Complexity compression: nurses under fire.

It has been documented that up to 40% of the workday of nurses is taken up by meeting the ever-increasing demands of the systems of healthcare delivery in which nurses are employed. These demands include the need for increasing documentation, for learning new and seemingly ever-changing procedures, and for adapting to turnover in management and administration. Attention to these issues also means that 40% of that workday is not available to patients. Believing that these increasing demands are affecting nurses' decisions to remain in nursing or to leave, a group of Minnesota nurses and nurse educators examined the work environments of nurses and the issues related to those environments. The result of this examination was discovery of a phenomenon affecting all nurses that may be central to the projected shortage of nurses. The phenomenon is complexity compression-what nurses experience when expected to assume additional, unplanned responsibilities while simultaneously conducting their multiple responsibilities in a condensed time frame. The phenomenon was validated by a group of 58 nurses who participated in focus groups that led to the identification of factors influencing the experience of complexity compression. These factors were clustered into six major themes: personal, environmental, practice, systems and technology, administration/management, and autonomy/control. Further validation studies are planned with the population of practicing professional nurses in the state of Minnesota.