Optimizing Hospital RN Role Competency Leads to Improved Patient Outcomes

Tuesday, 23 July 2013: 1:50 PM

Lynn Forsey, PhD, RN
Patient Care Services, Stanford Hospital and Clinics, Stanford, CA
Maria W. O'Rourke, PhD, RN, FAAN, FAAHC
OnSomble, Larkspur, CA

Learning Objective 1: discuss key factors leading to role competency using a model of the professional role applied to acute hospital nursing practice.

Learning Objective 2: describe a nurse education and performance improvement program that resulted in more comprehensive nurse-nurse handovers, improved unit work culture and increased patient satisfaction results.

Purpose: This session will report results from a program designed to improve patient outcomes through enhanced nurse professional role competency. Professional role competency behaviors are required to fully realize the Institute of Medicine’s Future of Nursing goals regarding full scope of practice and enhanced leadership roles in future patient care delivery.  Professional Role theory posits that confusion about nurse role accountability, responsibility and authority can result in a task-based versus professional focus. This role confusion was felt to be a barrier to optimizing RN scope that leads to practice excellence.

Methods: A pre/post design was used to evaluate the program intervention of: classroom training, staff nurse professional role assessments, peer-coaching, and targeted nursing unit performance improvement action plans. 10 cohorts of clinical nurses (n=365) from four intermediate/progressive care units completed the  program over one year at one academic medical center.  Program effectiveness was measured by class evaluations, participant feedback, and milestone completions. Role competency was measured using a validated online assessment tool. Outcomes measured were observations of staff handovers, unit work environment using the Practice Environment Scale (PES), and HCAHPS patient satisfaction scores. 

Results: 98% of staff completed the program.  Self-assessed nursing role performance increased from time one to time two (n=302).  Comprehensive reporting of patient care improved for medical (dependent) and nursing (independent) functions and an analysis of group differences (t<0.05) revealed there was significantly improved changes. Four nurse sensitive patient satisfaction questions (HCAHPS) were selected as directly relating to program content. Patient satisfaction scores improved for all four units on two satisfaction questions and one unit improved on all four questions.

 Conclusion: A program to enhance nurse professional role competency supported by nursing unit performance improvement actions was effective in improving staff nurse accountability for practice as evidenced by handover report observations, nursing work environment and improved nurse sensitive patient satisfaction outcomes.