A Study of Role Performance in Specialty Outpatient Clinics

Abstract

For 25 years the role of the nurse in clinical practice has been the subject of extensive inquiry, evaluation and recommendations. The emphasis in this particular body of literature has been on defining the rights, expectations and obligations of the nurse's role in a variety of different situations. This is in keeping with the structural-functional orientation of role theory (Banton, 1968; Gordon, 1966). Less attention has been given to determining the conditions under which various types of roles emerge. This type of investigation would be best located within the social-psychological orientation where behaviour is viewed as situationally derived, in part, from the demands and expectations of others (Palmer, 1970; Sarbin, 1966). From this perspective, the enactment of a role is interactive and circular in that it involves persons simultaneously fitting their acts into the ongoing acts of the other, and each receiving some sort of role support by the other (Carson, 1970). Thus, the behaviour of a part of a system (nurse's role) in a situation (clinical practice) can be partly understood in terms of the behaviour of the rest of the system (health care team; health care organization) (Von Bertalanffy, 1968; Ruesch & Bateson, 1951). It is the absence of this perspective in the literature that this study addresses. The enactment of a role does not occur in a vacuum but is interactive, by definition. Thus, conceivably it could be affected by the individual's educational preparation and experience, the availability and roles of other resources in this situation as well as the organizational structure and complexity of work demands. To test these assumptions, the present study was designed to compare the activities of nurses with different educational preparation (RN and RNA), while assessing the relationship between these activities and the confounding effects of the organizational arrangement and organizational demand. The College of Nurses of Ontario regulates the practice of nursing by establishing standards of practice which are required by each level of registrant, i.e., R.N. and R.N.A. Clear guidelines for practice