The result describes the registered nurses’ experiences of work-related stress. The analysis resulted in one central theme “Feelings of inadequacy and dissatisfaction contribute to work-related stress” three categories and ten subcategories that responded to the study's purpose. See an overview in table 2.
Feelings of inadequacy and dissatisfaction contribute to work-related stress
The results indicated that the registered nurses experienced different types of work-related stress. The main theme "Feelings of inadequacy and dissatisfaction contribute to work-related stress " was divided into three categories: Difficulty coping with their work tasks, Insufficient support, and Work-related stress affects private lives.
Difficulty coping with work tasks
Some of the difficulties connected to coping with their work were according to the registered nurses: Lack of time, Understaffing, Lack of control, Difficulties in prioritizing work, Heavy workload.
Lack of time
The participants described that they did not have enough time and resources to keep up with everything that should be done. Meanwhile, the number of patients was not decreasing, and there were always people in need of care. According to the participants, stress meant not having time to do the things they needed to do and sometimes they needed to be done quickly, depending on the situation. This problem was described as a new kind of stress that may not be there initially, but this was caused by a consistent lack of time.
“I may have to be fast depending on what happens to the patient and then I might feel further stress that was not there earlier” (Interviewee n.6).
Understaffing
The participants experienced too few staff in relation to the number of work duties and patients, which contributed to stress at work. They described the fact that they were understaffed, and it appeared that they were worried about not being able to do their work satisfactorily. Understaffing made them feel inadequate because they had more to do than they could handle. They described how the understaffing put tremendous pressure on them, leading to a more significant amount of stress.
“We are very… very understaffed and at the same time we have new nurses who should get the right introduction, they should have the right support” (Interviewee n.3).
Lack of control
The participants describe the lack of control as one of the causes which increased stress among them. The participants felt having no control over their work. They had no autonomy in the workplace, and this could likely lead to work-related stress. Nevertheless, there were times when the participants felt that they lost control, and not having control for them meant doing things more slowly, because they felt that the tasks needed more time or not having a plan B in the event of unexpected incidents.
“Everything that you feel that you do not have control over can create stress” (Interviewee n.2).
Difficulties in prioritizing work
Participants said they felt they had to prioritize in the workplace constantly as the workload increased and eventually, that could lead to decreased patient safety. Every time they had to prioritize, they experienced this as a stressful situation because they felt that they had not done enough for the patients and their relatives.
“We are nurses we are not superhumans” (Interviewee n.9).
The participants described how learning to prioritize goes beyond knowing how to use time properly. Making the wrong choice when prioritizing and planning can be problematic and be stressful. The participants said person-centered care should be prioritized to a greater extent to reduce stress in the workplace.
“Learning to prioritize can reduce stress. To do one thing at a time” (Interviewee n.10).
Heavy workload
The participants described how they had a large amount of work during a workday, which lead to increased stress. The results showed that participants who experienced a high workload and stress level at their workplace could have increased dissatisfaction with their work and either changed their place of work or left the profession, which increased the workload for those who remained.
“Work-related stress is for me a large amount of work no matter what the work procedures or the mental pressure are” (Interviewee n.3).
Insufficient support
Insufficient support described how the participants experienced stress and what work-related stress meant to them. Their responses were divided into three subcategories: Insufficient team collaboration, Insufficient knowledge and training, Insufficient management support.
Insufficient team collaboration
The registered nurses felt that the physicians’ work in the care team was insufficient, and this could contribute to experiences of work-related stress. It also emerged that the participants experienced difficulties contacting a physician and getting a response. They needed to call the doctor several times so they could get advice about a particular patient. This situation was stressful because participants described cases when there was urgent to get in touch with a physician and they could not.
“Then it can be stressful if you need a consultation from a doctor. You call them several times and no feedback. It can also be stressful” (Interviewee n.12).
The participants described how support and cooperation between colleagues needed to be improved. They outlined the importance of competence and the cooperation between the various healthcare providers to work towards the same goal.
Insufficient knowledge and training
The participants revealed that working with patients made them doubt their professional nursing skills. Some of the participants mentioned that they wanted further education in their profession in order to be more proactive and feel confident in their work. The amount of work overload and the responsibility for other nursing staff with insufficient knowledge made them feel stressed, and the participants made clear that, this was a cause of work-related stress.
“This uncertainty about their skills. I have no further education to lean on. I would like that. This too this is not going to be good. Even if you try” (Interviewee n.11).
Insufficient management support
From the interviews, it emerged that the participants experienced a lack of support from the management, which contributed to an increased feeling of stress among them. According to the registered nurses, some of the managers did not have a degree in nursing, and they did not understand the nurse’s perspective or know what the role or the duties of the registered nurse. The participants described how it was important to have a manager who was on site, empathetic and was willing to find compromises with the registered nurses. According to the participants, this could help to reduce work-related stress. The participants said that a supportive management could lead to less stress being perceived as less among the registered nurses.
“Cooperation with the manager is important” (Interviewee n.3).
Work-related stress affects private lives
In this category, participants described how the registered nurses experienced stress and how it affected their private life daily. In addition, they also talked about how their private life was affected in relation to the ongoing covid-19 pandemic. The two subcategories were: Impact of work‑related stress on the nurses’ private livesand Impact of the pandemic on nurses’ private lives
Impact of work‑related stress on the nurses’ private lives
The participants reported feeling tired and sometimes irritated, and they described how this could also affect their quality of life. The participants described how working as a registered nurse was often stressful. They perceived that stress at work caused negative consequences for both physical and psychosocial well-being. Fatigue was experienced as a significant problem for the participants. It was noticeable during working hours, but it also affected the person in their spare time. The participants described how they felt fatigued, drained of energy, and they often did not remember things, which frightened them. They felt there was a lot of stress at work. For some of them, it felt as if it could be challenging to maintain a professional approach at work, and they tried to hide their feelings and to do the best for the patient or the relatives of the patient, but it was difficult to do. Meanwhile, they described how this mix of feelings also affected the quality of their own life.
“I get tired, tired in my body, tired in my head, tired in general… I get gloomy” (Interviewee n.2).
Impact of the pandemic on nurses’ private lives
During the period when the interviews were conducted, a situation arose that had not existed before, and which led the participants feeling more stress. The situation was Covid‑19, and it has changed how everyone works. During a pandemic situation, there was added stress. The participants had significant concerns about the risk of being exposed to the disease at work or even spreading it to loved ones, but they were also uncertain about the future in their workplace. It was a dilemma that created working-related stress among the registered nurses in municipal care. For the participants, this new stressful environment, and the constant stream of new guidelines every week during the outbreak of Covid‑19 led to high work-related stress for the registered nurses. As a result, the workload became heavier, and the amount of stress increased. During the interviews, they also revealed that many and constant changes to rules and recommendations made the healthcare providers feel even more stressed about not having control over their work.
“It was a day when everything really exploded at once, I got a call related to the Covid‑19 epidemic and there was one person who was infected and then within a quarter of an hour there was another who was infected, and all hell broke loose at once and everything had to be done now” (Interviewee n.4).