Coincidence Analysis: A Novel Approach to Modeling Nurses' Workplace Experience

Area of Science:

• Nursing
• Healthcare Management
• Workplace Studies

Background:

• Assessing the appropriateness of patient assignments for registered nurses (RNs) in intensive care units (ICUs) is complex.
• Understanding the interplay of workplace conditions influencing RNs' perceptions is crucial for optimizing patient care and nurse satisfaction.

Purpose of the Study:

• To identify specific combinations of workplace conditions that differentiate high, medium, and low RN ratings of patient assignment appropriateness during ICU shifts.
• To explore the causal pathways influencing RNs' perceptions of workload and assignment suitability.

Main Methods:

• A collective case study design was utilized.
• Coincidence analysis was employed to identify causal configurations of workplace conditions.
• Data were derived from electronic systems, with 55 hypothesized conditions analyzed across 64 cases.

Main Results:

• Three distinct models were developed for high, medium, and low appropriateness ratings.
• The 'high' appropriateness model featured two pathways, both involving the absence of overtime.
• One pathway included before-noon patient discharge/transfer, while the other involved RN assignment to a single ICU patient.

Conclusions:

• Specific workplace conditions uniquely influence RNs' perception of patient assignment appropriateness.
• Multiple combinations of conditions can lead to similar outcomes, highlighting the complexity of nursing work systems.
• Findings support the development of decision support tools that account for causal complexity and equifinality in nursing.