The Edge of Coping


Last week I gave a talk to the ANMF Working Hours and Fatigue Conference on what I called 'The Edge of Coping'.

It went like this:

For 100 years, we have laboured under the work performance mantra of Time and Motion.

For nurses, that means: "If there's still time, for God's sake, DO SOMETHING!".

But our thinking is not quite right.

We need to consider the element of 'Human Performance'.

Nursing is an often intense physical, cognitive and emotional endurance event.

And so, if we want good people to do good things, we have to consider all three.


We often have trouble visualising the concrete boundaries of our infrastructure, time and human resources, and so we try to too much with too little, creating a time pressure.

So we make time look elastic, although in reality it has a concrete, mathematical upper limit.


Systems processes and Human Factor ergonomics seem set in stone.

They are written or culturally passed on as "this is the way we do it, because this is OUR way; the way we've always done it."

Motion seen in this way seems stubbornly fixed, but in fact, offers the best possibilities in terms of re-engineering flow in the system and removing obstacles to that flow.

It seems fixed, but in fact, is plastic.

Psychomotor Performance:

We know when the body and brain perform at their best:

When they are rested, fed and not overloaded.

We know when emotions work best:

When there is time for defusing, processing and disentangling.

Psychomotor performance seems flexible, because we can always make people work harder and faster and longer.

But, like time, the boundaries are fixed, and so the only flexibility in performance is the choice of high or low performance: art or survival.

So if we want Healthcare to be a high performance, high reliability, high safety industry, we have some leverage points to work with.

Then, instead of the level of coping (read: suffering) being the only adaptibility left in the system, we can build safety valves into sustainability and doability, replacing fatigue, musculoskeletal injury and stress with optimised sustainability, optimised outcomes and optimised engagement.

Read my complete script here!

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