Aims of the study. The aim of this study was to better understand the ways
in which conditions of work, including staffing, affect how nurses in long-
term care (LTC) facilities do their jobs and the quality of care they provi
de.
Background. The research reported here was performed in the context of publ
ic policy debates about the relationship between staffing levels and qualit
y in LTC.
Methods. In 1995 and 1996, interviews and participant observation were used
to examine how 18 licensed nurses employed in two LTC facilities in the mi
dwestern United States experience their day-to-day work.
Results. Time was an extremely salient work condition for the nurses interv
iewed. Under conditions of too little time and many interruptions, nurses c
ompensated by developing strategies to keep up or catch up. These strategie
s included minimizing the time spent doing required tasks, creating new tim
e and redefining work responsibilities. Although these strategies allowed n
urses to complete the tasks for which they were accountable, there were adv
erse consequences for nurses and residents. Nurses realized that time deman
ds often made it impossible to provide care of high quality. They expressed
their ideas about quality care as the notion of 'should do' work. In effec
t, time pressures forced them to forego the 'should do' work to complete th
e 'must do' work.
Conclusion. Increased staffing could improve the quality of care in LTC fac
ilities.