Framework Nursing Behaviors
DOMAIN: Clinical Skills and Knowledge
A C
Performs assessment and
identifies appropriate nursing
Assessment
diagnosis and/or patient care
standard with assistance
Recognizes data and
identifies obvious nursing
Diagnosis
Nursing
diagnoses
NURSING PROCESS
Practice is guided primarily
by policies, procedures, and
standards
Planning / Implementation /
Evaluation
Identifies expected outcomes
and nursing interventions to
meet identified diagnoses and
maintain standards of clinical
practice
Evaluates patients based on
basic standards
Note: Bolded behaviors within the domains denote behaviors that also apply to the “Contribution” domain
D E F - for Master’s prepared RNs
Independently and Independently and Exhibits highly developed Demonstrates mastery of advanced
completely performs consistently performs assessment abilities that assessment with diverse populations. Is able
focused assessment individualized assessment exemplify a comprehensive to coach and teach advanced assessment
to provide most when caring for all understanding of the total
Incorporates the perceptions and under-
effective patient care patients, including those patient/family situation
standings of the distinct health needs of
for a given patient with complex
vulnerable and at risk patients and families
Target audience: Nursing at Michigan | Contact: Mary Anne Brancheau | Last reviewed: 3/2019
population pathophysiological and
in planning
psychosocial needs
Prioritizes key Individualizes nursing Individualizes nursing Based upon patient story, mutually identifies
nursing diagnoses to diagnoses based on diagnoses based on needs and optimizes solutions through
assessment data and
address physical and assessment data mobilization of resources, incorporating
psychosocial/ integrates that with the and promoting evidence based practice
emotional areas diagnoses & priorities of
other disciplines in order to
provide holistic care
Practice is driven Practice relies on previous Practice is driven by an Practice is driven by evidence and patient
by theory and experience for focused intuitive base and is self- outcomes based on the patient population
experience analysis of problems and directed, flexible, and and allows for critical evaluation of work
solutions with individual innovative in the field
patient modification in
order to meet outcomes
Develops, Accommodates unplanned Is consistently effective in Builds and leads collaborative interprofessional
implements, and events and evaluates/ providing holistic care to groups in designing and implementing
evaluates plan of care responds appropriately ensure positive change even innovative solutions that address system
that recognizes subtle with speed, efficiency, in the most challenging problems and patient care issues***
changes in patient’s flexibility, and confidence patient care situations Anticipates complex patient population needs
condition and adapts and is able to modify or tailor solutions based
plan as needed on these needs
Clinical Skills and Knowledge Domain continued on next page…
***Relates to contributions outside of one’s home unit 1
Clinical Skills and Knowledge Domain continued…
A C
Utilizes standard unit
technology and with
assistance uses advanced
technology as appropriate
Technology
Utilizes computer correctly
for basic functions, including:
 Email
 Electronic Medical Record
 Electronic medication-
related technology
 Mandatory Programs/
Competencies
 Policies and procedures
NURSING PROCESS
With assistance, identifies
basic patient/family learning
needs
Patient / Family Education
Initiates teaching using
patient teaching protocols,
patient care standards and
critical paths
Utilizes patient education
resources on the unit
Identifies location of and
utilizes hospital policies and application of
Procedure/
Protocols
Policy/
unit procedures and protocols hospital policies and
Note: Bolded behaviors within the domains denote behaviors that also apply to the “Contribution” domain
D E F – for Master’s prepared RNs
Utilizes standard unit Becomes expert Takes a leadership role Models the active use of technology
technology and uses and resource for in evaluating technology and supports engaging others in its use
advanced technology use of standard unit and its potential for use through teaching/coaching competencies
as appropriate technology and Applies logical, critical and creative thinking
advanced technology to a range of clinical challenges modeling
as appropriate this behavior to colleagues
Utilizes computer for Becomes resource for Able to conduct literature Routinely utilizes evidence based
basic functions as use of computer search through library practice databases, monitoring and
well as reference on functions – CINAHL, synthesizing data
patient conditions and Cochrane, Medline,
treatment PubMed
Accurately assesses Identifies learning Anticipates patient/family Focuses on patient/family behavioral
patient/family’s needs of designated learning needs and utilizes a change; evaluates effectiveness of
readiness to learn, populations variety of teaching strategies behavioral change/modification
organizes and appropriate to the patient’s
Works collaboratively to Involved in or develops evidence based
