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By Gen Guanci

Advancing Professional Practice 

When asked if nursing is a profession, the response is an overwhelming YES. Yet, when asked what makes that so, most struggle to explain. Is it our education? Is it our numbers? Is it the fact that we carry a license? Internet search results show a profusion of professional practice models (PPM) and limited references explaining what professional practice is.  

The Creative Health Care Management, Culture of Excellence team has dedicated 2025 to advancing and understanding nursing professional practice. To that end, starting with this edition, you will see a focused professional practice article in our quarterly Excellence Exchange newsletter, free webinars addressing topics such as various professional practice components, and social media posts that deepen the understanding of professional practice.   

What is Professional Practice? 

As mentioned earlier, internet search results for nursing professional practice displayed various PPMs yet limited explanations of what makes up professional practice. 

While many know that a PPM is “a schematic description….that depicts how nurses practice, collaborate, communicate, and develop professionally to provide the highest quality care….” (ANCC, 2023 Magnet Application Manual, pg 200), they struggle to articulate what professional practice is. When we look at nursing, we know that no one factor or tenet makes us a professional. It is a combination of several tenets, including the following. 

Well-defined and standardized body of knowledge 

No matter where an individual completes their entry education or how long it takes to achieve essential licensure, all must pass a State licensure examination based on the same standardized body of knowledge.   

Code of ethics and a system of values 

While every profession has a code of ethics, nursing is governed by the American Nurses Association Code of Ethics for Nurses, which outlines the principles and values that must guide the behavior and decision-making of a nurse. It is the “social contract that nurses have with the U.S. public. It exemplifies our profession’s promise to provide and advocate for safe, quality care for all patients and communities.” (https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/, retrieved 2.2.2025)  

Continued professional development 

Professional development includes ongoing education to ensure competence with the rapid healthcare changes and advancement in formal education, including BSN, MSN, and DNP achievements. In her book Notes on Nursing, Florence Nightingale shares, “Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back” (Nightingale, 1860). 

Control over nursing practice and the practice environment 

No matter the profession, professionals control their practice within the confines of regulatory requirements and licensure scope of practice. The same is true for nursing. The most common demonstration of this is seen through the operationalization of shared decision-making/shared governance in which those delivering the care are empowered to make data-driven decisions, create associated action plans, and foster ownership of the outcomes of the plans. 

Driven by evidence-based practice, practice-based evidence, and research 

Gone are the days when nursing only did things because “that is how we always did it.”  Today’s nurses ask questions such as “Why do we do XYZ?” and “Is there a better way to do XYZ?” We have turned to the literature to find evidence of why we should or should not provide certain types of care. Nurses are contributing to the advancement of nursing as an intellectual discipline through the completion of research and the translation of that research into practice. 

Autonomous practice  

Noted nurse researcher and educator Marlene Kramer describes autonomy as the “freedom to act on what one knows.” (Krammer, 2003). It is “the ability to make the right decision for the patient at the moment that it matters” (Guanci, 2022). Today, nurses develop and utilize many nurse-driven protocols, such as urinary catheter removal, ventilator weaning, and diet advancement. These empower nurses to use the depth and breadth of their knowledge and clinical judgment.   

Peer review and feedback 

Peer review and peer feedback are vital tenets of professional practice with different aims. The American Nurses Association (ANA) defines peer review as a “process by which practicing registered nurses systematically assess, monitor, and make judgments about the quality of care given” (ANA, 2023). I define peer feedback as “an active, supportive practice to professionally acknowledge and enhance a colleague’s performance” (Guanci, 2022).  

Unique relationship with the patient 

While caring and compassion are not individual tenants of professional practice, we know that caring is the essence of nursing practice. Yet caring alone does not make one a professional. It is the individualized and unique relationships we build with each patient as we enter into their sacred space. We develop an individualized relationship with our patients by following the therapeutic practices of attuning, wondering, following, and holding.  

As the Cultures of Excellence team continues to foster the understanding of nursing professional practice, check our website for articles, news, and events. https://chcm.com/news-events/ 

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