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Nursing practice is always evolving, with new knowledge and a dynamic healthcare environment changing the way nurses care for patients.

So it makes sense that the model that guides overall nursing practice at Yale New Haven Health System evolve, too. Last summer, nurses at Bridgeport, Greenwich and Yale New Haven hospitals adopted an updated professional practice model (PPM) that graphically represents excellence in nursing practice and patient outcomes.

"The Professional Practice Model represents the overarching concepts that guide how nurses practice, regardless of where in the system they work and at what level," said Sue Fitzsimons, RN, PhD, senior vice president, YNHH Patient Services. "A nurse in one service line might use different techniques than a nurse in another, but the core elements of nursing practice that the PPM depicts are universal to nurses within the health system."

YNHHS nurses adopted the first systemwide PPM in 2013. In 2015, nearly 450 nurses at all practice levels from throughout the three hospitals participated in focus groups and completed surveys to evaluate that PPM. They examined six aspects of the nursing profession and to what degree the 2013 P PM included those aspects. Nurses provided feedback on the most essential aspects of nursing at YNHHS.

Nurses' responses were evaluated and used to create the updated PPM, which retains many visual elements from the 2013 model.

These include three figures representing the community of YNHHS nurses and a heart illustrating professor of nursing Jean Watson's Theory of Human Caring and patient- and family-centered care. A globe signifies the diversity of patients, and words around the globe reinforce YNHHS nurses' values: professional development, quality and safety, a healing environment and professional excellence.

The updated PPM includes new elements, such as brief explanations of the four values. The "we" in those explanations originally said "YNHHS nurses" but was changed when a clinical nurse pointed out that "we're all in this together."

Another new element in the PPM is the statement "Achieving outcomes through autonomy and accountability."

"This was a statement nurses felt very strongly about," Fitzsimons said. "They wanted to ensure that the Professional Practice Model addresses the critical role each and every nurse plays in improving the lives of our patients."