below: 1. To advocate for the health, safety and rights of each patient. 2. To monitor nursing practice and patient care outcomes that assure that the care rendered is consistent with evidence-based practice while keeping the patients needs in mind. 3. To implement best-practice systems for patient care delivery to maximize productivity while providing the highest level of safe, efficient and effective nursing practice. 4. To promote a healthy work environment, promote collaboration and open communication with other health professionals. 5. To participate in assessing the health needs of the community and assist with program development to address these needs. 6. To assure maintenance of nursing competencies and encourage participation in those activities that contributes to the ongoing development of the individual nurse, the profession and other health professions. 7. To support nursing research and research-based clinical practice. 8. To collaborate with clinical nurses, nurse managers and advance practice nurses to identify the learning needs of the patients and staff to determine priorities for educational programs. 9. To develop evidence-based procedures and protocols to improve the quality of health care delivery. 10. To provide leadership for the development, implementation and evaluation for the standards of practice. 11. To facilitate nursing participation on hospital-wide and unit based councils/committees in an effort to improve patient care and outcomes as well as effective administrative systems. 12. To participate in the nursing community and professional organizations. (Fashioned after Olean General Hospital Division of Nursing Bylaws, 2007) Section 2: Nursing Care Delivery Professional registered nurses at AWH deliver care to their patients utilizing the Caring Model of Professional Nursing Practice: Advocacy Caring must be present in all actions in the daily practice of nursing. It involves the humanity of the caregiver and their embracing the humanity of the person receiving care. It is the process of merging the intimacy of care patients need with the high level technology of health care today.

Competence Competency is the skills and knowledge required to deliver or assist in the delivery of quality patient care. It is an outcome of teaching, learning and experience. Nurses are personally responsible to maintain and continuously expand skills and knowledge through attendance at educational opportunities to enhance clinical outcomes. Accountability The act of accepting ownership for all actions, decisions and outcomes. Each nurse is ultimately responsible and accountable for the delivery of quality health care. Responsibility Responsibility is a charge to do something for which one is accountable to someone. Professional nursing requires each practitioner to accept ownership of his or her practice. Empowerment Empowerment is the personal authority to make decisions and act upon them. Health services are enhanced when both the nurse and the patient are empowered. Confidence Confidence is each nurses belief in their own ability to perform the responsibilities of their job. When the nurse acts with confidence, the relationship between patient and caregiver is strengthened and outcomes enhanced. Relationship Relationship is the connection between and among people. Building an empathetic relationship with a patient and their family is the key that unlocks the uniqueness of the patient and enhances the value of therapeutic interventions in achieving optimal health outcomes for the patient. Enable Enabling is providing the means for someone to be able to do something in order to learn and grow. In Professional Nursing Practice, it involves the effective and efficient transmission and flow of information and ideas so as to make possible adjustments in ones self, ones performance and ones outcomes. (Taken from Aspirus Wausau Hospital policy #5593 Nursing Practice Conceptual Design/Caring Model, 2006).

Article III
Services of Nursing Section 1: Definition Professional nursing at AWH utilizes the nursing process that centers on patient care. These actions include: 1. Assessing human responses to actual health conditions. 2. Identifying a nursing diagnosis and/or need that reflect the status of an individual, family or group. 3. Developing and implementing a treatment regimen in accordance with established evidencedbased practice and regulatory standards of care. 4. Educating patients and family 5. Collaborating with other health care professionals. 6. Promoting quality health care within a resource-efficient and fiscally-responsible framework. 7. Evaluating a patients response to the treatment regimen. 8. Implementing diagnostic and therapeutic regimens prescribed by medically privileged practitioners. 9. Administering, supervising, delegating, and evaluating nursing activities within the AWH nursing service guidelines and the Nurse Practice Act of the State of Wisconsin.

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Section 2: Nursing Scope of Services The services provided by professional registered nurses at AWH include, but not limited to: Ambulatory Behavioral Health Cardiac Care Services, including Critical Care Cardiac / Pulmonary Rehabilitation Diagnostic Imaging Education Emergency Care Services Employee Health Family/Community Geriatric GI Services, including endoscopy Hospice Human Resources Infection Control Maternity and NICU Medical/Surgical Services, including Critical Care Oncology Pain Management Palliative Care Pediatric Pre-Hospital Transport Services, including flight Psychiatric Quality Management Rehabilitation Renal Services, including dialysis (inpatient) Surgical, including PACU and Day Surgery Wellness Womens Health Wound care

Article IV
Collaborative Practice Decision Making Model (Shared Governance) Section 1: Definition Nursing at AWH is based on the Nursing Collaborative Practice Model. Collaborative practice empowers nurses to make decisions about their own nursing practice. All nurses collaborate in problem-solving and decision-making, thereby improving the practice environment and the patient care environment. Collaborative Practice and shared decision-making is based on the four principles of empowerment that are: partnership, accountability, equity, and ownership. All structures and processes are built around these principles, always focusing on the collaborative and interactive process. Partnership: means all members have a role/relationship in the structure. A key partnership is the RN/MD one that drives patient care. Accountability: is the why of our work. It is the results and the difference it makes. This is different than responsibility, which refers to the actual work processes and doing.

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Equity: refers to value and not the concept of equal. It is our obligation to define our value as a profession of nursing and prove our value individually. Ownership: refers to the investment we have to participate in improving value. We are all stakeholders and participants in the process.

