Nurses’ views on workload, care rationing and work environments

Abstract

Aims The article examines nurses’ experiences to institutionally enforced choices they must make regarding what patient care will be left undone. Cognitive dissonance theory is used to discuss how missed care is reconciled with the nurses’ sense of professionalism and feelings of compassion. Background Research into missed nursing care and care rationing is increasing, with an awareness that it impacts on nurses’ coping ability. Methods In‐depth video and telephone interviews were conducted with four experienced nurses who were asked to describe how they made choices regarding required patient care and how they managed care under workload pressures. Results Thematic analysis of interview narratives revealed four key themes describing the experiences of nurses managing their work: compromising care; incongruity between professional standards and organisational resources; emotional exhaustion; and depersonalization. Conclusions Nurses expressed concerns that their professional values regarding patient care are being lost in a quest to achieve financial targets. It raises questions regarding ethical and psychological dilemmas created for workers by work intensification. Implications for Nursing Management Financial effectiveness negatively impacts on nurses’ emotional and clinical well‐being cannot be easily dismissed, given that cognitive dissonance arises from attempting to provide quality care of patients whilst meeting organisational financial targets.

Perspectives of nurses’ role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses

“…Several contextual factors should be taken into account while translating nurses’ ideal roles in PC into clinical practice. Important prerequisites which were also already discussed in the literature were: sufficient education [ 32 , 33 ], knowledge (more pharmacology and pharmacotherapeutics) [ 34 , 35 ], an interprofessional collaborative approach [ 1 , 36 ], confidence in nurses [ 37 , 38 ], an open blame-free culture with clarity of team composition and roles [ 39 , 40 ], equality between professionals [ 41 ], adjusted legislation [ 42 ], readiness of professionals and patients to allow nurses to have responsibilities in PC [ 43 ], and a manageable workload leaving “time to care” [ 44 , 45 ]. Lack of time, shortage of nurses, absent legal frameworks and limited education and knowledge were described as main threats.…”

“…care" [44,45]. Lack of time, shortage of nurses, absent legal frameworks and limited education and knowledge were described as main threats.…”

“It's about how we do it, not if we do it”. Nurses’ experiences with implicit rationing of nursing care in acute care hospitals: A descriptive qualitative study

“…Despite considerable advancements, e.g., nurse-led care (Laurant et al, 2018), health care systems still underestimate the importance and value of nursing care. In addition to exposing the gap between ideal and reality, implicit rationing responds to and enables what Harvey et al (2020) described as the incongruity between professional standards and organizational resources.…”

The NUPHAC-EU Framework for Nurses’ Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe

“…Currently, the training of healthcare professionals remains largely a single discipline, which may reduce the ability to collaborate interprofessionally [69]. Therefore, more interprofessional education should be organized, as well as rigorous research on interprofessional PC to tackle the remaining barriers.…”