Workarounds in clinical nursing practice and patient safety

Response to Amber I. In high-volume primary care settings, clinicians may resort to workarounds when standard documentation and preventive screening workflows conflict with the demands of managing large patient volumes. One workaround I have used involves focusing solely on acute medical concerns and deferring recommended screenings, such as vaccination status or preventive questionnaires, during peak clinic hours when the waiting room is overcrowded. While the electronic health record (EHR) prompts providers to complete these screenings for quality and safety, the pressure to reduce wait times and prevent workflow delays often results in prioritizing problems that can be addressed immediately. This behavior reflects a tension between productivity expectations and safety culture ideals. Safety culture encourages adherence to protocols and comprehensive documentation to reduce variation and improve outcomes. However, when systems and workflows are perceived as poorly aligned with clinical realities, clinicians may choose behavior that appears more efficient in the moment. Debono et al. (2025) support this observation in an ethnographic study that found nurses frequently experience conflicting feelings about using workarounds, recognizing their necessity to deliver care under constraints while also feeling tension about deviating from policies that promotes safety and standardization. This internal conflict can create stress and anxiety among nurses, potentially leading to burnout, professional disengagement, and attrition (Debono et al., 2025). The tension surrounding workarounds highlights broader workflow design issues. Health informatics tools, such as EHR prompts for preventive screenings, must be designed with clinician workflow in mind so they do not create unnecessary cognitive or time burdens. When technology and workflow are misaligned, safety features can unintentionally encourage workarounds. Recognizing and analyzing the root causes of workarounds can guide improvements that both support a culture of safety and respect the realities of clinical practice. References Debono, D., Greenfield, D., Lipworth, W., Carter, D.J., Black, D., Hinchcliff, R., Carland, J.E., & Braithwaite, J. (2025). I know I shouldnt but… the inevitable tension of using workarounds to be a good nurse. Front Health Serv, 29(5). Response to Tiny C The workaround I have done before is not following the barcode scanning process for lab specimen collection. This process mainly has a couple of steps – first is the scanning the patient ID on wristband, second step is printing out the sample label at bedside, and the third step is the scanning of the specimen label after collecting sample. Patient identification and specimen identification are critical components and compliance of the process is significant in transfusion safety and clinical laboratory accuracy (Al-Eshaq et al., 2023). When our hospital first converted to Epic and started this process, it seemed like a long process and many staff were trying to workaround by taking shortcuts. At times, we were printing out the specimen labels at the nursing station by overriding the patient Identification (ID) and at other times, overriding barcode scanning at bedside. Non-compliance with patient and specimen barcode identification procedures could lead to an increased mis-identification risk for patients and specimens (Al-Eshaq et al., 2023). At that time, I thought I was saving so much time but was not realizing the risk-taking behavior which could have led to severe patient safety issues. Looking back at the reasons why I chose the workaround, I think it was multifactorial such as lack of knowledge, misjudgment of the anticipated risk, and over-confidence in the way we were performing this task before the barcode scanning system. According to Bianchi and Ghirotto (2022), a workaround may help overcome immediate obstacles that delay quick interventions, but it is not effective long-term, as it leaves the underlying problem unresolved. After an incidence of mislabeling samples and wrong ID, all nurses and phlebotomists were given education on the dangers of the workaround and the importance of following the process. In addition, lab started tracking the compliance of barcode scanning and sending out the monthly compliance report to managers. References Al-Eshaq, D. H., Bradley, R. T., McBride, E. R. A., Ford, J. C. (2023). Patient and specimen identification in a tertiary care pediatric hospital: Barcodes do not scan themselves. Transfusion, 63(7): 13101317. to an external site. Bianchi, M., & Ghirotto, L. (2022). Nurses’ perspectives on workarounds in clinical practice: A phenomenological analysis. Journal of clinical nursing, 31(19-20), 28502859.