The reasons for this are that the questionnaires do not provide sufficient information about the underlying causes of the problems. Therefore, it is challenging to use them to accomplish specific improvement efforts. We believe that the low scores on opportunities to participate, perceived control and workload are primarily dependent on organisational factors.
In our opinion, in order to work with this kind of working environment challenge we need knowledge that tells us more about underlying reasons and that can thus identify some organisational solutions to the problems. The employee survey can serve as an aid in the working environment assessment because it provides an overview of the working environment in the various units and of the line manager
However, we lack methods that properly capture the experiences of staff and that have a strong focus on understanding how the organisation affects their working environment. Alternatively, we can use more democratic methods of pinpointing, understanding and working with psychosocial working environment issues (25, 27). The current design of the working environment assessment does not capture the complexity of psychosocial working environment challenges, which means that it is difficult to solve them. The nurses therefore face these challenges alone.
Measures initiated by the occupational health service and NAV in connection with slander problems are clearly characterised by an approach that targets individuals. One of the nurses said that the conversation groups had helped to some extent but that it was easy to backslide in periods of considerable stress. Measures that solely focus on individuals have limited impact if other factors are not also considered, for example framework conditions for the work (3, 4).
The Norwegian Labour Inspection Authority’s (22) audits of six Norwegian hospitals in 2014 showed that the occupational health service has a much stronger focus on the individual level than on organisational factors. This thematic area can be viewed in light of a trend in contemporary working life to solve psychosocial working environment challenges by looking at the characteristics of individuals rather than solving these challenges at the executive level of the organisation (1, 8, 25). In our view, measures targeting the working environment that focus exclusively on changing behaviour also contribute to individualising nurses’ working environment challenges.
In their hectic working day, it is obvious that nurses direct many of their working environment challenges towards the clinical nurse manager. Therefore, in many ways the line manager appears to be the nurses’ key spokesperson vis-a-vis the organisation.
Pettersen and Solstad (28), who carried out a study in five Norwegian hospitals, believe that clinical middle managers have to deal with different types of management logics which partly entail a large responsibility for budgets as well as for professionally responsible conduct. The researchers believe that it may be difficult for a middle manager to reconcile these two kinds of logic.
The Swedish working life researcher Rydén (29) has the view that it is essential that employees’ views on their work situation should be heard. By this, she means that employees’ input must be discussed and not simply brushed aside as of lesser importance when discussing financial considerations, for example. She believes that the perception of not being taken seriously in these work situations reinforces the staff’s feeling of powerlessness in the encounter with the organisation (29).
The informants’ perceptions of being heard by their line manager are twofold: some feel that there is a lack of information from management about what has happened as a result of the nursing staff’s input, and they express powerlessness when it comes to having their views about their own working situation heard. Others are certain that the clinical nurse manager takes their descriptions of the working environment further up the management chain, while at the same time they are aware that decision-making powers rest with another service level in many cases.
The line manager can promote working environment-oriented efforts locally in the different hospital wards. However, strategic management must also be involved in order to change organisational factors (30). Continuing the research of Pettersen and Solstad (28), and Rydén (29), we can say that when staff are unable to express their opinions about their own working environment problems and the information is blocked in the system, this represents a serious failure.
Through examining the clinical incident reporting, quantitative assessments and HSE measures as well as personal follow-up, we have seen that the working environment challenges facing nurses are inadequately handled at the organisational level. Health personnel have an independent responsibility to report such challenges.
Meanwhile it is important to keep in mind that clinical incident reports represent information that shall and should be used to develop the organisation of the work. Neither HSE or HR are meant to individualise working environment challenges. We believe it is opportune to point out that there is a danger of the systems we have described, which are of central importance to the psychosocial working environment, losing their support and legitimacy. When they do not actually pinpoint and deal with causes and problems, it is clear that staff will not make use of them.
There is a need for further research to elucidate nurses’ psychosocial working environment challenges in a settings perspective. The specific areas we have dealt with do not appear to be able to tackle psychosocial working environment challenges as organisational issues.
At a time when nurses and other professional groups in hospitals are already subject to an unfortunate deluge of responsibility, it is regrettable if the responsibility for solving working environment challenges is also shifted to individuals.
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