Healthcare personnel's working conditions in relation to risk behaviours for organism transmission: A mixed-methods study.

AIMS AND OBJECTIVES: To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission. BACKGROUND: Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients. DESIGN: A mixed-methods convergent design. METHODS: Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research. RESULTS: Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients. CONCLUSIONS: These mixed-methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety. RELEVANCE FOR CLINICAL PRACTICE: The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.

Staff structural empowerment-Observations of first-line managers and interviews with managers and staff.

AIM: The aim was to study how first-line managers act to make structural empowerment accessible for nursing staff and furthermore to relate these observations to the manager's and their nursing staff's descriptions regarding the staff's access to empowering structures. BACKGROUND: Staff access to empowering structures has been linked to positive workplace outcomes. Managers play an important role in providing the conditions for structural empowerment. METHOD: Five first-line managers were observed for two workdays. Managers and staff (n = 13) were thereafter interviewed. Field notes and interviews were analysed using directed content analysis. RESULTS: The managers displayed intentional actions that could enable their staff access to empowering structures. Managers and staff described the importance of staff's access to empowering structures. CONCLUSION: Staff who perceive to have access to structural empowerment have managers who are present and available. Unanimity among managers and staff existed in regard to the importance of staff having access to structural empowerment. The managers work continually and intentionally, doing many things at the same time, to provide the staff access to empowering structures. IMPLICATIONS FOR NURSING MANAGEMENT: The study shows the importance of promoting managers' awareness of staff's access to structural empowerment and maximizing managers' presence and availability to their staff.

Staff Working Life and Older Persons' Satisfaction With Care: A Multilevel, Correlational Design.

BACKGROUND: The importance of staff working life for staff well-being has been demonstrated in several studies; less research has focused on staff working life and older persons' satisfaction with care. PURPOSE: The study aim was to study relationships between 1) staff assessments of their structural conditions/empowerment in elderly care, psychological empowerment, and job satisfaction and (2) older persons' satisfaction with care. METHODS: A multilevel, cross-sectional, and correlational design was applied using questionnaire data on working life (1021 staff members) and unit-level data (40 elderly care units) on older persons' satisfaction with care. RESULTS: Statistically significant relationships were found between all 3 working life variables and older persons' satisfaction with care. Furthermore, the results revealed an indirect/mediating effect of job satisfaction between structural empowerment and satisfaction with care, but not for psychological empowerment. CONCLUSIONS: Staff structural empowerment, psychological empowerment, and job satisfaction are linked to older persons' satisfaction with care.

Relationships between structural and psychological empowerment, mediated by person-centred processes and thriving for nursing home staff.

Person-centred care has been shown to have positive outcomes for patients and for staff. However, the complexity of the link between structural conditions, work in a person-centred manner and outcomes for staff is insufficiently described. We tested the relationship between structural empowerment and psychological empowerment, as mediated by nursing home staff members' self-ratings of working in a person-centred manner, the person-centred climate and thriving. Questionnaires were distributed to staff working in 12 nursing homes in Sweden. A serial mediation model was tested. The results showed that higher access to structural empowerment was related to higher psychological empowerment mediated by staff working in a more person-centred manner, improved person-centred climate, and improved staff ratings of thriving. These results point to the importance of strengthening the preconditions for staff to work in a person-centred manner and nursing home managers play an important role in this.

How do first-line managers in elderly care experience their work situation from a structural and psychological empowerment perspective? An interview study.

BACKGROUND: The work situation for first-line managers in elderly care is complex and challenging. Little is known about these managers' work situation from a structural and psychological empowerment perspective. AIM: To describe first-line managers' experiences of their work situation in elderly care from a structural and psychological empowerment perspective. METHOD: Interviews from 14 female first-line managers were analysed using qualitative content analysis. RESULTS: The theme described the managers' work situation as "It's not easy, but it's worth it." In the four subthemes, the managers described their work in terms of "Enjoying a meaningful job," "A complex and demanding responsibility that allows great authority within set boundaries," "Supported by other persons, organisational preconditions and confidence in their own abilities" and "Lacking organisational preconditions, but developing strategies for dealing with the situations." CONCLUSION: The managers described having various amounts of access to structural empowerment and experienced a feeling of meaning, competence, self-determination and impact, that is, psychological empowerment in their work. IMPLICATIONS FOR NURSING MANAGEMENT: It is vital that first-line managers have access to organisational support. Therefore, upper management and first-line managers need to engage in continuous dialogue to customize the support given to each first-line manager.

Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study.

AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance. BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers. METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services. RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates. CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance. IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

An intervention targeting fundamental values among caregivers at residential facilities: effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction.

BACKGROUND: In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities. METHODS: The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects. RESULTS: Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents' self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11.4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p = 0.002, Median difference -8.5, 95 % CI -13.6;-3.0) and quality of everyday activities (n = 36; p = 0.012, Median difference -11.6, 95 % CI-21.7;-3.4). Change over time between groups was significant for empowerment (p = 0.001, Median difference 6.0, 95 % CI 3.0;9.0), disempowerment (p = 0.006, Median difference -2.0, 95 % CI -4.0;-1.0) and person-centered climate (p ≤ 0.001, Median difference 16.0, 95 % CI 9.7;23.0) and for life satisfaction regarding the factor quality of everyday activities (p = 0.002, Median difference 22.1, 95 % CI 8.2;37.4). Results of GEE confirmed earlier results; revealed interaction effects for empowerment (parameter estimate -5.0, 95 % CI -8.3;-1.8), person-centered climate (parameter estimate -16.7, 95 % CI -22.4;-10.9) and life satisfaction regarding the factor quality of everyday activities (parameter estimate -25.9, 95 % CI -40.3;-11.5). CONCLUSION: When the Swedish national fundamental values were put into practice increases in empowerment, person-centered climate and quality of everyday activities were found among older people with intact cognitive ability living in residential facilities. Limitations to consider are the differences between the two groups at baseline, drop-outs and that neither the data collector nor the outcome assessors were blinded to group assignment of participants. TRIAL REGISTRATION: The study was registered in ISRCTN92658034 in January 2013.

A longitudinal qualitative study of health care personnel's perceptions of simultaneous implementation of three risk assessment scales on falls, malnutrition and pressure ulcers.

AIMS AND OBJECTIVES: In this study, the aim was to understand health care personnel's expectations and experiences of participating in an intervention aimed at the implementation of three assessment scales for fall injuries, malnutrition and pressure ulcers, and the performance of preventive measures in these areas over the period of 18 months. BACKGROUND: Fall injuries, malnutrition and pressure ulcers among older people are challenging issues for caregivers at different levels in the health care system. DESIGN: A descriptive design with a qualitative approach was used to follow health care personnel before, during and after implementation of a care prevention intervention. METHODS: Twelve health care personnel with different professions at the hospital, primary care and municipal care levels participated in a preventive care introduction. Seminars were held at four occasions, with assignments to be completed between seminars. Lectures and group discussions were performed, and three risk assessment scales were introduced. The participants were interviewed before, during and after the introduction. Manifest and latent content analysis were used. RESULTS: The main results are presented in the theme 'Patient needs are visualised through a gradually developed shared understanding' and in five categories. The work approach of performing three risk assessments simultaneously was perceived as positive and central to ensuring quality of care; it was not, however, perceived as unproblematic. CONCLUSION: The participants as well as health care team members showed a positive attitude towards and described the advantages of being given opportunities for shared understanding to improve patient safety and to provide structure for the provision of good care. RELEVANCE TO CLINICAL PRACTICE: The managerial approach of listening to and acting on issues stressed by health care personnel is important to ensure ongoing and future improvement initiatives.

A longitudinal study of working life among first-line managers in the care of older adults.

