Theme 1-Excessive workload

Common theme

Workload was considered to be a frequent stressor as evidenced in a large number of respondents’ statements. This perception appeared to cause concern for both newly qualified nurses and student nurses alike. Time constraint was considered to be heavily associated with workload and vice versa, therefore this theme incorporated both. Phrases, which addressed this issue, were often combined with comments about non-nursing duties and short staffing. This heavy workload was perceived to have a negative impact on patient care, particularly attending the emotional needs of the patient. Both student nurses and newly qualified nurses wrote about the pressure to achieve what was perceived to be an unachievable goal in relation to workload. The effect of this workload was cited as a stressor and was considered to be a contributory factor in sick leave. Student nurses associated workload with time pressure and wrote about the difficulty in working long hours with such a heavy workload. This was expressed as follows:

‘Too many non-nursing tasks, which adds to workload in limited time. This leads to stress at work. People always busy and rushing’. (S17)

Coupled with the feeling of heavy workload was the difficulty encountered with time management. One respondent wrote about this difficulty, particularly dividing time between documentation and direct patient care.

‘I find the most stressful situation can be in caseload and time management particularly dividing my time between documentation and direct patient care.’(Q69)

This appeared to compel some nurses to work at a faster pace. One person remarked that ‘not feeling quick enough’ (Q67) was considered a stressor when administrating medications and reading out the nursing report. Overall, both student and newly qualified nurses identified workload and time pressure as a major stressor. This finding is supported by the quantitative data, which revealed the highest measure in the Nursing Stress Scale for newly qualified nurses and second highest for student nurses. Workload and time limitations were interlinked and both were often perceived to be as a result of inadequate staffing.

4.2.3.1 Inadequate staffing

More than half of the student nurses expressed dissatisfaction at the low staffing levels in the clinical environment. This was associated with a call for better staff – patient ratios. Some student nurses felt that staff shortages placed the student into situations where care is compromised and this adversely affected quality of patient care. Reduced staffing was cited to be related to higher sick leave and students reported their dissatisfaction with having to pay back time in relation to time from sick leave taken while on clinical placement. Likewise, over half of the newly qualified nurses commented on short staffing as a major stressor. The comments included lack of staff numbers and poor skill mix. This was elaborated when talking about short staffing by one respondent who found that

‘There have been many days when I have been unable to take a lunch break in order to complete all my tasks’ (Q59).

References were made to the recent embargo on Health Service Executive staffing as a possible stressor

One nurse as expressed this:

‘Cut backs, cut backs and more cutbacks by the HSE’ (Q70)

References were also made to the low staff- patient ratio and dependence on agency nursing for nursing provision and employment. One respondent added that:

‘If there were higher staff levels, it will evenly spread the workload and decrease stress levels’ (Q59).

The negative effect of short staffing was also cited as leading to difficulty in keeping track of patients’ care paths, therefore affecting quality of care.

‘This is a very stressful position to be in when trying to give the best care to patients about concerns, anxiety, treatment when you are aware of work load and other patients that need you but there isn’t enough staff for patient ratio especially in the morning’ (Q45).

Not only was there dissatisfaction about the numbers of staff, but there were also comments about the poor skill mix, particularly in relation to senior/junior staff on a ward at a time. This was perceived to put extra pressure on senior staff with resulting negative attitude towards newly qualified staff. Junior nurses with allocation of excessive responsibility.

‘Once newly qualified, I found it stressful that because of staff shortages nurses more senior than me took on a lot when working with me, as I cannot administer drugs yet. Their added stress because additional workload to them is often reflected in their attitude towards me as if I am to blame for poor rostering, which is a management issue.’(Q43)

There was a sense that short staffing resulted in restricted time spent attending patients’ needs.

‘The primary stressor in my opinion is lack of staff. It is very frustrating and disheartening when one is unable to provide the type of complete holistic care one wants to.’(Q47)

4.2.3.2 Non-nursing duties

In an environment where both groups expressed dissatisfaction relation to shortages of staff and heavy workload, there was also a feeling that excessive time was spent carrying out non-nursing duties. Many commented on having to carry out clerical work such as answering phones, washing or moving beds, attending paperwork or simply carry out duties that were considered ‘non-nursing’. Performing non-nursing duties impinged on time that nurses could spend on direct patient care, leaving staff feeling exploited:

‘I feel as if I was utilised to perform a wide range of duties such as washing beds to carrying out clerical work, which I feel are not nursing tasks. I feel that performing those non-nursing tasks took up a large part of my time-time, which I could have otherwise attributed to direct personal/patient care. This left me feeling very stressed and under pressure to complete my own work’ (S26).

In the performance of non-nursing duties, both student nurses and newly qualified nurses spoke about how this impacted on time that could be spent with a patient and how this had an effect on their own feelings regarding their own responsibilities toward the patient:

consent and cannulate the patient (A patient going for a procedure) I have not had time to ask my patient how they felt or had they worries/ fears, no time to reassure my patient’ (S14).

There was a perception that the performance of non-nursing duties added to the stress associated with high workload and time pressure, reduce time spent with patient:

‘There is a huge amount of clerical work expected of nurses, which leaves us with less time for our patients. Patients should come first.’(Q54)

4.2.3.3 Unmet patients’ needs

Consequential to heavy workload, lack of staff and time spent carrying out non- nursing duties both students and newly qualified nurses felt that there was not enough time to attend to the emotional needs of their patients. There was a sense that there was not enough time to actually talk to the patients. One student nurses compared the final year negatively to the previous years in relation to the relationship that he/she had with the patients:

‘Comparing my first year placement and now fourth-year placement, there is no comparison. In first year I feel I knew my patients better and could take my time in giving them a wash or simply taking them on a small walk down the corridor, whilst engaging in conversation. These simple things patients appreciate. To day however, I don’t get a chance to enjoy or even do this with patients’ (S14).

This graphic picture of the busy clinical environment has left the student stating that: ‘Basic nursing care can be missed out on and I most definitely didn’t become (hopefully) a nurse to ignore a patients emotional needs and not to give them a quick wash and for my only interaction with them be doing regular observations and medication rounds’. (S14)

Time pressure and heavy workload appeared to account for the lack of opportunity to provide this emotional care to the patient. There was a feeling that nurses were not fully providing basic or holistic nursing care, which causes concern for the nurses.