(OAKBROOK TERRACE, Illinois, January 3, 2023) – Highly reliable patient care requires well-designed systems and professional accountability that support teamwork, trust and respect. Healthcare team members are well positioned to observe disrespectful and unsafe conduct – behaviors known to undermine team functions.

A new study in the January 2023 issue of The Joint Commission Journal on Quality and Patient Safety evaluated the feasibility and fidelity of implementing the Co-Worker Observation System (CORS), a tool and process  to address disrespectful behavior through feedback from trained peer messengers, for staff nurses. CORS has been shown to decrease instances of unprofessional behaviors among physicians and advanced practice providers (APPs).

Researchers implemented CORS at three academic medical centers (Keck Medicine of the University of Southern California, University of Iowa Health Care and Vanderbilt University Medical Center) using a project bundle with 10 essential implementation elements. Reports of unprofessional behavior among staff nurses that were submitted through the institution’s electronic reporting system were screened through natural language processing software – coded by trained CORS coders using the Martinez taxonomy – and referred to a trained peer messenger to share the observations with the nurse.

A total of 590 reports from the three sites were identified from September 1, 2019, through August 31, 2021. Most reports included more than one unprofessional behavior – a total of 1,367 unprofessional behaviors were successfully mapped to an existing CORS category:

• Clear and respectful communication – 48.8%
• Responsibility – 33.3%
• Appropriate medical care – 6.8%
• Professional integrity – 5.9%
• Report of concern/possibly egregious – 5.2%

Of the peer messages, 76.5% successfully completed a debriefing survey. The researchers believe the study supports that CORS can be successfully implemented with staff nurses when nursing infrastructure is adequate.

“As the largest group, by number, of healthcare professionals, nurses must be included in programs that promote professional accountability,” says Cynthia Baldwin, MS, RN, CPHRM, lead study author and senior associate, Department of Pediatrics and School of Nursing, Vanderbilt University Medical Center. “Prior research shows that unprofessional behaviors in healthcare settings lead to unhappy, less motivated workers and poorer outcomes for patients. We thought this was a unique opportunity to provide nurses with the capability to self-regulate as shared governance models highly support this concept. Creating a vision for respect and inclusion for all team members aligns with organizations’ values and nursing code of ethics.”

The January issue is available in special open access through the end of the year. Also featured in the issue:

• A Multicenter Collaborative Effort to Reduce Preventable Patient Harm Due to Retained Surgical Items (Ascension)
• Retained Surgical Items: How Do We Get to Zero? (editorial)
• Factors That Affect Opioid Quality Improvement Initiatives in Primary Care: Insights from Ten Health Systems (data from 10 U.S. healthcare systems)
• Impact of Adherence to a Standardized Oxytocin Induction Protocol on Obstetric and Neonatal Outcomes (HCA Healthcare)
• Determination of Unnecessary Blood Transfusion by Comprehensive 15-Hospital Record Review (observational analysis of 15 U.S. hospitals)
• Engineering a Clinical Microsystem to Decrease Workplace Violence for Medically and Psychiatrically Concurrently Decompensated Patients (University of Texas Southwestern Medical School, Dallas)

For more information, visit the JQPS website.

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Note for editors    
The article is “Implementation of Peer Messengers to Deliver Feedback: An Observational Study to Promote Professionalism in Nursing,” by Cynthia A. Baldwin, MS, RN; Kirsten Hanrahan, DNP, ARNP, CPNP-PC, FAAN; Stephanie W. Edmonds, PhD, MPH, RN; Alice M. Krumm, DNP, RN, CNOR, NEA-BC; Annette Sy, DNP, RN; Awa Jones, MS, RN; Theresa Murphy, MS, RN, CENP; Samantha Mitchell, MFA, MA; Heather A. Davidson, PhD; Jessica Thomas, MS, RN; Lynn Webb, PhD; Thomas W. Doub, PhD; and William O. Cooper, MD, MPH. The article appears in The Joint Commission Journal on Quality and Patient Safety, volume 49, number 1 (January 2023), published by Elsevier.    

The Joint Commission Journal on Quality and Patient Safety    
The Joint Commission Journal on Quality and Patient Safety (JQPS) is a peer-reviewed journal providing healthcare professionals with innovative thinking, strategies and practices in improving quality and safety in healthcare. JQPS is the official journal of The Joint Commission and Joint Commission Resources, Inc. Original case studies, program or project reports, reports of new methodologies or the new application of methodologies, research studies, and commentaries on issues and practices are all considered.