Nursing Philosophy
Nursing is the diagnosis and treatment of human responses to actual or potential health problems. Patient-centered nursing care promotes autonomous decision-making, leadership skills, collaboration with all health team members, is based on standards and research, recognizes nursing’s accountability for patient care, care coordination, education and advocacy, and values a healthy balance of mind, body and spirit.

Nursing Practice Model
The management of the patient’s care includes planning and providing care, monitoring its results, modifying or completing care and coordinating follow-up to help ensure that the patient’s care needs are met or referred. Multiple nursing theories are applied.

Family-Centered Care
A model based on the philosophy that the physical, social, psychological, spiritual and economic needs of the total family unit, however the family may be defined, are integrated and considered collectively.

In the family-centered care model, the patient and family are the central component, and they are supported by the hospital disciplines: nursing, respiratory care, social work, spiritual care, support services (pharmacy, imaging, lab, etc.), therapies (physical, occupational and rehabilitative), nutrition and medicine.

The nursing process serves as the framework for the delivery of coordinated patient care. The Functional Health Assessment, including physical, psychological and social components determines unidentified nursing diagnoses. Problems/needs are addressed on the plan of care with defined goals and interventions. Progress toward goals is evaluated and the plan modified as needed.

Professional Nursing Practice Standards

• Is to partner with and advocate for patients, families and loved ones.
• Is present to touch, heal and teach.
• Is to collaborate with physicians and health care professionals.
• Is to provide independent, interdependent and delegated interventions.
• Is accountable for the outcomes of our interventions.
• Evolved through research.
• Values and healthy balance in our own lives.

Case Management Model of Care
Coordinated care is population-based, across the continuum from pre-admission to post discharge, as needed. It is based on the professional nursing practice standards resulting in a healthy balance of mind, body and spirit. Level of care coordination is based on:

• overall plan of care needs
• patient's response to care delivered
• family involvement
• patient education needs
• discharge planning needs
• care settings involved (number and intensity)
• number of disciplines involved
• number of specialists involved
• length of stay.

Clinical Ladder Program
The Clinical Ladder Program at St. Cloud Hospital is designed to support growth in professional practice. The program:

• recognizes and rewards professional nurses for their clinical expertise
• empowers professional nurses to function as leaders
• promotes professional outreach/education.

The program is self-governed by registered nurse representatives from each area of the hospital. This group serves as a review panel for applicants seeking to achieve Clinical Ladder 3 or 4. The program has been in place 15 years and has active involvement from staff and great leadership support.

For more information, contact:

• Linda Donabauer, R.N., B.S.N., administrative nursing supervisor, at (320) 251-2700 or e-mail.

Nursing Research
Nursing research is promoted as a part of practice at St. Cloud Hospital and is supported by a Nursing Research Committee that promotes a philosophy of evidence-based practice. There is an increasing emphasis on using research as part of clinical and administrative decision-making.

Nursing research is promoted through:

• journal clubs
• Health Science Library journal holdings
• assistance from librarians with literature reviews
• Nursing Research Committee consultations
• integration of evidence into policies/procedures
• brown bag research presentation sessions featuring hospital RNs and faculty
• Nursing Week posters
• link for nursing research activities on hospital Intranet
• clinical ladder opportunities in research
• experienced nurse researchers as consultants
• Nursing Research Review Board consultations and approvals

We have a very active performance improvement program in which staff nurses are involved in reviewing nursing practice, asking “questions” and collecting/analyzing clinical data. Staff RNs are encouraged to actively participate in planning and implementing practice changes based on research. Performance improvement can be a bridge or stepping-stone to nursing research.

