Human Factors Evaluation of the Use of Workarounds Among Obstetric Nurses

To identify and categorize components of the work system that obstetric nurses address using workarounds.

Convergent parallel mixed methods.

Online survey distribution from September 7, 2024, to October 11, 2024, and virtual interviews from September 13, 2024, to November 20, 2024.

Registered nurses (N = 168) who worked in antepartum, intrapartum, and postpartum settings who completed an online survey and a subset (n = 30) who participated in semistructured interviews.

We collected data for the quantitative arm using the Nursing Workarounds Instrument and categorized the results according to the Systems Engineering Initiative for Patient Safety (SEIPS) model using descriptive statistics. For the qualitative arm, we used semistructured interviews to obtain a more in-depth understanding of the use of workarounds. We securely recorded, transcribed, checked for accuracy, and coded interviews using content analysis and the SEIPS components as a deductive framework. We used Dedoose software for data analysis and developed a joint display to facilitate data integration and interpretation.

Workarounds were most frequently related to the technology and tools component of the SEIPS model, and most participants (n = 133, 79.2%) reported that problems with technology interfered with their work. Participants described the need to "override" emergency medication systems through workarounds in the electronic medical record and at medication dispensing cabinets. However, nearly all participants reported a preference for following procedures when possible (n = 163, 97.0%).

Participants innovated and implemented workarounds as adaptive responses to operational failures. Quality improvement efforts to improve the work system could reduce the need for workarounds during patient care.