Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Strategies for managing complexity and balancing competing values and priorities

Individual strategies
 -Use self-reflection to identify personal values
 -Use ethical frameworks to assist with clarification and decision-making
 -Use research studies and patient and client outcome data to support staffing, skill mix and hours of care (Upenieks, 2002a)
 -Educate board members and the management team about the link between nursing work environments and patient/client outcomes, including the impact of staffing levels (IOM, 2004; Storch, et al., 2002)
 -Form alliances with like-minded groups and individuals
 -Check fit between personal philosophy and beliefs of organization before accepting role (Englebart,1993)

Team, unit and organization strategies
 -Develop and uphold a philosophy and mission statement that values nursing and places patients and clients first
 -Introduce governance models that encourage sharing information and decision-making (Rosengren, Bondas, Nordholm, & Nordstrom, 2010)
 -Create committees to review resource allocation (Renz & Eddy, 1996)
 -Establish forums for discussing ethical concerns, including formal and informal ethics rounds and ethics committees (Gaudine & Beaton, 2002; Renz& Eddy, 1996; Silva, 1998; Storch et al., 2002)
 -Develop whistleblowing policies (CNA, 2001; Erickson, et al., 2003)
 -Identify polarities in complex situations and map out strategies for managing them (Johnson, B. 1996)

For a full list of references, please refer to the guideline at