Night nursing - staff's working experiences
BMC Nursing 2008, 7:13 doi:10.1186/1472-6955-7-13
ISSN1472-6955
Article typeResearch article
Submission date26 June 2008
Acceptance date31 October 2008
Publication date31 October 2008
Article URLhttp://www.biomedcentral.com/1472-6955/7/13
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© 2008 Nilsson
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1
Night nursing - staff’s working experiences
Kerstin Nilsson1,2 §, Ann-Mari Campbell3, Ewa Pilhammar Andersson1
1
Sciences, Göteborg, SwedenUniversity of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care
2University of Skövde, School of Life Science, Skövde, Sweden
3
Malmö University, Faculty of Health and Society, Malmö, Sweden
§
Corresponding author
Email addresses:
KN: kerstin.nilsson@fhs.gu.se
AMC: ann-mari.campbell@mah.se
EPA: ewa.pilhammar@fhs.gu.se
2
Abstract
Background
Although the duties and working conditions of registered, and enrolled nurses have
previously been described from different perspectives, they have not been examined
from the night nursing aspect. The aim of the study was to describe the night nursing
staff’s working experiences.
Methods
The design of the study is qualitative and descriptive. Interviews were conducted with
10 registered and 10 enrolled nurses working as night staff at a Swedish University
Hospital. The interview guide was thematic and concerned the content of their tasks,
as well as the working conditions that constitute night nursing. In addition, the
interviews were transcribed verbatim and analyzed using content analysis.
Results
The night duties have to be performed under difficult conditions that include working
silently in dimmed lighting, and making decisions when fatigue threatens. According
to the night staff, its main goals are to provide the patients with rest and
simultaneously ensure qualified care. Furthermore, the night nursing staff must
prepare the ward for the daytime activities.
Conclusions
The most important point is the team work, which developed between the registered
and enrolled nurses and how necessary this team work is when working at night. In
order for nurses working at night to be fully appreciated, the communication between
3
day and night staff in health care organizations needs to be developed. Furthermore, it
is important to give the night staff opportunities to use its whole field of competence.
Background
In the main, intrinsic value is not attached to night work which tends to make night
nursing invisible. Night work is apprehended as separated from day work and night
work sometimes seems to be less valuable [1]. Night nursing is described as being
controlled by plans made in the daytime and staffed with fewer nurses on the wards
[2, 3]. Therefore, this study focuses on how the two occupational groups working at
the hospital wards at night in Sweden, registered nurses (RNs) and enrolled nurses
(ENs), experience their work at night.
All professionals in Swedish health care organizations are responsible for their own
actions. The general rule is that the one who performs health care tasks shall have
necessary
principally responsible for nursing and ENs are principally responsible for caring. RN
are allowed to delegate nursing tasks to an EN if the EN has real (not formal)
competence fore the task [5]. Thereby RNs and ENs mostly complete each other and
sometimes ENs can be seen as RNs’ assistant.
RNs are expected to be skilled in different areas including both caring and nursing.
The nursing discipline could be regarded as a practical one which joins knowledge
from the fields of both the Human, and Biomedicine Sciences. According to Kim,
nursing includes four domain typologies: the client, the client-nurse, the practice, and
the environment domains [6, 7]. The employers’ association and trade unions,
4
together with The Society of Nursing and the Board of Health and Welfare, have
formulated a description of the competence needed. RNs are required to examine and
treat patients independently, or in cooperation with physicians, and to carry out
medical prescription. Furthermore, the promotion of good health, the prevention of ill
health, as well as the development of safe and secure care, are also fields demanding
nursing competence. In addition, RNs are expected to be skilled in nursing
development, which means to have the ability to independently and continuous
analysis strengthens and weakness in own professional competence. They are also
expected to stand up for personal and professionall development of nursing
competence, as well as in teaching both patients and staff. They are also expected to
lead, prioritize, distribute and coordinate nursing care, as well as cooperate with other
professions [8]. However, this is a general competence description and does not
provide any guide for the skills required in night nursing. Previously, the Board of
Health and Welfare declared that a RN with continuous night work ought to have the
possibility of developing professional nursing skills and obtaining nursing experience
[9]. In the descriptions of nursing competence required from the National Board of
Health and Welfare in 2005 [8], there are no distinctions between day and night work,
or between RNs and ENs. In fact, Sweden has not developed a national description of
the competences required of ENs. It is worth mentioning that Swedish ENs have a
three year upper secondary school education. At present, a three-year university
education leading to a Bachelor’s degree is compulsory to become a RN in Sweden.
