1. Van Wagoner, Kathleen MSA, MSN, RN

Article Content

The role of the nurse can be quite complex, and the dilemma is perpetuated by the differing definitions and points of view as to what nurses really do. Professional nursing is an integral component of healthcare; patients and families highly regard compassionate care and recognize the nurse as one of the most trusted members of the healthcare team. The relationship-based care (RBC) delivery model provides compelling language to describe the values needed to safeguard the humanness of caring relationships with patients and families, colleagues, and the self. (See Table 1.)

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Table 1: RBC values2... - Click to enlarge in new windowTable 1: RBC values

The professional nurse has the insight and capacity to give voice to these crucial and valued relationships, and move from a task-based to a professional practice model with the patient and family at its core. Vital to the role of the professional nurse is the clarity with which the nurse influences humanness, which at times can be lacking in the healthcare system. This clarity must begin with nurses having a clear understanding of their own role and the ability to consistently give voice to and clearly articulate their influence and contributions.


Describing the opportunity

The problem that continues to surface is nurses' difficulty describing their highly regarded role and how they contribute to the healing environment for the patient. When asked, nurses grapple with readily identifying the American Nurses Association (ANA) Standards of Professional Nursing Practice.1 With coaching, most nurses will make the connection between their specific professional practice organization and the community standard of practice. Few nurses are able to describe effective delegation practices, how the public health code guides practice, and how their nursing license preserves the social contract with the patients and families for whom they care.


Nurses understate their contributions to healthcare, describing the role with vague and nondescript words. At times, nurses have even been known to dismiss the importance of their contribution to safety and quality of care. Nurses, without hesitation, are readily able to name the "tasks" that divert their attention from caring and will explain "if only others would perform their role, I could do mine more effectively." Nurses wrestle with defining what will change about how they provide care if the perceived "others" were more effective. Furthering this ambiguity, there are as many definitions of caring as there are nurses who make an effort to define the behaviors, attributes, and characteristics of professional nursing.


The question to be answered is: "How do we take every task a nurse describes and find the therapeutic value?" The vital work of the nurse is to do for the patient what they would do for themselves if they could. Nurses ensure that the necessary education is understood by the patient and family to become more independent in their care. The work of the nurse is therapeutic; the nurse learns about the patient, and plans and evaluates the care based on what's important to the patient, not always what the nurse thinks the patient needs.


Shifting to role clarity

Shifting the nurse's mindset to the intentional and deliberate effort of assisting the patient to navigate a complex healthcare system using therapeutic interventions permits the nurse to more fully engage in caring. Describing all of the care activities that the nurse provides as therapeutic avoids reducing the work of nursing to "tasks," which are repeatable actions that require minimal consideration when performing. Nurses engage in higher-level thinking and decision making in which critical knowledge, evidence, and wisdom are used to provide clarity and guide caring.


The role clarity and work alignment process anchors the role of the nurse in language and behaviors that describe the value of the therapeutic interventions and compassionate care nurses offer. When professional nurses can effectively articulate their scope of practice, they're more likely to care from a position of strength, intention, and purpose. This process incorporates the Nursing Interventions Classification (NIC) to describe the activities of nursing.3 The NIC taxonomy includes seven domains (physiologic, basic; physiologic, complex; behavioral; safety; family; health system; and community) and 30 classes associated with these domains. It also organizes over 500 specific interventions to describe the work of the professional nurse. Many nurses are introduced to the NIC for the first time during the role clarity and work alignment process. NIC offers a full range of nursing interventions, reflects current clinical practice and research, and provides consistent and useful language that's clinically meaningful to nurses.


Reflecting the ANA standards, the NIC clarifies the role of the nurse by describing the interventions that primarily remain within the nurse's domain, as well as identifying interventions that are safely delegated. Nurses can use the NIC to communicate the features of nursing to healthcare colleagues, patients, and families. The NIC provides intuitive language that's easily accessible, common among professional nursing, and established throughout multiple countries. Standardized language communicates the essence of nursing care to others and helps nurses advance and improve their practice through research.


Role clarity and work alignment uses Lean methodology that allows staff members to imagine, create, and design from the patient perspective and ideal caring experience, inclusive of therapeutic interventions. This methodology involves a small group of staff volunteers who are both positive and interested in designing the future of care delivery. The staff volunteers are encouraged to design the care process to simulate the ideal. When the design work is completed, the staff volunteers have the opportunity to create the simulated experience to facilitate design testing.


The design process is intended to incorporate a short practice trial, with learning from the experience. The short trial concludes with a debriefing to understand from the patient perspective and the participating staff what went well, what staff members want to continue to do, and what they would like to modify for a future practice trial. The priority is to first learn the benefits to the patient, followed by the benefits to the staff. The scientific underpinning of nursing practice is both reinforced and discovered during this process.


Role clarity and work alignment creates strength in professional practice, allowing nurses to live their caring strengths with abundance and clearly demonstrate their positive and lasting impact on the patients and families who receive care in a very complex system. Amidst the challenges of work realities, the professional nurse is well positioned to illuminate the caring and healing environment.


A clear difference

Clarity of self, roles, and systems inspires care providers and elicits their courage to challenge the status quo as they design and give voice to their practice role. To have clarity of self, professional nurses are clear about their role as an instrument of healing and that what they do or don't do matters. For clarity of roles, the nurse knows the broadest boundaries to optimize the collective efforts necessary for compassionate care and doesn't limit or minimize the value of the nurse's presence in the patient experience. Clarity of systems means that nurses embrace the mission and vision of the organization and focus on the best possible care for patients, families, and their colleagues.


Being clear about the difference that caring makes, having a vison to actualize compassion, and knowing what caring looks and feels like in behavioral words allows the nurse to more intentionally create the caring and healing environment for the patient and family. Nurses should appreciate the opportunity to pause and take a critical inventory of what they really do that's creating a profound difference in the patient experience. When patients and families are asked what they perceive as the most important gift the nurse offers to their healing, they'll often describe small acts of caring-the caring moment when the nurse paused to see the patient as a person.




1. Glembocki M, Fitzpatrick J. Advancing Professional Nursing Practice: Relationship-Based Care and the ANA Standards of Professional Nursing Practice. Minneapolis, MN: Creative Health Care Management; 2013. [Context Link]


2. Koloroutis M. Relationship-Based Care: A Model for Transforming Practice. Minneapolis, MN: Creative Health Care Management; 2014. [Context Link]


3. Bulechek G, Butcher H, Dochterman J, Wagner C. Nursing Interventions Classification (NIC). 6th ed. St. Louis, MO: Mosby; 2013. [Context Link]