There were 659 utterances related to factors positively affecting work motivation (n = 225, 96%), and 620 utterances negatively affecting work motivation (n = 227; 97%). Regarding factors positively affecting one’s beliefs in one’s own capabilities to continue working until expected retirement age, 553 utterances were emphasized (n = 218; 93%), while 507 utterances were related to negatively affecting beliefs (n = 202; 86%). Typically, the participants gave between one to three responses for each question. For each question separately, the categories that gathered the most utterances, and their sub-categories, are more closely presented below. The frequencies of categories for each question are presented in Fig. 2, and the results of the qualitative content analysis, including quotations in Table 2.
The results of the qualitative content analysis
Factors positively affecting work motivation
n = 225 (96%), 659 utterances
Satisfaction with colleagues
Satisfaction with leadership and organizational resources
being with coworkers [makes me feel good]
wonderful workmates and the cooperation we have
good and supportive work team
have influence over own work, can affect
to have a good supervisor, who listens etc.
Significance of the work
(161 utterances )
Enriching client meetings
"experience that the work is important”
the feeling that you make a difference in the elderly’s everyday life
to get to work with elderly people
get so much back from the clients
(131 utterances )
Competence and desire to develop
it isn’t monotonous work, something happens all the time
work independently, must make own decisions
challenging, requires physical and mental fitness as well as social skills
I feel I can do my job
opportunity to develop, learn new things
(77 utterances )
Recognition from clients and relatives
Recognition from colleagues and management
gratitude from clients and relatives
when a client thanks [you] for the help and is satisfied with the care
positive feedback from coworkers
appreciation from superiors
Factors negatively affecting work motivation
n = 227 (97%), 620 utterances
Organizational work environment
not equipment to get the job done
one should constantly take in so many darn new things
existing knowledge is not utilized
if superiors don’t listen or don’t care
unappreciative head nurse, only hear how bad we are
poor management – don’t understand our job
Significant rush and stress
Negative consequences of time pressure
hurry, tight work schedules that others plan
not knowing whether you have time to eat during the work day
lack of time [with] the clients, just in a hurry all the time
the lack of time - not having the time to perform one’s tasks
things that are left unfinished
A hard work
change of clients, that you are not allowed to care for the same clients but are instead forced to change daily = IRRITATING
home care clients are becoming more and more complex, and everything should be documented
wintertime when the roads are icy, poorly plowed, and early spring with poor road conditions
would like to continue to educate myself at regular intervals but it’s difficult to manage with full-time job
little possibility to influence decisions, even though I, for example, know something better than those who decide
It is not always so fun
bad atmosphere among the personnel
gossip, mean talk behind your back
poor work ethic among colleagues
if you can't trust your workmates (that the work has been done)
Factors positively affecting belief in one’s own capabilities to continue working until expected retirement age
n = 218 (93%), 553 utterances
A resource and a challenge
Health supporting activities
if [my] health stays the same as now, it will be ok
you don’t know whether you are capable until retirement because of the workload
I must take care of myself so that I am capable
hope to be able to improve [my] work ability
Satisfactory organizational resources
Strong workplace community
support and encouragement from my supervisor
that the employer recognizes age in a positive way
the support from work colleagues
our fine sense of community in the work team
Meaning of the work
Satisfaction from work
successful client meetings
[I] enjoy my work tasks
[I] like to help people
the feeling of making a difference
love for my own work
Nature of the work
Skilled in demanding work
there are always sick people
home care is also needed in the future
I don't feel old, I still want to learn new things
master different situations
that the work pace shouldn’t be pushed to the breaking point
Factors negatively affecting belief in one’s own capabilities to continue working until expected retirement age
n = 202 (86%), 507 utterances
Current life and health
Future health challenges
there is no such thing, unless [my] health fails
the pain that is getting worse
that [my] body is not capable of the work
I don't know if I am capable of ‘running’ to the end, probably not
Imbalance between resources and demands
shift work, heavy shifts on the weekends
the importance of anything else but patient contact
ever-increasing demands on knowledge
elderly people should live at home longer... But less personnel who should manage to get more done
if the workload increases more
too unvaried tasks without challenges
Consequences of lack of resources
too few personnel, not competent personnel
permanent fixed-term employment contracts
“that we don’t get more personnel when the number of clients increases
constant changes, which have often not been considered to the very end either, you can’t trust things
the worker is of less and less importance
[they] don't listen to the workers
unfair distribution of work, does not apply to everyone
Constantly present rush
Imminent threat of stress
stress/always a rush during work
too much of a rush with the clients
sometimes sleep poorly; the job is in [my] thoughts...