executes individual- needs
develop strategies to meet educational resources to advance patient
ized teaching plan,
learning needs Serves as expert resource and family education
evaluates patient’s
and facilitates other staff in
understanding and Seeks out challenging
improving patient
modifies approach as patient/family education
education
necessary opportunities
Seeks out additional Revises and develops Collaborates with other Constantly evaluates policies/procedures/
patient education patient education disciplines to develop protocols, related to patient/family
resources beyond unit materials and/or implement outcomes for effectiveness
patient/family teaching
programs
Demonstrates ease in Teaches and functions Researches, revises, and Constantly evaluating policies, procedures,
as a resource in the develops hospital policies and protocols, related to patient/family
application of hospital and unit procedures outcomes for effectiveness
unit procedures and policies, and unit and protocols utilizing
Understands policy, organization and
protocols procedures and appropriate channels
economics of health care***
protocols and resources***
Clinical Skills and Knowledge Domain continued on next page…
***Relates to contributions outside of one’s home unit 2
Clinical Skills and Knowledge Domain continued…
A C
Adheres to hospital policies
related to medication safety:
 Order writing conventions
Promoting Culture of Safety
 Correct administration
considerations
 Double checks and other
established policies and
practices
NURSING PROCESS
Familiar with and follows
standards related to patient
and staff safety
Admission assessment, flow
Documentation
sheets, MARs, and other
applicable documentation
forms are completed in a
timely manner according to
policy with minimal guidance
Note: Bolded behaviors within the domains denote behaviors that also apply to the “Contribution” domain
D E F – for Master’s prepared RNs
Identifies and Unit expert and Advocates for culture of Understands the unique and cumulative
intervenes when resource on medications safety through knowledge, effects of care (setting, circumstances,
there are concerns applicable to their problem solving, and contexts, environments) and care delivery
related to medication unit/clinical setting system changes*** processes on outcomes --- with a goal of
safety, providing improving the health and safety of patients
feedback to staff and providers through the provision of
members involved quality healthcare***
Anticipates and Facilitates others related
intervenes related to patient and staff
to patient and staff safety; actively works
safety toward prevention of
potential injury
Consults documen- Involved in ongoing Participates in the Mentors others in the use of
tation to identify quality monitoring of development of documentation tools that are evidence
trends in patient documentation of documentation tools, based and patient centered and include
status and enhance nursing care and patient standards, and/or policy*** possible interventions, goals, and
continuity of assess- outcome patient/family education based on
ment and ongoing the patient’s story***
nursing care
***Relates to contributions outside of one’s home unit 3
DOMAIN: Therapeutic Relationships
An intentional interactive relationship with patients and families that is caring, clear, has boundaries, positive, and professional. It encompasses the philosophy of the
institution, empowerment of the care givers and empowerment of the patient/family.
A C
Recognizes how the nurse:
patient/family relationship
Communication
impacts the patient experience
Therapeutic
Introduces self as a Registered
Nurse and describes role
Consistently wears identification
Establishes open communication
Recognizes the need for patient
Patient, Family
Empowerment
and family to participate in care
– Nurse,
Seeks help as appropriate to assess
readiness for participation in care
Actively listens to patient/family
Compassion
concerns in a respectful manner
Shows kindness and caring with
patients/ families
Recognizes, respects, and
supports patient/family rights
and maintains confidentiality
and Ethics
Advocacy
Aware of UMHS patient rights
and responsibility
Valuing of Diversity
Aware of and values the diversity
with Patients and
in patient and families
Family
Begins to incorporate diversity
considerations in patient care
Note: Bolded behaviors within the domains denote behaviors that also apply to the “Contribution” domain
D E F- for Master’s prepared RNs
Possesses clarity on one’s Consistently role models Intuitively uses expert Intuitively uses self in the
own values and how they individualized therapeutic therapeutic communication therapeutic relationship as
affect interactions, relation- communication based on with patient/family a means to enhance care
ships and boundary setting patient and family needs
Individualizes communication Initiates consultation/ Shares and promotes Provides consultation/ leadership
based on assessment of the leadership with the healthcare collaborative approach to with the healthcare team. Has
patients and families team to share and promote patient and family care collaborative mentoring
collaborative approach to relationships that actively
