1. Workaround: A common, but often misunderstood nursing concept
Jin Jun, MSN, CRNP, CCRN
New York University, College of Nursing
INTRODUCTION
THEORETICAL FRAMEWORK
Patient safety and quality of care are important
Nurses are known to be “masters of workaround”
Workaround became known in 1970’s during the emergence of computer technology
The purpose of this paper is to analyze and discuss the concept of workaround in healthcare and its relevance and application in nursing
Workaround
OBSTACLE
(Adopted from Halbesleben & Rathert, 2008)
BACKGROUND & SIGNIFICANCE
RESULTS
CONCEPT DEFINITION
ANTECEDENTS
Organizational factors
Personal factors
Systematic factors
RELATED ATTRIBUTES
Task
Organizational
Environmental
Technology
CONSEQUENES
Positive
Avoidance of inappropriate procedures
Drawing attention to things that need to be fixed
Revealing dynamic and innovative organizational culture
More efficient
Negative
Decreased job satisfaction
Linked to increased errors
Rendering safety to be meaningless by bypassing
Inappropriate/deception/breaking rules
Workaround is implemented as a way of responding the complexity of care within a system that increasingly demands standardization
Non-nursing reasons for workaround
to solve a problem,
to bypass problematic rules and blocks to workflow
to adapt to poorly designed workflow
to fix poor organizational and/or systematic flow to compensate for insufficient technology
to save time
to overcome insufficient staffing/equipment/supplies
Workaround in nursing is defined as circumventing or bypassing an obstacle to workflow in order to complete a necessary task and achieve a desired outcome
CONCLUSIONS & IMPLICATIONS
Workaround occurs more frequently than reported
Organizational, personal and systematic factors are related to the occurrence of workaround
Identifying workaround is the first step to improving work environment of nurses, safety, and quality of care
Findings of the concept analysis contribute to a better understanding of workaround in healthcare, especially in nursing
METHODS
Databases searched: PubMed, CINAHL, PsychInfo, and Web of Science
Key words used for search: ‘nurs*’, ‘workaround’, ‘work around’, ‘work-around’, ‘violation’, ‘short-term fix’, ‘deviation’, ‘policies’, ‘short cut’, ‘temporary fix’, ‘creative solution’ and ‘problem solving’
Primary literature: 197 articles. 15 articles were considered relevant after reviewing titles and abstracts
Rogers’ Evolutionary Concept Analysis
ACKNOWLEDGEMENTS
Special thanks to Dr. Susan Sullivan-Bolyai, DNSc, CNS, RN, FAAN and Dr. Christine Kovner, PhD, RN, FAAN