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3.3.2 Upholding a good workplace environmentAll leaders described their responsibility for the workplace environment and stressed the connection between thepersonnel’s job satisfaction and a high quality of care. Creating a good psychological climate in the ward and involvingthe personnel in decision-making was seen as an important part of their role. Being a fair, open and encouraging leader,giving honest feed-back and showing respect were expressed as important for upholding the personnel’s working moraleand job satisfaction. Personnel’s negative attitudes that sometimes could be noted were not accepted.‘… I came into a ward with lots of backtalk … they were talking bad about all and everything. So I had to bedetermined about that … every time I heard something I said: I don’t accept this, I don’t want such personnel inmy ward …’ (Informant nr 21).The leaders described themselves as mediators in conflicts among the personnel and took an active part inproblem-solving. This could sometimes be experienced as positive, but also very challenging, and most leaders expressedtheir need for support in these issues.As a good workplace environment was closely related to the workload of the personnel, balancing the workload on eachshift was seen as a means to ensure a good workplace environment. A lack of competent personnel could cause stressamong the personnel, which in turn impacted negatively both on the workplace environment and nursing quality.Participation in the employment process was seen as important to get the opportunity of controlling the competence of
nurses. Leaders who were not involved in this process stressed that this hindered them in upholding quality of care and a
good working environment.
3.3.3 Developing nursing care
Most of the informants saw themselves as responsible for development and improvement of nursing care. This gave
positive challenges and pleasure in work, but was also associated with disappointments and frustrations. Many leaders had
visions for their ward, which included competence development of their personnel, and they worked consciously to reach 238 their goals. A positive attitude towards development of care and research utilisation was expressed with regard both to
themselves and most of the personnel, but lack of time and competence was a hinder.
‘We are trying very often to dedicate time for competence development, but sick leave and too many patients in
the ward are hindrances, which feels very frustrating …’ (Informant nr 20)
In addition, reorganisations, economic restrains, and changes of rules and routines decided beyond their own control, often
hindered ongoing projects. Therefore, authority to make decisions about human recourses and other ‘ward affairs’ was
stressed as a necessity in order to achieve success in development projects. Due to lack of time some leaders had delegated
the responsibility for development and improvement of nursing care to another nurse in the ward.
3.3.4 Keeping the budget in balance
Most informants, no matter whether they were formally responsible or not, claimed that they operated on a minimum
budget, which was not to be exceeded. All of them considered that “budget in balance” was the most outstanding goal their
superiors expected them to fulfill, and they struggled hard to reach this. As these economic restrictions hindered them from
reaching other goals of high quality of care, good workplace environment and development of care, they experienced the
restrictions as a heavy burden.
‘You get a little bit weary and fed-up with all the cost-saving measures. It affects every single day…… the
constant nagging about the economy. …..’ (Informant nr 16).
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