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Colorado Differentiated Practice Model

Table of Contents
Assumptions
History, Purpose, Goals
Conceptual Model
Essential Model Components
A. Implementation & Samples Clinical Ladders
B. Competency Statements & Roles
C. Distinct Job Descriptions and Performance Evaluations
D. Skills' Checklist
E. Institutional and Individual Goals
F. Professional Activities for RN Advancement and Advancement Activities for Care Partners
G. Peer Review
H. Educational Modules
I. Competency Statement Examples Stage II, Stage III
Glossary
Bibliography
Participants

Acknowledgements:

ASSUMPTIONS

The Colorado Differentiated Practice Model for Nursing will:

  1. Be developed with consideration given to education, experience, and competency.
  2. Be based upon the changing health care needs of society as a whole.
  3. Be congruent with the Colorado Nurse Practice Acts.
  4. Allow for strategic planning to promote positive marketing of the profession to enhance the recruitment and retention of staff nurses.
  5. Contribute to the educational/experiential evolution of nursing as a profession, building on the competency statements and nursing roles developed for The Colorado Nursing Articulation Model (4).
  6. Develop role descriptions and responsibilities for practicing nurses at the Licensed Practical Nurse (LPN), Associate Degree Nurse (ADN), Diploma Nurse, Baccalaureate of Science Degree with a major in Nursing (BSN), Nursing Doctorate (ND), and Master of Science Degree with a major in Nursing (MSN) levels, realizing differences in delivery settings.
  7. In the future, the Certified Nurse Aide (CNA) and Doctor of Philosophy Degree with a major in Nursing (PhD) levels should be added.
  8. Provide a framework for practice settings to differentiate nursing practice within Colorado. The unique circumstances of each delivery/service setting will influence the level, the mode of adoption, and implementation in each care setting.
  9. Promote continued collaboration between nursing service and nursing education.
  10. Assist the nursing profession in communicating roles and scope of nursing practice to the public and other health care team members. Date: 1992/1994

The Care Partners component of The Colorado Differentiated Practice Model for Nursing will:

  1. Provide a flexible framework to differentiate practice of Care Partners that is replicable in a wide variety of practice settings.
  2. Be developed and implemented with consideration given to preparation, experience, and competency.
  3. Be based upon the changing health care needs of society as a whole.
  4. Promote continued collaboration between service, education, and regulatory agencies.
  5. Enhance the recruitment and retention of Care Partners to improve the continuity of patient care.
  6. Promote the utilization of the most appropriate provider to facilitate cost-effective, quality patient care, and outcomes.
  7. Assist in communicating their roles to the public and other health care team members.
  8. Be congruent with state and federal regulations.
  9. Be evaluated for its effectiveness and efficiency in delivery of cost-effective quality patient care and modified accordingly.

Date: 1995

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HISTORY, PURPOSES AND GOALS

HISTORICAL PERSPECTIVE

Since 1988, nurses around the state have been actively involved in dealing with ongoing issues pertinent to nursing education and practice. With funding provided by The Colorado Trust, a statewide model has been developed and implemented for both educational articulation and differentiated nursing practice.

The Colorado Nursing Articulation Model (CNAM) (4) was the first voluntary statewide model developed and implemented in the country. It has made it easier for LPN, ADN, and Diploma nurses to advance their education without testing in nursing content areas and without repetition of course work. All of the 30 public and private nursing programs in the state are participating in this historic model.

The Colorado Differentiated Practice Model for Nursing (CDPM) was developed by 200 practicing nurses from a wide variety of settings to positively effect the quality and cost-effectiveness of patient care by using the most appropriate nurse provider. The CDPM built upon the articulation model extending the development of competency statements along a career pathway for nurses in clinical practice. The model also includes a clinical ladder for career advancement with salary recommendations.

Phase I implementation and evaluation occurred in six hospitals across the state, four urban and two rural from 1992-1994. The model measured patient satisfaction, nursing satisfaction, recruitment and retention, group cohesion, and professional autonomy. Qualitative data from nurse interviews shows that the majority of nurses participating feel that this professional practice model has influenced positive patient outcomes by providing consistent care. New graduates in particular have high praise for the CDPM as they feel it gives them a clear "blueprint" for professional practice and has enhanced their socialization into the profession.

