Juggling Compassion and Competing Demands: A Grounded Theory Study of Pediatric Nurses' Experiences

Background: Not being able to provide high-quality care has been recognized as one of the major occupational stressors among nurses. Compromised care quality can prolong hospital stays, risk patient safety, and increase the suffering of children with cancer who often have comprehensive care needs. The purpose of this study was to explore pediatric oncology nurses' experiences of situations when they have not been able to provide the best care to children with cancer. Method: A qualitative study was conducted with a classic grounded theory approach. After purposive sampling followed by theoretical sampling, individual and focus group interviews were performed. Simultaneously with data collection, analysis was carried out in accordance with classic grounded theory. Results: Twenty-five nurses from three different pediatric units were interviewed between September 2021 and May 2023. Nurses' main concern was to uphold children's best interests. Lack of time was one of the major barriers to the best possible care, but even different views on children's best interests hindered nurses from practicing care as they wished. Nurses handled challenging situations by juggling compassion and competing responsibilities, which included prioritizing, shifting up a gear, settling for good enough, acquiescing, and pulling together. Discussion: This study suggests ensuring practical support during busy work shifts and creating opportunities for interdisciplinary discussions on care issues and on children's best interests.