Page 147 - GHES-2-3

Global Health Economics and
Sustainability
Nurses’ perceived affective well-being at work

Appendix A1. (Continued)
“And I was so cross, and I said to the doctor, ‘I think you should go and have a look at this patient instead of sitting here,’ and she looked at me, and she
was so dismissive. I went back there, and I said, ‘Well, I am going to go and get the relatives now to come and sit with him while he dies because he is
dying now, not tomorrow, next week, or next month when it suits you, now!’, so I went and got the relatives out, and he died 5e min later.” Group C
• Unworthy
“The workload on the ward is so much; for instance, if a nurse is allocated as your mentor, she has to always strike a delicate balance between
patient care, managerial duties and other things and her own personal things to do.” Group A
“There is a lot of pressure from above (management) to get people out of the hospitals; we also have to look at the fact that so many hospital beds
have been decreased; there is a big push in the past 10 years, and hospital beds have been halved to what they were 10 years ago.” Group B
“There is a lot more pressure on recording data and writing because your job is at risk if your data are not good enough; they can cut members of
your staff, and you have insufficient staff to do what is the proper standard. You are also expected to take on increasing amounts of GP’s work, but at
the same time, it can be very, very satisfying.” Group B
“The biggest change is probably professionally in that we are taking on a lot of doctor’s roles but not being recognized for it. You are doing, in fact, three-
quarters of a doctor’s job, and we are all on this course trying to be mini doctors, but we don’t get the status that goes with it professionally; it has changed
(the job) a lot, nurses are willing to do all the doctors’ jobs because we think in that way we might have a bit of a powering thing to the job.” Group C
“There is a lack of staff for a start, so it’s very difficult for all these multi-agencies to supply to your demand or to meet your demand because they
are also constricted and restricted by changes in government policy, which has cut out the budget so every single area under that umbrella has been
suffering and I think; as a result, every single one of them is frustrated not just the nurses.” Group C
“Hospital nurses can say their beds are full. District nurses have to admit and admit and admit ad infinitum with insufficient staff, which makes it
very dangerous… it’s paying Peter robbing Peter to pay Paul.” Group C
“They (doctors) seem to think they know best. I mean, how long have you been qualified? What’s that 5 min? Maybe a nurse with twenty years’
experience might actually have something useful to say.” Group C
Appendix A2. Experiential statement 2: “Negative feelings about others” and associated personal experiential themes

Personal Experiential Themes
• Isolated
“Most of them (nurses) are selfish. They probably hear the same level… the same as we do.” Group A
“Especially if you are managing another caseload of patients and it’s really busy, and there are things that you haven’t managed to do, but sometimes
you go home and think, ‘oh, I should have done that, and you wake up, and you know’…” Group A
“It was the hardest thing in the world for me not to burst into tears, and I am not exactly a teary person. I am not exactly a shrinking violet, but
the hardest thing I had to do was to sit there that afternoon (for the team building day) and watch and crucify my manager at the time, who’s
now retired; that was it for her. But I was so upset at how vicious, bloody-minded, and ignorant these people were. And I went to the pub and got
absolutely pissed…” Group B
“If you are a bit more vocal or want to take it to the public arena, you are troublemaker, militant troublemaker. You get the stigma. Women are very
unkind to women... if you work in an environment where you feel unsupported, then you don’t want to support because you haven’t learned what
supporting teamwork is all about, so of course, this culture continues somehow; it is linked to status and local power and make us nurses to become
a danger to ourselves.” Group B
“I was just going to say that as nurses we are lacking involvement in the political side of the NHS. Nurses, who are mainly women, like to talk about
it, but we don’t like to get involved actively or politically and be vocal about our rights. We tend to talk about these things in small groups, and we
don’t take it up in the public arena and this is because we don’t feel powerful in the job.” Group B
• Disillusioned
“From my experience, I think the sister on the ward has to be involved somehow… when I approached my mentor and asked why I couldn’t attend
the CPR training, she kept pushing me away..for me personally, I have somebody I call a life coach I always whatever happens. He’s always been a very
resourceful person…and if I’m angry, I cry.” Group A
“We have got targets. The government has set the targets for our matrons or whatever. The only thing is they forget that what these targets are about is
not machines; these are people.” Group B
“You can’t say I can’t assess a patient in 20 min; it might be that the patient is upset and uncooperative. Some patients come in particularly unwell they
can’t help it if the patient needs to be calmed down. That will take an extra ten or 20 min.” Group B
“You know that the patient’s best interest might not be what the best interest of your role is. It’s like the 4 h wait; it might be better for the patient
to stay and be observed, and it doesn’t fit. I just think that the aim of the business is different from the aim of the professionals; there are a lot more
targets now, there are always targets, and for our managers, all they are interested in is the number of face-to-face contacts we have and patients they
are not interested in anything else.” Group C
“I think most of us suffer with this idea that the patient comes first. How would you defend that in court? If this is your sort of rule stick if you are
standing in a court, you want to have a damn good argument, and at the end of the day, is your license.” Group C
“Because they are (nurses) so short staffed, everyone is kind of depending on everyone else at ward level but also out in the community… people
doing the nursing care and the acute care are run off their feet, and there are always risks for mistakes or drug errors or whatever. A lot of nurses (in
the community) work in isolation because of a shortage of staff. They (community nurses) have got the doctor, but you (the nurse) have to make
decisions. You can have some good GPs who are very responsive… there are other doctors that you can’t get hold of; they are like mercury.” Group C
“What is different today to what was before is that the patient was paramount. We are now getting this sort of business concept and sort of saying to
reduce admissions, and you have got a dichotomy.” Group C
“You can make your own decisions, but if your manager is pressurized by this business idea of how to run the hospital, you end up arguing.” Group C

Volume 2 Issue 3 (2024) 12 https://doi.org/10.36922/ghes.3012