The duties of nurses in relation to specific situations or patients with special diagnoses
have been studied previously. Such examples include a duty to prevent a patient from
self-inflicted injuries [10], military nursing in a combat environment [11], strategies
5
providing care for women with post partum psychosis [12], or the duty of attempting
to identify and meet children’s need of spiritual care [13]. A main nursing duty in the
operating room is to secure patient safety and prevent mistakes [14]. In an acute
setting, the nurses’ hospital-based practice of health promotion mainly consists of
providing prescriptive and individual preparatory information including for example
encouragement, explanations and instructions [15].
In a study of the work content of nurses at a Swedish hospital, it was revealed that 38
% of their working time consisted of direct nursing care of patients, while the
remaining time was used for other work-related tasks [16]. Nurses found that their
professional roles are vague, because the distinction between ENs and RNs is unclear.
However, the roles were also described as being that of ‘a spider in the web’, which
implied being coordinator, controller and leader [17]. In addition, previous studies
have examined the working conditions of nurses in relation to stress [18, 19], their
experiences of work satisfaction [20-22] and downsizing [23-27].
When the literature review focused on the duties and working conditions of night
nursing, fewer studies were found. Nevertheless, in a study about how learning at
night was accomplished, it was found that the monitoring and assessment of the
patients were of utmost importance for the provision of good and safe nursing care at
night [28]. Furthermore, in a study which measured the time spent for direct and
indirect care during three duty-shifts, it was found that the evening shift used most of
its time on direct nursing activities, while the night shift spent most of its time on
indirect nursing tasks [29]. When an instrument was used to evaluate the nursing care
6
provided at night, it was found that night nurses need to improve their ability to assess
the care needs of patients at night [30].
Other existing studies in relation to night nursing mainly concern problems associated
with changing the 24-hour body rhythm [31-34], difficulties with the working
environment [2, 35], the health status of shift-workers [36-38], as well as staying
awake while driving home after a night shift [39]. Furthermore, some studies describe
the difficulties of patients being able to sleep at night undisturbed [40], while others
compare night nurses’ and patients’ satisfaction with nursing care at night [30]. The
work of the night staff has been found to be largely invisible and unknown [41], and
there are still few studies which describe the duties of night nurses. Therefore, the aim
of this study was to describe the night nursing staff’s working experiences. The study
focused on the following issues: what constitutes the night work of the RNs and the
ENs, and under what kinds of working conditions does the night nursing staff perform
its duties?competence in order to guarantee good and secure health care [4]. RNs are
Methods
A descriptive, qualitative research design was selected, with the aim of contributing
new insights into the work of RNs and ENs at night. This design makes it possible to
obtain knowledge and understanding about the meaning people give to actions,
processes, beliefs and values in naturalistic settings [42].
found appropriate when research and/or literature on the phenomenon of interest is
limited [43]. Based on the aim of the study, the open-ended interviews were chosen as
the method of data collection. A thematic interview guide (see appendix) was used to
guide the interviews. In the interview situation, the researcher tries to understand the
7
interviewee’s perspective and experiences. The results of the interviews depend on the
quality of the interviewer-interviewee interaction, as well as on culturally inherent
assumptions about how experiences, feelings and intentions are understood [44]. It is
the outcome of the interviews that is analyzed and not the interaction [45].Qualitative design has been
Procedure
The heads of four departments, (Intensive Care Unit, Medicine, Surgery and
Geriatrics/Rehabilitation, divided into eight wards), at a Swedish University Hospital
were asked if they would like to participate in this study. These four departments
(including eight wards) were chosen from six at the hospital, because they all
provided 24 hour care and had recently undergone organizational changes. All four
department heads gave their permission for the study to be carried out.
