Flexing the boundaries: Nurses' dynamic decision making for safety and care

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Dr Valerie O’Keeffe, University of South Australia

In providing patient care, nurses apply judgement to balance risks while achieving work goals, one of which is safety. Existing occupational health and safety (OHS) risk assessment theories compartmentalise hazards as discrete entities and treat the resultant risks objectively. This approach overly simplifies the nature of work in complex environments, neglecting the interaction and reconciliation of rapidly changing task demands, individual and organisational factors, implying that risks remain fixed. Such an approach suggests a divide between theory and practice. This presentation explores how this divide is managed in safety critical contexts in healthcare, where risk assessment must respond to the evolving nature of risk and workers must actively participate in managing it. We highlight the dynamic and adaptive nature of safety decision making as a skilful response to risk in complex environments, where workers apply a flexible boundary to their assessment and management of risk.

Nurses from three Australian metropolitan hospitals were observed over 108 shifts, A sample of 45 nurses were interviewed and provided stories about patient interactions in which they encountered a risk to their own safety. These stories were analysed thematically to identify how and what factors influenced nurses’ safety decisions.

Date & time

7-8 June 2016

NCTL Learning and Conference Centre, Nottingham

What is a Complex System?

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