Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Jeanne Salyer


A nurse’s contribution to patient safety in regards to early detection of issues in the clinical setting is undisputed (Redman, 2008). If these patient situations require a response that is beyond the scope of nursing practice, in most instances nurses are not sanctioned to intervene without physician consultation (Gaba, 2000). The evidence in the nursing literature does suggest that some nurses exercise professional discretion and are, at times, making the decision to initiate interventions independently (Benner, Hooper-Kyriakidis, & Stannard, 1999; Hutchinson, 1990; Tiffany, Cruise, & Cruise, 1988). The focus of this inquiry was to examine the determinants of a nurse’s discretionary decision to respond to situations that place patients at risk for safety events but requires a response that is beyond the scope of nursing practice. This study utilized a cross-sectional correlation design. Data for this study were obtained using a survey questionnaire. The nurses were asked to respond to questions measuring each concept of the research model based on Thompson’s (1967) conceptual model of determinants of discretionary behavior (education, experience, situational awareness, proactive behavior, and perceptions of transformational leadership). In addition, the nurses were asked to read three clinical vignettes and answer questions regarding the decisions they would make if faced with the situation in the clinical setting. The overall fit of the research model for this study was significant at the 95% confidence level when two of the independent variables (proactive personality and nursing education) were retained, and the three independent variables were excluded (nursing experience, situational awareness, and perceptions of transformational leadership). The predictive power of the final model was low indicating that the two retained independent variables explained only a small amount of the model variance. Eighty percent (n = 84) of the respondents did indicate that they would make a discretionary decision that extends beyond the scope of nursing practice when the patient was at risk for a safety event. This study demonstrates that nurses do engage in this behavior, but fails to identify the majority of the variables that influence this behavior.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2011

Included in

Nursing Commons