Introduction
Methods
Design
Participants and sampling
Data collection
Data analysis
Meaning unit | Condensed meaning unit | Codes |
---|---|---|
There is a problem with the demand for nurses from other units. There is no control over the work of these nurses and usually, the care by the temporary workforce isn’t done properly. | Lack of control over the work of nurses coming from other units and consequently the reduced quality of nursing care. | - Lack of control over the work of temporary nurses - Doing lower quality of care by temporary nursing staff |
Sometimes the unit is so crowded that we’ve to delegate some work to the nurses of the next shift. If a lot of care is left to them, their workload will be increased. | An overcrowded unit forces the nurse to delegate care to the nurses of the next shift. Increased workload of the next shift nurses because of assigning a large number of cares to them. | - Mandatory delegation of care to the next shift nurses due to the overcrowded unit - High workload of the shift due to the number of cares delegated by the previous shift |
Rigor and trustworthiness
Results
No. | Gender | Age (year) | Education | Marital status | No. of children | Unit | Work experience (year) | Position | Interview time (minutes) | Number of interviews |
---|---|---|---|---|---|---|---|---|---|---|
1 | Female | 25 | Master’s degree | Married | No child | Internal, orthopedics, rheumatology and neurology | 2 | Nurse (rotating shift) | 25, 30 | 2 |
2 | Male | 36 | Bachelor’s degree | Married | 1 | ICU | 13 | Nurse (rotating shift) | 25, 30 | 2 |
3 | Female | 38 | Master’s degree | Married | 2 | ICU | 15 | Nurse (rotating shift) | 45 | 1 |
4 | Female | 40 | Bachelor’s degree | Married | 3 | Eye & ENT surgery | 17 | Nurse (rotating shift) | 20, 40 | 2 |
5 | Male | 25 | Master’s degree | Married | No child | CCU | 3 | Nurse (rotating shift) | 55 | 1 |
6 | Female | 34 | Bachelor’s degree | Married | 3 | Gastrointestinal surgery | 13 | Nurse (fixed morning shift) | 70 | 1 |
7 | Male | 29 | Bachelor’s degree | Married | No child | Infectious diseases | 6.5 | Nurse (fixed morning shift) | 45 | 1 |
8 | Female | 26 | Bachelor’s degree | Married | 1 | Pediatric and NICU | 2 | Nurse (rotating shift) | 35 | 1 |
9 | Female | 30 | Bachelor’s degree | Married | 1 | Pediatric | 8 | Nurse (rotating shift) | 30 | 1 |
10 | Female | 27 | Bachelor’s degree | Married | No child | Emergency | 4 | Nurse (rotating shift) | 35 | 1 |
11 | Female | 40 | Master’s degree | Single | No child | Oncology | 16 | Nurse (rotating shift) | 45 | 1 |
12 | Female | 35 | Master’s degree | Married | 1 | Nursing management office | 10 | Supervisor | 40 | 1 |
Theme | Categories | Subcategories | Examples of codes |
---|---|---|---|
Delegation of care, a double-edged sword | Insourcing of care | Seeking assistance from colleagues in the same shift | Seeking assistance from a colleague with a lower workload Seeking assistance from a colleague with more stable patients Seeking assistance from a more experienced colleague |
Seeking assistance from the head nurse | Seeking assistance from the head nurse for changing the dressing of orthopedic patients Seeking assistance fromthe head nurse for perform the care that the nurse is not skilled at Seeking assistance from the head nurse for changing the colostomy bag | ||
Delegating care to colleagues on the next shift | Delegation of the patient’s dressing to the next shift Delegation of the medication to the next shift | ||
Outsourcing of care | Patient transfer to other units | Transfer of patients with stable condition to another unit Transfer of patient with unstable condition to another unit | |
Demand for extra nursing workforce | Requesting nursing workforce from other units Requesting nursing workforce from the nursing office Requesting for temporary nursing staff | ||
Delegating of care to non-professionals | Delegating care to nurse assistant | Requesting the nurse assistant to do an electrocardiography Requesting the nurse assistant to perform a gavage Delegating the patient out of bed to the nurse assistant without the nurse’s supervision | |
Delegating care to nursing students in the internship course | Delegating drug therapy to an inexperienced student Delegating the preparation of drugs to the inexperienced student Delegating unsupervised oxygen therapy to a nursing student | ||
Delegating care to the patient’s family | Delegating of gavage to the patient’s family The patient’s change position by the patient’s family Disconnecting and reconnecting the IV drip by patient’s family |
Insourcing of care
Seeking assistance from colleagues in the same shift
“When the unit is crowded, if I have a colleague whose work is less, or whose patients are more stable, or my colleague is more experienced, I get help from them, and they usually help me.” (Participant No. 2).
“Colleagues usually cooperate with me. For instance, a few days ago, the unit was extremely busy, and I had a patient with appendicitis. I asked my colleague to assist by providing the patient with clothes and completing a pre-operative form for them before going to the operating room. Also, she helped me by sending the patient’s test results.”(Participant No. 8).