if… the stress increases more…
3.1. Factors positively affecting work motivation
The category “Work environment” (234 utterances), included the sub-categories “Satisfaction with colleagues” and “Satisfaction with leadership and organizational resources”, generated the most frequent responses. Work environment as a motivational factor was due to both colleagues and leadership, as well as resources to carry out work tasks. Satisfaction with colleagues included good relationships, and a feeling of having a connection with each other. Colleagues who felt that they were liked, conveyed a sense of wellbeing. It was essential to have a particular place in the work community. Well-functioning teamwork was emphasized, it was considered effective and a product of reliable and supportive colleagues with good collaboration skills. Enjoyment and well-being at work led to work pleasure. However, the HCNs’ own attitude to work was of importance for work motivation. Satisfaction with leadership included that the labour management trusted the HCNs; and allowed them to take responsibility and influence their work content, routines, work schedules, work quantity, and vacations. Another factor mentioned was to be able to perform other tasks for a change or supervise new colleagues. Furthermore, good supervisors, applying a supportive leadership style, including having a good attitude with workers and good dialogue skills were emphasized. If the necessary organizational resources were available, which were required to perform the job, it was possible to complete high quality work. This included appropriate work equipment, and good planning of work, for example functioning work schedules, sufficient staff, and sufficient time to perform client work, appropriate workload and peace and quiet to perform work.
The category “Significance of the work” (161 utterances) generated the second highest amount of responses, and included the sub-categories “Meaningful work” and “Enriching client meetings”. Home care work was described as both meaningful in order to help clients in their everyday life, but also a work driven by inner motives to help. Home care work as a profession was perceived being in line with the HCNs’ own holistic view. Home care work was considered important, meaningful and a necessary, allowing possibilities to make a difference in people’s lives. An intrinsic motivation to help other people was emphasized; having the will, ability, and permission to help clients in their everyday life, and to bring them happiness. HCNs enjoyed to work with the clients and cared for their well-being. Furthermore, home care work entailed recurrent social contacts; HCNs got to know their clients well, and felt close to them. However, not only did the HCNs help the clients; the clients’ welcoming reverberated positive feelings back to the HCNs.
The category “Stimulating challenges” (131 utterances), included the sub-categories “Multifaceted work” and “Competence and desire to develop”, emphasized typical duties of the work. Home care nursing was described as both varying and challenging, being encouraged to use many different skills and to further education. Home care nursing comprised both responsibility and freedom. The ability to do shift work and the work content were brought up. The work was unpredictable and varying, with different tasks every day and work in different places, mostly in the clients’ homes. There were challenging tasks and client situations, requiring both physical and mental power as well as social skills. According to HCNs, they had the work they desired and were educated for, allowing them to work in an interesting branch. Work experience and professional skills were emphasized. HCNs trusted themselves and had confidence in their skills and competence. They felt strengthened by results of work done and success in problem solving. Likewise, they wanted to continue developing their professional skills and attend additional work education.
The category “External response” (77 utterances) gathered the fourth most frequent responses, and yielded the sub-categories “Recognition from clients and relatives” and “Recognition from colleagues and management”. Positive feedback received externally from others for work done seemed to be of importance to gain motivation to continue working. Feedback received from the clients appeared as appreciation, praise and encouragement. A hearty welcome from the clients, who were grateful for getting help and a good care improved motivation. Likewise, recognition from relatives showing their thankfulness for good care were expressed. Positive feedback from colleagues as encouragement and displayed satisfaction were found to be important, as well as supervisors and employers expressing their appreciation.
Moreover, less frequently mentioned responses increasing motivation were “Income stability” (32 utterances), “Close relationships and leisure” (18 utterances), and “Sufficient health and energy” (6 utterances).
