Presentation
HE2 - A Mixed Methods Assessment of Obstetric Nurses’ Use of Workarounds Using the Systems Engineering Initiative for Patient Safety Model
SessionPoster Session 1
DescriptionThe United States has the highest rates of maternal morbidity and mortality in the developed world, with 80% of maternal deaths determined to be preventable. Efforts to improve these rates have centered on patient factors, with providers often blamed following adverse events and little attention to work systems factors. Solutions often focus on standardization of tasks and adherence to protocols, with deviations or violations seen as justification for punitive action. However, in common with many other healthcare and broader safety contexts, adaptation is often needed to maintain performance in complex, imperfect systems operating within different degrees of uncertainty. Our prior research examined the work systems of obstetric nurses in both tertiary care (Bernstein, Catchpole, Kelechi, & Nemeth, 2022) and rural hospitals (Bernstein, Picciolo, Grills, & Catchhpole, 2024). The results from that work inspired us to assess nurses’ use of workarounds.
Nurses innovate workarounds when the regular operations of their work system act as barriers to patient care. These are often seen as a threat to patient safety. However, they can also be understood as intentional violations of hospital policy or procedure, frequently undertaken to simplify or speed up a work task. This nurse-centered study provides new data about why nurses use workarounds in their daily care of patients to better understand how the nurse work system inhibits patient safety. Specifically, we sought to explore the aspects of the nurse work system that obstetric nurses are trying to overcome with workarounds.
METHODS
We used a convergent parallel mixed methods design to study obstetric nurses’ use of workarounds. The quantitative arm used the Nurse Workarounds Instrument to learn which parts of the nurse work system nurses are trying to overcome with their use of workarounds. Results were categorized using the Systems Engineering Initiative for Patient Safety (SEIPS) model. The qualitative arm used semi-structured interviews to delve more deeply into nurses’ use of workarounds to better understand how nurses experience their need for workarounds. Quantitative and qualitative data were collected simultaneously, analyzed separately, and merged in a joint display to compare, contrast, and synthesize findings.
RESULTS
We are currently in data analysis. Early findings indicate nurses are frequently using workarounds to overcome operational failures, including poorly functioning technology (such as ID bracelet scanners for medication administration.) Nurses also describe using workarounds due to high task burden during emergency events where speed of care is deemed more important than fidelity to protocol. Finally, nurses are using workarounds to bypass other professionals, including pharmacists and physicians, who do not respond in a predictable or timely fashion to nursing workflow needs and to protect patient safety.
Implications: Viewing nurse workarounds as a form of nursing innovation provides a new perspective on this practice and emphasizes nurse autonomy. A better understanding of the types of barriers nurses face in their daily work can provide new solutions to improve patient outcomes. By understanding workarounds as a form of innovation to protect patient safety, we can reveal new approaches to developing safe and adaptive systems of care.
Nurses innovate workarounds when the regular operations of their work system act as barriers to patient care. These are often seen as a threat to patient safety. However, they can also be understood as intentional violations of hospital policy or procedure, frequently undertaken to simplify or speed up a work task. This nurse-centered study provides new data about why nurses use workarounds in their daily care of patients to better understand how the nurse work system inhibits patient safety. Specifically, we sought to explore the aspects of the nurse work system that obstetric nurses are trying to overcome with workarounds.
METHODS
We used a convergent parallel mixed methods design to study obstetric nurses’ use of workarounds. The quantitative arm used the Nurse Workarounds Instrument to learn which parts of the nurse work system nurses are trying to overcome with their use of workarounds. Results were categorized using the Systems Engineering Initiative for Patient Safety (SEIPS) model. The qualitative arm used semi-structured interviews to delve more deeply into nurses’ use of workarounds to better understand how nurses experience their need for workarounds. Quantitative and qualitative data were collected simultaneously, analyzed separately, and merged in a joint display to compare, contrast, and synthesize findings.
RESULTS
We are currently in data analysis. Early findings indicate nurses are frequently using workarounds to overcome operational failures, including poorly functioning technology (such as ID bracelet scanners for medication administration.) Nurses also describe using workarounds due to high task burden during emergency events where speed of care is deemed more important than fidelity to protocol. Finally, nurses are using workarounds to bypass other professionals, including pharmacists and physicians, who do not respond in a predictable or timely fashion to nursing workflow needs and to protect patient safety.
Implications: Viewing nurse workarounds as a form of nursing innovation provides a new perspective on this practice and emphasizes nurse autonomy. A better understanding of the types of barriers nurses face in their daily work can provide new solutions to improve patient outcomes. By understanding workarounds as a form of innovation to protect patient safety, we can reveal new approaches to developing safe and adaptive systems of care.
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)