Researchers pilot peer messenger feedback model to reduce unprofessional behavior among nurses nationwide.

A program demonstrated to reduce unprofessional behavior and bolster retention among physicians and advanced practice providers is being adapted for nurses.

The Co-Worker Observation System (CORS) is an evidence-based tool and process developed at the Vanderbilt Health Center for Patient and Professional Advocacy nearly a decade ago. After a recent pilot study, CORS is now on track for implementation in medical centers worldwide.

“Up to 40 percent of nurse departures from organizations can be linked to unprofessional behavior,” said William O. Cooper, M.D., president of Vanderbilt Health Center for Patient and Professional Advocacy. “We set out to assess the feasibility and monitor the fidelity of implementing CORS for nurse professionals.”

Unprofessional behavior is categorized in nursing – and much of the rest of the medical field – as poor or disrespectful communication, irresponsible behavior, inappropriate care, or issues with professional integrity.

“Special considerations for the professional nurse population were needed due to differences in employment structure, contracts, policies, scheduling and uniqueness of identifying nursing peers,” Cooper said.

The CORS Process

According to Cooper, CORS is implemented and sustained optimally through 10 fundamental elements. This 10-part system bundle was first used to allow trained peer messengers to share patient complaints with physicians, resulting in a decreased number of complaints and lower malpractice risks, he explained.

“Organizations implementing CORS to address unprofessional behavior of physicians and APPs have had 84 percent fewer coworker concerns in the subsequent 12 months,” Cooper said. “By reducing incidents of unprofessional behavior through peer-messaging and self-reflection, CORS contributes to a supportive culture of patient safety and quality.”

A Pilot Study

In collaboration with Cynthia A. Baldwin, M.S., R.N., C.P.H.R.M., a senior associate in the Department of Pediatrics and School of Nursing at Vanderbilt, Cooper and his team launched a pilot study at three academic medical centers.

At each site, reports of unprofessional behavior by staff nurses were submitted through the site’s electronic reporting system and screened using natural-language processing software. The information then was coded by CORS-trained investigators and referred to a trained peer- messenger to share the observations with the nurse.

From September 2019 to August 2021, 590 reports were identified. Most reports included more than one problematic behavior, each of which was coded separately.

Based on the debriefing survey, 76.5 percent of the peer-messages initiated were deemed completed, while 2.2 percent were waiting for messenger feedback and 0.2 percent awaited messenger assignments. The result was 78.9 percent of messages ultimately delivered.

“Subsequent work has demonstrated a much higher rate of delivery of messages with refinements to the process learned in the pilot,” Cooper added.

Overall, the pilot experience confirmed the feasibility and fidelity of the CORS process.

“The project bundle was effective for implementing CORS for nurses,” Cooper said.

Implications for Nursing

These results have several implications for nurse professionals, Baldwin said.

“Incorporating CORS could assist an organization in creating a culture of patient safety and respect.”

Lessons learned during the pilot could inform how health care organizations reproduce and deploy peer-feedback tools and processes for nurses.

“Incorporating CORS with these practices to provide feedback could assist an organization in creating a culture of patient safety and respect,” Baldwin said. “This study demonstrated that CORS can be implemented with staff nursing when nursing infrastructure is considered.”

Based on these findings, CORS is on track for implementation in centers worldwide.

“It brings us great joy to see a growing interest in our model, making our work even more rewarding,” Baldwin said.

About the Expert

Cynthia A. Baldwin, M.S., R.N.

Cynthia A. Baldwin, M.S., R.N., C.P.H.R.M., is a senior associate in the Department of Pediatrics and School of Nursing at Vanderbilt University Medical Center.

William O. Cooper, M.D.

William O. Cooper, M.D., M.P.H., is professor of pediatrics and health policy at Vanderbilt University Medical Center. He is a pharmacoepidemiologist with a focus on the effects of psychotropic medications in children and adverse effects of prescription medication use during pregnancy. He has achieved international recognition for his work in using computerized databases to ask and answer important questions of drug safety.