Section 2. Councils Vision Statement: We are a committed team of visionary staff collaboratively creating a professional work environment, enhancing practice and patient care. There are seven councils: Leadership, Research, Practice, Education, Quality, Advanced Practice Nursing, and Coordinating. Each council has defined accountabilities. Each chairperson is elected from within, and has certain obligations to meet within the group. These obligations are as follows: Call and facilitate the meetings. Call the question. Lead the group process. Set the groups agenda. Resolve conflict in the agenda. Represent the council between council meetings, speaking for the council. The chair has critical power: right to speak without calling council into session. Duty to remove members who arent fulfilling obligations of membership. Represent the council to the Coordinating Council. Nursing Leadership Council Purpose: Organize and manage the resources of the nursing organization at AWH; Develop an environment that promotes and advances the practice of professional nursing at AWH; Actualize the initiatives outlined in the nursing strategic plan for the organization Accountabilities: The Leadership Council will: Define and manage the fiscal process Define, manage, and improve the mechanisms to provide materials and the environment essential to nursing operations Ensure the provision of human resources to meet applicable standards in delivering nursing care Ensure collaboration between nursing and other disciplines Ensure that mechanisms are in place to maintain regulatory requirements Ensure processes are in place to hold staff accountable to practice within the nursing model and policies/protocols Provide management information to the other Councils to facilitate decision-making Establish methods of communicating among its own members, other councils, and all disciplines involved in nursing care Membership: CNO Chief Nursing Officer, Chair of Coordinating Council, Nursing Directors, Hospital Supervisors, and Department Supervisors. Nursing Research Council Purpose: The Nursing Research Council will coordinate and promote nursing research to advance nursing practice. We believe that research needs development within the nursing organization both for improved practice and with the Magnet work. Research Council Accountabilities: The Nursing Research Council will: Promote evidence-based practice Build a nursing research program

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Educate staff on evidence-based practice and the use of research material Understand the elements of basic research and assist nurses in developing a knowledge base in the same Serve as a link between the institutional review board (IRB) and nursing Serve as a clearinghouse for nursing research projects Direct and assist nursing staff with publishing Membership: Registered Nurses representing varied clinical areas with an interest in developing nursing research and evidence-based practice. HRP (Human Research Protections) Coordinator/IRB Administrator Advanced Practice Nurses with CNS or NP accountabilities Chief Nursing Officer Staff nurses Others, as interested Nursing Practice Council Purpose: The Nursing Practice Council will define and manage issues related to clinical practice. Practice Council Accountabilities: The Nursing Practice Council will: Define and maintain the Nursing Philosophy and Model of Care at AWH. Address obstacles that reduce clarity of and adherence to the Model of Care. Develop and implement Standards of Care; address obstacles that reduce clarity of and adherence to Standards of Care; and approve policies and procedures governing nursing practice. Maintain a clinical documentation system that adheres to regulatory body mandates, reflects standards of practice, and promotes complete, streamlined recording of patient care. Maintain Nursing job descriptions, performance appraisal standards, a credentialing and privileging process and adherence to the Nurse Practice Act, that facilitates the expectation that every nurse will continually advance his/her education and improve his/her practice. Establish and maintain a career advancement program that encourages nurses to advance their knowledge and ability to elevate their practice. Maintains itself by continually evaluating the membership and internal processes of the Council. Be accountable to establish methods of communicating among its members, other councils, and the individual nurse. Membership: All RN Members Unit Structure Accountabilities: The majority of the actual work process occurs at the unit level. The Unit/nursing staff will: Have a working knowledge of the model of care and maintain/adhere to the Model through work with their peers. Determine and ensure adherence to unit level performance standards. Address obstacles at the unit level, taking ownership to problem solve and resolve the obstacles. Ensure continual evaluation of the unit structure and process to maintain function and flow. Write policies/procedures related to their unit specialty, educating staff and ensuring adherence to them. Maintain a communication link from the Unit Council to the individual members of nursing staff.

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Design and maintain unit-based needs for the clinical advancement process using the established framework. Establish unit-specific competencies. Determine the unit Council structure including: number of members, representatives, rotation, frequency of meetings, and ensuring full staff participation using the established framework.

Nursing Education Council Purpose: The Nursing Education Council will provide the structure for all the nursing education for the hospital, provide educational framework for all levels of nursing care providers, and create an environment in which nursing staff feel they want learn, not just that they have to learn. Education Council Accountabilities: The Nursing Education Council will: Perform the hospital-wide needs assessment for the nursing organization Develop and maintain a system for general nursing orientation that defines the general competencies required for each level of nursing staff. Develop the annual plan for nursing continuing education and general in-services Set the appropriate number of continuing education units (CEUs) required for nursing staff Coordinate the communication for the nursing organization including the Newsletter and the Nursing Forums. Empower individual nurses to take responsibility for their own continuing education. Provide a framework for the unit-based education councils. Assist other councils in planning and structuring educational components of their work. Serve as a link for information on educational opportunities for nurses including professional nursing organizations. A calendar of available offerings is maintained in collaboration with Educational Services. Coordinate Nursing Celebrations. Maintain itself by continually evaluating the membership and internal processes of the Council. Collaborate with Educational Services to allocate resources for educational needs/assessment. Membership: (All RN Members, may include one LPN) Unit Structure Accountabilities: The unit/nursing staff will: Complete a unit needs assessment Develop the unit-specific orientation program for all levels of nursing staff. Develop unit specific CEU programs and in-services Define how the unit education budget will be utilized. Provide a structure for unit staff to communicate education needs. Maintain a communication link for the Unit Education Council and the individual staff Plan unit-based nursing celebrations Nursing Quality Council Purpose: Provides a framework for, evaluates processes, and facilitates activities related to continuous improvement of nursing care and performance of the nursing care provider. Accountabilities: The Nursing Quality Council will: Understand and be knowledgeable about the hospital quality improvement plan. Develop the nursing quality improvement plan and incorporate it with the hospital quality improvement plan Integrate the individual unit quality improvement plans with the hospital-wide nursing plan.

