Operational failures and interruptions in hospital nursing.
OBJECTIVE
To describe the work environment of hospital nurses with particular focus on the performance of work systems supplying information, materials, and equipment for patient care.


METHODS
Primary observation, semistructured interviews, and surveys of hospital nurses.


METHODS
We sampled a cross-sectional group of six U.S. hospitals to examine the frequency of work system failures and their impact on nurse productivity.


METHODS
We collected minute-by-minute data on the activities of 11 nurses. In addition, we conducted interviews with six of these nurses using questions related to obstacles to care. Finally, we created and administered two surveys in 48 nursing units, one for nurses and one for managers, asking about the frequency of specific work system failures.


RESULTS
Nurses we observed experienced an average of 8.4 work system failures per 8-hour shift. The five most frequent types of failures, accounting for 6.4 of these obstacles, involved medications, orders, supplies, staffing, and equipment. Survey questions asking nurses how frequently they experienced these five categories of obstacles yielded similar frequencies. For an average 8-hour shift, the average task time was only 3.1 minutes, and in spite of this, nurses were interrupted mid-task an average of eight times per shift.


CONCLUSIONS
Our findings suggest that nurse effectiveness can be increased by creating improvement processes triggered by the occurrence of work system failures, with the goal of reducing future occurrences. Second, given that nursing work is fragmented and unpredictable, designing processes that are robust to interruption can help prevent errors.
Tucker
Anita L
AL
The Wharton School, University of Pennsylvania, 551 Huntsman Hall, 3730 Walnut Street, Philadelphia, PA 19104-6340, USA.
Spear
Steven J
SJ
D003430:Cross-Sectional Studies; D004868:Equipment Failure / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D048108:Nursing Informatics / Q000458:organization & administration*; D009741:Nursing Staff, Hospital; D014481:United States