Phase II implementation for hospitals has also been funded by The Colorado Trust and began in 1994 and will take place over three years. Five of the six original sites are continuing.

All of the research sites requested that the CDPM be expanded to incorporate nurse aides/extenders. A steering committee was appointed to oversee the development of this model and recommended that the framework for the CDPM be used. Next, a work group was assembled to develop the model and to write the competency statements. This was completed by the work group which included nurse assistants, project staff, RN's representing hospitals, home health agencies, long term care, and the Visiting Nurse Association. The name chosen for this new component of the CDPM is Care Partner and was selected to replace unlicensed assistive personnel based on the way this individual is envisioned to collaborate with the RN in the provision of care. Implementation of this component of the CDPM is expected to occur in 1996 in both acute and long term care settings. Funding for implementation in long term care has been provided for three years by The Retirement Research Foundation in Chicago.

PURPOSES

The two purposes for developing and implementing a framework to differentiate the practice of nurses and care partners are to:

  1. Positively effect the quality and cost-effectiveness of patient care by using the most appropriate provider.
  2. Enhance job satisfaction and reduce turnover rates by promoting work place distinction and opportunities for career advancement.

GOALS

The goals are to:

  1. Promote recruitment and retention of staff nurses and care partners in clinical practice in a variety of settings.
  2. Specify competency statements for nurses and care partners with varying educational backgrounds in a variety of settings, across their careers.
  3. Develop a clinical ladder that provides for advancement that provides for high-quality patient care while promoting job enrichment, satisfaction, and professional growth.
  4. Implement and evaluate the CDPM in long term and acute care settings.

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CONCEPTUAL MODEL

The Colorado Differentiated Practice Model for Nursing (Diagram 1.) illustrates the multiple backgrounds of preparation, career stages, and roles for staff nurses and care partners resulting in differentiated clinical practice. The Model is circular in nature in order to capture the wholeness of nursing practice and the contributions of all providers who are at the patient side giving care. The four expanding circles represent career stages with the inner circle (Roman numeral I) depicting the entry or beginning stage and the outer circle (Roman numeral IV) depicting the expert stage. Expert providers are placed on the outer circle to visually represent their support and guidance in clinical practice.

The circles are intersected with six lines that meet in the center of the innermost one to form six equal "slices." Each "slice" represents a distinct provider of care and is equal in size to represent the mutual valuing of all providers.

The linear diagram at the bottom of the Model shows the five roles (Member of the Profession, Provider, Teacher, Advocate, and Manager) all providers perform regardless of their preparation and stage of expertise. These roles are the foundation for the competencies that support commonalities while differentiating practice.

CAREER STAGES

To allow for professional growth and development throughout the staff nurse's and care partner's careers, the decision was made to expand upon the entry level statements written for The Colorado Nursing Articulation Model (4) by incorporating the work of Benner (1) and McBride (11) regarding career stages. The four stages were defined as follows:

Stage I - Is characterized as the entry/learning stage.

Stage II - Is characterized by the individual who competently demonstrates acceptable performance adapting to time and resource constraints.

Stage III - Is characterized by the individual who is proficient.

Stage IV - Is characterized by the individual who is an expert.

The stages in this model are not specifically named but, are defined by behaviors. Organizations implementing the model, however, may choose to name the stages.

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ESSENTIAL MODEL COMPONENTS

A. CLINICAL LADDERS

The Colorado Differentiated Practice Model for Nursing has a separate clinical ladder for the six preparatory backgrounds depicted on the conceptual model (Diagram 1). A nurse selects the education clinical ladder according to the nursing credential s/he has attained.

The framework for each educational ladder has four distinct stages. These stages allow nurses to self-pace their advancement. A nurse is placed in a stage according to one's own competency and experience.

Each nursing ladder has four weighted components as follows:

sample nursing career ladder

Diagram 2 depicts a sample nursing ladder with its four components - the competencies, skills check list, institutional goals, and professional activities, and four career Stages. When implementing the model each institution determines how the nurses are initially placed upon the clinical ladder.

The nurse can move on the clinical ladder by accomplishing all of the critical competencies for that stage as well as a percent of those in the other three areas - skills, institutional goals, and professional activities (Diagram 2). An individual nurse can also choose to move to another Stage or maintain a stage. An RN can move to another clinical ladder in the model by attaining another educational credential, for example the Baccalaureate Nurse who receives a Master's degree in nursing moves onto that ladder.

