Task Allocation Under High Workload: A Qualitative Study of Nurses' Fairness Experiences in Chinese Tertiary Grade A...

Under high-workload conditions, clinical nurses arrange care with limited time and staffing. Detailed accounts remain limited regarding how nurses evaluate fairness in everyday task allocation and relate these evaluations to their care experiences and views on reform.

To explore nurses' fairness experiences in task allocation under high-workload conditions in Chinese hospitals, including their expectations and concerns about reform.

This qualitative descriptive study used convenience sampling to recruit 27 female participants from seven tertiary Grade A hospitals in four regions of China. The core sample comprised 24 frontline clinical nurses; three head nurses were supplementary informants. Online semistructured interviews were conducted from April to May 2026. Thematic analysis combined the interview guide's predefined areas with open coding and comparison of interview data.

Six themes and 16 subthemes were identified. The themes were as follows: (1) fairness judgments in task allocation; (2) fairness experiences and care adequacy; (3) care trade-offs under resource constraints; (4) emotional and professional experiences; (5) expectations for task allocation reform; and (6) concerns about task allocation reform. Nurses evaluated burden distribution, staff availability, and alignment between effort and rewards. They also described care reduced under time constraints, changes in care priorities, guilt and lingering fear, emotional buildup and relationship strain, and a defensive work orientation. Expectations involved allocation based on actual workload, flexible support during peak periods, and clear allocation and rotation rules; participants feared further increases in work demands and insufficient resources for implementation, and remained cautious about reform outcomes.

Nurses' fairness experiences concerned task distribution and accompanying support and recognition, alongside concerns about care adequacy. These accounts provide a descriptive basis for considering task allocation changes responsive to nurses' needs.

Nurse managers could consider actual workload, flexible support during peak periods, and clear allocation and rotation rules, with attention to implementation resources and rest.