Whose safety? Flexible risk assessment boundaries balance nurse safety with patient care

Working effectively requires judgement to balance risks while achieving work goals, one of which is safety. Existing occupational health and safety risk assessment theories compartmentalise hazards as discrete entities and treat the resultant risks objectively. This approach overly simplifies the nature of work, neglecting the interaction and reconciliation of rapidly changing task demands, individual and organisational factors, implying that risks remain fixed. Such an approach suggests a divide between theory and practice. This paper explores how this divide is managed in safety critical contexts where risk assessment must respond to the evolving nature of risk and workers must actively participate in managing it. We highlight the dynamic and adaptive nature of safety decision making as a skilful response to risk in complex environments, where workers apply a flexible boundary to their assessment and managernent of risk. Nurses from three Australian metropolitan hospitals were interviewed and provided stories about patient interactions in which they encountered a risk to their own safety. These stories were analysed thematically to identify how and what factors influenced nurses' decisions. Results revealed that nurses applied a flexible boundary of risk assessment and management to balance patient and nurse needs, constantly re-evaluating their decisions to determine 'safe enough' strategies. Nurses used risk-based reasoning to determine this flexible boundary which may result in nurses' health and safety being traded off to achieve patient priorities. These findings highlight that managing risk is dynamic and the risk assessment and decision strategies adopted are flexible in response to evolving demands. (C) 2015 Elsevier Ltd. All rights reserved.