Definition and Relational Specification of Work-around.

There are many investigations of nursing work-arounds reported in the literature.1 Despite numerous studies the concept remains vague and not logically linked to a theory base. Assumptions associated with many of these studies are not clearly articulated, leading to poor logic fit with analysis. Nursing literature reflects the assumptions that work-arounds are bad and must be eliminated. This paper defines work-around in its full range of variation consistent with a complex adaptive system base from two perspectives: essential attributes when operating as a mediator and as a moderator. Given the need for increased conceptual rigor in Nursing Informatics research, the moderator/mediator delineation is important. Moderating variables tend to be endemic to situations and are relatively resistant to intervention while mediating work-arounds may represent appropriate problem solving management of routine exceptions2 A clearer understanding of work-arounds can inform integration of the Electronic Health Record and safety, quality and efficiency initiatives.