Table 3.
Content analysis, within analysis, municipality A and B. Theme 1
| Theme | Sub-themes | Category | Sub-category |
|---|---|---|---|
| T1: High nursing demands – variation in staffing and competence | Disparity in staffing and competence (Municipality A) | Tired nurses (NLT) | Increased workload leading to de-prioritizing of important tasks |
| Complex patients (NLT) | Seriously ill patients in need for complex treatment | ||
| Elderly patients are not prioritized | |||
| The patients don’t need to be hospitalized as often as before | |||
| Insufficient staffing (LLT + NLT) | RN staffing not satisfactory - RNs confer with each other by telephone | ||
| More nurses are needed, but there has been a staff reduction which increases sick leave among nurses | |||
| Low physician coverage | |||
| Trying to keep the balance between resource usage and patient safety | |||
| Sicker patients gives new challenges | |||
| Acceptable staffing (LST) | RN staffing is satisfactory in most wards | ||
| Physician coverage is satisfactory | |||
| Unpredictable staffing (NST) | Good physician coverage during weekdays | ||
| There is not always enough RN staffing during weekends | |||
| Varying competence (LLT) | Nurse competence is varying, but there is a focus on increasing it | ||
| High demands in care leads to high demands in competence | |||
| Fulltime positions is a way to increase competence | |||
| To many assistants | |||
| Reorganization can be positive in regards to competence | |||
| Sufficient competence (LST) | The competence is high and have increased – increasing competence is encouraged | ||
| The patient group makes need for high competence | |||
| High competence (NST) | RN competence and staffing are high, but at the expense of LPNs | ||
| Capacity building in focus (NLT) | Working towards increased competence | ||
| Reasonable staffing and competence (Municipality B) | Satisfactory staffing (LST) | Staffing is satisfactory, but vulnerable during weekends | |
| Good physician coverage and cooperation | |||
| RN density is increasing, which is positive for further recruitment | |||
| Acceptable staffing (LLT, NLT) | The staffing is good as long as there is no sick leave | ||
| There is a lot of assistants in some wards | |||
| Competence is good, but capacity building on all stages are in focus | |||
| There is a need for more LPNs | |||
| Sufficient competence (LLT) | RN coverage and RN competence is high in accordance to more complicated patients | ||
| Satisfactory competence and staffing (NST) | Physician coverage is good | ||
| Nurse competence is varying, but several have continued educations | |||
| There is focus on capacity building on all levels | |||
| Varying competence (LST | Capacity building is in focus | ||
| Capacity building in focus (LST, NLT) | Courses and guidance are not always provided but capacity building is organized internally | ||
| The nursing home patients are more complex and sicker when discharged from the hospital | |||
| Internally organized capacity building (NST) | Frustration in regard to discharge routines | ||
| Complex patients (LLT, NLT) | The nursing home patients are more complex and sicker when discharged from the hospital | ||
| The patients are more complex | |||
| Frustration in regard to discharge routines |