Role Clarity as the Foundation of Professional Nursing Practice

By Suzanne Cleere, MSN, MSBA, RN, CENP; Consultant, Creative Health Care Management

Across the country there is a deep desire to elevate professional practice in nursing. It makes me wonder: Do we see the word “professional” as merely a label or does it help to define who we are? The age-old debate on “entry level into practice” surfaces in this conversation. But what I have discovered both in informal conversations and formal assessments in health care organizations across the nation is that even in organizations with a high percentage of bachelor-prepared RNs, there is a deficit of understanding nursing as a profession.

The Importance of Role Clarity

There are multiple strategies that have the potential to awaken professionalism in nursing including work in role clarity. Role clarity helps us to clearly define what it is that is nursing’s alone to own as well as to define the role of each individual nurse in each domain of practice. Within the profession of nursing we have three domains within which we function. They are:

• independent practice (separate from medical practice)
• interdependent practice
• delegated practice (which requires direction/decision making by another discipline) 

Until we embrace that which is nursing’s alone to own (which can vary based on State Practice Acts), how can we appropriately enter into collaboration with individuals in any other discipline?

Standards of Practice for Nursing

It turns out that what we own is clearly articulated by the ANA in the ANA Scope and Standards of Practice (2010), along with the ANA Code of Ethics for Nurses with Interpretive Statements (ANA, 2001). Our professional organization provides us with firm ground to stand on and to build on. We own the nursing process. We own who we are in the provision of health care. As defined by the ANA, this is the work of the nurse:

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

Nursing’s boundaries are articulated by the ANA and the State Practice Acts. We are licensed to practice to the fullness of this definition, and we do this through the critical thinking model of the nursing process. Language has risen that describes our unique function, the interventions of nursing care, in Nursing Intervention Classification (NIC, 2013). Additionally we are called to a higher level of professionalism, well described in the 2^nd Edition of Nursing, Scope and Standards of Practice:

The Standards of Professional Performance describe a competent level of behavior in the professional role, including activities such as quality of practice, education, professional practice evaluation, communication, ethics, evidence-based practice and research, resource utilization, environmental health, and leadership, appropriate to their education and position. Registered Nurses are accountable for their professional actions to themselves, their healthcare consumers, their peers and ultimately to society. (ANA, 2010)

The scope of nursing practice can be overwhelming unless we take the time to reflect on what it means in our own professional practice environments and in our individual practices.

Questions Useful for Creating Role Clarity

Where do we begin? Clarity requires dialogue. It requires time to pause, to reflect. The first step in creating the role clarity necessary for professional practice to really happen is to ask yourself and your team these questions:

• How do we, in this department or this hospital, live out the standards of professional performance? Are there barriers to living the standards fully?How can I engage in personal professional development?
• Do I (regardless of my role) provide my team with a professional role model?
• Do I (as a leader) provide my team with opportunities to reflect and dialogue on professional development?
• How does my state practice act define my practice?
• Who are the patients we serve?
• What is the intensity of care that this population requires? What aspects of that care are within my independent domain, the interdependent domain, and the delegated domain?
• Who within the team is qualified to provide the care? 

When I know who I am in the work, what I am responsible for, and what you are responsible for, we are better together, a stronger team. We raise the level of care given, we improve the outcomes and metrics achieved, and we secure our role and legacy as professional partners in health care.

Reflection and dialogue are valuable first steps in establishing role clarity. Teams seeking further guidance may choose to work with a role clarity expert. The process is comprehensive, and therefore rarely fast, but working with a consultant can ensure that your team does its role clarity work as efficiently and effectively as possible. The most common response I hear from individuals in organizations who commit to the important work of role clarity is that they can’t believe they waited this long to do it!

Fostering connections at work and creating teams have always energized Suzanne, who is a consultant at Creative Health Care Management. She has Master’s degrees in nursing and business administration and is nearing completion of her DNP program, where her capstone project will explore “Reflective Practice: A Mechanism to Improve Relationship with Self, and Improve and Enhance Relationships with Patients and Peers.” All of her academic background is connected to real-world experience: she’s been a leader at every level, from 20-person nursing teams to VP and CNO. In every organization she’s been a force for positive change, leading by example.

Sources

American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements.Silver Spring,MD: Author.

American Nurses Association (ANA). (2010). Nursing: Scope and standards of practice (2nd Ed.). Silver Spring, MD: Author.

Bulechek, G.,  Butcher, H., Dochterman, J., & Wagner, C. (Eds.). (2013). Nursing interventions classification (NIC) (6th ed.). St. Louis, MO: Elsevier.