The Care Partner component of the Colorado Differentiated Practice Model for Nursing (CDPM) also has a clinical ladder depicted as a "slice" on the conceptual model. The framework for this "slice" also has four distinct stages. The stages allow the Care Partner to self-pace their advancement. A Care Partner is placed in a stage according to one's own competency and experience. The Care Partner ladder has three weighted components as follows:

a clinical ladder with 3 components

Diagram 3 depicts the details of a sample clinical ladder with its three components - the competencies/skills, institutional/individual goals, advancement activities, and four career Stages. When implementing the model each institution determines how the Care Partners are initially placed and/or advanced on the clinical ladder.

If an institution is hiring a new Care Partner with no experience that individual would be placed on the ladder in Stage I. S/he would remain there until the competencies of Stage I are achieved. The Care Partner would also be required to attain a number of points based on the institutional/individual goals, and advancement activities sections of the ladder in order to move as determined by the institution. Then the individual would be eligible to move to Stage II. This would happen when the Care Partner applied at time of annual evaluation to change stages.

Commonly, sites have used the annual evaluation form as an opportunity for individuals to demonstrate their choice to either maintain or change stages.

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B. COMPETENCY STATEMENTS AND ROLES

Competency is defined as performance that integrates cognitive, psychomotor, and effective skills in practice.

All of the competencies were written across the five nursing roles defined in The Colorado Nursing Articulation Model (4) and include: Member of the Profession, Provider, Teacher, Advocate, and Manager (Refer to Glossary for definitions).

Originally 34 competency statements were written across the five roles for nurses. However, after one year of implementation, the competencies were condensed to 16 as they were validated in practice. The original Care Partners Model was written with 16 competency statements (For examples refer to page 10).

C. DISTINCT JOB DESCRIPTIONS AND PERFORMANCE EVALUATIONS

Since this model promotes workplace distinction based on education, competency, and experience, distinct job descriptions are essential elements of the implementation process. Each implementation site first clarifies the patient care needs of the population they serve (current and projected).

Implementation site specific performance evaluation criteria are then developed. They support clarity of performance expectations across the four stages, from novice to expert. The development process of these performance criteria at each stage by the site participants integrates how their unique cluster of patient care needs are met and by whom. Thus, the care providers (with varying educational preparation, work experience, and competency development) are matched to most efficiently and effectively use their knowledge and skills.

D. SKILLS CHECK LISTS

For the CDPM each organization/unit implementing the model will need to develop its own skill's check list required for their specific patient population. Therefore, skills will be decided upon by each unit as part of the implementation process. It is weighted at 10% in the RN model and in the care partner component is weighted with the competencies for a total of 70% of their performance.

E. INSTITUTIONAL/INDIVIDUAL GOALS

Each organization is expected to incorporate its own goals for nurses and care partners to achieve based on its unique mission and philosophy. One example of an organizational goal may be customer relations. The institutional/individual goals are weighted at 15% on the clinical ladder.

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F1. PROFESSIONAL ACTIVITIES FOR RN's

Each institution is expected to develop its own list of professional activities (with input from the nursing staff) for nurses to earn points on the clinical ladder. The professional activities are weighted at 15% on the clinical ladder. The following items have been recommended by the regional committees as a starting point for discussion:

  1. Years of experience in the profession
  2. Years in facility
  3. Years in area of specialty
  4. Non-required certification (Advanced Cardiac Life Support ACLS) or (Basic Life Support BLS)
  5. Continuing education (above requirement for licensure)
  6. Professional awards
  7. Special projects
  8. Relevant education
  9. Facility-based committee memberships
  10. Preceptor activities
  11. Educational presentations
  12. Community involvement
  13. Publishing (Below the Master's level)
  14. Recommendations from peers, consumers, and health care workers
  15. Cross-training
  16. Teaching
  17. Enrollment in nursing degree program
  18. Healthy lifestyle
  19. Non-nursing degrees

F2. ADVANCEMENT ACTIVITIES FOR CARE PARTNERS

Each institution is expected to develop its own list of advancement activities (with input from the clinical ladder committee) for care partners to earn points on the clinical ladder. These activities are weighted at 15% on the clinical ladder. The following items have been recommended as a starting point for discussion:

