Nurses’ experiences of working under time pressure in care for older persons

Abstract

Background The international health workforce crisis had led to an increasing shortage of nurses, which has substantial implications for the quality of patient care. This shortage potentially results in nurse-perceived time pressure, which can be particularly challenging for nurses who provide care for older persons. Objective This study aimed to show how geriatric nurses experience working under time pressure, perceive its impact on care and deal with time pressure in daily care. Research design A qualitative descriptive interview design was used. Participants and research context Purposive sampling led to the inclusion of 11 nurses from three geriatric nursing wards in two general hospitals in Flanders (Belgium). Data were collected using semi-structured in-depth interviews and analysed using the QUAGOL (Qualitative Analysis Guide of Leuven). Ethical considerations The study protocol was approved by the Ethics Committee of the University Hospitals Leuven (Ethics committee of the University Hospitals Leuven). Findings In all interviews, time pressure was described as ubiquitous in the daily care of older persons. A sense of failure in providing care was the common thread in many interviews. Nurses felt compelled to ‘reduce’ good-quality care to basic care by focusing on the physical and visible aspects of care. Nevertheless, personal experiences with time pressure and strategies to cope with it differed among the interviewees. These variations were related to the working environment and the nurses themselves. They underscored the importance of nurses’ perspectives for a good understanding of the phenomenon of time pressure. Discussion and conclusion Working under time pressure in the care of older persons leads to various important challenges for nursing ethics. The findings show that providing care that promotes the human dignity of older persons in busy working environments in which care is rationed is an important ethical challenge. As such, our study offers a baseline for further research and discussion on how to support nurses working under time pressure.

Factors affecting Australian aged care facility workers in administering oral medication to residents with swallowing difficulties

“…Time was a common concept among almost all participants having a considerable impact on staff's already stretched workload. The problems around nurses' time pressure and its impact on the quality of nursing care have been widely discussed in the literature (Dierckx de Casterlé et al, 2020). Working under constant time pressure, nurses often have to prioritize or routinize their tasks to manage their time (Waterworth, 2003), as reflected in some of the responses in this study as well.…”

The integration of care ethics and nursing workload: A qualitative systematic review

“…This review sought to find how nurses are affected by the care they receive from nurse managers but found more adaptations due to lack of care received. If this final phase fails, nurses adopt survival strategies like increased pace of work, completion of care beyond allocated hours and sacrificing health and well-being to do what needs to be done (de Casterlé et al, 2020;Scott et al, 2019).…”

“…Care rationing compromises ethical values and leads to feelings of failures (de Casterlé et al, 2008(de Casterlé et al, , 2020 The resulting stress is known to lead to burnout that results in emotional exhaustion, depersonalization and lack of personal accomplishment (Andela & Truchot, 2017;Maslach & Leiter, 2008). Two solutions proposed were for management to not be monopolized by meetings to allow time for presence on the units and for management be encouraged to have mixed practices that allow for direct patient care (Martin & Bouchard, 2020).…”

What Older Patients and their Relatives Say is Important During Acute Hospitalisation: A Qualitative Study

“…This means that the reported variation in how the patients and relatives are being met by the health personnel cannot be explained by looking only at the personal characteristics of the individual nurse. The ndings must also be interpreted in light of the working conditions that health professionals often describe as physically hard, emotionally demanding and stressful with competing priorities (32,44). Thus, the respondents' frustration at not being seen and heard may, in part, be explained by the reported bustle and hurry in acute medical wards (32), which leaves psychosocial care for patients as a secondary concern (45).…”

“…However, gaining knowledge of the patient's habitual state and situation outside the hospital and providing adapted communication and information may be di cult, as nurses in acute care settings report being too busy and lacking time to provide adequate care (33). Health personnel describe time pressure as ubiquitous in the daily care of older persons, leaving them with a sense of failure in terms of providing care (44). This means that the reported variation in how the patients and relatives are being met by the health personnel cannot be explained by looking only at the personal characteristics of the individual nurse.…”