Maria Williams O'Rourke, DNSc, RN, FAAN, CHC

For nearly four decades, Maria Williams O' Rourke, DNSc, RN, FAAN, CHC, has held a variety of positions in nursing service and education. None, however, is more important than her current role as consultant, assisting nurse executives in advancing the professional development of staff to improve patient safety and outcomes. "Demonstrating the power and beauty of the professional role of nursing—and creating a professional role development program and assessment tool to ensure all who practice as registered nurses (RNs) are socialized to the expected role behaviors—has become the focus of my career and my life's work."

Recognized as an authority on the use of the professional role within an interdisciplinary team, Dr. O'Rourke is president and CEO of Maria W. O'Rourke Inc., a consulting firm located in Larkspur, California. The roots of her passion to illustrate the RNs' pivotal decision-making role and authority can be traced back to 1974, where she was one of the driving forces behind the rewriting of the California Nursing Practice Act. Dr. O'Rourke, who received her Bachelor of Science in Nursing from Boston University and her Master of Science and Doctor of Nursing Science degrees from the University of California, San Francisco (UCSF), published the first paper on the Act's implementation in 1976, helping to guide the profession in the appropriate use of RNs within a professional practice model.

A year later, she was selected as an NLN Robert Wood Johnson Fellow in Public Policy. While on faculty at UCSF in 1984, Dr. O'Rourke was commissioned by the Mayor's Committee for San Francisco General Hospital to assist with improving quality of care and raising the standard of nursing practice. Elected a Fellow of the American Academy of Nursing in 1985, awarded the Distinguished Alumni Award for Boston University School of Nursing in 1986, and certified as a healthcare consultant by the American Association of Healthcare Consultants in 2000, Dr. O'Rourke has conducted more than 10 major Patient Safety and Quality Initiatives in California and Hawaii since 1990. She is sought after nationally and internationally for her ability to clearly articulate the power and beauty of the professional RN role and its importance to patient outcomes. Through her dedication and extensive work, she has garnered several nominations for prestigious honors, such as the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) John M. Eisenberg Award for Patient Safety and Quality and the Association of California Nurse Leaders (ACNL) Best Practice in Clinical Practice Award.

Utilizing her vast experience, Dr. O'Rourke helps nursing leadership evaluate staff's level of role expertise which includes decision-making, critical thinking skills and care coordination, and tying performance improvement to error and risk reduction, patient safety, and enhanced clinical, service, and financial outcomes. "I have developed a program which achieves the goal of providing meaningful feedback to staff about their professional role accountability so they can grow and excel and realize a clear vision for nursing as a key decision-maker on the team. This data-driven approach helps us demonstrate that our practice matters."

In 2003, she partnered with Educare Technologies, Inc., to bring her Professional Role Development System to the Internet, giving more organizations the opportunity to implement a learning program that supports professional role development for RN students, LVN to RN students, and staff. "Currently, the online program is set up for registered nurses. But eventually, other professionals, like pharmacists, physical therapists, and social workers, will also have the ability to take advantage of this web-based program and assessment tool, as these professional role expectations apply irrespective of discipline."

In the following pages, Dr. O'Rourke defines the professional RN role and discusses the importance of role and outcomes-based practice, rather than task-based practice. Emphasizing the need for professional role accountability, she provides insights on how nurse executives can enhance best practices, as well as achieve staffing effectiveness. We at Healthcare Staffing & Management Solutions (HS&MS) appreciate her deep level of commitment and thank her for sharing her perspectives.

HS&MS: Please define the professional RN role and the state of nursing practice today.

Maria Williams O'Rourke (MWO): The professional role speaks to an RN's accountability, authority, and duty, as a member of a profession, to act in accordance with role obligations defined in scope of practice and professional nursing standards. It is a set of behavioral expectations that produces an individual who has the authority and capacity to self-direct through employing a rigorous decision-making process, using the theory and evidence to transfer knowledge and provide care.

The current state of nursing practice has advanced due to the profession's focus on developing the content of our practice. This knowledge base has advanced enormously, moving deliberately through many decades of generating the science used to determine how to care for the patient. Today, there is strong evidence for our actions, which is something with which I am extraordinarily pleased.