An enhanced professional practice program evaluation is proposed to determine the effect of increased control over practice on nurse satisfaction, quality of care delivery and patient outcome. The model to be tested in this project incorporates the findings of previous research concerning nurse retention and staff satisfaction. Outcome of the program will be measured by nurse satisfaction, quality of care delivery, patient outcome and cost- effectiveness. A quasi-experimental design combining time-series analysis with a static comparison-group will be used to test the impact of enchanced professional practice on patient care delivery and nursing retention. Where more than two appropriate medical, surgical or mixed medical-surgical units exist within one institution, units were randomly selected for study participation. Furthermore, random assignment to control and experimental groups was assured. The sample for this study is 4 experimental and 3 control units. The experimental group includes one general medical unit and a separate general surgical unit from the university hospital and one mixed medical-surgical unit from both the community and rural hospital. The participating rural hospital has only 1 medical- surgical unit open at this time; therefore, a control unit is not available at this site. Experimental units will participate in an enhanced professional practice model in which unit staff nurses have primary control over nursing resources and practice. Control units will continue to function within the established practice models at the program sites. Experimental and control groups will be compared prior to implementation of the program and at yearly intervals. Within hospital (experimental v. control), among hospital (rural v. community v. medical center) and unit over time comparisons will be made to fully describe the impact of the innovation program on nurse satisfaction and retention and on quality of patient care and outcome.
