Clarity of Role: Implications for RN-RN Role Synergy During the Rescuing Process

Purpose:

This qualitative study describes the RN role in rescuing patients, a process whereby adverse outcomes are avoided by the actions of the RN.

Methods:

Rapid response teams are a structured resource designed to respond to medical/surgical bedside nurses’ calls for assistance in assessing patient distress, clinical deterioration and aimed to reduce patient mortality. Although RN role in assessment of the patient condition and decision-making at the point of care is critical to patient safety and quality outcomes, a scarcity of literature documenting this contribution exists.

Results:

This qualitative multi-site study was conducted in six northern California acute care hospitals. Theoretical sampling was used to select key RN informants. Narrative data regarding best practices, communication, rescuing and other processes supportive of RN practice was collected in private, semi-structured interviews and focus groups using interview guides. The role of the RN as a decision-maker when providing care to patients who became unstable was explored in the study.

A key finding related to role clarity emerged, namely, the difference between the level at which the RRT RN and bedside RN approached and functioned in their roles during rescuing, leading to a synergistic rescue process. Skills used by RRT RNs augmented, reinforced, and supported the bedside nurse. Combined, role synergy between the two contributed to preventing adverse events as the two role orientations merged to address the situation and provide the best care for the patient at risk or in distress.

Conclusions:

This study raises awareness of the multilevel contributions RNs make to patient care. Increased clarity of the RN role, decision making authority and how RNs carry out life-saving care and preventive care processes may help illuminate best practices, improve safe care practices and quality care, as well as, identify opportunities for improving health care systems, nursing education, and professional role development.