From a total of 22 RNs and 21 ENs, working as permanent night staff on the eight
wards, 11 RNs and 11 ENs were purposefully [46] selected for the study to obtain a
variation in age and experience as this vouched for richness in data, i.e. descriptions
of working at night. The purposeful selection was guided by the information of
professional role, age and year of employment given in the respective staff lists of
each ward. For the selection, all the wards were regarded as one entity. The above
criteria were used for the selection process [47]. Two of the selected nurses did not
wish to participate.
The interviews were conducted according to an interview guide (see appendix)
comprising the following themes: the content of work, task changes over time, and the
working conditions that constitute night nursing duties. The questions were followed
with more penetrating enquiries, and with questions such as: can you describe that in
8
more detail, and can you explain? The interview guide was developed in relation to
the study questions and the researchers’ experience from the field in question and was
not changed during the period of data collection. All the interviews were taperecorded
and transcribed verbatim. Each interview lasted from 45 to 120 minutes.
Fifteen of the interviews were conducted at the workplace, 12 at the beginning of the
shift and three during the day, while four were carried out in the participants’ homes,
and one in a neutral place.
Analysis
The interviews were analyzed using manifest content analysis that means the analysis
has focused on what the text said, i.e. visible and obvious content [44]. After the
interviews were transcribed, they were read through to gain a sense of the whole. The
unit of analysis was the interview text in its entirety [48]. Units with a meaningful
relation to the aim of the study were then identified. These units of meaning consisted
of words, sentences and text sequences and emerged from the data. The meaning units
were labeled with a code. The codes were related to the comprehensive content of the
meaning units. The phase of condensation or abstraction of the meaning units was
omitted, since the discovered units of meaning were sufficiently condensed and
manageable in their original forms.
then compared and sorted into content categories. Finally, themes emerged through
reflecting about the categorized content.The differences and similarities in the codes were
Demographic information
Twenty participants, of which 19 were female and one was male, were interviewed.
The median age was 45 years, and their ages ranged from 31-60 years. The average
9
length of night work experience was 11.9 years for the RNs and 13.2 years for the
ENs, and they only worked at night.
Ethical considerations
According to Swedish law, no approval from an ethics committee was required for
this type of study at the time it was conducted. Permission to carry out the study was
provided by the head of each department. Furthermore, informed consent was
obtained from all the participants in accordance with the Declaration of Helsinki [49].
This means that the participants were informed about the purpose of the study, data
collection method, their voluntary participation, the confidential treatment of data and
that they could withdraw at any time. The information was given twice; the first time
at the first telephone call and secondly at the interview occasion. To protect the
participants’ confidentiality, the interviews were coded with a number.
Results
The results are presented in three themes: conceptions of night work, working
conditions, and duties.
Conceptions of night work
The conceptions of night work are related to what the night staff hears from the day
staff. According to the night staff, these conceptions are based on a lack of knowledge
about night work among the day time staff.
Holding the fort
The statements illustrate that it is difficult to describe what night work entails, and
that it is not understood by the day nurses until they experience it. The interviewees
revealed the tension existing between day and night staff.
10
Most of the day staff doesn’t understand what we are actually doing at night, but
it’s this stuff about we only hold the fort, and it’s not like that because it’s
awfully hard work between five and seven. At five we start washing our patients,
and weighing and changing beds and the 24 hours ends at six, and then all drains
and all pumps everything has to be read, and measured. We carry a very heavy
burden between five and seven, but I don’t really think that the day staff
understands what we’re doing, so we never get any real understanding for how
much we really do (I 3).
