Exploring the turbulent nature of nurses' workflow.

Turbulence is a central feature of nurses' workflow, yet it has received insufficient attention regarding how it affects nurses' work conditions. To enhance understanding of turbulence, we expanded upon and added refinements to an early conceptualization that included communication and workload as major sources of turbulence. For communication, the contributions of interruptions and handoffs are further explored. For workload, patient turnover and supplies/equipment are further explored; human resources and the built environment were added. Potential consequences of turbulence are also identified including increased cognitive work, increased workarounds, and diminished nurse well-being. Actions to address turbulent workflow include teaching students and nurses strategies to manage turbulence; attending to the practice environment such as staffing composition, remedying longstanding issues with supplies and equipment, and developing technology platforms with nurse input; and suggesting investigations to advance understanding of how turbulence influences nurses and to devise effective interventions.