Solving Wicked Problems

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Today’s nursing shortage is unlike any other that we have confronted in my more than four decades of nursing. The gap between the number of nurses needed and those available continues to grow. The Surgeon General warns it could be as high as one million nurses in a few years. More than 90% of nurses now report working in a state of continuous staff shortages. The overall nursing vacancy rate is 15%, which will continue to grow if the 20% of nurses eligible to retire choose to do so. Backfilling against this shortage will be impossible in the short run and maybe even into the long run. Younger nurses are already voting with their feet and leaving positions while also choosing not to recommend nursing as a career to their friends.

Solutions like mandated staffing ratios or billing for nursing care will not solve what has become a wicked problem. They may play well to some nursing audiences but won’t solve our challenges. Wicked problems are different from other problems. Some of the key features of these problems include the following:

• Involve many unknown unknowns.
• Lack a definitive explanation as they are an outcome of many factors.
• Are entangled with other organizational issues.
• Are symptoms of other problems.
• Are moving targets across time.
• Lack a straightforward articulation and are impossible to solve in a simple or final way.
• Involve complex interdependencies and many viewpoints.
• Are nuanced and may not be the same across geographical areas.
• They are expensive to solve, and one-shot solutions can have consequences.

The challenge is that we often assume a problem like nursing shortages is complex versus wicked. Complex problems can be solved by rational analysis followed by a logical reductive process designed to get the situation firmly under control. Wicked problems are different.  They are subjective, relative, chaotic, and ambiguous, full of stakeholders and different agendas. They are messy, ad hoc, and sometimes unsolvable.  You may achieve great results for a while with your interventions, and then you are back in the messy middle. You will try many things, and some will work, but you never completely control the problem.

When we face ambiguous situations and are stressed, we tend to default to what we know. We look at what we’ve done before, what we’re comfortable with, or what we think will take the least effort and give us the most control. And what we tend to default to most is the assumption that the problem we are dealing with is complex, logical, and solvable. This is fine if that is what it is, but it is likely to be disastrous if the problem is, in fact, wicked like this current shortage.

So what should nurse leaders do with this information?  The first step is to recognize that the problem you are dealing with is a wicked problem. We may not solve it, BUT our interventions can improve or worsen it in our setting. Achieving positive outcomes will take time, and we need to remain flexible.  Before taking any critical steps, ask whether the step you will take will improve the situation or worse.  In other words, is this intervention useful in the long run?  And remember – you are working in a highly complex and ambiguous space.  You will make mistakes, but even these can lead to progress. You can’t solve wicked problems by waiting for a body of evidence to support your decisions. Wicked problems keep changing and are contextual. You must take small bets and be at peace that this wicked problem may stay with us for a long time.  To learn more about wicked problems, read this Harvard Business Review post.

© emergingrnleader.com 2023

 

 

 

 

 

 

 

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