Professional Role, Leadership, Quality Improvement, and Interprofessional Collaboration
Role, leadership, quality, and teams
Practice is governed by the state nurse practice act and shaped by the ANA Scope and Standards of Gerontological Nursing. Certification does not expand scope; it documents expertise. Advocacy - for the patient, caregivers, and system change - is an explicit professional obligation, and suspected abuse or neglect must be reported under state law.
Evidence-based practice asks a focused PICO question, appraises the literature, and implements with attention to local context. Quality improvement is not research: QI changes a local system and does not require generalizable knowledge or the same IRB oversight.
QI toolkit: the Model for Improvement (What are we trying to accomplish? How will we know a change is an improvement? What changes can we test?) with PDSA cycles; run charts and control charts to separate signal from noise; root cause analysis after a sentinel event; failure mode and effects analysis prospectively. Track nurse-sensitive indicators - falls with injury, hospital-acquired pressure injuries, catheter-associated UTIs, delirium, restraint use.
Leadership: transformational leaders inspire shared purpose; situational leaders flex style to team readiness. Shared governance and a just culture improve safety - a just culture asks what in the system allowed the error rather than blaming the individual. Delegation uses the five rights (task, circumstance, person, direction, supervision); the RN keeps accountability for assessment, teaching, and clinical judgment.
Interprofessional collaboration: use SBAR and structured huddles, clarify roles, resolve conflict early, and treat patient and family as team members. Culture-change models (Eden Alternative, Greenhouse, Pioneer Network) put person-centered care into practice. Worked example: falls rise on a unit - do not single out the night nurse. Use PDSA: identify contributors (a new sedative order, missed toileting), test a medication review plus scheduled toileting, then re-measure.