What would happen to the culture of your organization if all staffing and work flow decisions become knowledge-based and patient-centered rather than task based?


Role Clarity and Work Alignment (RCWA) is a dynamic process used to 1) determine the intricacies of work activities of all nursing care providers for a specific population of patients and 2) identify the complexity of the interventions routinely performed.

Role Clarity and Work Alignment is neither a patient classification nor scheduling system, but it provides data essential to both.  Using Nursing Interventions Classification (NIC) language, representatives from a nursing unit analyze the complexity and volume of work, what work is appropriate for delegation, and the structural relationships that support delegation.

Why Clinical Nurse Mangers and Staff Nurses Love RCWA

RCWA is a consultative package that provides a clear, comprehensive picture of how each unit functions so that changes in roles, policies, processes, and procedures can be aligned and enhanced to actively advance care delivery and professional practice initiatives. Through this process, unit staff develop a deep appreciation for the complexity of clinical nursing care and what is unique about their individual unit

As caregiver roles are clarified, staff members gain new insight about ways to lift up the role and extend the knowledge of professional nurses while optimizing the contributions and work satisfaction of all caregivers in caring for patients as a unified team.

As work and roles are explored, group members develop a more extensive awareness of the complexity, scope, and value of their work and develop new ways of approaching old problems and dilemmas. Clarity of roles is essential to trust and thus to effective delegation.


Jayne Felgen, consultant and President Emeritus of Creative Health Care Management, explains how Role Clarity and Work Alignment (RCWA), improves the quality of patient care, increases efficiency, and gives staff nurses the confidence to work interdependently with physicians and clinicians in other disciplines.

Outcomes of this Program

The consultant facilitating Role Clarity and Work Alignment integrates the findings of the RCWA analysis for each individual unit in order to create a comprehensive plan for transformational change that is customized for the organization. Specific outcomes include the following:

  • Creation of a knowledge-based, patient-centered approach to care delivery.
  • Improved documentation and interdisciplinary communication.
  • Sharpened critical thinking skills including new understandings of organizing and accomplishing work activities.
  • Establishment of a rational framework for delegation decisions that maximizes skill mix.
  • Optimized use of resources through awareness of time spent in value-added and non value-added work.
  • Development of optimal interdisciplinary relationships.
  • Creation of platform to engage the staff in implementing unit-specific responses to organizational initiatives.
  • Preparation of organization for comprehensive electronic clinical/resource information system.

The Role Clarity and Work Alignment process is not simply about identifying current realities, but about moving people forward toward greater care for those they serve. When staffing and work flow decisions become knowledge-based and patient-centered, staff satisfaction and the patient experience cannot help but improve.