For The Greater Good, Candy Goulette
Advance for Nurses, January 1, 2007

“You cannot change the standard of care if you don’t change the standard of practice,” she [Maria W. O’Rourke, DNSc, RN, FAAN, CHC] said.  “And you can’t change the standard of practice unless you know what to do when you show up.  That can’t happen until we know our own professional roles, then act on that knowledge.  We must use our role and deliver our practice so the patient is better for having met us.” “If we want to change patient outcomes, we must change our conversations.”

Beyond Rhetoric to Role Accountability:  A Practical and Professional Model of Practice, Maria Williams O’Rourke DNSc, RN, FAAN, CHC
Nurse Leader, June 2006

“If you want to improve the standard of care, then you must improve the standard of practice. Improving the standard of practice is based on one’s understanding of professional role authority, responsibility, and accountability.  My emphasis continues to be on professional role development and socialization that addresses role competence based on the tenets of a profession, scope of practice, and standards rather than skill competence or clinical practice competence both of which are dependent on role competence.  When used consistently and systematically, PRDG (Professional Role Development Guide™) helps develop and sustain a highly functioning professional staff and leadership team that is role and standards based.  This program supports the concepts and principles found in the Forces of Magnetism and when used facilitates the journey toward Magnet designation.  A professional model of practice is a practical way, beyond rhetoric, to structure the learning needs of nurses.  Through a professional role development and role socialization program, staff will be motivated and rewarded for effectively using their role in the service of the patient.”

Professional Role Competence & Improved Patient Outcomes, Bobbi Harrison
Healthcare Traveler, May 1, 2005

“According to Dr. [Maria W.] O’Rourke, the professional role of the registered nurse consists of two core obligations: Aiding in recovering the patient from the medical condition and assisting him or her in realizing higher levels of wellness.  “RNs are authorized to have broad decision-making authority and care coordination control.”

Rebuilding a Professional Practice Model The Return of Role-based Practice Accountability, Maria Williams O’Rourke
Nursing Administration Quarterly, Volume 27, No. 2   2003

“There is no patient care without clinical practice.  To improve the quality of health care, organizations must build a finely tuned and resilient clinical enterprise, one founded on clear role accountability and decision authority within the team.  The author views scope of practice and professional standards as the foundation for practice accountability and decision authority. Lack of understanding of the “who and the why” of professional role authority generates role and interpersonal conflict from those who attribute nursing’s exercise of role authority as a struggle for power.  Therefore, the key principle of the professional practice model is that accountability for determining the patient’s condition and directing care activities in relation to the patient’s changing status is a professional role responsibility.  This is a message that must be clearly communicated and promoted at all levels of the organization. Risk reduction is a critical issue in every organization, and performance improvement departments are charged with helping organization ferret out the root cause of the error. This obligation is grounded in the performance component of the Patient Care Model [PCM]. The professional practice decision process with its nine steps is a useful tool in evaluating the cause of sentinel events. The professional role that is responsible for managing the patient condition and determining the nature and extent of the clinical work to be carried out must maintain the position of leadership on the care team.  Effective leadership by the professional role will require a setof core competencies.”

Professional Practice and Collaboration:  Implications for Care Team Redesign by Maria O’Rourke, RN, DNSc, FAAN
Nursing Horizons, 1994

“It is interesting to note that despite a clear, legal definition of nursing’s role, the goal, the processes and the outcomes of nursing practice and the behaviors associated with this professional role are not consistently evident in the practice setting. Restructuring the practice setting requires a shift from our current environment, which fosters self-interest, turf wars and the blurring of roles, to one in which there is an understanding and appreciation of the valuable differences among professional, technical and assisting roles.  The commitment to implement a professional practice, collaborative model and a plan to manage the transition process will require role change on everyone’s part and at all levels of the organization.”