1. Baker, Kathy A. PhD, RN, ACNS-BC, CGRN, FAAN

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I am writing my editorial from Adelaide, South Australia, having just experienced the effects of the Qantas strike from a first-hand perspective. I am "down under" with students and faculty attending the Joanna Briggs Institute Colloquium. Although I was not directly impacted (I arrived in Adelaide the day before the flights were grounded), several of my students and colleagues were. As I watched how my colleagues managed the crisis, I was amazed at the problem-solving skills of nurses!

Kathy A. Baker, PhD,... - Click to enlarge in new windowKathy A. Baker, PhD, RN, ACNS-BC, CGRN, FAAN

One colleague, a nonnurse with a very high-level administrative job, just threw up her hands and succumbed to the strike. She immediately cancelled her trip and began grieving the loss of a trip long anticipated. A nursing colleague, planning to leave later this week for Australia, immediately booked himself on another airline. Although there is a $300 cancellation fee if he ends up taking his original flight, he reasoned that the trip to Australia and opportunity to present his systematic review work to an international audience and receive further training in systematic review methodology were worth the possible loss of a few extra dollars.


One of my doctoral students was boarding her plane in Los Angeles headed to Brisbane and then on to Adelaide when the Qantas planes were grounded. Because Qantas employees had no idea what was happening, they were unable to assist travelers with transfer plans. My student immediately called her husband and, together on their laptops, rebooked her on a Cathay Pacific flight. While she had to travel through Hong Kong and experience an extra layover to an already-lengthy travel itinerary, she solved her problem and arrived having missed only 1 day of training.


Nurses are experts at problem solving. Whether collaborating with the healthcare team to find a "workaround" for a challenging patient need, juggling procedure schedules so that patients and families are minimally inconvenienced by the constant changes in the healthcare setting, or directly assisting patients to access the care they need despite barrier after barrier, nurses use problem-solving skills every day to overcome obstacles. Generally, problem solving involves identifying a problem, weighing alternatives, and making a decision about how to manage the problem. Some problems are simple, but in the nursing practice environment, problems are typically very complex.


Tucker and Edmondson (2002) actually investigated problem solving by nurses in the hospital environment. They found that nurses utilized problem-solving skills multiple times throughout a day to the point that problem solving was actually a routine aspect of a nurse's day. Unfortunately, they discovered that nurses tended to problem solve by using guidelines and algorithms that directed them toward what to do without pushing them to solve the underlying problem. Their study suggests that nurses should also address underlying issues that may be unique to the problem-solving situation they encounter. Solving a single problem with "routine" responses does not contribute to long-term resolution of the problem.


Toyota has utilized problem-solving strategy (supported by Tucker and Edmondson's [2002] findings) to empower employees at the frontline to solve problems identified during the routine assembly of automobiles (Fishman, 2006-2007). Toyota holds daily work-group meetings, provides opportunities to submit written suggestions for improvement, and supports long-term problem-solving teams. Employees recognize problems during the routine assembly of Toyota automobiles, make suggestions for addressing the problem based on their first-hand knowledge of the issue, and are empowered by leaders at the front line to make the necessary changes without going through unnecessary protocols and steps to facilitate the needed change. One key to the success of this cultural change is that Toyota employees recognize that before they address a problem, they need to study the underlying process or standard in order to truly understand what is causing the problem, and then create a long-term solution.


Their problem-solving strategy results in not only the immediate solution to a problem, but greater efficiency, safety, and quality for Toyota consumers as well.


Problem-solving strategies must be more than "second nature" for nurses. Nurses must push themselves to look beyond guidelines, algorithms, and institutional policy to identify underlying causes for problems we face repetitively in providing care and supporting patients' healthcare needs. Once underlying causes are identified, we must be well-versed on the latest evidence and present articulate, well-thought-out plans for solving problems to improve healthcare delivery at every level where we have influence. Implementing problem-solving strategies is inevitable for a nurse; however, learning to maximize problem-solving skills is critical if nurses are to lead the healthcare team in addressing the complex challenges affecting identification and utilization of "best" evidence (Institute of Medicine, 2011).




Fishman C. (2006-2007). No satisfaction at Toyota. Fast Company, 82-92. Retrieved from[Context Link]


Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press. [Context Link]


Tucker A. L., Edmondson A. C. (2002). Managing routine exceptions: A model of nurse problem solving behavior. Advances in Health Care Management, 3, 87-113. [Context Link]