‘Entanglement of nursing care’: A theoretical proposition to understand the complexity of nursing work and division of labour

Ongoing challenges in the provision of care, driven by growing care complexity and nursing shortages, prompt us to reconsider the basis for efficient division of nursing labour. In organising nursing work, traditionally the focus has been on identifying nursing tasks that can be delegated to other less expensive and less highly educated staff, in order to make best use of scarce resources. We argue that nursing care activities are connected and intertwined. As such 'entanglement' is a hallmark of nursing work, it needs to be understood to identify optimal and sustainable options for division of labour in nursing. We elaborate the value of entanglement as a theoretical proposition to shift the focus away from old models of task-oriented nursing and put forward a model of labour division that acknowledges the importance of entangled nursing care activities. We build on the work of Jackson, Anderson, and Maben (2021) in which nursing work was conceptualised as a combination of cognitive, emotional, organisational, and physical labour. We assert that just allocating labour based on the type of work will not do the trick. The complexity of nursing work also needs to be considered. This is commonly framed as the combination of care activities required in the interest of patients and the complexity of each of these activities ('task complexity'). Integrating the concept of entanglement brings to light that even 'simple' care activities contribute to the complexity of work, as activities are potentially bound up with other activities ('entangled care activities'). That is to say, nursing work is not simply a function of the tasks undertaken. Based on our conceptualisation, we propose that the existence and nature of entangled care activities ('task entanglement') should be taken into account, to express what is needed in dividing the labour ('labour complexity'). This should in turn underpin future staffing and skill mix decisions. In the pursuit of guaranteeing high quality of care, further research on 'ideal' mixes of skills and optimal team compositions in various health care contexts is necessary. For nursing practice, our theoretical proposition can be used to explicate the complexity of daily work. Hereby, giving nurses something to demonstrate their added value in providing the best care to patients. Tweetable abstract: Nursing work is more than the accumulation of care activities; to comprehend its complexity care entanglement (intertwining) should be acknowledged.