  1. Years of experience in role
  2. Years in facility
  3. Years in specialty
  4. Continuing education
  5. Recognition awards
  6. Facility-based committee memberships
  7. Community involvement (volunteerism)
  8. Publishing-Internal/External
  9. Commendations from peers, consumers, and health care workers
  10. Enrollment in nursing degree program
  11. Wellness concept
  12. Non-nursing degrees

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G. Peer Review

Peer review is another essential component of the CDPM since it is designed to foster individual accountability for professional development in practice as well as group accountability for the overall quality of professional practice. The purposes of peer review are to 1) establish an objective means for providing evaluation feedback to each individual nurse and care partner; 2) analyze the consistency of each individual's practice compared to accepted professional standards; and 3) identify specific areas of each individual's practice needing further development. The ultimate goal is to establish a peer review system that will benefit each individual nurse and care partner, the institution, the profession, and most importantly, the patient/client.

Each site is expected to set up its own peer review system that meets the needs of the project as well as the needs of the organization.

H. Educational Process

In order to be successful in implementing any significant change in practice, there must be time for the staff to be involved in education, education, and more education! As part of the implementation of CDPM for nurses, twelve educational modules were developed to enable the staff to understand the components of differentiated nursing practice, the CDPM itself, and for the nurses to develop the skills to successfully apply it effectively in the patient care setting. The modules developed were:

These modules were developed as video presentations which were accompanied by workbooks that contained a chapter related to the content of each video. In addition to the videotapes and workbooks, the education process also occurred through the use of posters that were created for display in each site.

This same educational process will be followed for the implementation of the care partner component. Modules will be developed that have content that is relevant to this role i.e., delegation.

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I. COMPETENCY STATEMENT EXAMPLES

PROVIDER ROLE
COMMUNICATION & RELATIONSHIPS

STAGE II STAGE III
CARE PARTNER Effectively communicates to build care relationships with individual/family. Assists in development of caring communication with individual/family and team members.
LPN Identifies barriers to therapeutic communication and therapeutic relationships. Relays this data to supervisor. Uses interdisciplinary resources to enhance therapeutic relationships/communications with individual/family.
ADN/DIPLOMA Recognizes barriers to communication and seeks interdisciplinary expertise to establish therapeutic relationships. Analyzes socio-cultural variables to adapt nursing interventions and serves as a mentor in establishment of therapeutic relationships with individual/family/group.
BSN Analyzes socio-cultural variables to adapt nursing interventions and integrates interdisciplinary expertise to establish therapeutic relationships. Serves as a mentor and uses a variety of intervention methods which affect therapeutic relationships with individual/family/group.
MSN Collaborates and coordinates with multi-disciplinary team to provide effective communication/relationships to high risk/ problem prone individual/family/group in area of specialty based on theory and research Evaluates and modifies communication/relationship approaches to high risk/problem prone individual/family/group with multiple social/cultural variables based on theory and research.

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GLOSSARY

ACCOUNTABLE
Responsible for outcomes.

ADVOCATE ROLE (CARE PARTNER)
The Care Partner collaborates with the RN in providing a climate in which individuals/families may act in their own interest.

ADVOCATE ROLE (RN)
The nurse promotes a climate in which individuals/families may act in their own interest. The nurse intervenes when individuals/families are unable to act in their own interest.

ALTERNATIVE NURSING CARE DELIVERY SYSTEMS
Innovative and/or non-traditional methods of delivering nursing care, i.e., methods new to a given setting.

ANALYSIS
Separation of whole into its parts for purpose of examination and interpretation for application of the nursing process.

ASSESSMENT
Systematic dynamic process by which physical, mental, social, and functional data about clients are collected.

BEHAVIORS
The ways in which an individual acts or conducts their own self.

CARING/HEALING ARTS MODALITIES
Independent nursing care approaches that focus on caring and healing of the whole person. This includes but is not limited to therapeutic touch, massage, relaxation, imagery and visualization, self-hypnosis, and the use of music and sound.

COLLABORATION
Working with others in a cooperative way.

COMPETENCY
Performance that integrates cognitive, psychomotor, and affective skills in nursing practice.

COMPLEX HEALTH NEEDS
Multi-system health needs that are complicated by factors affecting the predictability of the

CONSUMER
A recipient of health care services.

