Four resource nurses and four ward nurses participated in individual interviews. Analysis of the data yielded three categories:

  1. 1.

    Expectations of better competence in the ward

  2. 2.

    Expectations of better cooperation between professions and different levels of healthcare services

  3. 3.

    Improvements and hindrances

Expectations of better competence in the ward

The data shed light on an expectation from the ward nurses regarding better competence in the ward, and the resource nurses want to contribute.

The data showed that the ward nurses did not have sufficient time to maintain the level of competence in the ward by themselves. They explained that they wished to highlight the resource nurse’s role and make use of her potential, organize the resource nurse’s work to include planned days in the staff shift schedule and develop the role towards education, counselling, reflection and quality improvement.

As a leader I do not have a chance to observe the quality and level of knowledge in the ward, so having a person that has the primary responsibility for that follows up and has the time for it. We could not have managed without.

The ward nurses stated that patient safety is at risk when the level of competence in the ward is not satisfying. They described the necessity of professional personnel to provide safe and secure services. Furthermore, they stated that in a ward in continual development and frequently new personnel in need of training, the resource nurse was essential. Unfortunately, due to time constraints, the resource nurse’s role was not utilized to its full potential. This hindered professional development and caused personnel to feel insecure as well as necessary training to be halfway done, according to the ward nurses.

Another issue which described by the ward nurses was that the resource nurse had to take care of her own patients first, and secondly supervise her colleagues in order to keep them up to date and capable of dealing with challenging tasks.

The threat is that the expectations are a bit too extensive because (being a resource nurse) is a duty in addition to the ordinary tasks (service to the patients).……. I don’t have the opportunity to just give her more time, because then I will not be able to solve the (ordinary) tasks.

The ward nurses also mentioned the necessity of describing their expectations about the role of the resource nurses to them. They expected the resource nurse to show her competence and become confident in her role, and to be available for her colleagues.

I support her to take her stand; you must take, you cannot wait to get. Show your competence. If your colleagues don’t listen, it is their problem, but you make yourself available.

The ward nurses mentioned that the resource nurse met the patient in the early stages of care, often together with the specialist cancer care nurse in the municipality. This way she got a general view of the patients in need of cancer and palliative care and was thus prepared to inform and counsel her colleagues.

The resource nurses stated that they wish to convey new knowledge to their colleagues and keep them up to date, promote vocational and ethical reflection, and discuss proper care of the patients. The resource nurses said that they tried to answer questions from their colleagues and to inform them when there are new procedures, treatments, or medications to be updated.

If we drive together, then maybe we can converse in the car, reflect and talk together; (we talk about) how we handled this or that situation, if it was good or if it was bad. You get better then, and maybe do a better job next time.

According to the data, the ward nurses wanted to utilize bedside counselling as a tool to increase and maintain competence for the personnel. The resource nurse suggested that she might observe the caregiving of the novice colleague and counsel her afterwards, or to counsel through a show-and-tell in the actual situation.

Expectations of better cooperation between professions and different levels of healthcare services

The data made clear that the ward nurse anticipated better cooperation and that the resource nurse had the potential to fulfil this expectation.

The data, both form the ward nurses and the resource nurses showed that every nurse in the ward participated in interdisciplinary cooperation regarding their own patients. This could result in patients not getting proper help, according to the resource nurses. They said that as resource nurses they could have contributed with their competence and experience in such situations.

The ward nurses described that they wanted the resource nurse to contribute to interdisciplinary cooperation and take responsibility for promoting the nurse’s perspective, e.g., make suggestions founded on the nurse’s perspective when an individual plan for a patient is made. In palliative care, interdisciplinary cooperation may sometimes be insufficient, but the resource nurse, with her competence, could help to remedy this, the ward nurses explained. The resource nurses said that they wanted to discuss matters with the physician and reach a common understanding of the different professional perspectives in decision making.

I think we (the resource nurses) could participate and contribute; we are not really included there yet. That is the dream scenario; it is more every single nurse with her patients …. We (personnel on the ward) have the meeting before the doctor’s round twice a week with all the doctors and one nurse, but we (the resource nurses) do not participate there.

The ward nurses said that there was no organized or planned interaction between different levels of healthcare services concerning the palliative care, such as face-to-face meetings, except for telephone calls and e-link when it was necessary. Sometimes the specialist cancer care nurse in the municipality invited the resource nurse to participate in meetings concerning a patient’ discharge. However, discharge meetings were rarely arranged, due to time constraints, the ward nurse informants said. The resource nurses highlighted the importance of meeting the physician and patient face to face before discharge. This provided an opportunity to understand what the patient wanted, and made it easier to know what to ask about.

Interaction between the levels of care was necessary e.g., when a patient needed equipment and assistance after discharge, when a patient’s situation at discharge was unclear and vague or when next of kin did not want the patient to come home. The resource nurses expressed that she would have been able to contribute in the interaction, but it is not organized that way.

“for the time being I have not been involved in a situation (interaction with the municipality) …… but it would have been quite natural to assist, but this is not something that I can do here.

Improvements and hindrances

The data shed light on the fact that the resource nurse’s role is affected by circumstances that can further or hinder it.

The resource nurses described that they needed support and feedback from the ward nurse in order to fulfil the role as resource nurse.

The leader must be interested in utilizing that resource; without embeddedness in leadership it will not be used…., the resource nurse must be engaged herself and the leader must be involved, too.

The resource nurses described support from the ward nurse regarding the organization of the care and supportive feedback, but the resource nurses also noted that they did not get very much recognition or appreciation.

Busy days could impede reflection and competence building. The resource nurses said that they barely had time to sit down for lunch, and that the one-on-one reflections were done in a hurry.

The data also showed that it takes time before the resource nurse became confident and posed questions about the patients to her colleagues. Furthermore, the colleagues needed to feel confident in the cooperation with the resource nurse.

The ward nurses stated that the personnel were sometimes unwilling to listen to the resource nurse, because they were experienced nurses themselves and worked independently to a large extent.

“When she said you must update yourself on the integrated care plan, then they did not care so much …. they know a lot and have a lot of experience; maybe they felt it was unnecessary …. but it is a good idea not to be too arrogant.”

According to the resource nurses, it was important that the colleagues experienced that the resource nurse contributed positively, e.g. that she took care of issues or communicated issues to the ward nurse. Furthermore, the conversation had to be a dialogue where the resource nurse herself was open to criticism. If she is open, then it is possible to get approval of proposals that may not be popular.

Even though I am the resource nurse, it is important that the other is receptive. Give the other nurse some space, then we can talk about this or that…

According to the ward nurse informants, the resource nurse must enhance her own competence to be able to improve her colleague’s competence. Therefore, she needs time and access to newer knowledge, the resource nurse informants explained. The resource nurse was interested in a wide area of topics related to palliative care and read on the internet or consulted the nursing textbooks. Furthermore, by participating in the local network of resource nurses, which is facilitated by the specialist cancer care nurse, she acquired new knowledge, learned from peer resource nurses, and discussed current topics, according to the resource nurse informants.

I seldom get a no if I ask to participate in (network-) meetings or courses, to increase my knowledge

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