According to the theory-driven (the salutogenic theory) interview guide and data-driven analysis of the interviews, the results are presented in relation to the three dimensions of the core concept of SOC: meaningfulness, manageability and comprehensibility. This means that the participating nurses have provided a deeper understanding of the content of the three SOC dimensions. The nurses described factors explaining their ability to remain in work and the profession, that is, factors that strengthen them in everyday life (Table 3).
Table 3. Salutary factors explaining why hospital nurses may remain in work and the profession. Themes and subthemes.
-Feeling job satisfaction and having fun at work
-Being acknowledged and feeling productive
-Feeling togetherness and secure in the work team
-Having a manageable workload
-Having varied tasks
-Having a work-leisure balance
-Having good interactions and strong leadership
-Feeling valuable, needed and doing good work
-Feeling pride in your professional role
In the workplace, the nurses are in a context that is important to them and feels straightforward. The nurses have a need for acknowledgment from colleagues, patients and their relatives, as such acknowledgement makes the usefulness of their work efforts clear to them and increases the meaningfulness of their work. In this way, the nurses feel they are productive; they can see the results of their own work. The nurses also need to be included in meaningful healthcare teams that are characterized by job satisfaction and humor.
Feeling job satisfaction and having fun at work
The nurses see job satisfaction as one of the most meaningful factors for remaining in the workplace for a long time. This can involve job satisfaction in the team or the joy felt when a patient expresses something positive.
Job satisfaction for me, it's getting someone to smile. Try to spread positive emotions. Be happy and make it easier for others. That gives me job satisfaction, I feel good. A patient who looks at you and says “thank you,” and you can see that everything you did went well (Nurse, medical outpatient care).
Having fun at a workplace marked by humor is also something the nurses describe as important to remaining in the workplace for many years. This can entail, for example, using humorous jargon in the team, colleagues having a twinkle in their eyes or being able to laugh together. The nurses also describe how important it is to have work that is meaningful; they go to work with a positive feeling.
Now we have a very fine atmosphere. Our students say that they’ve never been on a ward where they felt so welcome right away, a basic positive feeling and that’s how we want it. We are able to joke and talk to each other. However, I almost see my colleagues more than I see my family (Nurse, psychiatric inpatient care).
Being acknowledged and feeling productive
According to the nurses, the meaningfulness of their work increases when they are acknowledged. It is often patients who provide this acknowledgment, either directly or when the nurses have contributed to patients’ improved health. But it can also be colleagues or relatives who acknowledge the nurse.
Every day when you get this feedback from patients, whatever it may be, it feels like I've done something good. But, it's not always so, there are others too. Most of the time I’ve done something good every day/…/I feel good about being seen and acknowledged and seeing and acknowledging others (Nurse, surgical outpatient care).
The nurses have a great need to feel productive and useful in their work. They can provide self-acknowledgement, especially when patients recover. Then they see how their involvement has contributed to the positive outcomes.
A workplace where I thrive and feel I go to easily, that I’m useful, needed in any way. That’s what I get from both patients and staff (Nurse, psychiatric inpatient care).
Feeling togetherness and secure in the work team
Feeling togetherness and secure in the work team is central to nurses’ experience of meaning at work. Cohesion means a great deal to the nurses, that is, working as a team and solving problems together, especially in precarious care situations.
I think togetherness gets a little stronger in crisis situations. I actually think that there are probably many institutions that feel that way, that you get a little tighter during crisis situations. Togetherness gets stronger in strained situations (Nurse, medical inpatient care).
The nurses experience togetherness when they are accepted, involved and part of the work team. They feel they are not alone and have full responsibility for care provision. They feel they are part of a greater whole.
Being accepted by the group, that you’re part of the group, being seen and heard. That people listen to what you have to say, and being involved in making decisions. I think it’s important to belong to a group, because that's probably what being a nurse means, that you’re independent but still part of the whole. Having colleagues and supporting each other (Nurse, medical inpatient care).