CONSUMER RIGHTS
Those things to which an individual has a just or lawful claim (i.e., privacy).

CONTINUUM OF CARE
The care provided for individuals from entry through exit within the health care system.

COOPERATIVE RELATIONSHIP
A group of individuals working together to attain mutual goals.

CRITERIA
Standards on which judgments can be based.

DATA
Factual pieces of information measurements (i.e., vital signs).

DEPENDENT FUNCTIONS
Components of practice that are delegated by another.

DIFFERENTIATED PRACTICE
A method of ensuring that the work of nursing is carried out and directed by the most appropriate provider in the most appropriate way.

ENTRY INTO PRACTICE
Educational credentials needed to enter nursing practice.

EVALUATION
The determination of the individual's response to care and progress to meet desired outcome goals.

HEALTH
"It is a state of complete physical, mental, and social well-being and not just the absence of disease or infirmity." (WHO)

HEALTH CARE PROVIDER
Institution, organization or individual who provides health care.

HEALTH CARE TEAM
A multi-disciplinary group including the consumer who plan, coordinate, and provide individual/family care.

HOLISTIC
Pertaining to totality of the individual; with consideration to biological, psychological, social, spiritual, cultural, developmental and economic factors that are seen as interacting components that contribute to the whole.

IMPLEMENTATION
The action associated with carrying out interventions. (ANA)

INDEPENDENT FUNCTIONS
The components of practice for which the nurse accepts accountability.

INDIVIDUAL
The client, family, group, or community for whom the nurse is providing formally specified services as sanctioned by the Colorado Nurse Practice Acts.

INTERDEPENDENT FUNCTIONS
The components of practice in which responsibility and accountability are shared with others.

INTERDISCIPLINARY
Involving other fields of study or practice other than ones own within the health care disciplines.

INTUITIVE
The faculty of knowing as if by instinct, without conscious reasoning, based on one's previous education and experience as a nurse.

MANAGER ROLE (CARE PARTNER)
The Care Partner as a partner with the RN works to achieve desired outcomes through implementation of individual/family care with effective use of time, equipment, resources, and supplies.

MANAGER ROLE (RN)
The nurse as manager works to achieve desired outcomes through coordination of individual/family care with effective use of personnel, equipment, supplies, and work systems.

MEMBER OF THE PROFESSION ROLE (CARE PARTNER)
The Care Partner is responsible for their ethical, legal, and personal behavior as a partner related to all nursing roles.

MEMBER OF THE PROFESSION ROLE (RN)
The nurse is accountable for the ethical, legal, and professional responsibilities related to the roles of: member of the profession, provider, teacher, advocate, and manager.

MENTOR
An individual who acts as a coach or tutor.

MULTI-DISCIPLINARY
Involving other fields of study or practice.

NURSING DIAGNOSIS
Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual and potential health problems/life processes. Nursing diagnosis provide the basis for selection of nursing intervention to achieve outcomes for which the nurse is accountable (NANDA).

NURSING PROCESS
The means of using assessment, analysis, planning, implementation, and evaluation to identify and synthesize clinical data and to order nursing interventions to reduce, eliminate, or prevent (health educational domain of nursing. (2).

OBSERVATIONS
The gathering of information, facts, occurrences; information obtained from watching another's actions, behaviors.

PARTNER (SHIP)
An associate or colleague; to team up with another in a working relationship.

PEER REVIEW
An evaluation process by colleagues/peers for the purpose of improving the quality of care given.

PLAN OF CARE
A detailed list of interventions used to attain desired outcomes.

PLANNING
The identification of interventions used to attain desired individual outcome goals.

PRACTICE TRENDS
The expected direction in which nursing practice is intended, professional working goals of nursing practice.

PREDICTABLE OUTCOMES
Results that can generally be anticipated in advance.

PROFESSIONAL FRAMEWORK
Within an established structure of ideas that agree with the beliefs of the profession of nursing and the institution where the practice is taking place.

PROVIDER ROLE (CARE PARTNER)
The Care Partner, using accepted standards of practice based on the nursing process, under the supervision of an RN, helps individual/family to identify and to meet basic health needs in a wide variety of settings.

