Nurse Executives Focus on Complexity of Care Delivery

Rebecca Hendren, for HealthLeaders Media , April 19, 2011

The researchers shared that one nurse who was observed illustrated cognitive shifts or interweaving among five patients 74 times in eight hours.

"Think about what that does to a nurse's ability to think," says Sitterding.

Sitterding described a study where researchers observed medication administration. The researchers found that interruptions occur in 53% of all observations. Of those medication administrations that included an interruption, 39% ended up with a clinical error.

We have to understand the current nature of nursing work to understand how to improve patient safety. The way care is carried out now is incredibly complex and requires nurses to perform many tasks at the same time and nurses must be constantly aware of unexpected situations that may arise. 

The factors that contribute to work complexity are:
  • Actual demands in the practice field that affect the behavioral and cognitive care delivery work of RNs
  • Operational failures
  • Flawed facility design
  • Inadequate communication
  • Complicated or irrelevant policies
  • Task management

This leads nurses to perform cognitive task management to handle competing priorities:

  • What needs to be done first?
  • What can wait?
  • To what extent can care delivery be performed according to organizational policy or personal standards given competing goals?

"Cognitive task management is happening with every nurse on every unit in every hospital," says Sitterding.

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