patient and family care engage others
Incorporates patient/family Invites patients and families Maximizes patient/family Actively empowers colleagues and
in planning and implementing to actively participate in plan participation in decision advocates for patients and families
care of care to foster growth and making and goal setting in decision-making and goal-setting
competence along the continuum of care
Demonstrates empathy Plans and provides nursing Intuitive understanding of Same expectations as
in interactions with care that promotes intentional patient/family experience Level E
patient/families caring and is proactive in providing
creative approaches to
optimize comfort and support
Mobilizes appropriate Challenges situations and/ Challenges and adapts Advocates for patient and
resources in response to or decisions that obstruct systems to maximize the family concerns by collaboratively
situations that have the positive patient outcomes benefits for patient care working with the multidisciplinary
potential to negatively impact and works to reduce barriers healthcare team
patient/family outcomes
Recognizes ethical issues/ Anticipates patient/family
seeks assistance in needs
addressing them
Seeks to learn about and Demonstrates actions Embraces visible and invisible Same expectations as Level E
optimize the unique contrib- that incorporate the rich diversity; seeks out erspectives
ution inherent in the diversity traditions, beliefs, and values from those of different
and culture of each individual of patients and families backgrounds and cultures
Integrates understandings of
populations into patient care
***Relates to contributions outside of one’s home unit 4
DOMAIN: Professional Relationships
An intentional interactive relationship with the health care team that is marked by mutual regard, trust, and active engagement.
A C
Recognizes role of each member
of the health care team that includes
the patient/family
Collaboration with the
Health Care Team
Aware of importance of team
collaboration and with guidance
begins to initiate collaborative
communication
Initiates referrals
Recognizes the impact of one’s
behavior on others
Identifies self as member of nursing
and health care teams
Begins to generate trust, respect, and
Valuing Teams/ Teamwork
compassion within the workgroup
Takes responsibility for developing
beginning team relationships
Seeks assistance with resolving conflict
Meets professional commitments
consistently
Asks for and accepts help when needed
Acknowledges when conflict exists
Aware of and values diversity in all
Diversity in
Valuing of
members of the health care team
Team
Recognizes own biases and begins to
demonstrate empathy as a member of
the health care team
Note: Bolded behaviors within the domains denote behaviors that also apply to the “Contribution” domain
D E F - for Master’s prepared RNs
Initiates, recognizes and Is sought out by members of the Through shared values Works both autonomously
values professional multi-disciplinary health care team and a clear professional and collaboratively as a
collaborative communica- identity, demonstrates and primary nurse to promote:
role models an inter-  care planning
tion and the positive effect
disciplinary collaborative  efficient provision of care
on patient outcomes
 evaluation of care
approach to patient care
Identifies and utilizes Frequently initiates consultations Participates and/or leads Builds and leads collaborative
collaborative resources with health care team team care conference interprofessional teams
that support continuity
of care
Monitors referrals
Actively collaborates with health Actively navigates and inte-
care team in delivering care grates care services across
Recognizes need and calls for team the healthcare system***
conference
Acts as resource to nursing and
health care team
Functions as an Fosters mutual regard, respect, Demonstrates team values Actively works to establish a
independent and and trust that orient people to care healthy, collaborative work
supportive team member about performance and environment
Demonstrates flexibility
Provides assistance to success of others
others Creates conditions and relationships
that promote creative, innovative,
Demonstrates empathy and positive processes and outcomes
and compassion in
interactions with team Role models behaviors that
members demonstrate compassion and caring
Approaches conflict
Fosters other’s development of Recognizes value of
situations in a constructive conflict resolution skills conflict in individual and
manner organization learning and
Demonstrates active engagement
to enhance patient care and growth
promote a positive workplace
Seeks to learn about and Role models and helps to establish Depends on diversity of A leader in integrating
optimize the unique group norms that promote valuing workforce to enrich and diversity in the practice setting
contribution inherent in of all health care team members build great places to work
the diversity and culture
of each individual on the
health care team
Professional Relationships Domain continued on next page…
***Relates to contributions outside of one’s home unit 5
Professional Relationships Domain continued …