AIM: To study whether the number of subordinates plays a role in first-line managers' and subordinates' ratings of empowerment, stress symptoms, and leadership-management performance. The aim was also to study relationships between managers' empowerment and stress symptoms and leadership-management performance. METHODS: A longitudinal and correlational design was used. All first-line managers (n=98) and their subordinates (n=2085) working in the care of older adults in five municipalities were approached. RESULTS: With fewer (≤30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with ≥31 subordinates. Furthermore, structural empowerment was related to the managers' stress symptoms and leadership-management performance, mediated through psychological empowerment. Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms. CONCLUSION: The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership-management performance they rated over time.

First-line managers' descriptions and reflections regarding their staff's access to empowering structures.

AIM: To elucidate first-line managers' descriptions and reflections regarding their staff's access to empowering structures using Kanter's theory of structural empowerment. BACKGROUND: Good structural conditions within workplaces are essential to employees' wellbeing, and their ability to access empowerment structures is largely dependent on the management. METHOD: Twenty-eight first-line managers in elderly care were interviewed. Deductive qualitative content analysis was used to analyse data. RESULTS: Managers perceived that staff had varying degrees of access to the empowering structures described in Kanter's theory - and that they possessed formal power in their roles as contact persons and representatives. The descriptions mostly started from the managers' own actions, although some started from the needs of staff members. CONCLUSION: All managers described their staff's access to the empowering structures in Kanter's theory as important, yet it seemed as though this was not always reflected on and discussed as a strategic issue. IMPLICATIONS FOR NURSING MANAGEMENT: Managers could make use of performance and appraisal dialogues to keep up to date on staff's access to empowering structures. Recurrent discussions in the management group based on such current information could promote staff's access to power through empowering structures and make job definitions a strategic issue in the organisation.

Male first-line managers' experiences of the work situation in elderly care: an empowerment perspective.

AIM: To describe male first-line managers' experiences of their work situation in elderly care. BACKGROUND: First-line managers' work is challenging. However, less attention has been paid to male managers' work situation in health care. Knowledge is needed to empower male managers. METHOD: Fourteen male first-line managers were interviewed. The interview text was subjected to qualitative content analysis. RESULT: Work situations were described as complex and challenging; challenges were the driving force. They talked about 'Being on one's own but not feeling left alone', 'Having freedom within set boundaries', 'Feeling a sense of satisfaction and stimulation', 'Feeling a sense of frustration' and 'Having a feeling of dejection and resignation'. CONCLUSION: Although the male managers report deficiencies in the support structure, they largely experience their work as a positive challenge. IMPLICATIONS FOR NURSING MANAGEMENT: To meet increasing challenges, male first-line managers need better access to supportive structural conditions. Better access to resources is needed in particular, allowing managers to be more visible for staff and to work with development and quality issues instead of administrative tasks. Regarding organisational changes and the scrutiny of management and the media, they lack and thus need support and information from superiors.

The ward round--patient experiences and barriers to participation.

BACKGROUND: Patients' participation is essential to their well-being and sense of coherence, as well as to their understanding of and adherence to prescribed treatments. Ward rounds serve as a forum for sharing information between patient and caregiver. The purpose of the ward round is to obtain information and plan medical and nursing care through staff-patient communication. AIM AND OBJECTIVE: The aim and objective of this study was to investigate patients' experiences during the ward round and their ability to participate in their care. METHODOLOGICAL DESIGN AND JUSTIFICATION: The study was qualitative and descriptive in design. Fourteen inpatients at a cardiovascular ward were interviewed. Qualitative content analysis was used for the analysis. ETHICAL ISSUES AND APPROVAL: The ethics of scientific work were adhered to. Each study participant gave his/her informed consent based on verbal and written information. The study was approved by the Research Ethics Committee at Uppsala University. RESULTS: The analysis revealed one theme and three subthemes related to patients' experiences of ward rounds. The main theme was handling of information from the daily ward round while waiting for private consultation. The subthemes were making the best of the short time spent on ward rounds; encountering traditional roles and taking comfort in staff competency; and being able to choose the degree to which one participates in the decision-making process. CONCLUSIONS: Several aspects of traditional ward round routines could be improved in regard to the two-way information exchange process between caregivers and patient. Patients' and caregivers' ability to communicate their goals and the environment in which the communication occurs are of great importance. The information provided by nurses is easier to understand than that provided by physicians. The atmosphere must be open; the patient should be treated with empathy by staff; and patients' right to participate must be acknowledged by all healthcare professionals involved.

District nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management.

AIM: To describe district nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management; and to examine associations between the variables. BACKGROUND: Obesity is increasing worldwide and primary care could play a central role in the management. METHODS: Questionnaire data were collected from 247 nurses in 33 centres. RESULTS: The most common activities performed weekly were; advice about physical activity (40.1%) and general lifestyle advice (34.8%). However, nearly one third seldom/never performed these activities. Approximately half seldom/never performed BMI assessment and even fewer waist circumference (78.1%). Values for the factors Importance of obesity and Personal effectiveness were skewed towards a positive view and Negative view close to neutral. Multivariate analysis revealed that nurses with specialized tasks, longer working experience and higher perceived personal effectiveness performed more clinical activities. CONCLUSION: Managers need to make efforts to engage all personnel in obesity management; and strategies to increase self-efficacy are called for.

An explorative and confirmative factor analysis of the Leadership and Management Inventory-II among staff working in elderly care.

PURPOSE: The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden. DESIGN/METHODOLOGY/APPROACH: Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061). FINDINGS: The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results. ORIGINALITY/VALUE: The instrument measures both leadership and management performance and can be used to continually measure managers' performances as perceived by staff to identify areas for development.

Nurses' assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress.

BACKGROUND: Nurses' working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees' behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions. OBJECTIVE: To investigate the relationship between nurses' assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress. METHODS: A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, the Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed. RESULTS: The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254-0.268. Significant differences in self-efficacy were found in the grouped working conditions. CONCLUSIONS: This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

The multidrug-resistant bacteria attitude questionnaire: validity and understanding of responsibility for infection control in Swedish registered district, haematology and infection nurses.

AIM: To assess the discriminative and construct validity of the Multidrug-Resistant Bacteria Attitude Questionnaire and to study registered nurses' knowledge of, behaviour toward and emotional responses to patients with multidrug-resistant bacteria in relation to how they understand their own, managers' and politicians' responsibility for adherence to preventive measures for infection control. BACKGROUND: Multidrug-resistant organisms are a global problem and an essential topic in healthcare regarding patient safety improvement. DESIGN: Descriptive and correlational cross-sectional survey. METHOD: Data were collected in a non-random sample consisting of 397 registered nurses; district, haematology or infection registered nurses. One-way analysis of variance and independent t-tests were used for comparisons and a principal component analysis was performed. RESULTS: Discriminative and construct validity were supported, as the infection registered nurses generally had higher scores on knowledge, behaviour and emotional response, compared with district registered nurses and haematology registered nurses and the three-factor solution was confirmed. Registered nurses with higher scores on knowledge and emotional response attributed greater responsibility to themselves and to politicians. The Multidrug-Resistant Bacteria Attitude Questionnaire was translated using a forward-back translation process. CONCLUSION: The questionnaire has adequate psychometric properties. Insufficient knowledge of, behaviour toward and emotional response to patients with multidrug-resistant bacteria were described, but the registered nurses did estimate their own responsibility for adherence to preventive measures for infection control as being great or very great. RELEVANCE TO CLINICAL PRACTICE: There is a considerable need to improve knowledge, behaviour and emotional response regarding infection prevention measures among healthcare workers. The hospital management are responsible for such improvements and the Multidrug-Resistant Bacteria Attitude Questionnaire is useful in identifying such needs, as it has adequate psychometric properties and is able to discriminate between groups. Evaluation among healthcare workers may indicate where to situate additional training, as this is of clinical significance for safe care.

A complex challenge with unclear improvement: the need for involvement, contextualization and facilitation when managers implement a leadership model.