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Establish a mechanism to detect trends and patterns of performance that affect more than one department. This includes:

o Developing, monitoring and measuring tools o Monitoring effectiveness of established practices o Identifying trends from data and utilize Plan, Do, Check, Act (PDCA) format for performance improvement methodology o Communicating trends/opportunities to improve the affected worksites, committees and/or members of the healthcare team
Refer identified process improvements to appropriate council for collaboration, such as Education Council. Educate unit-based practitioners and worksites about quality tools. Maintain itself by continually evaluating the membership and internal processes of the council. Establish methods of communicating among its members, other councils, and the individual nurse. Membership: (All RNs with one LPN/CNA)

Unit-based Accountabilities:
The practitioner will: Demonstrate a basic understanding of performance improvement as it relates to their work. Be knowledgeable of process improvement activities utilizing PDCA, and regulatory standards/requirements as they apply to point of care Identify who, what, why, where, when, how of a process. (definition of quality) Use a tool kit to measure processes and evaluate progress (outcomes). (The seven basic data collection tools) Gather information to raise awareness and improve performance related to quality Identify variances that do not align with good nursing practice. Develop unit-based/point-of-service activities to incorporate hospital-wide key quality initiatives. Participate in unit-based/worksite specific activities that will lead to improvement and positive outcomes Create new stories that enhance the communication of process improvement activities. Be empowered to introduce new ideas and better ways of doing things. Anticipate and accept the noise around change.

Advanced Practice Nursing Council Purpose: To provide the vision and leadership to advance the practice of professional nursing at AWH.

Advanced Practice Nursing Accountabilities:

Support the mission and philosophy of AWH. Define the role and model of the Advanced Practice Nurse (APN) at AWH. This includes advancing professional nursing practice. Establish methods of communication among its own members, other councils, and individual nurses. Identify process improvement opportunities and refer to other councils as appropriate and assist with implementation into nursing practice. Promote the visibility and collaboration of APNs within nursing, other disciplines, and the community. Support and mentor nurses who are pursuing advanced degrees. Continue to look for methods that promote the principles of advanced leadership and standards of theory, education, research, and practice.

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Promote collaboration among APNs within AWH, Aspirus affiliates, and other organizations and entities.

Membership: Registered nurses functioning in advance practice roles including clinical nurse specialists, nurse practitioners, educators, administrators, researchers, clinical care coordinators, and those practicing at the clinical point of care (may include interested nurses near the completion of their Masters Degree). Additional members include the Chief Nursing Officer who is a representative from the leadership Council and/or a member of the Leadership Council. Nursing Coordinating Council Purpose: Coordinate, integrate and facilitate Collaborative Practice at AWH. Accountabilities: The Coordinating Council will: Develop the strategic plan for nursing at AWH. Resolve accountability conflicts between councils. Manage the evolution of the Collaborative Practice design. Membership: This council is comprised of council chairs, in addition to the Chief Nursing Officer and nursing directors as ad hoc member. (Taken from Aspirus Wausau Hospital Nursing Collaborative Practice Manual)

Article V
Healthy Work Environment Section 1. Definition AWH has made a commitment to actively promote the creation of healthy work environments that support and foster excellence in patient care wherever nurses practice. This commitment is based on the American Association of Critical Care Nurses (AACN) model and dedication to optimal patient care and the recognition that the deepening nurse shortage cannot be reversed without healthy work environments that support excellence in nursing practice. The creation of healthy work environments is imperative to ensure patient safety, enhance staff recruitment and retention, and maintain the organizations financial viability. AACNs six standards for establishing and sustaining healthy work environments have been identified. Putting forth these six essential standards for establishing and sustaining healthy work environments is an important step in meeting our commitment. AWH recognizes the inextricable links among quality of the work environment, excellent nursing practice and patient care outcomes. The standards represent evidence-based and relationship-centered principles of professional performance. Each standard is considered essential since studies show that effective and sustainable outcomes do not emerge when any standard is considered optional. The standards align directly with the core competencies for health professionals recommended by the Institute of Medicine. They support the education of all health professionals to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. With these standards, AACN and AWH contribute to the implementation of elements in a healthy work environment articulated in 2004 by the 70-member Nursing Organizations Alliance. The standards further support the education of nurse leaders to acquire the core competencies of self-knowledge, strategic vision, risk-taking and creativity, inter-essential personal and communication effectiveness, and inspiration identified by the Robert Wood Johnson Executive Nurse Standard Fellows Program. The standards are neither detailed nor exhaustive. They do not address critical dimensions such as elements of physical safety, clinical practice, clinical and academic education and credentialing, all of