Nursing Committees
Nursing Resource Management
The goal of resource management is to have a nursing staffing system that is effective at the unit levels as well as hospital-wide, to ensure appropriate distribution of resources for deficits and increase in demand. Deficit demand is a very critical piece that is considered. Areas to consider include clinical (patient care activity and acuity), operational, cost-effectiveness and human resources (respectful to employees). Components include budget, schedule, daily staffing and management information. The Resource Management Committee is responsible for predicting service demand (open positions, critical staffing needs and historical labor intensity). Tools used to support resource management include: Census trends, admission trends, ADT ratios, LOS, DRG mix, schedule holes report, float staff utilization report, premium pay, HPPD, productive and non productive hours trends, patient satisfaction survey results, employee satisfaction survey results and staffing effectiveness analysis. Staffing plan includes consideration of openings, applicant pools, turnover data, new grad information, scope of nursing practice permitted by state law and hospital policies.

For more information, contact:

• Linda Chmielewski, R.N., M.H.A., vice president operations, chief nursing officer, at (320) 251-2700 or via e-mail.

Administrative Nursing Practice Committee (ANP)
This group is a subset of a larger group that provides a coordinated approach to addressing administrative patient care issues. Nursing leaders address patient care issues specific to the practice of nursing which may include clinical responsibilities, staffing, budgeting, job descriptions, review of administrative policies and regulatory/professional standards. ANP facilitates effective and appropriate communication and decision-making regarding nursing delivery systems, nursing practice and nursing process. ANP coordinates key activities related to recruitment and retention, recognition, peer review, student affiliations and research.

For more information, contact:

• Linda Chmielewski, R.N., M.H.A., vice president operations, chief nursing officer, at (320) 251-2700 or via e-mail.

Clinical Nurse Practice (CNP)
Advanced practice and staff nurse representatives address clinical practice issues to include standards of care/practice, policy/procedures and clinical documentation forms/systems, to provide direction for evidence-based practice and dissemination of best practices. The group is a subset of a larger multidisciplinary team that provides a coordinated approach to patient care practice and issues. The CNP group revises policies/procedures, standards of care, skill sets and validation checklists. The group works with the development and monitoring of documentation systems, approves chart forms and order, provides input to ANP regarding clinical practice models and implementation of care delivery systems, strategic planning, goal-setting and performance improvement issues.

For more information, contact:

• Joannie Nei, R.N., B.S.N., orientation/educator/clinical materials management, at (320) 251-2700 or via e-mail
• Linda Chmielewski, R.N., M.H.A., vice president operations, chief nursing officer, at (320) 251-2700 or via e-mail.

Administrative Nurse Practice Committee - Performance Improvement (ANPC - PI)
Staff nurses and nursing leaders are responsible to plan for, monitor and evaluate nursing practice performance improvement activities throughout the organization. The group develops an annual house-wide PI plan, goals and measurement criteria and then monitors and reports the results. They coordinate evaluation of nursing practice when appropriate with medical staff and other disciplines. The group makes recommendations for practice improvement and refers to other committees are needed.

For more information, contact:

• Linda Chmielewski, R.N., M.H.A., vice president operations, chief nursing officer, at (320) 251-2700 or via e-mail.

Education Council
Staff nurses and educators provide a coordinated approach to support the achievement of specific educational outcomes and competencies throughout the organization. The group develops, implements and evaluates educational goals, methods, objectives and long-range plans. The nursing subgroup considers the nursing philosophy, St. Cloud Hospital mission, values and culture statement as well as regulatory needs. The group also conducts an annual needs assessment that specifically addresses house-wide nursing needs based on changes in practice, performance improvement, regulation, new equipment/technology and high-risk/low-volume issues. The group reviews general orientation and plans and revises generic competency based orientation and assessment. In addition, the group gives input into the nursing specific house-wide orientation.

For more information, contact:

• Larry Asplin, R.N., M.S.N., co-chair, at (320) 251-2700 or via e-mail
• Linda Chmielewski, R.N., M.H.A., vice president operations, chief nursing officer, at (320) 251-2700 or via e-mail.

Nursing Consultations/Resources
St. Cloud Hospital nurses have areas of expertise they are willing to share/consult based on availability/time commitments. To contact any of the resources listed below, please call (320) 251-2700.