Strategic threat management: An exploration of nursing strategies in the pediatric intensive care unit

Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level – useful for understanding strategic threat management generally – and a description at an operational, specific level – useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management. •Strategic threat management of ICU nurses was studied with structured interviews.•We classified and mapped strategies to threats and to the cues that evoked them.•Most threats involved technology, staff, or organization.•Most strategies involved staff and patient, or were cocktails of work facets (treatment, exam).•Most threats were managed by strategies that reflected the threat's work facet.