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which are amply addressed by a multitude of statutory, regulatory and professional agencies and organizations. These standards are absolutely required; not to be used up or sacrificed. This is an authoritative statement articulated and promulgated by the profession, by which the quality of practice, service or education can be judged. Structures, processes, programs and behaviors are required for a standard to be achieved. The standards are designed to be used as a foundation for thoughtful reflection and engaged dialogue about the current realities of each work environment. Critical elements required for successful implementation accompany each standard. Working collaboratively, individuals and groups within an organization should determine the priority and depth of application required to implement each standard. Section 2. Standards Skilled Communication Nurses must be as proficient in communication skills as they are in clinical skills. Critical elements: The healthcare organization provides team members with support for and access to education programs that develop critical communication skills including self-awareness, inquiry/dialogue, conflict management, negotiation, advocacy and listening. Skilled communicators focus on finding solutions and achieving desirable outcomes. Skilled communicators seek to protect and advance collaborative relationships among colleagues. Skilled communicators invite and hear all relevant perspectives. Skilled communicators call upon goodwill and mutual respect to build consensus and arrive at common understanding. Skilled communicators demonstrate congruence between words and actions, holding others accountable for doing the same. The healthcare organization establishes zero-tolerance policies and enforces them to address and eliminate abuse and disrespectful behavior in the workplace. The healthcare organization establishes formal structures and processes that ensure effective information sharing among patients, families and the healthcare team. Skilled communicators have access to appropriate communication technologies and are proficient in their use. The healthcare organization establishes systems that require individuals and teams to formally evaluate the impact of communication on clinical, financial and work environment outcomes. The healthcare organization includes communication as a criterion in its formal performance appraisal system and team members demonstrate skilled communication to qualify for professional advancement. True Collaboration Nurses must be relentless in pursuing and fostering true collaboration. Critical elements: The healthcare organization provides team members with support for and access to education Programs that develop collaboration skills. The healthcare organization creates, uses and evaluates processes that define each team members accountability for collaboration and how unwillingness to collaborate will be addressed. The healthcare organization creates, uses and evaluates operational structures that ensure the decision making authority of nurses is acknowledged and incorporated as the norm. The healthcare organization ensures unrestricted access to structured forums, such as ethics committees, and makes available the time needed to resolve disputes among all critical participants, including patients, families and the healthcare team.

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Every team member embraces true collaboration as an ongoing process and invests in its development to ensure a sustained culture of collaboration. Every team member contributes to the achievement of common goals by giving power and respect to each persons voice, integrating individual differences, resolving competing interests and safeguarding the essential contribution each must make in order to achieve optimal outcomes. Every team member acts with a high level of personal integrity. Team members master skilled communication, an essential element of true collaboration. Each team member demonstrates competence appropriate to his or her role and responsibilities. Nurse Managers and medical directors are equal partners in modeling and fostering true collaboration.

Effective Decision Making Nurses must be valued and committed partners in making policy, directing and evaluating clinical care and leading organizational operations. Critical elements: The healthcare organization provides team members with support for and access to ongoing education and development programs focusing on strategies that assure collaborative decisionmaking. Program content includes mutual goal setting, negotiation, facilitation, conflict management, systems thinking and performance improvement. The healthcare organization clearly articulates organizational values and team members incorporate these values when making decisions. The healthcare organization has operational structures in place that ensure the perspectives of patients and their families are incorporated into every decision affecting patient care. Individual team members share accountability for effective decision making by acquiring necessary skills, mastering relevant content, assessing situations accurately, sharing fact-based information, communicating professional opinions clearly and inquiring actively. The healthcare organization establishes systems, such as structured forums involving all departments and healthcare disciplines, to facilitate data-driven decisions. The healthcare organization establishes deliberate decision making processes that ensure respect for the rights of every individual, incorporate all key perspectives and designate clear accountability. The healthcare organization has fair and effective processes in place at all levels to objectively evaluate the results of decisions, including delayed decisions and indecision. Appropriate Staffing Staffing must ensure the effective match between patient needs and nurse competencies. Critical elements: The healthcare organization has staffing policies in place that are solidly grounded in ethical principles and support the professional obligation of nurses to provide high quality care. Nurses participate in all organizational phases of the staffing process from education and planning including matching nurses competencies with patients assessed needs through evaluation. The healthcare organization has formal processes in place to evaluate the effect of staffing decisions on patient and system outcomes. This evaluation includes analysis of when patient needs and nurse competencies are mismatched and how often contingency plans are implemented. The healthcare organization has a system in place that facilitates team members use of staffing and outcomes data to develop more effective staffing models. The healthcare organization provides support services at every level of activity to ensure nurses can optimally focus on the priorities and requirements of patient and family care.

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The healthcare organization adopts technologies that increase the effectiveness of nursing care delivery. Nurses are engaged in the selection, adaptation and evaluation of these technologies.

