Chronically pressed for time: a grounded theory of time-pressure experiences among perioperative nurses working in operating rooms and post-anesthesia care units in South Korea

Abstract

Time pressure is an important source of occupational stress in clinical nursing and has implications for patient safety. Despite its potential consequences, how perioperative nurses experience and manage time pressure remains underexplored. This study aimed to develop a substantive theory explaining how operating room and post-anesthesia care unit nurses experience and manage chronic time pressure. A grounded theory study was conducted in tertiary general hospitals in South Korea. Twenty nurses working in an operating room or post-anesthesia care unit, with at least 1 year of experience and a perceived time pressure score of ≥ 4 on a validated 7-point scale, participated. Individual in-depth semi-structured interviews were conducted from December 2022 to April 2023. Data were collected and analyzed concurrently using the constant comparative method, and theoretical saturation determined the sample size. The core phenomenon was chronically feeling time pressure. Four contributing conditions—professional responsibility and personal traits, the demands of perioperative nursing work, a hierarchical and blame-oriented perioperative work culture, and revenue-driven organizational policies—were identified, and time pressure intensified in situations involving unfamiliar tasks, unpredictable perioperative events, and interpersonal dynamics with colleagues. Participants coped in three ways—proactive self-directed coping, colleague-reliant coping, and resigned acceptance of an unchanging reality. Participants described consequences spanning psychological burden, work-related breakdown, reduced nursing care quality, and threats to patient safety. Over time, participants described relief after task completion, becoming an unwanted version of oneself, and consideration of leaving the profession. These categories were integrated by the core category, “fulfilling tasks while chronically enduring time pressure,” which captures how nurses continued to complete required work while the underlying pressure remained unresolved and was reinforced or eased through interactions with others. This study explains how perioperative nurses continue to fulfill work demands while chronically enduring time pressure, and how their responses and interactions ease or reinforce pressure within this ongoing process. These findings suggest that understanding and addressing time pressure in perioperative nursing requires attention to individual coping alongside the organizational and interpersonal conditions surrounding the work.