Interruptions in clinical nursing practice

Aims and objectives To report a descriptive study of interruptions in hospital nurses' work and discuss their consequences for nursing work. Background Interruptions negatively affect procedures, work flow and patient safety. They disturb the emotional atmosphere, reflective processes and the interaction with patients. The constant rearranging of priorities forced by interruptions are a source of frustration to nurses and may lead to a feeling of being pressed for time that results in reduced job satisfaction and stress‐related symptoms. Design An ethnographic study. Methods Observation of five nurse's work over three weeks in January 2007 and qualitative interviewing of two nurses. Results Nurses were interrupted primarily by brief question–answer exchanges between nurse colleagues. Grouped by task, interruptions during medicine preparation in the ward's drug storage room were the most frequent, while the patients were responsible for fewer interruptions than was any other group. Nurses regarded some interruptions as unavoidable, others as avoidable, while the perception of other professional groups as the primary instigators of interruptions was not corroborated. Conclusions Interruptions confront nurses with a dilemma between being accessible to others and remaining focused in order to ‘see the big picture’. Nurses' professional ‘groundedness’ seems to determine their ability to retain a state of equilibrium in a field of unnecessary interruptions and to prevent interruptions from occurring. Relevance to clinical practice The study contributes new knowledge to the discussion of issues concerning organisation, management, training and clinical work, including nurse's ability to ‘see the big picture’. It further seeks to clarify conditions for nursing that take into account professional standards and values as well as mutual understanding between colleagues.