Meaningful Recognition Nurses must be recognized and must recognize others for the value each brings to the work of the organization. Critical elements: The healthcare organization has a comprehensive system in place that includes formal processes and structured forums that ensure a sustainable focus on recognizing all team members for their contributions and the value they bring to the work of the organization. The healthcare organization establishes a systematic process for all team members to learn about the institutions recognition system and how to participate by recognizing the contributions of colleagues and the value they bring to the organization. The healthcare organizations recognition system reaches from the bedside to the board table, ensuring individuals receive recognition consistent with their personal definition of meaning, fulfillment, development and advancement at every stage of their professional career. The healthcare organizations recognition system includes processes that validate that recognition is meaningful to those being acknowledged. Team members understand that everyone is responsible for playing an active role in the organizations recognition program and meaningfully recognizing contributions. The healthcare organization regularly and comprehensively evaluates its recognition system, ensuring effective programs that help to move the organization toward a sustainable culture of excellence that values meaningful recognition. Authentic Leadership Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement. Critical elements: The healthcare organization provides support for and access to educational programs to ensure that nurse leaders develop and enhance knowledge and abilities in: skilled communication, effective decision making, true collaboration, meaningful recognition, and ensuring resources to achieve appropriate staffing. Nurse leaders demonstrate an understanding of the requirements and dynamics at the point of care and within this context successfully translate the vision of a healthy work environment. Nurse leaders excel at generating visible enthusiasm for achieving the standards that create and sustain healthy work environments. Nurse leaders lead the design of systems necessary to effectively implement and sustain standards for healthy work environments. The healthcare organization ensures that nurse leaders are appropriately positioned in their pivotal role in creating and sustaining healthy work environments. This includes participation in key decision making forums, access to essential information and the authority to make necessary decisions. The healthcare organization facilitates the efforts of nurse leaders to create and sustain a healthy work environment by providing the necessary time and financial and human resources. The healthcare organization provides a formal co-mentoring program for all nurse leaders. Nurse leaders actively engage in the co-mentoring program. Nurse leaders role model skilled communication, true collaboration, effective decision making, meaningful recognition and authentic leadership. The healthcare organization includes the leadership contribution to creating and sustaining a healthy work environment as a criterion in each nurse leaders performance appraisal. Nurse

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leaders must demonstrate sustained leadership in creating and sustaining a healthy work environment to achieve professional advancement. Nurse leaders and team members mutually and objectively evaluate the impact of leadership processes and decisions on the organizations progress toward creating and sustaining a healthy work environment.

(Taken from AACN Standards for establishing and sustaining healthy work environments)

Article VI
Nurse Credentialing Section 1. Definition Credentialing is a process of reviewing, verifying, and evaluating credentials. Credentials are a listing of the nurses education, training, experience, certifications, licensure and other professional qualifications. Credentialing will assure nurses are held to the highest standards of professional practice care for patients. The process includes self-verification, peer evaluation, and supervisor review. This should be initiated at the point of hire. It becomes the responsibility of the individual to keep their credentials up to date for review yearly. Section 2. Background The profession of nursing has become increasingly complex. Research continually highlights the contributions of nursing to quality patient care. Between the core of nursing practice outlined in the Scope and Standards of Nursing Practice, to achieving specialty certifications, each nurse chooses his/her own path of professional growth. Although initial educational standards for Registered Nurses exist, standards of continued nursing competence have yet to be developed. Competence must be ensured in the clinical setting. Through credentialing, the nurse can demonstrate his/her competence and professional achievements to ensure that caregivers are held to the highest professional practice standards of care for patients. The process includes self-verification, peer review, and supervisor review. Literature suggests that the professional nursing portfolio is an excellent tool for self-evaluation of professional growth. This also offers the professional nurse to define his or her strengths as well as opportunities for professional improvement. Section 3. Vision & Philosophy The professional portfolio, developed over time, facilitates both external evaluation and self-reflection. Periodic review of ones portfolio would provide feedback on growth, goal achievement, career path, and competence. The professional portfolio is a showcase of background and expertise. The development of a Registered Nurse Credentialing Program at AWH evolved from the need for a method to both encourage and facilitate the professional growth of the Registered Nurse in the clinical setting. AWH uses the program to initiate and guide the nurse in the provision of excellence in nursing care. Section 4. Conceptual Framework Nursing professional development refers to professional nurses effort to actively seek and participate in learning activities that enhance their practice, competence, and career goals. These activities build on the experiences and education associated with the careers of nurses with the primary goal of promoting the delivery of excellent healthcare to the public. A mindset of lifelong learning motivates nurses to seek activities that improve their competence and increase their contributions to the profession. Continued learning can include continuing education and staff development activities as well as formalized undergraduate/graduate education and obtaining specialty certifications. Professional

