Expanding the hospital nursing role: an administrative account.

In reality, role change among staff RNs is a continuous phenomenon. As medical technology increases, patient care regimes follow suit, and the staff RN is constantly called upon to apply a knowledge base in different ways and to acquire new knowledge and behaviors. The nursing administrator who keeps pace with this growth can capitalize on the phenomenon, guiding the change to see that it is progressive, that it assists the nurse in developing a more advanced nursing (as opposed to mini-physician) identity and that it does improve extant nursing practice. Undertaking a new project of this sort on the unit is likely to create a number of beneficial by-products. For example, nurse-physician rapport and communication increase as each group opens professional boundaries in defining and planning the content of role expansion. The unit's traditional operation must also be examined in the course of building in new functions. System critiques stimulate the unit's nursing manager to weed out less than optimal features of the existing nursing care delivery system. The expanded role has favorably affected nursing care at Mercy Hospital. Physicians, nurses, and most important, the patient have reaped the benefits. The nurse is able to function in a more advanced capacity, and physicians see the benefits to their patients; fewer delays in specific aspects of care delivery with a more sophisticated, higher quality of nursing care. What is exciting about this concept is that the principles could apply to virtually any RN work group that gives direct care to a homogeneous patient population.