High demands are placed on the nurses as regards being able to manage their day-to-day work. These high demands concern both more routine tasks and stressful situations, but the nurses find ways to cope with the different care situations. Factors that make the work situation manageable include receiving support from colleagues and managers, being involved and being able to interact with colleagues and other healthcare professionals. A good balance between work and leisure makes the work more manageable. An additional factor is being able to mentally leave work duties behind at the end of the workday. Having an individual work schedule is valuable for the nurses, as it allows them to have a great deal of flexibility. They also express a need to have a manageable workload, that is, to have control over various care situations. Using these factors, they can build sustainable strategies for managing different care situations and coping with the work, both physically and mentally, for a long time.
Having a manageable workload
Nurses typically have a high workload and must prioritize tasks if they are to cope with a variety of care situations. It is important to have enough nurses on the ward to handle the high workload. Having a manageable workload means there is a readiness for unexpected and emergency events.
Enough staff, that is number one, there has to be enough nurses. Enough, so that both nurses and auxiliaries feel they are coping with the work, and that there’s a buffer if something happens. That there are extra staff every day, because there’s usually someone who is absent, children who are sick. So that you have a small buffer to rely on, so that you never have to be understaffed for longer periods (Nurse, surgical inpatient care).
When the workforce is sufficient and the workload is balanced, there is time for important tasks other than pure physical care or emergency care. This means that nurses have the opportunity to take more time to create care relationships with patients and can perform qualitatively good nursing. This allows them to finish their workday with a higher level of satisfaction.
When we’re sufficiently staffed, just enough workload, then I have time for my responsibilities, I have time to deal with things that are hanging over me. That I get a moment to sit and finish, so I can catch up with my duties (Nurse, medical outpatient care).
The workload can vary during the day and across work shifts. If the nurses have opportunities to slow their pace during the day, they can take a break between more stressful tasks, which allows a kind of recovery. This recovery, in turn, can provide extra energy to tackle more strenuous situations.
I can work at a fast pace one day, because then I know that the next day, maybe, will be a bit calmer, and then I slow down, and I can manage the work. I know that I would have burned out otherwise (Nurse, psychiatric inpatient care).
You can work under stress temporarily, you can do it, you can push yourself and then you have to find a recovery phase/…/What the recovery phase looks like is individual, you have to find a recovery phase, a bit every day, and then you can handle more stress again. But I have been stressing for 16 years and then suddenly "Bang!" and I've been there, I know how it feels and I never want to be there again. I’m an expert at learning to say "stop and no," even if I want to (Nurse, surgical outpatient care).
Having varied tasks
Nurses’ professional role involves a variety of everyday tasks and challenges. Although many tasks are based on experience and routine management, nurses are exposed daily to challenges and trials. The nurses feel their tasks are positive challenges in that they create variation, which means working as a nurse never becomes monotonous.
No days are identical, there are encounters with different people, patients and situations. Nothing gets boring, you have to be on the ball all the time and this makes you more mentally alert (Nurse, surgical outpatient care).
I'm very pleased with my situation, that I have a bit of everything, I come in when someone is sick or when there is a shortage of nurses, so it feels good (Nurse, psychiatric inpatient care).
The varying tasks mean that the nurses are constantly learning, especially when their knowledge is tested in more challenging situations.
That it’s varied, it’s very instructive, it never gets monotonous, and it never gets old. There are always new things happening all the time. Both in the way we work and how we handle our duties. The fact that the tasks themselves are varied means that you never really stop learning (Nurse, surgical outpatient care).
Having a work-leisure balance
If nurses are to recover properly and cope with their work, they need to find a balance between work and leisure. This means having an active leisure time and feeling good at home, while having the energy to deal with patients.
If you have a good home life and leisure time, it’s reflected in your work, then you can do a good job. If you’ve had a good weekend at home and feel that it’s given something, then you’re more rested and positive when you come to work (Nurse, medical inpatient care).
The nurses need to be able to leave their duties behind and feel they are "finished" with them at the end of the workday. This entails being able to leave their work behind, both physically and mentally, so that it does not accompany them home and affect their leisure time.
Work must not take over so that I can’t cope with my spare time, and the same thing, leisure time should be energizing and help me cope even better at work, so that there’s a balance there. So I feel I have time for both in a good way (Nurse, psychiatric inpatient care).
The home situation can affect the nurses if they do not have enough energy for work. If there is an open, accepting atmosphere in the working team, the nurses can get support from colleagues and thus manage their work situation more easily.
