ABSTRACT
Health care organisations and the profession of nursing have been characterised as complex adaptive systems with uneven and undulating demands and barriers to delivering care. Workarounds differ from organisationally prescribed or intended procedures and are employed to circumvent a perceived or actual hindrance to achieve a goal or achieve it more easily. Workarounds have the potential to create an 'underground economy in unsafe practices'. Workarounds are examples of resilience in action, demonstrating how frontline clinicians continuously adapt to fluctuating conditions and bridge the gap between work-as-imagined (WAI) and work-as-done (WAD) to deliver care. Mapping the ideal medication administration process, or WAI, illuminated gaps with WAD and highlighted where workarounds occurred. Shadowing observation was used to identify the occurrence or non-occurrence of workarounds in medication administration process, contextual factors in which workarounds were embedded and the ways in which nurses managed their own, and responded to their colleagues' use of workarounds.