Working at night gives days off
The lack of understanding about night work also leads to a lack of understanding of
the night staff’s need of rest during the day. The informants claim they need as much
sleep, and under similar conditions, as the day staff.
... but many of them [day staff] say well it’s very good to work nights because
then you can lie and sleep on the beach in the summer, but one knows that
doesn’t work… I certainly can’t cope with that, you know, so it’s wearing (I 3).
The staff also sleeps at night
The patients also have conceptions based on the assumption that everybody sleeps at
night. In such a circumstance, asking for help is equivalent to disturbing the night
sleep of the night staff.
All the elderly people think that the night staff sleeps and they don’t want to be a
nuisance. We have to explain … but we don’t sleep, we are here at our job, we
are awake at night and sleep in the daytime. Then they say, oh dear, oh dear,
poor you, but then we tell them it’s our own choice (I 20).
According to the participants, the perceptions are changing towards a better
understanding of night work. One reason is that there is often a lack of night staff,
which means that day staff has to work at night. The day nurses then become aware of
what night work entails. Another reason is related to changes in the organization,
11
where the heads of the ward play a decisive role in creating a sense of comradeship
among the staff.
Working conditions
The working situation at night is described as specific, because all activities on the
ward are carried out in a subdued environment. This means that the tasks are
performed under conditions which benefit the patients but are more difficult for the
staff to carry out than during the daytime.
Working in silence
It has to be quiet and peaceful at night to enable the patients to sleep. When the fans
are turned off, it becomes so quiet that all sounds are amplified and an ordinary
conversation in the corridor can disturb the patients’ night sleep. Consequently, the
nurses lower their voices, and noisy duties, such as showering and working in the
sluice, are avoided.
I’m very careful to tiptoe around, plus that you don’t talk when you’re inside the
room if you don’t need to (I 8).
Nevertheless, the ambition to create a silent night milieu can be difficult to achieve.
Many elderly patients have poor hearing and when the nurses whisper, a patient can
loudly ask what was said. This can consequently wake all the patients in the room,
which means that the nurses’ efforts to work quietly have been wasted. Another way
to avoid disturbances at night is not to wheel newly admitted patients into the rooms.
They are placed instead in a treatment room, day room or corridor until the morning
work starts. A further way to muffle sounds is to wrap hand towels around door
handles to prevent them from making a noise when opening and shutting the doors.
12
Working in dim light
In the evening, the lights on the ward are dimmed, and those in the rooms are
switched off. When the patient’s status, infusions or bandages are checked, this is
done with the help of a torch, which means that the inspection is restricted to within
the range of its beam.
Int: Do the patients look different in dim light?
I:16: Yes they do – definitely – you have to look more at, what shall I say, you
listen more to their breathing when the patient is asleep, if it changes in any way,
or some other disturbing element in the patient, maybe more often, and then you
have to, because there’s no light you might not see any variation in color, but
you may—you feel.
Int: You feel and you listen?
I:16: Yes, exactly. To be able to notice if there is any change of any kind that
you might have seen, that you perhaps see more in the daytime than, well so
there are other senses.
Coping with fatigue
After the second night round (2 a.m.) has been carried out, fatigue starts to be trying
and is felt creeping into the body. The RNs’ statements revealed that it is at this point
in time that medicines are dealt out and drugs are requisitioned. Concentration is low,
and the work is tedious, because the tablets must be checked several times.
… you probably have to be a special person to have the strength to work at night,
because the thing is that it’s also a question of whether you, as an individual, can
manage to keep awake a whole night, and I have seen workmates who are not
very quick-witted after one o’clock at night, but are tired and exhausted (I 19).