You have to feel good about your social life at home. But it should be okay, if you have problems at home, that you don’t have to forget them when you come to work/…/What’s nice about my job is that I can come here and tell somebody that I've had a hard night or whatever it might be (Nurse, surgical outpatient care).
The nurses report a need to have work schedules that enable a balance between work and leisure. When there are opportunities to have individual schedules, the chance of improving the balance between work and leisure is increased.
I’ve been working daytime for three years. We try to reschedule as best we can, so that I work maybe only ten evenings, and work as much daytime as possible. It works very well at home, when my husband works irregularly. Then I’m at home if he works early mornings. And when my husband works late evenings, I’m the one who can pick up the children and manage the practical things (Nurse, psychiatric inpatient care).
Having a schedule that suits me and that lets me recover. I have a little difficulty working evenings and getting up early. I’ve changed my schedule, so I work evenings before my day off (Nurse, psychiatric inpatient care).
Having good interactions and strong leadership
Interacting with others is an important precondition for managing the work situation. In interaction with others in the team, the nurses have the opportunity to get support, which helps them handle different care situations. Nurses can also receive support and expert help from other professionals, such as doctors, physiotherapists and auxiliaries.
We work well together, we all work together, support each other and discuss things. We cooperate really well, I think. If there’s something you don’t know how to do, then you’re not afraid to get help from someone else, or to say "I can’t, but…" It challenges you, I think that’s really important (Nurse, psychiatric inpatient care).
In order for nurses to develop good manageability, clear leadership is needed and, thus, a clear and strong manager. Such leadership provides security and is a precondition for the work team to function satisfactorily.
A good manager makes the whole team work, she does almost everything for us, I almost said. She plays around with the schedule/…/she makes a special schedule for those who work until five and some work every other weekend, then they have special schedules. She really spends time and energy on us, which makes people want to stay and enjoy being on the ward, and you gain confidence (Nurse, psychiatric inpatient care).
Creating sustainable work situations for registered nurses means making these situations comprehensible. Comprehensibility is created when the nurses can reflect on their role and the work they do. Comprehensibility helps the nurses understand that they are needed and that they are providing good care for their patients. The nurses need varying tasks, so that their work is not trivial and monotonous. Nurses develop and learn when they face new challenges on a daily basis. In this way, the professional role is constantly evolving. The nurses are proud of their professional role, and their professional role and function are valuable in the healthcare organization.
Feeling valuable, needed and doing good work
The nurses understand that their professional role is of great value owing to the knowledge they have and the tasks they perform, which involve great responsibility. They feel needed and that they are contributing something important to patients’ health.
To me, my professional role means feeling I am capable. Having sufficient knowledge so that I can help people and have the energy to help when someone is powerless. Being able to support that person is a strong driving force for me (Nurse, psychiatric inpatient care).
I’m thriving as a nurse, I enjoy meeting new people, and I enjoy helping, doing something for someone else, and as you can see... it usually turns out good for them (Nurse, surgical outpatient care).
Sometimes, it is only the feeling of doing something that benefits someone else (the patient) that gives this satisfaction.
Yes, being able to help and provide support gives me satisfaction that it is working in all ways for our patients (Nurse, psychiatric inpatient care).
It’s the best profession in the world. Being able to help someone who needs it and to alleviate problems or support or treat in the best way. That's what I want to do (Nurse, medical outpatient care).
The nurses feel highly committed to their work, which means they get deeply involved in their patients and try to do that "little extra" for them. It is important for nurses to not only carry out basic nursing, for example, patient hygiene care, but also help patients by talking with them and building trusting relationships.
I try to do that little extra, even for the patients, "to give of oneself." If I get good treatment in return, it means a lot to me. I hear someone say, you did great, yes it means a lot to me (Nurse, medical outpatient care).
At the same time, the nurses understand that they cannot get too deeply involved in patients’ situations; they must also think about themselves. This is an approach they have developed over a long period of time to prevent work-related stress and ill health.
You have to take care of yourself, not get involved in everything. It’s important that you don’t do everything yourself, that you can ask others for help and know their limitations, I think that’s important. That you don’t wear yourself out, because that helps nobody, if you have to stay at home sick just because you’ve gotten too involved. Somehow, it’s about getting involved in the right things (Nurse, psychiatric inpatient care).