Stuck between a rock and a hard place: the work situation for nurses as leaders in municipal health care

Figures & data

Figure 1 Managing performance in a squeeze.

Table 1 Data excerpts, subthemes, and themes

Meaningful data excerpts	Subthemes	Themes
– Responsibility for reporting	– Economy	Leadership: managing performance in a squeeze
– Raise consciousness on not to use many extra hours	– Control systems
– We have a thorough economy report every month	– Loyalty conflict; system versus practice
– Too much time on external demands and reports	– Paradox: at the same time, a feeling of being in control and powerless
– We are in a squeeze between the needs of the patients and economy
– Especially the economic part can be complicated
– And it is energy demanding, work intensive, all the time. But that is also what I like […] I like this squeezed position between patients, personnel and my superiors
– It can be too much – powerless and worn out
– Part of external meetings perceived as totally irrelevant	– Top-down	Relation with the superior: management by email
	– Interaction on demand
– Meetings as the only place information is shared	– Absent leader
– Mainly I have to be the one to call on her
– I feel that she is there if I need help
– (Superior) expects self-management
– I do not see her very often
– They will call if they feel insecure	– Interaction on demand	Relation with the subordinates: availability and respect
– There is a lot of intention-based management here since they (subordinates) work independently and autonomously	– Personal interest and care
– Their (subordinates’) jobs are largely my business
– There are many other nursing leaders that I can call and ask “what would you have done if so and so?”	– Informal and horizontal interaction	Relation with peers: professional and personal
	– Professional issues
– I am lucky not to be alone	– Collective reflection
– They (peers) give me a lot of support	– Support and care
– We do a little bit of coaching for each other	– Learning and competence development
– The group is surprisingly good at giving good, tactical advice
– We may speak about what we work with, how we are doing