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I also see it as precariousness [referring to the rooms/wards]; We don’t have screens on the windows. There is a lack of HGT equipment, shower chairs, electrocardiogram equipment, IV poles, screens, and the structure of the unit itself, which is very long (N6). The rooms are cramped. It is not possible to reach patients, to assess, perform a puncture, aspirate. It’s the companion’s backpacks, the armchair, the companion, the infusion pumps, the monitor that doesn’t work, the window that’s stuck (N5). The patient doesn’t have things on edge. The beds are very close together. The bathrooms do not have hot water. We only have two shower chairs. Monitors, we also have few on the floor! So, it’s quite difficult like that. This lack intensifies our work (NT7). The wards have five patients and five companions, and then you go to give a bath to an elderly woman, who has protected herself all her life and doesn’t have a screen. We don’t have air conditioning or fans in the rooms, and this also impacts (NT13). The physical space is precarious! The headboard is small, the drawer is falling out! (NT2). Sometimes we need infusion pumps, and having to borrow them takes time. At night, we don’t have access to mechanical ventilators, so when the patient gets worse, it’s difficult (N05). In two-bed wards, there is only one headboard with an oxygen network and a compressed air outlet, so you have to change the patient’s room. The patient doesn’t have things at the bedside, you have to run from one side to another (N10). The bells don’t work, or the sensor beeps but doesn’t show which room, so you have to go out looking [...] in this regard, it increases our workload (N1). You go to pick up the patient, there is no wheelchair, so you need to go downstairs to get the chair and take the patient there for the exam. It’s too late, it’s wasted time! (NT15). |
| Class II - Complexity of patients’ clinical condition |
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It is not uncommon for us to have patients on mechanical ventilation on the floor. So, our patients end up being [admitted to the unit] (NT2). We receive patients coming from the ICU, the recovery room, the emergency room, the cardiology unit, so these are patients who require a lot of care (N9). Patients are increasingly unstable. We see fewer patients, but with very different levels of complexity. So, it is pulled towards the nursing team. So, this factor of patients’ severity is an immutable factor (N10). We have many semi-critical or some chronic patients who come from the ICU, tracheostomized, with skin lesions, using a probe, central venous catheter, bladder catheter (N4). Patients are increasingly serious, increasingly unstable, especially the surgical patients we have. The unit, despite being open, has many seriously ill patients, even patients who would be in intensive units. Today, I had two patients on mechanical ventilation, two with tracheostomy (N10). |
| Class III - Weaknesses in professional training, qualification and number |
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Now, in this time of pandemic, the lack of staff and absenteeism are very visible, and this greatly interferes with our daily lives (N16). During the pandemic, we were the ones who covered the certificates, who were working, and then, the days we would have had off, we ended up having to work (NT2). In general, we work with four co-workers (nursing technicians) and one or two nurses; There are days when we take on up to 10 or 11 patients. We still have nursing assistants, and it puts a lot of burden on them, because they don’t have support to carry out some activities. Therefore, the nurse must be careful to organize the schedule (NT3). One of the factors that influences nurses’ work is the team itself. We know our co-workers, and we know, today is going to be tough! (N14). The teams of nursing technicians are not fixed, and if you ‘get’ a weak team, you already know that you will have to keep an eye on them all the time, so it’s very difficult! (N17). Training is fragile, not only for the nursing technician, but for other professionals on the team. If the doctor or physiotherapist has more control over the situation, the actions are more correct and you don’t have to worry about other things (N18). It is visible that schools, that teaching, is fragile. There are a lot of people who were hired and who don’t understand the process, some things that are considered basic (N13). The lack of qualifications is glaring and, with the pandemic, it became much more evident (N17). |
| Class IV - Work rhythms and demands |
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You have to have attention and vision. There are a lot of details, there are a lot of chances to make mistakes, a lot of chances! So, you have to read, re-read, interpret a medical prescription (NT3). The time when the patient receives the most medications is at night. So, there are several trays throughout the night, so it ends up that at night the use of medication intensifies more (NT3). I think the work is boring. There are things that are not the responsibility of [nursing] technicians, such as vacuuming and here we still do that (NT7). It requires organization, understanding priorities, and knowledge to assess patients. It requires skill, competence, leadership, knowledge about the clinic itself (N1). This diversification of patients’ clinic, you are studying all the time, ends up intensifying, because, in addition to your work shift, when you get home, whether you like it or not, you have to study to be able to handle your work the next day (N11). These situations happen every day, where you have to improvise, where you have to go back. So, all of this ends up tiring and, at times, demotivating you a lot (N6). There are times when there is a shortage of material, you end up spending more time looking for the material or going to other sectors to borrow it. Not long ago, for example, we ran out of 20 (ml) syringes and so we ended up using two 10 ml syringes, we had to improvise (NT12). We have to be creative and look for other resources. This also ends up influencing work intensification there on a daily basis (NT9). |
| Class V - Work process organization |
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Computerization makes it easier, but it also creates more work; It requires you to write more, to speak in more detail, to assess the patient better, and this takes time, mainly because, sometimes, the system is very slow (NT2). We make an effort to leave as few issues as possible, but sometimes there is something left, but it is not within your power (N4). What also interferes are the double shifts. You have an employee who is tired, stressed, due to the number of hours worked, and here, in the hospital, many co-workers work double or triple shifts, and this influences the occurrence of some errors (N17). The lack of routine, conversation, and standardization creates overload. There is no implementation of a routine aimed at improving flow for teams (N14). In addition to our service, we have to check everything the technicians do. So, there are some teams that we can trust and there are other teams that this is more complicated, that we need to go after, that we need to check everything (N7). |
| Class VI - Weaknesses in management |
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Next, we need to give an “opinion” on some materials, but even so, after a while, we notice that, even so, the material was purchased (N18). Another aspect that could be seen is the issue of lack of management, of routines, of small things that can be done daily, both by those who manage (NT3). The lack of material influences a lot, sometimes equipment needs to be repaired and it takes a while to return, so you have to borrow it from other units (N9). The lack of equipment is certainly an obstacle, because, often, we have to organize things from here to there so we can provide better assistance (N6). So, from providing the minimum materials needed for the shift, to training the secretary, this takes time and a certain amount of care (N6). |
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It depends on the team you’re on; if the team is good, the work flows. Of course, everyone has their own particularities, but I see the lack of teamwork intensifies this! (NT12). If all teams focused on the patient, converging their thoughts, it would greatly improve quality of care, reducing stress and rework (N18). Sometimes, we don’t even know that the patient has an exam. This could have already been seen. And, look, it happens a lot [changed the intensity of his voice], it’s very complicated! (N14). Sometimes, a department wants you to rush the patient, but they don’t know the conditions; need a stretcher bearer, elevator; There is the issue of patients’ condition. This lack of communication is very disruptive, and there is also a lack of empathy among co-workers (N06). I see that the lack of teamwork intensifies this! When you work as a team, work intensification becomes less. There are days when I leave work exhausted and I can’t stand the pain in my legs from walking so much (N5). |
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