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Abstract
Hospital patient care units are complex work environments in which frontline registered nurses regularly adjust their work to meet the ever-changing needs of patients and the evolving demands of the workplace. Hospitals employ software-based staffing and patient acuity systems to plan staffing for individual work shifts. Still, hospitals currently lack dynamic, automated assessments of changes in workplace conditions that have the potential to result in care delays, elevated patient safety risk, and caregiver overload during a work shift. Through qualitative inquiry, this study identifies adaptive work strategies and environmental activity changes that hospital-based registered nurses recognize as signs of strain.