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Unclear goals and performance obstacles in a surgical department in Sweden, A case study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Vårdvetenskap)
Centre for Research & Development, Uppsala University/Region Gävleborg .
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Department of Occupational and Environmental Medicine, Medical Sciences, Uppsala University, Sweden.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: To improve working conditions and counteract nursing shortages, more knowledge is needed about the goals that guide nurses’ work, and the opportunities nurses have to carry out their work well. The aim of this study is to describe how nurse managers, registered specialist nurses and non-registered assistant nurses interpret stated organisational goals and their own daily goals, and to identify performance obstacles for nurses in a surgical department.  

Methods: A descriptive case study design was performed in a surgical department, comprising structured individual and group interviews according to work content analyses with nurse managers, registered specialist nurses and assistant nurses. Interviews were analysed in terms of predetermined aspects regarding working conditions and criteria for performance obstacles. Extracts from documents stating goals and registered data supplemented the interviews.

Results: The findings show that the daily surgery schedule, not the goal documents, guided daily work. An over-optimistic surgery schedule with unplanned changes and cancellations, over which the nurses had very little influence, as well as the time required to locate necessary equipment that was spread throughout the ward, resulted in nurses rushing through medical records and other preparations rather than preparing calmly for surgery. Although the registered specialist nurses and assistant nurses considered quality of care to be highly important, no standardised evaluations on quality of care were performed.

Conclusion: Due to goal incongruence and performance obstacles, the nurses were often unable to reach their daily goals. Involving registered specialist nurses in the schedule-planning process could facilitate their work to better match the requirements of the physical work environment and the staff availability. In order for the Surgical Department Goal Document to guide work, goals must be transformed into understandable, realistic, applicable and evaluable aims, and incorporated into daily work.

The study also reveals the importance of a functioning physical work environment including storage, technical equipment supplies, and the positioning of technical equipment in operating rooms, in order for registered specialist and assistant nurses to perform their tasks well.

Keyword [en]
case study, interview, nurses, operating rooms, organisational objectives, professional practice
National Category
Medical and Health Sciences
Research subject
Caring Sciences
URN: urn:nbn:se:uu:diva-267047OAI: oai:DiVA.org:uu-267047DiVA: diva2:872711
Available from: 2015-11-19 Created: 2015-11-17 Last updated: 2016-01-13
In thesis
1. Attractive Work: Nurses´ work in operating departments, and factors that make it attractive
Open this publication in new window or tab >>Attractive Work: Nurses´ work in operating departments, and factors that make it attractive
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Previous studies show that nurse retention is one of the most effective strategies to counteract nursing shortages. Few studies have focused on the crucial resource of registered specialist nurses in operating departments.

Aim: The overall aim of this thesis was to gain knowledge on registered specialist nurses’ and assistant nurses’ work in operating departments and on what factors they consider to be important for attractive work.

Methods: In Study I, operating room nurses were interviewed regarding their perspective on their work. In Studies II and III, specialist registered nurses and assistant nurses at operating departments in a Swedish county council responded to the Attractive Work Questionnaire. Study IV is a case study with interviews, a review of organisational goal documents and data concerning the number of planned, acute and cancelled operations.

Findings: The adaption of the Attractive Work Questionnaire for nurses in operating departments was satisfying. The most important factors for attractive work were: Relationship, Leadership and Status. The factors with the largest discrepancies between their important to work attractiveness and their rating at the nurses’ current work were: Salary, Organisation and Physical Work Environment. It was important for nurses to be able to prepare for and be in control of the different work tasks. However, the daily operating schedule guided the nurses’ work, and changes in the schedule, nurse shortages and the design of the premises constituted obstacles to their work.

Conclusion: The Attractive Work Questionnaire provided specific information to management on what to focus on to make work attractive. The majority of the identified attractive factors are already known to be of importance in nurse retention; however, factors requiring more investigation are Equipment, Physical Work Environment and Location (of the workplace). Their work prerequisites did not enable the specialist and assistant nurses to reach what they saw as their daily goals. Regularly occurring activities, such as acute and cancelled operations, were interpreted as obstacles to reaching daily goals.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 74 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1164
attractive work, nursing workforce, personnel turnover, job satisfaction, nurse retention, nurse shortage, operating room
National Category
Medical and Health Sciences
Research subject
Caring Sciences
urn:nbn:se:uu:diva-266338 (URN)978-91-554-9420-9 (ISBN)
Public defence
2016-01-08, Brömssalen, Gävle sjukhus, Gävle, 13:00 (Swedish)
Available from: 2015-12-16 Created: 2015-11-07 Last updated: 2016-01-13

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Björn, Catrine
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