Role Based Leadership: Transforming the Practice Culture Through Role Clarity and Structural Support for Autonomy

Wednesday, 1 August 2012: 10:30 AM

Nancy Loos, RN, MSN, PHN, NE-BC
Northridge Hospital Medical Center, Northridge, CA
Maria W. O'Rourke, DNSc, RN, FAAN, FAAHC
Role-Based Practice Solutions, Larkspur, CA


This study examined the relationship between autonomy and organizational structure within a magnet context through self-reports of  adult-critical care RNs. Role clarity at management and clinical levels is essential to ensuring full RN role capacity realized at all organizational levels. Structural and process support for decision-making autonomy within a healthy work environment is considered crucial to RN professional role enactment and empowerment, work satisfaction, and evidence-based practice.  A defined model of the professional role clarified autonomous professional practice while the patient care model provided structural and system support for autonomous decision-making. 


This quantitative, cross-sectional survey design was completed with a convenience sample of direct-care RNs in adult ICU in a large suburban trauma center (N ~ 92). Of 92 nurses, 69 completed the survey (75%); 58 (63%) completed a role development program and professional role orientation survey, the Professional Role Development Guide(63%). Participation included voluntary, one-time, anonymous completion of the 58-item Essentials of Magnetism II (EOMII). Two optional 10-point single item scales—Organizational Job Satisfaction (OJS) and a Nurse-assessed Quality of Patient Care (QC) were included.


75% (N=69) return rate across two shifts. More than 60% of PRDG role behaviors were in the Competent to Proficient expertise level. Autonomy score was positively related to OJS (r=0.46) and QC (r=.58) (p<0001).  Mean OJS score:  5.38 and average QC score was 6.0 on a 10 point scale. Total EOMII scores were positively related to total OJS (r=0.507) and QC outcome indicators (r=.601; p<.01; n=64).


A professional role orientation within nursing management serves as the driving force for ensuring structural support and system clarity for autonomous clinical decision-making in order to positively impact quality of care and nurses’ job satisfaction. Role clarity regarding RN unique sphere of practice and their decision-making authority is essential to an autonomous practice culture.