Complexity Compression, the Tipping Point for Nurses in the Practice Environment: An Interview with Lynn Jaycox
Weydt, Alice P. Ms, Rn, Creative Nursing
A participant in a study of complexity compression conducted by the Minnesota Nurses Association and the University of Minnesota School of Nursing discusses how nurses cope with the increased complexity of client needs and systems of care, and with the increasing demands from both.
Alice Weydt: Please tell us about your background.
Lynn Jaycox: I started my nursing career as an LPN, transitioning to an associate degree in nursing and then a BSN. I worked for a year in a nursing home and then moved into hospital nursing. Aft er 23 years as a staff nurse working mostly in orthopedics and ICU, I moved into leadership positions. I have worked as an administrative supervisor and patient care manager for the Resource Team (the in-house float pool) and the staffing office. I retired from full-time employment in 2006. Since then, I have been working part-time as an administrative supervisor.
Weydt: What changes have you seen over the years?
Jaycox: The world and our work environment have changed more over the past 30-35 years than in the previous 300 (Zemke, Raines, & Filipczak, 2000). I have seen a tremendous increase in the use of technology in our workplaces. Technology and changes in reimbursement have resulted in decreased lengths of stay and therefore higher acuity and complexity in both inpatient and outpatient areas.
Weydt: What challenges have emerged?
Jaycox: The biggest challenges are related to the acceleration of the work and, thus, the condensed time frame in which we must accomplish our work. What is expected of nurses at the point of care and nurses' expectations of themselves are increasing. We can never finish all that we are expected to do, and we can never know enough. These challenges affect all disciplines in health care, not just nursing. I had a physician tell me that when he graduated from medical school he knew all of the medications that he would prescribe for his patients. Now he needs to rely on the expertise of pharmacists because of the explosion in the number of drugs available.
Weydt: Can you explain complexity compression and how it affects our practice?
Jaycox: Complexity compression is the phenomenon that nurses experience when they are expected to assume unexpected and/or additional responsibilities in addition to their already multiple responsibilities in a shortened time frame. It's the addition of increased non-patient-care work in an environment of shortened length of stay and increased patient acuity. Complexity compression is occurring both at the bedside and in leadership positions. Nurse leaders are expected to accomplish more in a condensed time frame while managing nurses are expected to do the same.
Weydt: You participated in a major study of work complexity.
Jaycox: The University of Minnesota and the Minnesota Nurses Association collaborated to conduct a study of RNs working in Minnesota in 2007 to explore complexity compression, which is thought to be a major factor in nurses choosing to leave the profession (Krichbaum et al., 2007). The phenomenon is the "tipping point for nurses in the practice environment" (Diemert, 2006, p. 13). We stated in reporting our results that complexity compression can't be explained only by shortened lengths of stay or increased patient acuity, and that it is "related to increasing complexity of systems and clients and to the increasing demands from both" (Krichbaum et al., 2007, p. 88). We identified six themes, including personal, environmental, practice, systems, administration and management, and autonomy/control.
Personal themes emerging from the University of Minnesota and Minnesota Nurses Association Complexity Compression study included factors that affected individual nurses, such as fatigue, unmet physical needs, and conflicts with balancing work and family/personal needs.
Environmental themes included physical, psychological, and cultural factors that affected nurses in their work area. …