| Healthcare research reveals important links between nurses' workflow and patient adverse events. There is evidence in the literature to support the use of technology to increase patient safety and improve the quality of patient care. The use of technology, however, comes with its own set of risks. In order to get their work completed in a timely manner, nurses work around issues that block their workflow. These workarounds may pose direct threats to patient safety. There has been a significant amount of research related to workarounds in relation to software application; however, there is little empirical literature on workarounds specifically in relation to nurses and the practice environment in which they work.;The purpose of this descriptive, correlational study was to explore the relationships among workarounds, the practice environment, and factors that affect the practice environment: the foundations of quality care; nurse participations in hospital affairs; nurse manager ability, leadership, and support of nurses; staffing and resource adequacy; and collegial nurse-physician relations at the time that obstacles present. A blending of Donabedian's Structure Process Outcome Theory and Orlando's Nursing Process Discipline Theory provided a framework for this study. A convenience sample of 234 registered nurses recruited from a list of currently enrolled students or alumni of the researcher's institution participated in this study. The nurses completed the Workaround Instrument, the Practice Environment Scale of the Nursing Work Index, and a demographic questionnaire using a web-based survey that was e-mailed via an honest broker to the participant's listed e-mail addresses. Data analysis involved descriptive, correlational, and regression statistics. The data demonstrated that there was a significant inverse relationship between the workarounds and the acute care practice environment (r = -.35, p < .01). Additionally, staffing and resource adequacy was the best predictor of workarounds.;The findings of this study add empirical support for the link between a healthy work environment and workaround performance, and have implications for nursing science, education, practice, and administration. This study extended Donabedian's Structure Process Outcome Theory and Orlando's Nursing Process Discipline Theory using a methodology that applied the blended theories to a quantitative study. The results also suggest a need to understand how the acute care practice environment affects the use of workarounds in order to implement interventions to prevent their occurrence, thereby increasing patient safety. |