“Since other colleagues may also have their own tasks to complete, we typically seek help from a colleague who less busy. This ensures that we can collectively finish all the work while allowing that colleague to assist us as well. Otherwise, our colleague may not be able to accommodate our requests or can inadvertently forget them.” (Participant No. 4).
“Sometimes my colleagues delegate care to me, but I forget. For example, I was given an urgent care to do, or to notify sonography; I was so busy or involved in my own tasks that I forgot to do it or follow it up.” (Participant No. 10).
Seeking assistance from the head nurse
“Here, the head nurse is a man. If we’re on an all-female shift, we ask him to lend a hand with the urology patient, and he gladly pitches in. Sometimes, he assists us in changing the dressing of orthopedic patients which are big and heavy. We appreciate his help because it allows us to handle the patient’s care more efficiently.” (Participant No. 6).
“Sometimes, nurses don’t know how to handle certain care, so they call the head nurse to come and do it, hoping to learn from them. Tasks like changing the colostomy bag, taking care of the port, removing the sheet after angiography, washing the chest bottle, and so on.” (Participant No. 12).
Delegating care to colleagues on the next shift
“For example, when a patient goes for dialysis, ultrasound, or needs a simple x-ray, it takes a while for them to return to the unit, and you won’t have enough time to fully take care of them. So, you end up leaving some of the patient’s care for the next shift.”(Participant No. 2).
“Sometimes, the unit gets super hectic, and the patient is very ill; so that you end up having to pass on some of the tasks to the next shift. But the care gets delayed, and that puts extra pressure on the next shift.”(Participant No. 4).
“It’s just unfortunate when a very sick patient transfers to your unit and you find out that some of his/her nursing cares weren’t done or were done incompletely, and they’re delegated to your shift. You already have your own work to handle, but now you’ve to deal with the unfinished care from the previous shift as well. It adds to your tasks and makes it hard to complete all your duties for the patient during your shift.” (Participant No. 3).
Outsourcing of care
Patient transfer to other units
“We, in the pediatric unit, call the gynecological surgery unit. If they show us the green light, we send stable patients over five years old there. Another example is when the extra beds were all occupied and we had no choice, we sent patients with more stable conditions to the gynecological surgery unit. It helps to decrease our tasks a bit and ensures we can manage all the cares.”(Participant No. 9).
“Sometimes a patient with “special conditions” such as a CCU patient who also needs monitoring is transferred to our unit because of an infection. Our unit is an infectious disease unit, but sometimes the large number of patients and the workload of the unit means that the nurses cannot provide the full care of them, and some care may be missed.” (Participant No.7).
Demand for extra nursing workforce
“Sometimes, when there’s a lot of work and the number of nurses is low, we call the nursing office and ask them to provide us with a temporary nurse.” (Participant No. 2).
“If I realize that I won’t be able to finish all the tasks before the end of my shift, I’ll ask the supervisor to provide some temporary nursing help, maybe for an hour or to fully assist us throughout the shift.” (Participant No. 9).
“We sometimes ask for temporary staff to come into the unit as well. However, we can’t guarantee that the care will be fully carried out because the staff from other units have different routines. The type of care provided for the patients varies until they become familiar with the unit’s care practices and routines. So, it’s not always possible to complete all of care entirely.”(Participant No. 3).
Delegating of care to non-professionals
Delegating care to nurse assistant
“Here, we ask the nurse assistants to perform ECG, or BS, or even in some cases do venipuncture.” (Participant No. 8).
“When the hospital gets busy, we usually ask the nurse assistant to do tasks like taking an ECG or performing a gavage for the patient, even though they may not be highly skilled in these areas.” (Participant No. 5).
Delegating care to nursing students in the internship course
“Some colleagues delegate the responsibility of medication to interns. Some students, who are still learning nursing care, may not yet have the confidence to administer medication independently without supervision.”(Participant No. 8).
“At times, nurses assign interns to care for patients, but these interns may forget to do some necessary care.” (Participant No. 11).
Delegating care to the patient’s family
“It’s better if patients have someone accompanying them when they are hospitalized because when we’re overwhelmed with work, we often have to rely on the patient’s companion to take care of certain tasks, even though we’re aware it’s not the ideal approach.” (Participant No. 10).
“Unfortunately, there are times when nurses pass on certain care tasks to the patient’s family; Tasks such as administering tube feeding, assisting with repositioning and movement, and even providing oxygen therapy. In some cases, the nurse instructs the patient’s companion to disconnect and reconnect the IV drip, disconnect and reconnect the monitoring equipment, or administer insulin to the patient without supervision.”(Participant No. 12).
Delegation of care, a double-edged sword
“Sometimes, because we’ve so much work to handle, we end up passing on certain care tasks to our colleagues. It helps us manage our patients’ caring tasks, but the downside is that we can’t supervise or ensure that the delegated tasks are done correctly. On the flip side, there are instances when we ask our colleague, “Did you do that?” only to find out that they completely forgot to do it.” (Participant No. 11).