Not being afraid of the dark
Working at night also requires that nurses have to leave the ward to attend to errands
throughout the hospital alone. For example, they have to deliver samples to the
13
laboratories, accompany patients to x-ray examinations, or transport to and from the
operating theatre.
... dare go off on your own on a bicycle in the middle of the night all through the
hospital, if you have to go off to the lab, or...and not be afraid of the dark /…/
because it’s very empty you know, and it’s locked everywhere (I 12).
If more than one member of staff is required to carry out a task outside the ward,
another ward often has to stand by with its staff. When manpower is low, it is
impossible for two nurses from the same ward to leave it at the same time.
Cooperation
A special relationship develops between RNs and ENs during night work, because
this is when both categories of staff are dependent on each other. This dependence
applies to both personal relations and professional knowledge.
Well, we know each other /…/ we depend on each other quite simply, and even
the RNs themselves say that they think it’s really nice (I 9).
How the work was divided between the two professional groups varied according to
the composition of the team, but there were clear boundaries between the RNs’ duties,
which comprised handling medicines and making decisions about medication, and
those of the ENs.
Duties
As in the daytime, the work at night comprises general care, specific care and
different forms of service tasks.
General care
The aim of general care at night is to provide the patients with good sleep to enable
them to have the energy to cope with daytime treatment and training. In addition to
distributing hypnotics/sleeping pills, the following types of care are applied: ensuring
well-being, relieving anxiety and creating calmness.
14
Caring for the patients at night is an art; one almost has to treat patients with kid
gloves (I 4).
Ensuring well-being implies ensuring that the patient lies comfortably in a dry and
smooth bed, and that pillows are placed to relieve pressure and help the body relax. In
addition, administering an analgesic, particularly before the painful process of being
turned, also increases the feeling of well-being.
Patient anxiety is pronounced at night. This can occur after the day’s activities and
movements have quieten down, and the patients are left with their own thoughts and
anxieties about their condition, treatment and what the future will bring.
During the night the demons and dreadful thoughts come, say the patients, and
they become anxious and sad and start thinking why has this happened to
me…and you have to listen and take your time (I 19).
Relieving anxiety is a theme that recurred in all the interviews, and the informants
exemplified the different types of care provided to alleviate this problem. Nurses tried
to reduce anxiety by sitting beside patients, holding their hands, being close by ready
to answer a patient’s summons, and taking the time, even if only for a few minutes.
These kinds of measures can be of importance to the patient at night, and they all
exemplify the care activities of the ENs and RNs. Another anxiety that many patients,
particularly elderly ones, experience is physical in nature. Using the bathroom at night
is not the same as during the day. Many patients who manage to visit the lavatory
perfectly well in the daytime can have difficulties at night. They can be affected by
the dimmed lighting, sleeping pills, fatigue, and a sense of disorientation about where
they are and in what physical state they are in. All or any of these effects can lead to
them wandering about and falling over.
15
Specific care
Organizational and structural changes at the hospital studied have reduced the
differences between night and day work. Patients are now admitted at night, not only
in emergency cases, but also from the waiting list. This means that specific measures
to prepare patients for various treatments and interventions, such as x-ray
examinations and laboratory tests, are frequently undertaken at night.
… and maybe we are going to take some patient’s ECG and sometimes it is
laboratory tests that have to be taken (I 11).
The RN is usually the only one responsible for assessing the patient’s status and
deciding whether and when a doctor should be called. As a result of the shortage of
staff, irrespective of category, a system of relay doctors is used, that is, doctors who
are employed to cover the vacancies that arise. These doctors seldom know the
patient, which means the RN must, firstly, make comprehensive assessments, and,
secondly, decide what information the doctor needs in order to determine the
measures required. This nurse-doctor conversation is usually conducted on the
telephone.
