Table 4 Joint display of quantitative and qualitative results

Time pressure (objective and subjective)

Both, objective and subjective, time pressure variables were associated with higher stress (standardized β coefficient 0.169, p < 0.05, for direct care time, and 0.249, p < 0.001 for subjective time pressure)

Higher subjective time pressure was associated with lower job satisfaction (standardized β coefficient -0.222, p < 0.01)

Confirmatory findings: Excessive time pressure was a key load factor, which was mainly due to the large number of clients and too short planned visit times

Contradictory findings: The lack of breaks and the underestimation of the time needed for transitions and office work in work planning (or ‘indirect care time’) were raised as a significant load factor

Role conflicts (subjective)

Role conflicts were associated with higher stress (standardized β coefficient 0.223, p < 0.001) and lower job satisfaction (standardized β coefficient -0.220, p < 0.001)

Confirmatory: Nurses got tasks without having enough resources (time) to carry them out. The implementation of unrealistically planned work/client lists created conflicts because planned time did not always correspond to the clients' care needs, or their need for care was at the same time (overlap of visits)

Contradictory: The nurses did not describe having to act against the rules or operating principles to get tasks done

Interruptions (objective) and disruptions (subjective)

Interruptions and disruptions were associated with higher stress (standardized β coefficient 0.122, p < 0.05 and 0.187, p < 0.01, respectively)

Confirmatory: Any changes in the client's care needs or other unexpected additional work (e.g. due to the absence of another employee) disrupted and lengthened the work day and significantly increased the strain

Contradictory: Interruptions (such as phone calls, picking up keys, waiting for an ambulance, problems with car/traffic etc.) were not raised as a stress factor

Job resources explaining home care nurses’ stress and job satisfaction

Autonomy (subjective)

Autonomy at work was associated with higher job satisfaction (standardized β coefficient 0.372, p < 0.001)

Confirmatory: The current working time arrangements and external work planning had led to decreased autonomy (management and planning of one's own work), which had a negative effect on work enjoyment and well-being

Contradictory: -

Care continuity (objective)

Poorer care continuity (working with many unfamiliar clients) was associated with higher stress in the univariate model and with lower job satisfaction (standardized β coefficient -0.150, p < 0.05) in multivariate model

Confirmatory: The realization of continuity of care (working with familiar clients) was prevented by the constant absences of employees and the lack of substitutes. The client visits of missing employees were added to the lists of those at work, which meant that new/unfamiliar clients had to be cared for continuously

Contradictory: -

Other work planning related factors (objective)

ERP system that considered the teams and where teams were able to influence the planning of client visits was associated with higher job satisfaction in the univariate models. However, in the multivariate models, the variables lost their significance

Confirmatory / Contradictory:

Dissatisfaction was expressed in relation to the external ERP system when it did not consider the changing situations of the teams and there was no flexibility in the work lists. Dissatisfaction was also expressed in relation to overlaps in client visits, illogicality in the planned routes, and the amount of work, which did not always correspond to the time allocated to it

Social support (subjective)

Having more social support was associated with lower stress and higher job satisfaction in the univariate models. In the multivariate models, it lost its significance

Confirmatory / Contradictory: A well-functioning work community, where support was received and given, as well as a positive atmosphere among employees were described as the most important asset in reducing stress and promoting well-being at work. Constant rush and heavy workload were reflected in the work atmosphere and created negativity between nurses