JCAHO Releases Study Evaluating Nurse Peer Messengers Reporting Unprofessional Behavior

The latest issue of the Joint Commission Journal on Quality and Patient Safety published findings from a recent study designed to improve professionalism in nursing. The Co-Worker Observation System (CORS), formerly used among physicians, for staff nurses in three major medical centers. Here’s what the research showed and how it may be used to improve nursing culture. Read about the CORS study here. 

Background of the CORS Program

The CORS program was developed in 2013 by the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center. The bundle has successfully addressed disrespectful behavior using feedback from trained peer messengers. It includes a reporting tool, a complaint process, and training.

CORS was initially used for sharing complaints with physicians to decrease complaints and reduce malpractice risk. More than 73,351 medical professionals have gone through the program. The latest study published in the Joint Commission Journal evaluated the feasibility and fidelity of implementing CORS for staff nurses.

The CORS Study Among Nurses

Researchers evaluated the implementation of CORS at three medical centers:

• Keck Medicine, the University of Southern California

• The University of Iowa Health Care

• Vanderbilt University Medical Center

During the study, nurses reported unprofessional behavior through an electronic reporting system. Records were processed using software and trained coders, then assigned to one of these categories:

• Poor or disrespectful communication 

• Irresponsible behavior 

• Inappropriate care 

• Lack of professional integrity 

Reports were then referred to a trained peer messenger who would meet with the nurse to discuss the report. Afterward, the messenger completes a debriefing survey, including information about the message delivery, recipient response, and other pertinent details from the discussion.

Peer messengers were selected based on criteria, including:

• Ability to communicate effectively

• Listening skills

• Adherence to organizational policies and procedures

Training included a 90-minute training session conducted by program faculty. 

From September 1, 2019, to August 31, 2021, 590 reports were generated. The majority of the reports contained more than one unprofessional behavior. Consequently, 1,367 unprofessional behaviors were mapped to the CORS categories. 

The study yielded a 78.9 % message delivery rate over a 12- to 24-month time frame.

Researchers believe this study supports that CORS can be successfully implemented with staff nurses when adequate infrastructure is adequate. Moreover, by reducing incidents of unprofessional behavior through peer messaging and self-reflection, CORS can support a culture of patient safety and care quality.

CORS and the Nursing Profession

We know that disrespectful behavior by professionals in a clinical setting is associated with the following:

• Increased surgical complications

• Decreased teamwork

• Poor communication and engagement

• Decreased productivity

Additionally, the nursing profession has a reputation for “eating their young,” which can negatively impact patient outcomes, nurse well-being, and organizational turnover. In fact, the prevalence of incivility among nurses in clinical settings may be as high as 55.1%. Furthermore, unprofessional behavior is responsible for up to 40% of nursing turnover.

“As the largest group, by number, of healthcare professionals, nurses must be included in programs that promote professional accountability,” said Cynthia Baldwin, MS, RN, CPHRM, lead study author and senior associate at Vanderbilt University Medical Center.

The Takeaway

Unprofessional and unsafe conduct can undermine clinical teams. In a safety culture, team members who have concerns should ideally speak directly with each other. However, there are many reasons they may choose not to speak up. That’s why mechanisms such as event reporting software may be useful for promoting a culture of safety.

“Prior research shows that unprofessional behaviors in healthcare settings lead to unhappy, less motivated workers and poorer patient outcomes,” Baldwin said. “We thought this was a unique opportunity to provide nurses with the capability to self-regulate, creating a vision for respect and inclusion for all team members.”