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Background: Increasing nursing shortages observed globally including Sweden have resulted in a matrix of challenges not least strained health care systems and achieving/maintaining well-functioning health systems but also population wide health outcomes as outlined by the WHO in its Millennium Health Goals. Policy makers in nations around the world as well as leading international organizations have begun to address the issue of nursing shortages in hopes of off-setting the negative spiral of this phenomenon. While challenges, figures and proposed policy interventions are somewhat well documented in reports and studies regarding the issue of nursing shortages fewer studies have focused on nurse’s experiences of shortages and related implications. The aim of this study is to understand how nurses working at one of Sweden’s major hospitals (NUS) experience these shortages in terms of stress, coping and the quality of care they provide through interviews based on their perspectives.

Methods: Qualitative methodologies using an abductive approach comprised of semi-structured in-depth interviews were used to conduct this study. The setting of the study was Norrland’s University Hospital in Umeå Sweden. Interviews were held individually with five different nurses working at the cardiology department. Participants were contacted through the departmental director and informant’s participation was voluntary. All but one informant had at least 5 or more years of experience working as a nurse to ensure balanced and credible data of nursing experience. A qualitative content analysis was used to synthesize data including 5 rounds of coding and a final cross-sectional analysis. A cross sectional analysis was generated in order to identify common themes between interviews.

Results: The content analysis resulted in six (major) themes surrounding the nature and consequences of nursing staff shortages at the cardiology department at NUS. These themes are implications of stress on a personal level, coping implications on a personal level, care/hospital related aspects of stress and coping, limitation, opportunity, motivation. Participants perspectives and opinions yielded a better understanding of the implications nursing shortages at the cardiology department as they relate to stress and coping experiences as well as the quality of care delivered to patients.

Conclusion: The data corroborated many key issues and findings from reports and studies surrounding nursing staff shortages in Sweden and especially internationally. The data revealed how nurses at the cardiology department experience and perceive these shortages daily rather than approaching the issue of nursing shortages from a pure policy or theoretical lens. Key findings from the analysis show that the combination of reduced hospital beds, treatment of different patient groups due to over-capacity and a lack of resources coupled with a combined night and day shifts or consecutive night shifts created highly stressful working conditions. Nurses burnt out and preferred working less than full time. The cardiology department was resilient and coped with such conditions by prioritizing medical treatment over caring. Shortages and stressful days on the floor enhanced delegation and coordination of tasks among nurses and other staff at the ward. The division of sub units within the ward and rotation between them among nurses created a more rewarding and efficient work- iii -experience. Given the current and expected future relevance of nursing staff shortages in Sweden and abroad the findings of this study help contextualize nursing shortages by giving voice to those who experience it directly. The findings add to a growing pool of literature in acknowledgement of such challenges informing policy by informing decision-makers.