Workarounds in nursing practice in acute care: A case of a health care arms race?

© Robert L. Wears, Erik Hollnagel and Jeffrey Braithwaite 2015. Time: 05:52 - 07:00 Place: a 24-bed medical ward in a metropolitan hospital where the patients are just waking up Personnel: Registered Nurse (RN) Samantha, responsible for seven patients Bed Numbers: 7-13; six geriatric medical; one surgical outlier, because there are no beds on the surgical ward Patient Profile: four males; three females; 65-89 years Room allocation: four-bedded room (male); two-bedded room (female); one single isolation room (female) Environment: the relative quiet before the storm, nurses walking about their business briskly; cleaning staff congregating in the Utility Room to collect equipment; catering staff preparing the tea and coffee trolley in the kitchen at the end of the ward; and the venepuncture nurse in the main staff office checking the names of the patients from whom blood is to be collected. There is equipment in the corridors and patient rooms including digital vital signs recording machines; computers on wheels (COWs); scale trolleys; clean and dirty linen trolleys; dressing trolleys; walking frames; commode chairs; glucometers; patient folders; venepuncture trolley; tea and coffee trolley; and water jug trolley