Nurses' views on workload, care rationing and work environments.

AIMS: The article examines nurses' experiences to institutionally enforced choices they must make regarding what patient care will be left undone. Cognitive dissonance theory is used to discuss how missed care is reconciled with the nurses' sense of professionalism and feelings of compassion. BACKGROUND: Research into missed nursing care and care rationing is increasing, with an awareness that it impacts on nurses' coping ability. METHODS: In-depth video and telephone interviews were conducted with four experienced nurses who were asked to describe how they made choices regarding required patient care and how they managed care under workload pressures. RESULTS: Thematic analysis of interview narratives revealed four key themes describing the experiences of nurses managing their work: compromising care; incongruity between professional standards and organisational resources; emotional exhaustion; and depersonalization. CONCLUSIONS: Nurses expressed concerns that their professional values regarding patient care are being lost in a quest to achieve financial targets. It raises questions regarding ethical and psychological dilemmas created for workers by work intensification. IMPLICATIONS FOR NURSING MANAGEMENT: Financial effectiveness negatively impacts on nurses' emotional and clinical well-being cannot be easily dismissed, given that cognitive dissonance arises from attempting to provide quality care of patients whilst meeting organisational financial targets.

Balancing the scales-Nurses' attempts at meeting family and employer needs in a work-intensified environment.

AIMS: This paper describes findings from a survey conducted in New Zealand exploring nurses' decision-making about when to delay care, delegate care, hand care over or leave care undone. Unanticipated findings identified processes that nurses go through when deciding to take planned/unplanned leave when wards are constrained through budget limitations. BACKGROUND: Missed/rationed care is increasingly the focus of attention in international studies, identifying a complex interplay of organisational, professional and personal factors affecting nurses' decision-making when faced with limited organisational time, human and material resources to provide care. METHODS: The survey presented nurses with Likert-scale questions with option for free text comments. This paper reports on the commentaries about work-life balance. RESULTS: Nurses described workload pressures that lead to rationing care affected them, and the long-term effect on them as individuals. Nurses verbalized the difficulties and associated guilt about taking leaving and sick leave when wards were short staffed. CONCLUSIONS: Nurses consider how their absence will affect the workspace and their home first, considering the impact on themselves last. IMPLICATIONS: The findings may provide valuable insights for nurse managers in relation to workforce allocations and resources where acknowledgement of work-life balance is considered.