Table 1 Final coding template of interview data with quotes, examples of descriptions and numbers of responses to open survey questions corresponding with interview data

1. Strenuous work situation

1.1 Time pressure (21)

“I know several colleagues who look for other jobs, because they are – it is the time pressure that wears us down, terribly. Yeah, it is tearing on us, it is the worst part, the absolute worst”

1.1.1 Physical strain

‘being highly strung’; ‘working at a high pace’; ‘running from place to place’

1.1.2 Mental strain

‘being preoccupied with the next task on the work list’; ‘worrying about not having time to complete all tasks and getting to the next patient in time’

1.1.3 Emotional strain

‘feeling bad about not having the time to do the job properly’; ‘having to leave patients behind’; ‘feeling drained by constantly being behind schedule’

1.2 Organizational demands

1.2.1 Full work lists

‘five visits are listed at 09. a.m.’; ‘no time for lunch’

1.2.2 Patient characteristics

‘more demanding diagnosis’; ‘more complex cases’

1.2.3 Distribution of work lists (6)

‘extra assignments handwritten on my work list’

1.2.4 Unexpected incidents

‘finding a dead patient’;’someone requiring extraordinary care’

1.2.5 Indirect time (5)

‘Time for transferring is not included, and I move around by car for maybe 40–50 minutes – before 12 a.m.’

1.3 Conflicting work demands

“Time pressure makes you mentally drained because you’re not able to do what you are supposed to […]. Comforting, talking, stroking their backs, for example, make them breakfast on a Sunday morning. The caring part of the job is disappearing.”

2. Changes affecting the work situation

2.1 Increased workload (19)

“Well, we have all these requirements directed at us, a lot more now than it used to be, about documentation and all kinds of stuff we must register and – we’re not able to do half of what we are supposed to…”

2.1.1 Additional work tasks

‘We get more and more tasks’; “We get more and more patients but not more staff, right”

2.1.2 Efficiency demands (9)

‘They [municipal level] are very eager at cutting down and cutting down time’. ‘Some years ago, no visits were less than 15 minutes, now they’re down to 5 minutes’.

2.2 Unit mergers (17)

“There have been some organizational changes, you know, and it tears on us – When they start with all that, I’m just like: AGAIN!?”

2.2.1 Strain related to the process

‘lack of information and participation’;’employee resistance and dissatisfaction’

2.2.2 Strain related to the consequences (16)

‘culture clashes’; ‘unit size too large’; ‘chaos’; ‘larger geographical distances’; ‘new localities’; ‘establishing and mastering new roles’; ‘new ways of cooperating’

2.3 Budgetary constraints (10)

“You are told that the budget situation is getting worse and worse. And you are told that you have to do more and more in less time. It affects you, you feel; Ok, fine, there is a limit for – yeah – for what you can handle”

2.4 Work environment interventions

“We have done a lot of work… Routines are in place, the work is better organized. The unit is run much, much better” versus “It fails after a while anyway. When the council’s economy is poor, we go back to where we used to be”.

2.4.1 Improved organization (30)

‘work lists are organized based on geography and a steady group of patients’

2.4.2 More equipment and facilities (28)

‘we have more equipment now’; ‘more cars and telephones’

2.4.3 Improved routines for cooperation (7)

‘relieve each other’; ‘call each other if someone has time available’

3. Consequences of strenuous work situation

3.1 Worker health

“I get pain in the neck, shoulders and head, get stiff-necked, and it is not just me – many of us struggle with our shoulders, neck and head. It is the time pressure that tears on all of us, that kind of stress, you know.”

3.2 Job performance

‘indirect tasks are postponed’; ‘leaving parts of the job undone’; ‘being forced to prioritize’

3.3 Sick leave (10)

“I remember… Earlier, if someone called in sick, we never talked about it. We just said ‘Oh! Get well soon!’, but today we’re more like ‘Oh my God, TODAY as well!’.”

3.4 Work environment

“Now the unit is a lot less clear, there are too many people to deal with. […] There is more commotion and noise; I feel it is hectic because of all the people around you”; ‘we get irritable when we’re stressed’