Service tasks
Changes in the duties have occurred gradually over the years. More tasks have been
allocated to the night staff, for example, washing wheelchairs and beds, dusting,
watering plants, preparing the breakfast, as well as laying the table, which are all felt
to be a burden. The following statement illustrates the feeling these kinds of service
tasks arouse:
… in some situations, I could be replaced by both a cleaning woman and a
servant (I 18).
Other tasks that are done to help the day staff can include filling the wagons, sorting
the washing and replenishing the stores. While such tasks are not obligatory, they are
16
carried out in order to help, and out of a sense of duty and pride in being able to hand
over a ward in excellent order to the day staff.
Discussion
In this study, the experiences of the interviewed RNs and ENs varied, but taken
together these experiences are extensive and also cover different health care units.
This variation and range of experiences must be regarded a strength of the study,
since they provide an understanding of the content of care. The interview situations
were characterized by openness, as well as the nurses’ willingness and interest in
talking about their experiences, which facilitated understanding the interviewees. On
the other hand people in the interview situation can choose to say what they want or
feel to say at the moment, which could be seen as a limitation of the interview method
[44]. Therefore attempting was made to control the interviews in order to gain
answers to the questions still with maintenance of openness.
Consequently, the content of the interviews is rich. The interviewer has personal
experience working as a nurse, both on day and night shifts, and was thus able to
better understand the nurses’ situation, which facilitated the interview situation
considerably. This could also be seen as a weakness of the study, because some
information could have been taken for granted and not penetrated further. In addition,
the analysis may have been affected by the researcher’s prior understanding of the
work and competence needs of RNs and ENs. However, during the analysis process,
the awareness of prior understanding was constantly present to minimize this risk.
The analysis was validated by the authors’ discussion of the findings during
manuscript preparations [44].
17
The result of the present study shows that the night staff experiences its work as being
largely invisible and unknown and not always appreciated by the day staff, although
nursing care continues 24 hours a day. Many regard night work as less qualified [50]
and surrounded with myths [34, 51]. According to the interviewees, these myths about
night work, for example, that the night staff sleeps on duty, still exist among day staff
and patients. The day staff’s false notions about working at night, found in this study,
were also revealed in an earlier study [51]. Health care has been developing with
regard to technical, medical as well as organizational matters [23, 52, 53], therefore
the night work is increasingly beginning to resemble the day work. In this study, it
was shown that the duties at night have to be performed under difficult conditions,
such as working in silence with the lights dimmed, and making decisions when
fatigue threatens. According to the night staff, the main goals of the work are:
•
healing and treatment.To provide the patients with rest to enable them to restore their strength for
•
independent assessments.To provide qualified care in which the RN has the medical responsibility for
•
possible state.
Although the night work assignments are, according to the night staff, similar to those
in the daytime, they are carried out by fewer staff. In this study, it was found that RNs
and ENs appreciated their team work and relied on each other’s competences and
responsibilities to carry out the tasks that need to be done. This result contradicts the
results from a study of nurses’ roles in the daytime, where it was found that the
distinction between the work roles of ENs and RNs was unclear [16].
18
The manning of the wards at night has increased over time at the hospital studied,
despite cost savings and periodic employment freezes. However, does this mean the
patients’ secure and safe medical care has also increased or has the work load
decreased? A previous study showed a relation between increased manning and
decreased complications, as well as instances of death [54]. However, the results of
this study indicate no such positive relation between more nurses and either increased
care quality or decreased complications. Nevertheless, the results point to the
importance of manning with regard to the patients’ health status, as well as nursing
and caring needs. The increased work load in combination with low manning at night
could affect the nurses’ experiences of their own health, which has been shown in a
study about the staff’s own health experiences during downsizing [26]. That study
revealed that nurses working alone at night felt insecure, because they did not have
any colleagues to consult in situations where they had to make assessments and
decisions. According to Hertting and explicit colleagues, more substantial demands
were put on the nurses at the same time as new methods of treatments were being
introduced, and increasingly more advanced nursing care was being required by the
patients. The results of this study indicate that work duties had been added over time,
partly to occupy the night staff (RNs as well as ENs) and partly to facilitate the duties
of the day staff. The higher proportion of service tasks at night has been shown in an
earlier study [29]. Many of the service tasks performed at night are of the kind that
should be cheaper to execute during the daytime, or by less qualified, thus less
expensive, nursing staff at night. However, the night staff not only carried out service
tasks for the day staff, but also prepared patients for surgery or treatment. This kind of
preparation work was also included in a description of night watch activities at a postanesthesia
care unit [55].
