Nurses' Perspectives on Workarounds in Clinical Practice: A Phenomenological Analysis

Aims And Objectives: To explore the phenomenon of workarounds in clinical practice through the nurses' perspective and identify which factors according to their experience contribute to activities carried forth non-compliantly to procedures, protocols and rules defined by an Institution.

Background: A workaround in clinical practice is a non-compliance and a violation of an organisation's defined procedures, regulations or rules that may prevent adverse events. Its increasing recurrence in the workplace calls for a deeper analysis of the phenomenon.

Design: A phenomenological descriptive design, following Colaizzi's analysis.

Methods: In-depth interviews were conducted with 16 nurses about their experience of workarounds. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed three phases: extracting significant statements, creating formulated meanings and aggregating them into themes. The process employed NVivo 12 software. COREQ checklist was used for reporting.

Results: Data analysis identified 17 sub-themes falling into the four macro-themes: (i) living the profession in saved times; (ii) Perceiving contingencies as a guide to action; (iii) sense of personal responsibility; and (iv) emotional aspects.

Conclusions: From a nurses' perspective, a workaround is often triggered by the need to overcome problems interfering with efficient and timely patient care in everyday clinical practice. This will of undertaking responsibilities favouring gained efficiency is closely linked to their confidence acquired over years of experience in the field.

Relevance To Clinical Practice: The results of this study can help clinical leadership to acknowledge workaround, understand the underlying triggers and work towards reconciling official procedures with real-world situations. They can help nurses working in clinical practice to reflect and understand how to reconcile the needs related to the demands of organisations with the need to live their profession, which is more patient-oriented.