Unpredictability in Inpatient Nursing Work: An Evolutionary Concept Analysis

Background and Purpose: Health care systems are characterized by significant unpredictability. For inpatient nurses, unpredictability is a work stressor that creates mismatches between work demands and available resources. Although unpredictability is recognized as a facet of nursing work, it has lacked formal conceptual analysis. This article examines and clarifies the concept of unpredictability within nursing work. Methods: Rodgers' evolutionary approach was used to identify the concept's defining attributes and contextual features, including its antecedents, consequences, surrogate terms, related concepts, and references. Inductive thematic analysis was used to analyze a total of 69 articles, identified through a systematic search of literature in CINAHL, Academic Source Complete, and MEDLINE databases. Articles that described unpredictability in the work, work processes, and/or work environment of inpatient nurses were included. Results: Unpredictability in nursing work arises from individual heterogeneity, uncertain diseases, dependence on shared resources, and system complexity. Nurses experience unpredictability in their patients' acuity and care needs, personal safety, resource sufficiency, team dynamics, and workflow. Consequences of unpredictability include process inefficiencies, harm to nurse well-being, and negative impacts on patient care. This concept has demonstrated rising interest from multiple academic disciplines across the world. Implications for Practice: Concept analyses provide new insight into poorly defined phenomena within nursing practice. This article offers practicing nurses clarity into their own work, including the currently recognized causes, attributes, and consequences of unpredictability. Practicing nurses should advocate for policies and institutional strategies to address the drivers of unpredictability and better support nursing work.