Nurse Work Complexity: Implications for Collaboration On Implementation of Evidence-Based Practice
Pat Ebright, RN, DNS, School of Nursing, Indiana University, Indianapolis, IN, USA
The ability of registered nurses (RNs) to manage information effectively, including the implementation of evidence-based practices for safe patient care and quality outcomes, is challenged by an increasingly complex healthcare environment. This paper will review findings from four studies and ongoing clinical projects that describe: 1) the complexity of RN work in acute care and outpatient settings, 2) differences in factors driving expert versus novice decisions, 3) and important considerations in the planning for introduction of evidence-based practices. Using human factors and work complexity frameworks for each of the small mixed method studies, multiple human and environmental factors in addition to clinical knowledge have been found to influence RN decisions regarding care management. Study samples included experienced medical surgical RNs, new graduates with less than one year of experience, critical care RNs, and outpatient clinic RNs. Time pressures, uncertain information, conflicting goals, high stakes, stress, and dynamic conditions such as variable staffing, high acuity, and unpredictability have been found in each of the studies. RNs were challenged in each of the studies to access, sort, and critically analyze pertinent data for rapid and appropriate decision making that did, or might, affect clinical outcomes and patient safety. Understanding how RNs manage their work in specific settings, and how the introduction of additional information, processes and/or procedures have the potential to change that work, have important implications for the collaborative design and successful implementation of evidence-based practices.