PURPOSE: Management and leadership in health care are described as complex and challenging, and the span of control is known to be a key component in the manager's job demands. The implementation of change can be a challenge in health care, and managers often have roles as implementation leaders. Little attention has been given to how managers perceive the process of implementation. Thus, this study aims to explore second-line managers' perceptions of, prerequisites for and experiences from the implementation of changes in their manager's work conditions. DESIGN/METHODOLOGY/APPROACH: A grounded theory-based qualitative design was used. Data were collected from a purposive sample of nine second-line managers by individual semi-structured interviews. The three stages of initial coding, focus codes and axial coding were used in data analysis. FINDINGS: Three thematic areas were identified: engagement, facilitation and achievement. The second-line managers' descriptions suggest that the change work entails a complex challenge with an unclear result. Involvement, consideration for the context and facilitation are needed to be able to conduct a cohesive implementation process. ORIGINALITY/VALUE: This study findings outline that to succeed when implementing change in complex organizations, it is crucial that managers at different levels are involved in the entire process, and that there are prerequisites established for the facilitation and achievement of goals during the planning, implementation and follow-up.

Working life and stress symptoms among caregivers in elderly care with formal and no formal competence.

AIM: The aim of the present study was to describe and compare caregivers with formal and no formal competence on job satisfaction, psychosomatic health, structural and psychological empowerment and perceptions of care quality. A further aim was to study relationships among study variables. METHODS: A convenience sample of 572 caregivers in elderly care participated. RESULTS: Caregivers with no formal competence perceived higher workload, more communication obstacles, less competence, poorer sleep and more stress symptoms than did their colleagues. Linear regression analyses revealed that the factor self-determination was an explanatory variable of stress levels among caregivers with no formal competence, and self-determination and impact among caregivers with formal competence. Linear regression analysis revealed that different dimensions in structural and psychological empowerment explained the variance in staff job satisfaction, perceived stress symptoms and quality of care. CONCLUSIONS: No formal competence seems to be a risk factor for psychosomatic health problems. IMPLICATIONS FOR NURSING MANAGEMENT: Managers need to have a strategic plan for how to create a working environment for caregivers with no formal competence. Caregivers' self-determination seems to be important for stress symptoms. Meaning, self-determination, impact and opportunities appear to be important for job satisfaction and competence, opportunities, resources and formal power for quality of care.

Leadership and management skills of first-line managers of elderly care and their work environment.

AIM: To study the leadership and management skills of first-line managers (FLMs) of elderly care and their work environment in Egypt and Sweden. BACKGROUND: FLMs in Egypt and Sweden are directly responsible for staff and quality of care. However, FLMs in Sweden, in elderly care, have smaller units/organizations to manage than do their colleagues in Egypt. Furthermore, family care of the elderly has been the norm in Egypt, but in recent years institutional care has increased, whereas in Sweden, residential living homes have existed for a longer period. METHODS: A convenience sample of FLMs, 49 from Egypt and 49 from Sweden, answered a questionnaire measuring leadership and management skills, structural and psychological empowerment, job satisfaction and psychosomatic health. RESULTS: In both countries, FLMs' perceptions of their leadership and management skills and psychological empowerment were quite high, whereas scores for job satisfaction and psychosomatic health were lower. FLMs had higher values in several factors/study variables in Egypt compared with in Sweden. CONCLUSION AND IMPLICATIONS: The work environment, both in Egypt and Sweden, needs to be improved to increase FLMs' job satisfaction and decrease stress. The cultural differences and levels of management have an effect on the differences between the two countries.

Nursing student's expectations for their future profession and motivating factors - A longitudinal descriptive study from Sweden.

BACKGROUND: The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored. OBJECTIVE: To describe students' motives to become registered nurses and their expectations regarding their future profession. DESIGN: A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education. PARTICIPANTS AND SETTING: A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden. METHODS: A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis. RESULTS: An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education. CONCLUSION: The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.