O’Rourke Role Based Practice Theory

Contributor: Maria Williams O’Rourke
September 12, 2019

Author – Maria Williams O’Rourke, RN, PhD, FAAN

First published – 1976
Major Concepts

Role clarity

1. Characteristics and expected role behavior
2. Role obligations

a. Professional -Tenets of Profession

i. Self-regulation
ii. Theory based practice
iii. Evidence based practice
iv. Ethics based practice
v. Transfer Knowledge
vi. Service orientation

b. Societal

c. Legal

Professional Comportment

1. Role Identity formation
2. Role taking/adoption
3. Role adaptation
4. Role Integration
5. Role conformity
6. Role consensus and shared understanding
7. Role development

Role Autonomy and Accountability

1. Privilege
2. Decision making authority
3. Leadership
4. Position and personal power
5. Collegiality and collaboration
6. Governance
7. Competency

Typology

Middle-range theory

Brief Description

Role clarity as a concept is foundational to our understeering of self and our role relationships with others, with systems, families and other social situation. Through role clarity the decision making authority within each role can be made explicit, such that, it allows the individual to engage in their role in a fulfilling and effective manner. Role based practice theory provides a theoretical framework that helps better understand role clarity and is derived from Role and Symbolic Interaction Theory (George Herbert Mead 1934 ) which hypothesizes a link between one’s definition of the situation and subsequent actions based on that definition. Specifically, role based practice builds on that linkage and posits that if, one knows their role (role clarity), defines oneself in relation to expectations, norms, ethics and standards related to that role (role definition and role consensus), views oneself as embodiment of that role definition (role identity) and adopts and owns it as their own (role taking- acquisition and accountability), then, there is a higher likelihood that one will behave or strive to behave in accordance with that role definition (role enactment). Role base practice theory aims to raise awareness of the need for professional role development and identify formation in the early stages of nursing education.

Key Assumptions of Role Based Practice Theory in Healthcare

Within healthcare, role based practice theory serves as an framework for explaining the role behavior by professional, technical and assistive roles (role differentiation) and level of decision making authority associated with these role (role authority). This role authority serves as the bases for appropriate role relationships. Given the thesis that role clarity is linked to behavior, it is important to uncover how role clarity by employees, practitioners and management can impact patient care quality and outcomes.

In health care, the quality of patient care outcomes is influenced by two main factors: the quality of the decisions that determine what actions are to be taken and the quality of the process with which those actions are taken. Role based practice theory focuses on the appropriate types and numbers of professional, technical, and assistive practitioners are needed to meet the patient care requirements in a manner that produces positive outcomes for patients or helps them achieve a peaceful death.

Primary Sources

O’Rourke, M.W., Loos, N., (2012) Autonomy, Job Satisfaction and Quality of Care: Barriers and Facilitators of a Role Based Approach to Practice within the Context of the Essentials of Magnetism. Sigma Theta Tau International Conference, Brisbane, Australia

Kulikowski K, O’Rourke, M.W. (2010) Building Professional Role Capacity, Chapter 9, 257-276 in Teaching Nursing: the art and science 2nd edition, volume 2. Caputi, L. (Ed.) College of DuPage Press: Glenn Ellyn, IL.

O’Rourke, M.W. (2009). RNs’ Professional Role is Established by Law. California Board of Registered Nursing, BRN Report, fall/winter 2009, 10-12.

O’Rourke, M.W., White, C. (2007). New graduate transition to practice: Implementing a role-based professional development system for effective role transition. Poster presentation: UCSF/Stanford Center for Research and Innovation in Patient Care, Research Days, San Francisco, CA.

O’Rourke, M.W. (2006). Beyond Rhetoric to Role Accountability: A Practical and Professional Model of Practice. Nurse Leader. June 2006. Volume 4. Issue 3, 26-44.

O’Rourke, M.W. (2003). Rebuilding a professional practice model: The return of role based practice accountability. Curtain, L. (Ed). Nursing Administration Quarterly 27(2), 95-105.

O’Rourke, M.W. (1994). Professional practice and collaboration for care team redesign. Nursing Horizons. Long Beach Memorial Medical Center Division of Nursing, CA.

O’Rourke, M.W. (1989). Generic professional behaviors: Implications for the CNS role. Clinical Nurse Specialist, 3(3), 128-132.

O’Rourke, M.W. (1981). Health policy: The clinical perspective. NYC: National League for Nursing.

O’Rourke, M.W. (1980). Professional issues and development in psychiatric nursing. In P. Pothier (Ed.), Psychiatric nursing: A basic text. Boston: Little, Brown, and Company.

O’Rourke, M.W. (1976). California Nursing Practice Act: A model for implementation. San Francisco: California Nurses’ Association.

