The Transformational Model for professional nursing practice, is a model that describes various components that are necessary to support and develop professional nursing practice and the processes necessary to meet the challenges of tomorrows health care system. The model is based on the following assumptions;

• Quality of patient care must be maintained or improved.
• Financial resources are likely to be reduced, and,
• Consumer and caregiver satisfaction must be maintained or improved.

Underpinning the model are four main components;

1. The professional practice component.
2. The process component.
3. The primary outcome component, and,
4. The strategic outcome component.

The ideal organisation in which to implement this model is the learning organisation. This is an organisation where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspirations are set free, and where people are continually learning how to learn together. This paper will focus primarily on the Professional Practice component, which is further divided into four separate sections;

1. Transformational Leadership.
2. Patient Care Delivery System.
3. Professional Development, and,
4. Collaborative Practice.

Each of the four sections that make up the Professional Practice component is made up of a number of value statements that support the notions of Transformational Leadership, Patient Care Delivery, Professional Development, and Collaborative Practice. Once the value statements are defined and understood objectives can be established that meet and support the values and then a strategic plan can be developed to achieve the desired outcomes.

Transformational Leadership:

This section of the professional practice component illustrates the type of leadership necessary to shift organisational culture and paradigms. Transformational leadership is viewed as an interactive relationship based on trust, that impacts positively on the leader and employees. It is a mutual responsibility of both, and as leadership transforms, the purposes of the leader and employee become focussed, creating unity, wholeness and a collective purpose. There are seven value concepts that support transformational leadership within the model;

1. Hardiness - Personality characteristics that reflect an individual perception of commitment, challenge and control. Hardy individuals have a strong commitment to self and work, believe they are in control of events and see difficult events as a challenge instead of a crisis.
2. Empowerment - An awareness of one’s personal talents and power and how they can contribute to the organisations goals.
3. Vision - Delineation of a possible and desirable future state.
4. Decentralisation – A management philosophy that allows decision making to occur at the lowest, most appropriate level.
5. Participative Management - A management philosophy in which the employee’s input is considered an important contribution to the decision making process.
6. Organisational Culture - Values and beliefs of the organisation that prescribe the behaviours necessary for the organisation to achieve its goals. In Transformational cultures, trust, caring, mutual respect, and enthusiasm are common characteristics.
7. Operating Systems – The various systems and methods used to accomplish the organisations goals.

Patient Care Delivery System:

The patient care delivery system should allow for a significant amount of consumer input and provide for the careful use of limited resources through partnership and negotiation. To accomplish this, the patient care delivery system should be designed to give one nurse the responsibility, authority, and accountability for planning, organising and evaluating nursing care throughout the patient episode. There are six value concepts that support this level of practice.

1. Responsibility - Those things that one is assigned and accepts the obligation of performing.
2. Authority - The power granted to fulfil a responsibility and the right to act.
3. Accountability - A formal obligation to be answerable for what one has done.
4. Standards of Care - Nursing processes used to achieve specific patient care outcomes.
5. Quality Assurance - Evaluation of nursing processes and their relationship to patient outcomes.
6. Resource Utilisation - The use and control of organisational resources to meet patient needs.

Professional Development:

The nursing profession as an applied discipline is evolving within a dynamic body of knowledge. The quality of nursing practice is contingent on the knowledge of individual practitioners and their willingness to engage in professional relationships and behaviours. Nurses need to have the skills and knowledge to explore, validate, and direct the evolution of nursing practice. Within the model, five value concepts support professional development.

1. Knowledge Base - The grounding knowledge base on which clinical practice decisions are made.
2. Continuing Education - Continuing learning activities that are designed to benefit the individual and the profession.
3. Mentoring and Networking - Professional relationships that are established with the intent of supportive growth for the individual and the profession.
4. Research - Qualitative and or quantitative inquiry into factors affecting professional nursing practice.
5. Career Development - Purposeful, planned strategies that are designed to enhance short and long term professional goals.

Collaborative Practice:

This section describes the framework for the development and ongoing support of relationships between and among professionals working in the unit. This framework is composed of the formal structures of the organisation, such as policies, procedures, committee structures and reporting relationships. But more importantly, addresses the components of the social culture of the work environment. It encompasses the expectations, personal values, and the interpersonal relationships of the people within the unit. There are four value concepts supporting collaborative practice.

1. Professional Communication - Verbal and non verbal interactions that define the relationships.
2. Unit Norms Generally accepted, formal and informal rules that govern interactions within the unit, which are consistent with the organisational culture.
3. Professional Shared Governance - A structure to support collaboration among professionals in determining standards for professional nursing practice.
4. Interdisciplinary Relationships - The interaction of the roles the various members of the health care team.

Each of the value concepts described above will operate differently, depending on the level of the organisation. Developmental levels of organisations have been described as, reactive, responsive, proactive and high performing. The primary outcomes of the Transformational Model are professional nursing practice, quality nursing care, caregiver satisfaction and consumer satisfaction.

This paper has been adapted from an original article by;

Wolf G A, Boland S, and Ankerman M, (1994), A Transformational Model for the Practice of Professional Nursing. Journal of Nursing Administration. Vol 24 No 4 p 51 – 57.