Complexity Compression

By Barb Wang, RN, BSN, Sixth Floor

My first patient needs an antibiotic dose but his IV just infiltrated. My next patient is scheduled for a specialized test this morning requiring an on-line form that I have never seen before, and his family needs an interpreter. And my third patient is on a high-flow oxygen system that I have never used. My daughter just had an accident in her high school parking lot and is trying to contact me. It is only 9:00 in the morning, and I HAVEN’T HAD MY COFFEE YET!

Is it a bad day or is it complexity compression?

Since April 2003, nurses at the Minnesota Nurses Association (MNA) and the University of Minnesota have been collaborating on a research project on the phenomenon of complexity compression, which they define as

The phenomenon that nurses experience when expected to assume additional, unplanned responsibilities while simultaneously conducting their multiple responsibilities in a condensed time frame.

Demands for documentation, adjustments to changing management, unfamiliar equipment, and revisions to procedures are just some of the factors that contribute to the complexity of the environment that a nurse enters each day. Add to that the responsibility for training of new staff, compliance with regulations, technological innovations, differences in decision-making styles, the cultural needs of a diverse population, and staffing issues, and it is easy to see why the job that a nurse really loves to do may feel like too much to handle. Complexity compression has the potential to drive bedside nurses out of the hospital and exacerbate the already well-documented nursing shortage.

The current research project seeks to identify the phenomenon of complexity compression and to develop strategies to help nurses cope with the challenges. Frustration and discouragement can lead to a culture of hopelessness and weariness in a community of nurses as they face the daily stresses of a complex environment.

Inviting nurses who are affected by these complex issues to address the problems and come up with solutions is one way to help nurses gain control over some of their environmental concerns. For example, nurses on one unit were frustrated trying to find wheelchairs quickly. Their solution was to establish a “wheelchair zone” where chairs would always be returned to after use. This is an example of how a relatively small problem can quickly add up to become a major crisis involving how nurses feel about their ability to perform on the job.

Recognizing complexity compression will contribute to a culture of safety for both patients and nurses. Learn more about this phenomenon by visiting the MNA web site www.mnnurses.org. On the sidebar, click on ‘Complete the Questionnaire’ and take fifteen minutes to respond to the 55-item questionnaire. You will be providing research data for the investigators as well as becoming more aware of information about this phenomenon. The web site also has stories from nurses and an invitation to share your stories as well.

There is no doubt that complexity is here to stay in our nursing environment. Learning to identify and manage it will remain one of our greatest challenges. Progress comes with a price. But are there any of us who would want to go back to counting drips in an IV chamber or wearing a starched, white cap? This year I celebrate my 30^th year as a nurse. I am proud (and humbled) to say that I have managed to survive SMART pumps and EMR implementation. With a little help from my friends, I have found that we can go forward with new ideas and perspectives and continue to deliver the excellent and compassionate care that distinguishes Children’s as a national leader, regardless of how complex it becomes. Our goal of Delivering Next Generation Care will help guide us through the complexities and reward us with successes as we continue to develop as experts in art of caring for sick children and their families.

P.S. My shift has ended and I am on my way to assess the damage to my daughter’s car. Maybe I’ll stop for a cup of coffee along the way . . .

(Information for this article was obtained from the website: www.mnmurses.org)

Barb Wang, RN, BSN, is a staff nurse on 6^th Floor.