Application Sources

Adoption by Key Organizations: UCLA, Dartmouth, Honor Health, Samuel Merritt College, Santa Clara Valley Medical Center, Community Medical Center, John Muir Medical Center, OHSU,

Bonnice, B. (2019) A Nursing Leadership Challenge: making the Integration of Professional practice Standards into Nursing Operations a Reality. Nurse Leaders. June 2019 Volume17. Issue 3,207-214.Guest Editor: M.W. O’Rourke.

Landstrom, G.L. (2019) Interprofessional Practice: Just a Trend or Worthy Investment. Nurse Leaders. June 2019 Volume17. Issue 3,220-224.Guest Editor: M.W. O’Rourke.

Petersen Smith J., Kehl S. (2009) One Public Hospital’s Journey to Nursing Excellence: Professional Practice as the Foundation. Nurse Leader. December 2009 Volume 7. Guest Editor: M. W. O’Rourke.

Jones, B., White C., Segura Smith A. (2009). Data-Driven Systems for RN Autonomy. Nurse Leader. October 2009 Volume 7. Issue 5, 28-32. Guest Editor: M.W. O’Rourke

O’Rourke M.W., Gibbs R. (2007). Professional role-based practice: The basic foundation for providing quality care and achieving practice excellence. Poster presentation: Association of California Nurse Leaders Annual Conference, Newport Beach, CA.

O’Rourke, M.W., Jones, B., White, C., and Segura, A. (2006). Striving for the highest RN professional role performance: Implications for professional RN role accountability, authority, and patient safety. Poster presentation. Association of California Nurse Leaders Annual Program. Century City, CA.

O’Rourke M.W., Bucher, R (2004). Improving the quality of the clinical conversation: A commitment to patient safety. Poster presentation: American Nurses Association Biennial Convention, Mpls, MN.

O’Rourke M.W., Thompson, C. (2004). Building a strong clinical practice system: The case for interdisciplinary professional practice model. Peer reviewed poster presented: Tomorrow’s Nursing Workforce: Practice Solutions for Success. Forum on Health Care Leadership, Nashville, TN.

O’Rourke, M.W., Goeppinger S. (2000). Interdisciplinary professional practice: good for patients, good for business. Poster presentation. American Academy of Nursing, Annual Conference, San Diego, CA.

Author

Maria Williams O’Rourke

Dr. O’Rourke is currently a Full Professor, Clinical Series, UCSF School of Nursing, Department of Community Health Systems, Program Support Faculty, Healthcare Administration and Inter-professional Leadership Program (HAIL), and, CEO & President of Maria W. O’Rourke & Associates LLC. Her practice helps healthcare systems support inter-professional practice based on appropriate use of the professional RN with the intent to improve patient outcomes through role clarity. This work has helped organizations on the ANCC Magnet journey increase their understanding of the essence of profession and build professional practice models highlighting the key decision making role of the RN.

Her expertise on professional role clarity is grounded in her early work in 1965 as an activist who witnessed the serious lack of understanding of professional RN role. This lead to her legislative efforts where she was instrumental in rewriting the California Nursing Practice Act in 1974 which transformed the role of the RN in California as an equal professional partner on the interdisciplinary team. Her clarity of thought on the profession as a discipline and the RN role within that discipline was the impetus for development of her role based practice theory which posits that role clarity is linked to role identification and role enactment/ comportment. Her leadership development expertise and skill are used to conduct strategic planning events for management using her unique conceptual method called RESULTS.

Although her roots are in nursing, Dr. O’Rourke’s expertise serves as a foundation for inter-professional leadership. She is committed to helping members of the health care team better understand the professional RN role. To that end, in 1994 she co-founded the O’Rourke Institute for the Advancement of Professional Practice, a forum for healthcare professionals to dialogue and obtain support/advice about their professional practice and leadership efforts. She has been relentless in her efforts to bridge the theory- research- practice gap, and, as the first UCSF Assistant Dean for Clinical Affairs at San Francisco General Hospital she established the first nursing research committee that advanced this effort through faculty-bedside clinician collaboration.

A member American Academy of Nursing member since 1985 she participates in Nursing Expert Panels on Building Health Care System Excellence and Theory Guided Practice. As a mentor she facilitated the leadership development of nurse leaders and as guest editor of a National Nursing Journal, Nurse Leader June 2019 edition, she used it as a platform for showcasing her mentees and colleagues work.

In 2015 she became the Inaugural Distinguished Scholar in Residence at Honor Health in Scottsdale Az., and in 2018, was awarded the 2018 ANA/California Ray Cox Award for her lifelong commitment, impact on and dedication to the advancement of Nursing as a profession. She served locally on the Commission on Status of Women, Marin County and was research design consultant for San Francisco Foundation Grant needs assessment for women, Board of Directors Hospice of Marin, Chair, Larkspur’s Citizen’s Advisory Committee tasked with reviewing environmental impact studies regarding quality of life and health and safety issues, resulting in preservation of open space.