3.2. Factors negatively affecting work motivation
The most frequent responses negatively affecting work motivation yielded the category “Organizational work environment” (176 utterances), and the sub-categories “Lacking resources” and “Unsatisfactory leadership”. Consequences of shortages in resources as well as unsatisfying leadership influenced the work environment. Due to a reduction in financial resources and optimization, worsening care conditions, resources not meeting the needs of care, and inequalities between work teams were revealed. HCNs stressed inadequate or lack of necessary work tools, inappropriate workspaces, and poor indoor air quality. Frequent changes caused concern, as they often occurred at short notice, and were perceived both difficult and burdensome. Changes were seen in existing responsibilities as well as in new tasks and new ways of working. Both incompetence among the permanent workers and difficulties in finding skilled staff were stated. Nevertheless, accessible skills among HCNs remained sometimes unused. Moreover, a negative effect on work motivation was a weak leadership. Significantly leaders’ negative attitude towards workers, and their lack of response, support and appreciation. Insufficient dialogue between workers and leaders was emphasized, including poor information, work instructions and guidance at work. Leaders being inaccessible, escaping their responsibilities or making too high demands, sometimes without adequate follow-ups. Injustice in everyday work, unclear job descriptions, as well as poor work planning and scheduling were accentuated, in addition to HCNs not being involved in the work planning. Further hindrances stressed were unclear criteria and purposes of the home care work, and an overall unsystematic work organization.
The category “Time constraints” (144 utterances) gathered the second most responses, and generated the sub-categories “Significant rush and stress” and “Negative consequences of time pressure”. There was a constant time stress causing a negative strain. HCNs perceived their work pace as too high due to time pressure, leading to a considerable and sometimes unreasonable rush. Physical and mental stress were present in everyday work. Among some HCNs, the stress arose periodically, while others considered it a constant and extreme stress. Too many client visits a day and time pressure when driving from one client to another triggered the stress. HCNs were often behind the scheduled time. They experienced less time for completing tasks, and for listening to the clients. Consequently, tasks were left unfinished or undone, with the quality of work suffering and the workload perceived as too hard.
The category “Job characteristics” (119 utterances), yielded the sub-categories “A hard work” and “Lowered ambition”, and had the third most frequent responses. The multifaceted nature of home care nursing included demanding challenges affecting the HCNs’ energy and get-up-and-go-ahead spirit. Home care nursing as a solitary and highly demanding work requiring great responsibility felt burdensome. HCNs expressed a feeling of uncertainty and being unsatisfied. There were many client visits per day, with often new clients and new tasks. Additionally, the work environment was often non-ergonomic and many clients were physically heavy to assist. Sometimes the work environment was unclean. The shift work was perceived as hard, and additionally home care nurses worked a lot of overtime. In addition, they experienced little opportunity to influence their working hours and schedule, as well as the work routines and job tasks. Not feeling involved in decision making was negatively affecting home care nurses’ motivation. The amount of administrative work had increased during the last years. It was perceived as taking too much time from the client work, and some assignments were considered unnecessary. Unfinished administrative work was stressful, and besides, HCNs stated deficiencies in documentation, even among ordinary staff. Additionally, there were frequent staff changes with lots of new colleagues. The weather conditions of the seasons were at times challenging. Lots of kilometres were driven by car, sometimes in demanding weather and bad road conditions. Working in the clients’ often very warm homes followed by driving in a cold car were conveyed. Alarming was that the already high workload was perceived as increasing, because of a higher amount of work, increasing requirements, and more complex clients with more challenging care needs. HCNs wanted to improve their skills, but at the same time, they experienced declining levels of energy and willingness. The work became an old habit, and the attitude and the feeling towards work became increasingly negative.
The category “Work community” was the fourth most frequently mentioned utterance, (74 utterances), and yielded the sub-categories “Negative atmosphere” and “Poor engagement”. A poor work community, including a bad atmosphere and negative and tired colleagues, was negatively affecting work motivation. Poor cooperation and conflicts in the working group along with the complaining of others, arrogance, gossip, slander and jealousy were brought up. In addition, a language barrier between Swedish and Finnish speakers was mentioned, although only by a few HCNs. Lack of commitment and motivation were expressed as poor work ethic and poor activity among the staff; colleagues being lazy, high usage of private mobile phones, and not participating in tasks other than client work. HCNs emphasized poor responsibility among colleagues when tasks were left undone and colleagues were not helping each other even though needed. As a result, a loss of confidence in colleagues was seen.
