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Table 3 Content analysis, within analysis, municipality A and B. Theme 1

From: Nursing home leaders’ and nurses’ experiences of resources, staffing and competence levels and the relation to hospital readmissions – a case study

Theme

Sub-themes

Category

Sub-category

T1: High nursing demands – variation in staffing and competence

Disparity in staffing and competence (Municipality A)

Tired nurses (NLT)

Increased workload leading to de-prioritizing of important tasks

Complex patients (NLT)

Seriously ill patients in need for complex treatment

Elderly patients are not prioritized

The patients don’t need to be hospitalized as often as before

Insufficient staffing (LLT + NLT)

RN staffing not satisfactory - RNs confer with each other by telephone

More nurses are needed, but there has been a staff reduction which increases sick leave among nurses

Low physician coverage

Trying to keep the balance between resource usage and patient safety

Sicker patients gives new challenges

Acceptable staffing (LST)

RN staffing is satisfactory in most wards

Physician coverage is satisfactory

Unpredictable staffing (NST)

Good physician coverage during weekdays

There is not always enough RN staffing during weekends

Varying competence (LLT)

Nurse competence is varying, but there is a focus on increasing it

High demands in care leads to high demands in competence

Fulltime positions is a way to increase competence

To many assistants

Reorganization can be positive in regards to competence

Sufficient competence (LST)

The competence is high and have increased – increasing competence is encouraged

The patient group makes need for high competence

High competence (NST)

RN competence and staffing are high, but at the expense of LPNs

Capacity building in focus (NLT)

Working towards increased competence

Reasonable staffing and competence (Municipality B)

Satisfactory staffing (LST)

Staffing is satisfactory, but vulnerable during weekends

Good physician coverage and cooperation

RN density is increasing, which is positive for further recruitment

Acceptable staffing (LLT, NLT)

The staffing is good as long as there is no sick leave

There is a lot of assistants in some wards

Competence is good, but capacity building on all stages are in focus

There is a need for more LPNs

Sufficient competence (LLT)

RN coverage and RN competence is high in accordance to more complicated patients

Satisfactory competence and staffing (NST)

Physician coverage is good

Nurse competence is varying, but several have continued educations

There is focus on capacity building on all levels

Varying competence (LST

Capacity building is in focus

Capacity building in focus (LST, NLT)

Courses and guidance are not always provided but capacity building is organized internally

The nursing home patients are more complex and sicker when discharged from the hospital

Internally organized capacity building (NST)

Frustration in regard to discharge routines

Complex patients (LLT, NLT)

The nursing home patients are more complex and sicker when discharged from the hospital

The patients are more complex

Frustration in regard to discharge routines