Implementation Challenges of a Renal Nursing Professional Practice Model

503 formed. Membership included: registered nurses (RN); nurse practitioners/clinical nurse specialists (NP/ CNS), the renal clinical educator, management personnel, and members of the Professional Pr a c t i c e Leader Nursing Te a m . The process of PPM development took approximately 2 years from design to implementation. The PPM was implemented across all sites and in the regional community HD units. The definition of a PPM that guided the development of our model is: A set of integrated beliefs, values, philosophy and vision which directs individual nurses in their practice and guides the organization in its relationship with nursing. It should include a shared decision making framework that provides and empowers nurses with increased opportunities for autonomy, accountability, responsibility, control over their clinical practice and collaboration (Zelauskas & Howe, 1992). A PPM is more than a care delivery system and includes a number of interrelated and critical elements that represent the principles, structural supports, and relationships central to the nursing practice system ( Wong et al., 1997, p. 5). Principles from the work of Benner (1984) as well as Wo l f , Boland, and Aukerman (1994) were incorporated into the theoretical framework of our model. Co n c e p t s from case management and primary nursing were adapted to guide the nursing care delivery system. In 1997, there was a corporate initiative toward articulating professional nursing practice in the organization. Nursing leaders developed recommendations for professional nursing practice (Wong et al., 1997). In addition, the renal program was facing further fiscal restraint and the pending merger of two different hospitals. The team acknowledged the associated challenges and adapted the organization's plan for professional nursing practice. The London Health Sc i e n c e s Centre (LHSC) is an academic teaching center that provides a wide range of programs and services to approximately 1.6 million people in So u t hwestern Ontario. The renal services provided are comprehensive and include: general ambulatory nephrology, care for patients with progressive renal insufficiency, three hospital hemodialysis (HD) units, seven regional community HD units, selfcare and home HD, daily/nocturnal HD, peritoneal dialysis, and renal transplantation. An interdisciplinary team provides care across the continu u m . The PPM is a transformational model of care. It is utilized throughout the renal program in HD, peritoneal dialysis, and will be applied on the inpatient nephrology ward of one site when the renal program assumes leadership for this area in the future. A renal professional practice steering committee of 24 individuals with representation from all sites was Implementation Challenges of a Renal Nursing Professional Practice Model