Other factors negatively affecting work motivation, although mentioned less, were “Weakened health and energy” (35 utterances), “Feedback from clients and relatives” (23 utterances), “Salary level” (23 utterances), “Staff shortage” (19 utterances), “National controlled decrees” (6 utterances) and “Age” (1 utterance).
3.3. Factors positively affecting the belief in one’s own capabilities
The most frequent response supporting one’s confidence to work until the expected retirement age yielded from the category “Own health” (140 utterances), with the sub-categories “A resource and a challenge” and “Health supporting activities”. Overall, HCNs conveyed their health as an important resource in work life, worth investing effort in. The health was both a resource and a challenge. The current health and wellbeing provided confidence to continue working among home care nurses with no existing health impairments, or when they were able to manage well with health challenges. However, hope for good physical and mental health to continue were expressed. Existing health declines were perceived as a challenge to continue working. Some HCNs felt anxious about their deteriorating health; they perceived worries about their future work ability and voiced the need to prioritize their health before continue working until the expected retirement age. However, HCNs declared an intention to and an interest in promoting and maintaining their health, by participation in rehabilitation programs, and with appropriate physical exercise, rest and eating habits. Some HCNs hoped for a better health after a forthcoming surgery. Only a few HCNs saw support actions as a demand in being capable to continue working.
The category “Workplace resources”, received the second most responses (118 utterances), and yielded the sub-categories “Satisfactory organizational resources” and “Strong workplace community”. Overall, well-organized work was in high demand, including both material resources, good leadership and good relationships with work mates. Having enough disposable HCNs, both temporary and skilled workers, and retaining existing workers using continuing employment agreements were emphasized. Moreover, supply of the ergonomic tools which are required and the ability to adapt the clients’ homes for their care needs, as well as job training to cope with demanding clients were mentioned. A good leader was considered to be supportive, responsive, understanding and encouraging, showing appreciation for efforts made and treating workers equally. HCNs emphasized the importance of participation in work related matters, such as the influence over working hours, workload, work content and opportunities for job rotation. Employers noticing the age of the workers in a positive way was also emphasized to influence confidence. Furthermore, the availability of modified tasks in line with current work ability was stressed, as well as the importance of qualitative occupational health care service. A strong work community was essential. Likable colleagues, who HCNs got on well with, produced job satisfaction. In well-functioning work teams, colleagues supported and helped each other. Sometimes, an even deeper friendship developed. However, the possibility to be able to switch to another work team in the case of poor work community was also highlighted.
The category “Meaning of the work” gathered the third most frequent responses (97 utterances), and generated the sub-categories “Satisfaction from work” and “Intrinsic motivation”. The deeper meaning of the work comprised of the clients themselves, the work tasks, and a strong intrinsic motivation of the HCNs. HCNs liked their clients and were very pleased to work with them. The client relations provided social interaction and rewarding meetings that strengthened motivation. Moreover, HCNs were satisfied with the work tasks and their workplaces. HCNs enjoyed and got pleasure out of their work. A great intrinsic motivation and a strong desire to help and take care of people were emphasized. HCNs experienced their work as meaningful, and highlighted the large amount of people in need of assistance. They stressed feelings of love for their work, and stated home care nursing as their dream profession. A work where their own work morale was essential.
The category, “Nature of the work” (94 utterances) had the fourth most frequent responses, and yielded the sub-categories “Job stability” and “Skilled in demanding work”. The multifaceted and challenging home care work provided opportunities to develop and use professional skills, as well the fact that there are a large amount of available positions within this field. The home care profession was stated as a stable work, since there is a continuous need of work staff, and future demand due to the changes in the society concerning more people living at home for longer. The sense of security to continue working within the same field and work team was also expressed. HCNs appreciated the multifaceted nature of home care. They experienced themselves as skilled, with confidence in managing the varying work tasks. They saw continued changes and work related challenges as inspiration, as they were motivated to develop their own professional skills. However, HCNs longed for reasonable mental and physical workload, as well as for a better status for the home care work.
Furthermore, but in less degree, the categories “Family life and leisure” (35 utterances), “Joy of living and wisdom” (32 utterances), “Income needed” (18 utterances) and “Appreciation and feedback” (17 utterances) emerged. Two people had not thought about what provided them with confidence to continue working.
