More Thoughts About Culture as a Metaparadigm Concept: Rejection of the Reality of Subcultures.

This essay is an extension of a previous essay in which culture was identified as a distinct concept of our disciplinary metaparadigm. Here, we define subculture and discuss our rationale for rejection of the reality of subcultures.

Professional role clarity and competency in health care staffing--the missing pieces.

Professional role clarity and role competency are the missing pieces to achieving staffing excellence. The relationships among professional practice models, professional role competency, professional role clarity, patient safety, data, and staffing effectiveness build a solid equation, which supports improved patient outcomes. An essential variable binding these elements is housed in the patient handover conversation.

Building organizational capacity for a healthy work environment through role-based professional practice.

The professional practice of registered nurses (RNs) and their professional role competence are key variables that have an impact on quality and patient safety. Organizations in which RNs practice must have the capacity to fully support the professional role of those RNs in exercising their legitimate power derived through nurse licensing laws and professional standards and ethics. The interplay of individual RN practice and organizational practice, and measurement thereof, are the essence of organizational capacity.

Rebuilding a professional practice model. The return of role-based practice accountability.

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.