Nursing Daily Routine Activities: A Considered Response or Coping Mechanism?

Routine activities have important roles in the daily workplace. Routine provides a sense of coordination, organisation and stability and its very regularity demonstrates its important place in the everyday (Aldrich & Dickie, 2013; Zisberg et al., 2007). A routine can be a rule, such as the ideal routine, as well as a behaviour, where the routine is expressed as a pattern (Feldman & Pentland, 2003; Pentland & Feldman, 2005). Routine can be viewed both positively and negatively. Perceptions of routinisation may consider it rigid and hence stifling creativity (Aldrich & Dickie, 2013) and perpetuating monotony of repetition (Rytterstr€ om et al., 2011). It can be viewed as an unconsidered, automated-like response, suppressing more considered approaches. Alternatively, routine can present a constructed approach to tasks, and provides a negotiation between the needs of the situation and our personal capabilities (Aldrich & Dickie, 2013). Health care is one context that experiences high levels of flux between stability and change, between flexibility and adaptation, and thus may benefit from routinisation of some elements. The introduction of routines can provide daily activities with a more structured approach and thus reduce the cognitive demands placed on already busy staff (Rytterstr€om et al., 2011). The positives associated with structure, predictability, and reduction of complexity, with the potential to minimise errors, make routinisation an important component of health care (Ross et al., 2019; Rytterstr€ om et al., 2011; Tournier et al., 2012). The routinisation of some tasks may allow for health staff to apply cognitive resources elsewhere where they are more needed. Implementing routines encompasses two ideas which can be applied in the context of health care. Routinisation can firstly be considered the journey, where the process of routinisation is implemented to make an activity regular and unchanging (Simon et al., 2016). Secondly, it can be a destination where the act of making something routine can provide improvements and support quality within the health care setting. These aspects were the focus of a study that examined the journey of routinising HIV testing in an Emergency Department, with findings suggesting that the destination of the new routine allowed nursing staff to feel empowered and patients being more likely to receive testing. Empowerment of nursing staff to order HIV testing under certain circumstances improved testing rates over a two-year trial period and was facilitated by making HIV testing part of the routine practice within the Emergency Department setting (Simon et al., 2016). The destination that results from routinisation in health care is not always empowerment and improved patient care. Routinisation may make some actions and outcomes commonplace and ritualised, rather than conscious and reflective. A study of one ICU that focused on mechanically ventilated patients found that many physiological changes in patients were undocumented by staff (Engstrom et al., 2017). This was due to health staff considering such changes to be ‘normal’ and a common part of the ICU routine and therefore not noteworthy, an unwanted consequence of routinisation in the ICU setting. This resulting routinisation of the ICU environment posed potentially negative outcomes for patients and highlights the dangers of routines becoming unconscious and unconsidered (Engstrom et al., 2017). Routinisation can also have the opposite effect to its intended purpose and can become counterproductive. While it might be created for the purposes of increasing control and stability, the unintended consequences can be otherwise. For example, one study of routine rounds of patients on a hospital ward found these rounds had been introduced to increase efficiency and reduce disruptions caused by patient call-bells (Willis et al., 2016). However, the reverse had occurred, with nursing staff perceiving such rounds as an intensification of their workload and contributing to role stress (Ross et al., 2019; Willis et al., 2016). Given the intrinsic relationship between health care workloads, stress and patient outcomes, the need to balance these with appropriate and effective routines is paramount. The adherence to routines regardless of their effectiveness and without conscious consideration of their appropriateness can negate the benefits of creating routines within the complex health setting. Routines can be prone to becoming ritualistic, which may result in less considered approaches to patient care (Walsh & Ford, 2001). Over-routinisation and