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organization membership can be passive/supportive, or very active. Maintaining licensure may depend on the attainment of continuing education contact hours; regardless, changes across practice arenas require nurses to constantly update their knowledge and skills. The ability to increase expertise and flexibility will continue to be in demand. Positioning within the profession to achieve this flexibility and expertise requires career commitment, continuous self-development, a passion for nursing, and a strong foundation as a leader (Dadich and Yoder-Wise, 2003). Section 5. Benefits Some of the key benefits of the Registered Nurse Credentialing Program for the nurse are: 1. The opportunity to work at a level commensurate with his/her professional development. 2. The opportunity to evaluate his/her own clinical performance and to identify developmental deficiencies specific to his/her current and anticipated levels of practice. 3. Monetary incentives for those who chose to advance their degrees and/or further upgrade clinical skills. 4. The recognition of proficiency in clinical and leadership skills. Section 6: Goals The goals for the RN Credentialing Program are to: 1. Improve patient outcomes 2. Recognize and reward clinical nursing practice at all levels 3. Enable professional nursing progression through recognition of clinical levels 4. Encourage clinical nurse involvement in organizational growth 5. Retain qualified nursing staff 6. Strengthen nursing recruitment, retention, and job satisfaction The Registered Nurse Credentialing Program provides the professional nurse the opportunity to work towards advancement, recognition, and professional growth within a framework that is individualized in focus and exhaustive in scope. Section 7: Credentialing Components All Registered Nurses at AWH must meet these credentialing standards: Licensure to practice in the state of Wisconsin Nurses are encouraged to obtain unless otherwise defined in their job description: certifications, accreditations, and certificates. Completion of Mandatory education Documentation of continuing education requirements Evidence of satisfactory criminal background check Possession of the knowledge/skill sets listed on the job description Completion of hospital/unit specific orientation Health screen/status: a. Tuberculosis - Annual Purified Protein Derivative (PPD) test. If the clinician has had a previous positive PPD skin test, documentation of the positive PPD skin test, Chest X-ray and Physical evaluation done at the time of the positive PPD are required. b. Hepatitis B - Documentation of positive surface antibody or appropriate vaccination record and antibody titer c. Measles - Documentation of positive titer or appropriate vaccination (two doses of live measles vaccine at least 28 days apart or after first birthday given subcutaneously). d. Mumps Documentation of positive titer or appropriate vaccination (two doses of mumps live vaccine at least 28 days apart or after first birthday given subcutaneous.)

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e. Rubella Documentation of positive titer or appropriate vaccination (one dose of rubella live vaccine). f. Chicken Pox Documentation of positive titer, or documentation of appropriate vaccination. If negative history, documentation of a varicella titer is required. g. Attestation of no present use of illegal drugs or substances. Completion of preemployment drug and/or alcohol screen in accordance with AWH Drug and Alcohol Free Workplace Policy h. Attestation and demonstration of the physical and emotional ability to perform the essential functions of the employment position, with reasonable accommodations if necessary. Section 8: Performance Review AWHs performance review process has three objectives: 1. To measure individual job performance 2. To identify opportunities for improvement and advancement 3. To develop professional skills through open and constructive feedback Successful job performance requires a clear understanding of what work is to be performed (expectations), desired outcomes, and how well the work has been completed (outcome achievement). Performance appraisal ensures that employee and supervisor expectations are aligned. Through this process, the employee and supervisor collaborate to improve job performance and grow professionally. The appraisal emphasizes the following components: Core Behaviors typify AWHs core values. Generally, strengths and areas for improvement in behavioral areas are consistent with strong job performance. However, an individual may achieve significant results while still demonstrating negative behaviors inconsistent with our values and culture. Job Responsibilities focus on measuring performance related to current job accountabilities and any assigned special projects. Professional Development and Growth Plan ask the nurse and supervisor to establish developmental areas of growth or educational goals for the upcoming year. Section 9. Mandatory Annual Education Once nurses complete their hospital and unit-based orientations, as applicable to their role, they must continue to meet mandatory educational conditions of employment, including, but not limited to: Required hospital-wide competencies assigned annually during the anniversary month of their hire. Current CPR certification and any other mandatory certifications (e.g., Advanced Cardiac Life Support (ACLS), Trauma Nurse Core Course (TNCC), Pediatric Advanced Life Support (PALS), Neonatal Resuscitation Program (NRP)) deemed necessary to perform their roles EPIC proficiency maintained and updates attended. Age-specific competency training to ensure that nurses are qualified to care for patients with agespecific needs Cultural diversity competency. Required unit-based educational opportunities.

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Section 10. Continuing Education AWH believes that continuing education for all staff is essential to our future. A minimum of 0.7 Continuing Education Units (CEUs) are required (7 contact hours) annually, measured from March 1st to March 1st. One tenth of a CEU equals one hour of education. One contact hour equals one hour of education. A maximum of ten contact hours related to formal credits are allowed. One college credit equals three contact hours as defined by AWH Education Council. The college credit will be allowed if it pertains to nursing. Example: Credits from psychology class will be accepted. Credits from an Art, English, or Geography class will not be accepted. Section 11. Peer Evaluation Process At AWH we value and encourage some form of peer evaluation. Peer Evaluation is the process by which performance of the Registered Nurse is evaluated by a group of his or her peers. Annually, each unit elects a team of Registered Nurses to comprise the evaluation team, based on nominations from their peers. The team is then required to sign a document to insure confidentially and that information sharing is only with the unit Director or supervisor. Upon evaluation, the individual nurse may choose to participate in the discussion or receive written feedback. Each team uses a tool, such as the American Nursing Association (ANA) Standards of Practice or the American Association of Critical Care Nurses (AACN) Standards of Care for Acute and Critical Care Nurses, as a guideline for evaluating the practice of each nurse. A copy of the ANA Scope and Nursing Standards of Practice can be obtained from the AWH Medical Library. The AACN Standards of Practice are found in Appendix A. Upon completion of evaluations, each nurse receives a written synopsis of the peer evaluation. A copy is given to the unit director to be utilized as part of the annual evaluation process. Individuals are encouraged to discuss any components of their evaluation with team members. Section 12. Clinical Advancement Program (CAP): The Clinical Advancement Program (CAP) is a voluntary program that is designed to recognize nurses who advance nursing practice through research, mentoring, and collaboration. This program rewards nurses who go beyond excellence in bedside care. CAP is independent from the annual performance appraisal, but the same portfolio can be used for both processes. The program is based on Benners novice-to-expert theory: Novice Practitioner: 1. Tends to be more formal, very focused on tasks 2. Obtains and uses theory, focused on rules, policy and procedures 3. Does not incorporate context with cares 4. Thinks in the abstract Advanced Beginner: 1. Applies theory to actual situations 2. Manages according to rules and procedures 3. This heralds a time of rapid learning and requires great mental effort 4. Tends to focus on work as if a working machine 5. May guide learning in an effort to hone skills Competent: 1. Encompasses much practical know-how 2. Sees relational aspects of situation 3. Strives to limit the unexpected 4. Feels good when things go well 5. Feels bad when things go bad.