19
As shown in the results, the RNs make medical assessments about whether or not to
call the doctor or carry out any other treatments. This medical responsibility becomes
particularly emphasized during the night when the RNs do not have a colleague close
by to consult. The physician who RNs may need to consult when a patient’s health
status changes can be an unfamiliar doctor with whom the RN has no working
relationship. A negative or intimidating relationship between a physician and a nurse
has been found to be a risk factor for the safe and secure care of patients [56]. It is
known that the quality of nurse-physician relationships affects the job satisfaction of
nurses [57]. Does this imply that the lack of a satisfactory working relationship also
means that the patients are placed in hazardous situations?
The increase in medical development and nursing demands, mentioned above, further
magnifies the responsibility of having to make correct medical assessments. This
additional responsibility should influence nursing education. It has been argued that a
preparation program for the care of the aging population also needs to include the
requirements of night shift work [58]. Consequently, the Swedish descriptions of
RNs’ competence [8] have to be questioned with regard to them not making any
distinction between day and night work.
Nurses working at night also have the responsibility of informing new staff members,
as well as judging their actual competence necessary to carry out the collaborative
night work. The duties incumbent upon the RNs at night differ from the Swedish
descriptions of RNs required competence [8]. Based on a holistic and ethical attitude,
RNs are expected to have theoretical and practical nursing competences (nursing and
20
caring), as well as nursing research, teaching and leadership skills. However, in this
study, the night nurses’ descriptions only include images of nursing and caring, and,
apart from some information given to relatives, the RNs’ pedagogical function is
lacking in the descriptions. A previous Swedish study revealed that RNs do not
provide information to patients at night [30]. Furthermore, they do not devote
themselves to research, development and preventive work, or staff management. It
could be argued that not using their entire range of competences might jeopardize
RNs’ nursing skills and cause difficulties when they change from night to daytime
work. This kind of self-imposed competence limitation could be one reason for the
survival of the night nursing myths.To put the ward in order for daytime activities and to hand it over in the best
Conclusions
Efficient organizations require time to recover from their daily activities. In a hospital,
the night is considered to be a period in which the wards are restored to order and
both the day staff and the patients renew their strength to cope with the day’s work
and treatment. The most important point is the team work, which developed between
the registered and enrolled nurses and how necessary this team work is when working
at night takes the point of departure in nursing. In order for nurses working at night to
be fully appreciated, the communication between day and night staff in health care
organizations needs to be developed. In addition, it is important to give the night staff
opportunities to use its whole field of competence developed in education and
practice.
Competing interests
The authors declare that they have no competing interests.
21
Authors' contributions
KN Study design, data collection, manuscript preparation. AMC Study design,
manuscript preparation. EPA Study design, analysis, manuscript preparation.
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Tables
Table 1 - Participants in the study
Division RN EN
ICU 2 3
Medicine 3 1
Surgery 2 2
Geriatrics/Rehabilitation 3 4
Total 10 10
Additional files provided with this submission:
Additional file 1: appendix interview guide night nursing.doc, 24K
http://www.biomedcentral.com/imedia/1679070477223260/supp1.doc
Kerstin Nilsson (kerstin.nilsson@fhs.gu.se)
Ann-Mari Campbell (ann-mari.campbell@mah.se)
Ewa Pilhammar Andersson (ewa.pilhammar@fhs.gu.se)