A C D E F - for Master’s prepared RNs

Functions as part of nursing team;
able to describe and begin to use
5 Rights of Delegation when
delegating to UAP:
 Right task
Delegation
Readily able to delegate to Recognizes and values inter-
UAP according to the 5 dependent relationships
Rights of Delegation Recognizes strengths of other
team members that would benefit
the patient and the team – aligns
Adaptable, flexible, and
consistently effective in
delegation
Demonstrates foresight in
Assists in the development
of colleagues with the
evaluation of effective
workflow and processes

Facilitates continuity of anticipating and planning to Collaboration with team that

 Right circumstances
 Right person
 Right communication
 Right supervision and evaluation
Recognizes value of nurse-to-nurse
delegation
care and nursing work
skill sets of individual nurses/UAP
meet patient and family creates solution to issues
to specific patients
flow through nurse-to- concerns regarding delegation
nurse delegation
Successfully organizes and
coordinates multiple activities,
requests, and needs
Develops work processes that
maximize team work

DOMAIN: Professional Development

Committed to the professional development of self and others.
A C D E F – for Master’s prepared RNs
Engages in self-assessment Sets goals for knowledge/ skill Sets goals for knowledge/ Sets goals in self-directed Evidence of advancing
related to orientation and ongoing enhancement within the practice skill enhancement within manner and actively seeks out professional identity at
learning needs and seeks out unit setting and beyond the practice opportunities for knowledge/ state, regional, national,
resources to assist in meeting setting*** skill enhancement within and international levels***
needs beyond the practice setting***

Completes mandatory/
competency requirements during
orientation and annually
Self
Seeks out additional learning Attends inservice(s)/CE Evidence of advancing Pursues learning as a
experiences within practice area: within and beyond practice professional identity journey of ongoing personal
 Unit specific certifications area*** (at least one): development and excellence
 Consultation with experts  Certification in specialty in and beyond chosen

 Inservices/rounds (ACCN, ANCC Specialty discipline

 Collaborating with Areas)
Maintains certification in
multidisciplinary team  Active participation in area of specialty
Professional organization
(i.e.: clinical specialty
organizations, UMPNC,
MNA, ANA)
 Active membership/
leadership role in institutional
groups related to nursing***
Professional Development Domain continued on next page…

Note: Bolded behaviors within the domains denote behaviors that also apply to the “Contribution” domain ***Relates to contributions outside of one’s home unit 6
Professional Development Domain continued…
A C
With guidance, provides
respectful feedback to preceptors,
peers, and Manager related to
orientation and initial learning
experience
Contribution to Others
Note: Bolded behaviors within the domains denote behaviors that also apply to the “Contribution” domain
Participates in peer feedback
Expands knowledge of the
feedback process:
 Formal training
 Authentic, accountable,
respectful, relevant to
clinical performance
 Identifiable/attributable
Contributes to others knowledge Takes a leadership role in
and skill development in
practice setting
May act as preceptor of
new and present staff when
applicable
Utilizes own knowledge/skills
to improve professional
development environment
on the unit
D E
Shares in/contributes to
others knowledge/skill
development in practice
setting; examples include:
 Conducts inservices
 Develops staff education
tools
 Acts as interdisciplinary
clinical resource and
informal mentor
building and maintaining
an environment where all
team members thrive
Recognizes professional
strengths in others and
builds upon them
***Relates to contributions outside of one’s home unit
F – for Master’s prepared RNs
Works to create and sustain
a culture that is supportive
and rewards and recognizes
professionalism
Mentors nurse colleagues in
achievement of Professional
Development Framework
progression
Acts as a clinical resource/
liaison beyond the unit
setting***
Builds and supports a
mentoring culture
Contributes to the
knowledge base of the
healthcare system
Assumes the role of
working collaboratively
or supporting and guiding
colleagues***
Uses awareness built
through pursuit of new
knowledge to support or
formulate novel approaches
to care and/or provision
of care
7
DOMAIN: Advancing Evidence Based Practice Through Innovation and Research
Demonstrates ongoing innovation by reviewing, critiquing, and applying evidence to practice by applying performance improvement methodologies.
A C D E F – for Master’s prepared RNs
Demonstrates an awareness Conducts literature search Implements change in practice Actively uses skills related to data
of current literature in area for evidence based articles for a population of patients based on collection and analysis to inform
of practice journal club, related to area of practice the application of current research decisions and guide practice
inservices, etc. findings and evaluates effectiveness changes
of practice changes.
Evidence Based Practice and Research

Participates in unit/ Identifies individual patient Takes on leadership role Makes recommendation for changes Leads unit/area based and/or
area based Continuous problems which require in relation to innovations/ in practice based on findings institutional CQI projects
Quality Improvement investigation improvements in practice
Shares findings of Continuous Leads change in practice, based
projects setting
Identifies areas for creative Quality Improvement projects, on best practices/evidence, to
improvement in practice setting such as: improve quality outcomes
Has knowledge of and and seeks out resources and  Unit presentation
supports established Consistently role models and
avenues to address them (unit  Rounds infuses evidence based knowledge
nursing improvement practice council, content  Poster into practice
projects/endeavors in
practice setting
experts, etc.)  Publishing
Fosters intellectual inquiry and
Partners with CNS or other unit/area knowledge development
lead on Improvement Initiatives to
implement and evaluate a change in Reads and critiques (generically)
practice evidence based articles related to
area of practice – shares relevant
Independently seeks out findings in efforts to improve
opportunities to share information health care
and influence evidence based
nursing practice***
Evaluates effectiveness of
innovation/practice challenges

Note: Bolded behaviors within the domains denote behaviors that also apply to the “Contribution” domain ***Relates to contributions outside of one’s home unit 8