Changing our lens: seeing the chaos of professional practice as complexity


  • Unless referenced otherwise, all data in quotes are excerpts from recorded nurse interviews related to the Getting Work Done issue. These data have not been published elsewhere. Excerpts related to the same topic, from multiple interviewees are separated by ellipses points.


Marlene Kramer

Health Science Research Associates

3285 N. Prospectors Rd.

Apache Junction

Arizona 85119





The purpose of this evidence-based management practice project was to analyse dimensions of the Getting my Work Done issue, the only one of seven issues of highest concern for which 907 nurse interviewees were unable to identify effective strategies, formulate a ‘best management practice’, integrate the practice into clinical settings and evaluate results.


The evidence-based management practice process was used to identify the major impediment to Getting Work Done–assignment to multiple patients with simultaneous complex needs. Best management practice consisted of class presentation of a clinical-management problem scenario to 144 residents in nine Magnet hospitals, a private action commitment, class discussion and terminal action commitments.


Responses indicated that this ‘best management practice’ was effective in helping newly licensed registered nurses manage and handle multiple patients with simultaneous complex needs. A major avenue of resolution was perception of professional practice responsibilities as a series of complex, interrelated, adaptive systems.

Conclusions/implications for nursing management

Perception and use of the principles of complexity science assists newly licensed registered nurses in mastering management dilemmas that inhibit professional practice. In many participating hospitals, plans are underway to expand this best practice to include input and perception exchange among experienced nurses, managers and physicians.