Versatility--consequence of changing from mixed to all registered nurse staffing on a surgical ward.

• BACKGROUND: Pressure on governments to reduce the costs of healthcare whilst improving the quality continue unabated throughout the developed world. As a consequence of budget cuts on a large Swedish University hospital, a decision to change from mixed nurse staffing to all registered nurses (RNs) in one surgical ward was made to evaluate if nursing costs could be reduced. AIM: This study was developed to gain a deeper understanding of the process of change in a hospital ward when all practical nurses were replaced by registered nurses. METHODS: A substantive theory was inductively derived, using a modified version of grounded theory methodology. FINDINGS: The change encouraged the nurses to become versatile. When the nurses adopted a patient focussed philosophy the content of their work changed and individualized care became possible. The versatility fostered a spirit of creativity, permitted a high degree of freedom of choice and increased the competence, but also led to some negative reactions in the form of complaints about weariness, lack of support and vulnerability with regard to the working environment. CONCLUSION: Versatility can be an opportunity for the nurses to expand their knowledge and develop nursing care but there is a risk that versatility results in weariness.

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