PROVIDER ROLE (RN)
The nurse, using accepted standards of practice based on the nursing process, helps individual/ family to identify and to meet basic health needs in a wide variety of settings. The nurse coordinates care of the individual/family/group using a multi-disciplinary, holistic approach.

QUALITY ISSUES
Expected outcomes or results based on excellence of practice.

RESEARCH
Formal: Uses formal research methodologies.
Informal: Studies of processes/issues or problems.

ROLE MODEL
Sets an example of excellence for others to follow.

SELF-IMAGE
The way in which a person represents their own self (i.e., dress, behavior, attitude).

STANDARDS OF CARE
Principles of care based on the nursing process.

STANDARDS OF CARE
Define a competent level of care based on the nursing process.

STANDARDS OF PRACTICE
The criteria against which one measures one's practice.

STRUCTURED SETTING
An organized environment in which policies, roles, responsibilities, and the decision-making process regarding nursing care are clearly defined.

TEACHER ROLE (CARE PARTNER)
The Care Partner using the established plan of care directed by the RN, reinforces individual/family education using a wide range of teaching activities to promote health in a variety of settings.

TEACHER ROLE (RN)
The nurse using the nursing process provides individual/family/group education using a wide range of teaching activities to promote health in a variety of settings.

UNPREDICTABLE OUTCOMES
Results that generally cannot be anticipated in advance.

VALUES FRAMEWORK OF NURSING
Set of beliefs or principles that define the milieu in which the practice of nursing occurs.

WELL-BEING
The state of being happy, healthy, and stable.

WELLNESS/ILLNESS CONTINUUM
Scale which defines the continually changing process of life between optimal wellness and death.

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BIBLIOGRAPHY

Colorado Differentiated Practice Model for Nursing

1. Benner, P. From Novice to Expert. California: Addison-Wesley Publishing Company, 1984.

2. Carpenito, L. Nursing Diagnosis: Application to Clinical Practice. Philadelphia: J.B. Lippincott Company, 1983.

3. Cleland, V. The Economics of Nursing. Connecticut: Appleton & Lange, 1990.

4. Colorado Council on Nursing Education, The Colorado Nursing Articulation Model, 1990.

5. Kneedler, J., and others. Competency Based Career Ladders. Nursing Management. 1987. July. 18(7):77-78.

6. Koerner, J., Bunkers, L., Neslon, B., and Santema, K. Implementing Differentiated Practice: The Sioux Valley Hospital Experience. Journal of Nursing Administration, 1989. 19(2):13-20.

7. Kramer, M., and Schmalenberg, C. Job Satisfaction and Retention, Insights for the '90s, Part I. Nursing 91. 1991. March. 21(3):50-55.

8. Kramer, M., and Schmalenberg, C. Job Satisfaction and Retention, Insights for the '90s, Part II. Nursing 91. 1991. April. 21(4):51-55.

9. Kreman, M. Clinical ladders: A retention strategy. Nursing Management. 1990. July. 21(7):23-25.

10. Malloch, K. M. and others. A Model for Differentiated Nursing Practice. Journal of Nursing Administration. 1990. February. 20(2): 20-26.

11. McBride, A. Orchestrating a Career. Nursing Outlook. 1985. Sept/Oct. 33(5): 244-247.

12. Mayer, G. C., Madden, M. J., and Lawrenz, E. (Eds.) 1990. Patient Care Delivery Models. Maryland: Aspen Publishers.

13. McClure, M. L. Differentiated Nursing Practice: Concepts and Considerations. Nursing Outlook. 1991. May/June. 39(3):106-110.

14. Merker, L. R., and others. The Clinical Career Ladder: Planning and Implementation. New York City: Springer Publishing Company, 1985.

15. Pitts-Wilhelm, P., Nicolai, C. S., and Koerner, J. Differentiating Nursing Practice to Improve Service Outcomes. Nursing Management. 1991. December. 22(12): 22-25.

16. Primm, P. L. Differentiated Practice for ADN- and BSN-Prepared Nurses. Journal of Professional Nursing 1987. July/Aug. 17(4):218-225.

17. Sanford, R.C. Clinical Ladders: Do They Serve Their Purpose? Journal of Nursing Administration. 1987. May. 17(5):34-37.

18. Vestal, K.W. Financial Considerations for Career Ladder Programs. Nursing Administration Quarterly. 1984 Fall. 9(1):1-8.

