Addressing Nursing Workaround Solutions to Encountered Problems: Engagement of Frontline Nurses in STAR-2++ Network Study

Purpose:  Frontline nursing staff experience first-order operational failures negatively impacting their ability to provide optimal care. Frontline nurses problem solve and navigate around first-order operational failures using “workaround” solutions to overcome encountered system failures. Participation in the Improvement Science Research Network’s (ISRN) Small Troubles, Adaptive Responses (STAR-2⁺⁺) study aimed to contribute to global and institutional nursing knowledge by identifying and reporting practice environment relationships with direct care clinicians’ quality improvement engagement and clinical outcomes in the surgical intensive care, pediatric medical-surgical, and oncology units. By tracking and developing a better understanding of first-order system failures, researchers seek to identify relationships among practice environment, frontline nurse quality improvement engagement, and clinical outcomes in three hospital acute care units. Combining data from 14 participating hospitals furthers global knowledge and understanding of frontline nurses’ quality improvement engagement and clinical outcomes.

Methods: Prospective, cross-sectional, multivariate, quantitative research study was conducted. Research was conducted at a large urban 881 bed acute nonprofit tertiary-care hospital in West Texas. Nurses recruited for study participation according to the STAR-2⁺⁺ study protocol. Unit data was collected from unit locked boxes and entered into a data collection network for aggregated analysis. Purposes were to measure the following study variables: 1) incidence and type of first-order operational failures encountered by direct care registered nurses during their work shift on a clinical unit; 2) associations between staff identified first-order operational failures encountered on the frontline of care delivery and those detected by non-participant observers; and 3) associations among frontline engagement (measurement of detection of operational defects and team vitality study variables), work environment (measurement of culture of patient safety and excellence in work environment study variables), and quality improvement outcomes (measurement of quality improvement activities, quality of care, and job satisfaction study variables).

Results: To be determined

Conclusions: Study results informed the participating acute care institution of existing system issues leading to first-order operational failures, thus improving patient care provided by frontline nursing staff.