Untenable Expectations: Nurses' Work in the Context of Medication Administration, Error, and the Organization

Area of Science:

• Nursing
• Healthcare Administration
• Organizational Behavior

Background:

• Medication administration is a complex nursing task.
• Understanding the realities of nursing work is crucial for improving patient safety.
• Existing models may not fully capture the dynamic nature of nursing practice.

Purpose of the Study:

• To explore the nature of nurses' work in medication administration.
• To identify factors contributing to medication errors within the organizational context.
• To develop a theoretical model of nurses' work.

Main Methods:

• Secondary analysis of ethnographic data.
• 92 hours of non-participant observation.
• 37 unstructured interviews with nurses, administrators, and pharmacists.
• Think-aloud observations and institutional document analysis.

Main Results:

• Nurses' work is characterized by 'chasing a standard of care,' 'prioritizing practice,' and 'renegotiating routines.'
• Nursing work is cyclical, chaotic, and complex, challenging linear models.
• A new theoretical model highlights the inseparability of work from contextual contingencies.

Conclusions:

• Current efforts to reduce medication errors may be ineffective due to overlooking contextual factors.
• Organizational context significantly influences medication administration and error occurrence.
• Accountability for medication errors should consider the environment in which nurses work.