CARE PARTNER:

1. Crawley, W., Marshall, R., Till, A. (1993, November/December). Use of unlicensed assistive staff. Orthopaedic Nursing. 12(6), 47-53.

2. Gardner, D. (1991, October). Issues related to the use of Nurse Extenders. Journal of Nurse Administrators. 21(10), 40-45.

3. Hayes, P. (1994, May/June). Non-nursing functions: Time for them to go. Nursing Economic$. 12(3), 120-125.

4. Lengacher, C., Mabe, P. (1993, March). Nurse Extenders. Journal of Nurse Administrators. 23(3), 16-19.

5. Lengacher, C., Mabe, P., Bowling, C., Heinemann, D., Kent, K., Van Cott, M. (1993, December). Redesigning Nursing Practice: The Partners in Patient Care Model. Journal of Nurse Administrators. 23(12), 31-37.

6. Neidlinger, S. Bostrom, J., Stricker, A., Hild, J., Zhang, J. Q. (1993, March). Incorporating Nursing Assistive Personnel Into a Nursing Professional Practice Model. Journal of Nurse Administrators. 23(3), 29-37.

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STEERING COMMITTEE MEMBERS:

Marie Miller, RN, PhD
Project Director, Colorado Differentiated Practice Model for Nursing
Director, Area Health Education Centers

Joyce L. Falco, RN, MSN, CNS
Project Coordinator, Colorado Differentiated
Practice Model for Nursing

Marianne Boettner, RN, MSN
Retired, State Board for Community Colleges & Occupational Education Systems

Susan S. Brown, RN, MSN
Consultant

Crickett Cobleigh, RN, MSN, CNS
LPT Program Director, Wheat Ridge Regional Center

Ellen Jones, RN, MS
Administrator, Liberty Heights Manor

Joanna King, RN, BS Ed, BSN
Director, Provenant Home Health Care, Provenant Health Partners

Sheila Morgan, RN, MSN
Clinical Education Department, Swedish Medical Center

Elizabeth Pade, RN, BSN, MA, MSN, EdD
Coordinator, Nursing Program Emily Griffith Opportunity School

Judy Ragon, RN, MSN
Division Manager, Visiting Nurse Association

Joyce Spray, RN, MS, CNS
Site Coordinator, Colorado Differentiated Practice Model for Nursing,
Senior Life Center, Provenant Health Partners

Joyce E. Vernon, RN, MS,
RN Educator, Penrose/St. Francis Healthcare System

Kris Wenzel, RN, MBA
President, Cornerstones Organizational Consultant

Leslie Williams, RN, MN, CEN
Education Specialist, Provenant/St. Anthony Hospital, Central

Jan Zubieni, RN, MS
Colorado State Board of Nursing Nurse Aide Education Consultant

WORK GROUP MEMBERS:

George Baumchen, RN, BSN
Site Coordinator, Colorado Differentiated Practice Model for Nursing, Montrose Memorial Hospital

Joyce L. Falco, RN, MSN
Project Coordinator, Colorado Differentiated Practice Model for Nursing

Faye Leali, CNA
Visiting Nurse Association

Helen Lester, RN
Administrator, At Home Healthcare

Barbara Martin, RN-C, BSN, NHA
Bent County Memorial Nursing Home

Nita McKnight, RN
Staff Development Coordinator Christian Living Campus University Hills

Stephanie Miller, CNA
Memorial Hospital

Joyce Spray, RN, MS, CNS
Site Coordinator, Colorado Differentiated Practice Model for Nursing, Senior Life Center, Provenant Health Partners

Joyce E. Vernon, RN, MS
RN Educator, Penrose/St. Francis Healthcare System

Kris Wenzel, RN, MBA
President, Cornerstones Organizational Consultant

Leslie Williams, RN, MN, CEN
Education Specialist, Provenant/St. Anthony Hospital, Central

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ACKNOWLEDGEMENTS
The Colorado Trust
The Research Retirement Foundation

THE COLORADO DIFFERENTIATED PRACTICE MODEL

FOR NURSES AND CARE PARTNERS © Copyright 1995 For information you may write or call the Colorado Alliance For Nursing: 4200 East Ninth Ave, Campus Box C288, Denver, CO 80262, (303) 315-8779, (800) 248-2344