A systems-focused context for understanding the RN role and performance

A myriad of sociocultural, political, organizational, and micro unit-level systems comprise contexts in which the registered nurse (RN) role is defined, operationalized, and evaluated. This paper offers several systems- focused perspectives for understanding the RN role and performance within and across systems of care. An organization-level systems approach highlights the interaction effect of the organizational design factors that link organizational structure to RN work. Another approach addresses one specific aspect of the RN role – delegation of nursing services – highlighting the regulatory and functional mechanisms that influence ways the RN role is operationalized. A micro-systems approach addresses specific RN practices associated with prevention of pressure ulcers, and the unit-level interactions that facilitate and/or limit RN knowledge, beliefs, and values associated with best practices. The knowledge gained from applying systems-focused perspectives to understanding the RN role provides critical insights and directions for interventions aimed to maximize RN role effectiveness in long term care.