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Proficient: 1. Sees changing relevance of aspects, risk taking 2. Increase in pattern recognition 3. Is attuned to the situation 4. This is also a time of rapid learning 5. Sees what needs to be done, but still needs to decide how to do it Expert: 1. Comprehends the whole picture or situation 2. Draws upon vast knowledge and situations 3. Sees what needs to be done and does it almost simultaneously (Haag-Heitman, 2005) Clinician One and Clinician Two are designations that indicate proven proficiency or expertise in the field of nursing. The general characteristics of nursing performance at each of the two levels follow: Clinician I Employee in good standing at AWH for a minimum of one year who meets the minimum educational criteria: Associate degree in Nursing with Specialty Certification Diploma in Nursing with Specialty Certification Bachelor of Science in Nursing (BSN) Clinician II Employee in good standing at AWH for a minimum of one year who meets the minimum educational criteria: BSN with Specialty Certification Masters of Science in Nursing Applications and guidelines for the portfolio are obtained from AWHs Human Resource Department. Nurses who earn Clinician I or II recognition are rewarded an educational stipend to be used for professional development. (Clinical Advancement Program, 2007)

Article VII
Nursing Ethics Nursing ethics is the discipline of evaluating the merits, risks, and social concerns of activities in the field of nursing. There are many defined codes of ethics for nurses. Nursing ethics share many principles with other branches of health care ethics, such as beneficence and non-maleficence, but apply within the nursing profession. (ANA Code of Ethics, 2001). The nurse integrates ethical provisions in all areas of practice in accordance with the ANA Code for Nurses and AWH Policies and Procedures. Ethical nurses: 1. Deliver care in a manner that preserves/protects patient autonomy, dignity and rights. 2. Maintain patient confidentiality and privacy within legal and regulatory parameters. 3. Serve as a patient advocate and assist patients in developing skills so they can advocate for themselves. 4. Maintains a therapeutic and professional patient-nurse relationship with appropriate professional role boundaries. 5. Contributes to resolving ethical issues of patients, colleagues or systems. 6. Reports illegal, incompetent, or impaired practices in accordance with the Wisconsin Nurse Practice Act and AWH Policies and Procedures. (Adapted from St. Joseph Hospital, 2004)

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Article VIII
Peer Review Section 1. Definition and Purpose Nursing Peer Review (NPR) is the process by which practicing RNs are systematically assessed and receive recommendations about the quality and appropriateness of nursing care provided from their peers. Standards of Practice are defined by the Nurse Practice Act of Wisconsin and AWH Professional Standards of Care. The NPR committee will make recommendations that facilitate a nurses successful practice of high quality, competent nursing care. This work occurs solely among peers who are dedicated to an environment of CARE and CARING. Nursing Peer Review (NPR) is designed to provide a process for fact-finding, analysis, and study of events by nurses in a climate of collegial problem solving. It is focused on obtaining all relevant information about an event, and making recommendations of corrective actions. The purpose of Nursing Peer Review (NPR) is to maintain standards of nursing practice in a non-punitive manner while encouraging peer support. Section 2. Nursing Peer Review Utilization Policy See Nursing Peer Review Utilzation Policy 4317

Article IX
Nursing Leadership Section 1. Role of Nurse Executive in the Professional Organization The role and responsibility of the Vice President/Chief Nursing Officer (CNO) is to ensure the highest degree of safety and quality in nursing care for the patients served at AWH. The CNO is a collaborative member of the AWH Executive Team and participates on the Accountability Committee of the Board of Directors, the Hospital Quality Review Committee, the Medical Executive Committee, and represents nursing at all levels of the organization. In conjunction with the highest standards of nursing practice, the CNO reflects the strength of nursing by leading through a clearly articulated vision and strategic planning process for the organization. The CNO empowers the nursing staff through facilitation of the Forces of Magnetism, Healthy Work Environment, and Collaborative Practice. The CNO is a voting member on the Coordinating and Leadership Councils and an ad hoc member of the other house-wide councils. The CNOs professional practice is continuously enhanced and focuses on the energies and abilities of all nurses at AWH to provide superior nursing care. The CNO promotes professional development of nurses and facilitates leadership succession planning. Section 2. Role of Management in the Nursing Department The role of nurse management within AWH is to collaborate with staff to set the vision and goals within individual nursing departments consistent with the organization, oversee operations, ensure accountability of its members, and foster an environment conducive for professional practice. This environment promotes individual and team development, continued education, and performance improvement. The role of management in the nursing department is to work collaboratively with its members in evaluating the departments achievements and outcomes and assuring safe patient care with measurable quality outcomes.