3.4. Factors negatively affecting beliefs in one’s own capabilities
The category “Health-related decline” (145 utterances) gathered the most frequent responses, yielding the sub-categories “Current life and health” and “Future health challenges”. Simply if the overall health remains; the HCNs did not see any hindrances to continue working until the expected retirement age. However, the current health and balance in life revealed challenges. HCNs brought up a long list of diagnosed diseases, such as mental health disorders, musculoskeletal diseases, and hypertension. Many reported aches and pains in the back, shoulders, knees or fingers. Due to the current health limitations, HCNs expressed concerns and uncertainties of whether the current diseases will deteriorate, and about future illnesses. Along with physical decline, high mental strain, insomnia, reduced energy and weakened recovery caused uncertainty about the future. Moreover, the concern of close relatives’ health were also stressed. However, only a few mentioned their ageing as a concern.
The second most frequent responses generated the category “Multifaceted work” (115 utterances), and the sub-categories “Demanding work” and “Imbalance between individual resources and demands”. HCNs stated home care nursing as burdensome. The multifaceted and challenging nature of the work imposed high demands on balancing individual resources. The shift work was hard, with irregular and inconvenient working hours, intense, and too many shifts without days off. Moreover, extended working days, frequent overtime and being asked to work at short notice were brought up. Increased work areas also entailed longer work trips and more travel time in the car. HCNs expressed discontent with the increased amount of administrative tasks, sometimes at the expense of client work. An increased requirement on knowledge was experienced, and some HCNs stressed an inadequate knowledge level in relation to the requirements. Moreover, concerns about an imbalance between individual resources and work demands were emphasized. HCNs revealed an already heavy but still increasing physical and mental workload. There was an increase in the amount of clients, often with more demanding care needs, and yet often less time for caring and assistance. Care giving in clients’ homes, often with insufficient ergonomic tools, entailed physical heavy workload. Mentally challenging was the need to be constantly flexible at work, the already high and increasing work demands, as well as the uncertainty about future demands and an even greater workload. HCNs sometimes perceived too much responsibility, and were concerned about the poor quality of the final home care being provided. Dealing with clients and relatives was also stated to be mentally challenging as well. In contrast, lack of challenges, personal development and promotional opportunities also negatively affected confidence in being able to continue working until retirement age.
The category “Organizational resources” gathered the third most frequent responses (96 utterances), and yielded the sub-categories “Consequences of lack of resources” and “Unsatisfying leadership”. Lacking resources and economic savings was conveyed as staff reductions, understaffing, hiring freezes, despite the need of workforce, incompetent workers and the continuous employment of temporary workers. Due to savings, involuntary team and workplace changes were forced. Home care nursing was exposed to frequent and continuous changes due to the organizational changes, reorganizations and fusions of organizations. Many changes were considered irrational, causing either deterioration or not achieving the expected results, and were mentally stressful and energy draining. Some changes were considered as uncontrollable, and the uncertainty and fear of losing one’s job was revealed. Dissatisfaction with leadership and poor leadership skills were emphasized, decreasing HCNs’ confidence to work until the retirement age. Lack of support, appreciation, respect, justice and equality were disclosed, as well as unclear or missing information. HCNs experienced that they sometimes were not listened to, and that their supervisors had inadequate understanding of home care nursing. Moreover, excessive demands with no resources for realization were stressed, as well as poor and unfair work distribution.
The category “Work related strain” (65 utterances), which generated the sub-categories “Constantly present rush” and “Imminent threat of stress”, had the fourth most frequent responses. A constant rush causing stress reactions was negatively affecting HCNs’ belief to continue working until the expected retirement age. The hurry was an existing companion in the everyday work, perceived to be further increasing, and too hard. Some HCNs wanted to change work, because of the rush. Concerns about continuous stress was emphasized. Home care nurses expressed reduced stress tolerance, including thoughts about work interrupting their sleep, and that they were worried about future stress aggravated reactions.
In addition, categories with less responses were “Political and national decisions” (23 utterances), “Workplace community” (20 utterances), “Financial reasons” (18 utterances), “Retirement and family life” (7 utterances), “Lack of motivation” (7 utterances), and “Unemployment” (4 utterances). Four utterances stated that nothing could negatively affect their belief of continue working until the expected retirement age, and four people had never thought about it.