There is a deepening crack in the foundation of healthcare: the lack of clarity in job descriptions.
In recent years, shifting care models, workforce shortages and new technologies have pushed healthcare organizations toward more flexible, team-based approaches — but often at the cost of clearly defined roles.
When Deana Sievert, DNP, RN, joined Chicago-based Rush University Medical Center in November as the system’s chief nursing officer, she discovered role ambiguity across units and departments.
“We have such a strong recognition of the importance of nursing as a main cog in that wheel of patient care,” Dr. Sievert told Becker’s. “We’ve really been fortunate to have a really strong foundation of resources for nursing at Rush.”
Those resources include four types of nursing leaders who provide patient care: charge nurses, clinical nurse leaders, unit leaders and clinical nurse specialists.
Over the last few years, lines blurred and inefficiencies appeared.
She asked employees who share the same role but work in different departments variations of the question, “What do you do here?” Their answers uncovered a lack of consistency that hospitals cannot afford, Dr. Sievert said.
“They were all doing things all day that they thought were the right things,” she said. “But the reality of it is that when you look at the bigger picture of intersecting those four different roles, they really should be staying in this one line.”
In some cases, the same role functioned differently from unit to unit, creating confusion for care teams and making it harder for staff to work efficiently across departments.
Role ambiguity begets frustration and limits people from working at the top of their license, said Dr. Sievert, who recently served as CNO of Ohio State University Wexner Medical Center and Ross Heart Hospital in Columbus, Ohio.
Position-specific expectations shifted during the COVID-19 pandemic due to worsening healthcare workforce shortages, she said, leading to more team-based care models. While these interdisciplinary teams create flexibility and improve patient outcomes, they can also jumble expectations around individual responsibilities.
“We did that intentionally to allow more flexibility [and] promote stronger interprofessional collaboration,” Dr. Sievert said. “But I think we’ve allowed that pendulum to go a little bit too far.”
The result is often duplication of work, inefficiencies and uncertainty among staff about what they should prioritize day to day, she said.
Peter Pronovost, MD, PhD, chief quality and clinical transformation officer of University Hospitals in Cleveland, told Becker’s “the problem of many hands” — or widespread, shared accountability — is another driver of hazy expectations.
Similar to the bystander effect, if everyone is accountable, no one is accountable.
Too many people sharing responsibility without clear ownership can degrade performance, Dr. Pronovost said.
At the same time, modern care delivery requires deep coordination across roles that sometimes lack clear boundaries. In many cases, physicians, nurses, pharmacists, case managers and social workers are all working toward the same outcome — but without a shared understanding of who owns which tasks.
Healthcare leaders are responsible for intentionally course-correcting this drift, she said.
At Rush, that means redefining roles around core responsibilities — or “nonnegotiables” — while also allowing flexibility for unit-level needs.
The latter gives employees the autonomy and ability to flex their role depending on patient populations, department culture and current skill sets. That flexibility is increasingly important as many bedside nurses now have fewer than five years of experience, requiring room for skill development within roles, she said.
Any change to care models can disrupt role expectations and a team’s flow, Dr. Pronovost and Dr. Sievert said.
Launching virtual nursing models, reintroducing licensed practical nurses to acute care units, and rolling out new technologies to make healthcare delivery safer or more cost-effective can all create role ambiguity.
Emerging technologies such as AI are expected to further reshape responsibilities by redistributing cognitive tasks and decision support, requiring leaders to continually reassess who does what.
For leaders, the solution is not less collaboration but more intentional design.
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