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CONCLUSION
Professional nursing must be defined. For years, the profession has floundered, not realizing nursings impact on society. This document provides definitions that can be utilized to educate those within the profession, the public and other professions as well. We are interdependent practitioners, scientists, contributors to society, and independent decision makers with regards to patient care. With acknowledgement and ownership of our accomplishments, we advance our profession. These advances result in nursing excellence, and the public and our patients reap the benefits. We must strive for excellence, for nothing else is acceptable.

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REFERENCES
AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. Downloaded 8/17/2007 from www.aacn.org. American Association of Critical Care Nurses. Standards of Care for Acute and Critical Care Nurses. Downloaded 10/14/07 from www.aacn.org. American Nurses Association (2001). ANA Position Statement: The Non-negotiable Nature of the ANA Code for Nurses with Interpretative Statement. Available at: www.nursingworld.org/mainmenucategories/thepracticeofprofessionalnursing/ethicsstandards. American Nurses Association. (2000). Scope and Standards of Practice for Nursing Professional Development. Washington DC: American Nurses Association.

ANCC Forces of Magnetism. Downloaded 10/27/2008 from www.nursecredentialing.org

Aspirus Wausau Hospital Clinical Advancement Program (CAP), 2007. Aspirus Wausau Hospital Policy on Credentialing Standards for Physicians, On Base #6008, 2000. AWH Nursing Collaborative Practice manual. Gengler, T. (2005). On Base #5603, Mission and Values of Aspirus Wausau Hospital. Dadich, K., & Yoder-Wise, P. (2003). Career management: Putting yourself in charge. In P. YoderWise (Ed.), Leading and managing in nursing (3rd ed.). St. Louis: Mosby. Gengler, T. (2006). On Base #5593 Nursing Practice Conceptual Design/Caring Model. Haag-Heitman, B. (2005). Clinical Practice Model. Landwehr, D. and Blair, C. (2004). Aspirus Wausau Hospital Policy and Procedure #4317, Nursing Peer Review Committee. Olean General Hospital, Division Of Nursing By Laws. From www.ogh.org/professional/bylaws.htm Downloaded 7/22/2007. Porter-OGrady, T. (2001). Is shared governance still relevant? JONA, 31 (10), 468-473. St. Joseph Hospital, Nursing Bylaws (2004). Downloaded 7/22/07. From www.st.jospephhospitalnursingbylaws.org

State of Wisconsin Department of Regulation http://drl.wi.gov/prof/rn/def.htm Downloaded 7/22/2007.

and

Licensing

Code

Book,

2006

Wisconsin Nurse Practice Act (1999). Downloaded from www.wisconsinnurses.org 10/31/2008.

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APPENDIX A
Standards of Care for Acute and Critical Care Nursing Practice STANDARD OF CARE I: ASSESSMENT The nurse caring for the acutely and critically ill patient collects relevant patient health data. STANDARD OF CARE II: DIAGNOSIS The nurse caring for the acutely and critically ill patient analyzes the assessment data in determining diagnoses. STANDARD OF CARE III: OUTCOME IDENTIFICATION The nurse caring for the acutely and critically ill patient identifies individualized, expected outcomes for the patient. STANDARD OF CARE IV: PLANNING The nurse caring for the acutely and critically ill patient develops a plan of care that prescribes interventions to attain expected outcomes. STANDARD OF CARE V: IMPLEMENTATION The nurse caring for the acutely and critically ill patient implements interventions identified in the plan of care. STANDARD OF CARE VI: EVALUATION The nurse caring for the acutely and critically ill patient evaluates the patients progress toward attaining expected outcomes. Standards of Professional Performance for Acute and Critical Care Nursing Practice STANDARD I: QUALITY OF CARE The nurse caring for the acutely and critically ill patient systematically evaluates the quality and effectiveness of nursing practice. STANDARD II: INDIVIDUAL PRACTICE EVALUATION The nurse practice reflects knowledge of current professional standards, laws, and regulations. STANDARD III: EDUCATION The nurse acquires and maintains current knowledge and competency in the care of acutely and critically ill patients. STANDARD IV: COLLEGIALITY The nurse caring for the acutely and critically ill patient interacts with and contributes to the professional development of peers and other healthcare providers as colleagues. STANDARD V: ETHICS The nurses decision and actions on behalf of acutely and critically ill patients are determined in an ethical manner.

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STANDARD VI: COLLABORATION The nurse caring for the acutely and critically ill patient collaborates with the team of patient, family, and health care providers in providing patient care in a healing, humane, and caring environment. STANDARD VII: RESEARCH The nurse caring for the acutely and critically ill patients uses clinical inquiry in practice. STANDARD VIII: RESOURCE UTILIZATION The nurse caring for the acutely and critically ill patient considers factors related to safety, effectiveness, and cost in planning and delivering patient care.

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Aspirus Wausau Hospital Nursing Bylaws

Acknowledgement

I acknowledge I have received and have read the Aspirus Wausau Hospital Nursing Bylaws. I understand that Aspirus expects me to promote the practice of nursing, and to contribute to and participate in the development of the nursing profession as outlined in the bylaws.

Name (Print):______________________________________________________

Signature:____________________________________________________ Date:________________________________________________________

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