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Barriers to Critical Thinking: Workflow Interruptions and Task Switching Among Nurses

Cornell, Paul PhD; Riordan, Monica PhD; Townsend-Gervis, Mary MSA, RN; Mobley, Robin MSN, RN

JONA: The Journal of Nursing Administration: October 2011 - Volume 41 - Issue 10 - p 407-414
doi: 10.1097/NNA.0b013e31822edd42

Nurses are increasingly called upon to engage in critical thinking. However, current workflow inhibits this goal with frequent task switching and unpredictable demands. To assess workflow's cognitive impact, nurses were observed at 2 hospitals with different patient loads and acuity levels. Workflow on a medical/surgical and pediatric oncology unit was observed, recording tasks, tools, collaborators, and locations. Nineteen nurses were observed for a total of 85.2 hours. Tasks were short with a mean duration of 62.4 and 81.6 seconds on the 2 units. More than 50% of the recorded tasks were less than 30 seconds in length. An analysis of task sequence revealed few patterns and little pairwise repetition. Performance on specific tasks differed between the 2 units, but the character of the workflow was highly similar. The nonrepetitive flow and high amount of switching indicate nurses experience a heavy cognitive load with little uninterrupted time. This implies that nurses rarely have the conditions necessary for critical thinking.

Author Affiliations: President (Dr Cornell), Healthcare Practice Transformation, Dallas, Texas; Postdoctoral Researcher (Dr Riordan), University of Memphis, Tennessee; CNO (Ms Townsend-Gervis), Baptist Memorial Hospital-DeSoto, Mississippi; and Clinical Director, Inpatient Units (Ms Mobley), St Jude Children's Research Hospital, Memphis, Tennessee.

The authors declare no conflict of interest.

Correspondence: Dr Cornell, Healthcare Practice Transformation, 3412 Parr Rd, Grapevine, TX 76051 (

© 2011 Lippincott Williams & Wilkins, Inc.