Changing our lens: seeing the chaos of professional practice as complexity

• Published in: Journal of nursing management Vol. 21; no. 4; pp. 690 - 704
• Main Authors: Kramer, Marlene, Brewer, Barbara B., Halfer, Diana, Maguire, Pat, Beausoleil, Summer, Claman, Kristin, Macphee, Maura, Duchscher, Judy Boychuk
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.05.2013; Hindawi Limited
• Subjects: complex adaptive systems; evidence-based management practice; Humans; multiple patient/simultaneity complexity; Nurse Administrators; Nursing; Nursing Care - organization & administration; Nursing Care - standards; Nursing Staff, Hospital - organization & administration; Nursing Staff, Hospital - standards; Organizational Case Studies; professional practice; Systems Analysis; Canada; United States > US
• ISSN: 0966-0429; 1365-2834
• DOI: 10.1111/jonm.12082

Aim The purpose of this evidence‐based management practice project was to analyse dimensions of the Getting my Work Done issue, the only one of seven issues of highest concern for which 907 nurse interviewees were unable to identify effective strategies, formulate a ‘best management practice’, integrate the practice into clinical settings and evaluate results. Method/process The evidence‐based management practice process was used to identify the major impediment to Getting Work Done–assignment to multiple patients with simultaneous complex needs. Best management practice consisted of class presentation of a clinical‐management problem scenario to 144 residents in nine Magnet hospitals, a private action commitment, class discussion and terminal action commitments. Results Responses indicated that this ‘best management practice’ was effective in helping newly licensed registered nurses manage and handle multiple patients with simultaneous complex needs. A major avenue of resolution was perception of professional practice responsibilities as a series of complex, interrelated, adaptive systems. Conclusions/implications for nursing management Perception and use of the principles of complexity science assists newly licensed registered nurses in mastering management dilemmas that inhibit professional practice. In many participating hospitals, plans are underway to expand this best practice to include input and perception exchange among experienced nurses, managers and physicians.