EMPIRICAL STUDIES
12064
Gerontological nurses’ perceptions of their rights in Finland
Mari Kangasniemi PhD (University Lecturer, Post Doc-researcher)1, Kati Utriainen PhD (Coordinator, Post
€ PhD (Professor)3
Doc-researcher)2 and Anna-Maija Pietila
1
Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland, 2Faculty of Medicine, Institute
of Health Sciences, University of Oulu, Oulu, Finland and 3Department of Nursing Science, Faculty of Health Sciences, Kuopio Social and
Health Care Services, University of Eastern Finland, Kuopio, Finland
Scand J Caring Sci; 2014; 28; 347–354
Gerontological nurses’ perceptions of their rights in
Finland
Background: These are challenging times for gerontologi-
cal nurses, due to the increasing need for older people
care services and nursing expertise and to the burden-
some nature of older people care. These changes also
challenge professional ethics. Traditionally, literature has
focused more on nurses’ duties and responsibilities,
rather than on their rights.
Aim: The aim was to explore the concept of nurses’ rights
from the perspective of nurses in gerontological care.
Methods: A qualitative study conducted among geronto-
logical nurses (n = 29) in the older people care of two
publicly provided municipal older people care organisa-
tions in two mid-range towns in Finland. Participation in
the study was voluntary, and the participants were
recruited in collaboration with a nurse executive. The
data, collected in 11 interviews (1–4 participants in each)
Introduction
The demand for gerontological nurses’ expertise in older
people care has increased (1–4) due to new global demo-
graphic and epidemiological trends, such as increased
ageing rates (2, 4), life expectancy (2) and morbidity (1–
3), but due to the insufficient number of gerontological
nurses, it has become very challenging to provide appro-
priate care for the growing number of older people (aged
65 or older) requiring healthcare services (5, 6). This sit-
uation is exacerbated by the restrictive health and bud-
getary policies (2, 5–7), as well as young peoples’
negative attitudes towards older adults (6, 7), which
Correspondence to:
Mari Kangasniemi, Department of Nursing Science, Faculty of
Health Sciences, University of Eastern Finland, PO Box 1627,
70211 Kuopio, Finland.
E-mail: mari.kangasniemi@uef.fi
© 2013 Nordic College of Caring Science
doi: 10.1111/scs.
using open-ended interview method, were analysed by
inductive content analysis.
Findings: Based on our findings, nurses’ rights are an
integral part of everyday nursing. As professionals, nurses
pointed out that their rights are based on legislation and
ethics, and their rights involve colleagues, managers,
organisation, and patients and relatives. Their rights were
connected to nurses’ professional expertise and their
well-being at work, but at the end, they were a factor to
improving quality of older people care. This required that
nurses’ rights were taken as visible and elementary part
of management.
Conclusion: On the basis of our findings, especially in very
demanding areas of nursing, like older people care,
nurses’ rights deserve major visibility and should be
taken into consideration when planning care.
Keywords: ethics, nurse, older people care, profession,
rights.
Submitted 19 December 2012, Accepted 27 June 2013
leads gerontological nurses to reflect deeply about their
work.
The increasing complexity of older people care (1, 3, 8)
requires advanced nursing skills, competences and
knowledge (9–11). However, older people care has been
found to be burdensome for nurses due to the high
workload (12). Moreover, working with other staff mem-
bers (12) and patients’ relatives (13) in some cases can
be very challenging, not to mention the risk of work-
related violence or abuse, mostly by patients (14).
These are only some of the factors that illustrate the
demanding nature of gerontological nurses’ work. They
also give rise to issues that challenge the ethical princi-
ples of gerontological nurses work and in particular the
role of professional ethics. Nursing had a solid basis of
professional ethics that includes not only professional
values and rules, but also the freedom and power of the
nursing profession (15–17). In older people care, as in
nursing in general, the concept of professional autonomy
does not only refer to nurses’ responsibilities, duties and
347
348 M. Kangasniemi et al.
demands (9, 11), but also to their rights (18). Previous
studies examining nurses’ rights as a part of professional
autonomy have been fragmentary and have not been
conducted in the context of older people care.
Conceptual framework
The conceptual framework of this study is based on
‘rights’ in general and on ‘nurses’ rights’ particularly in
older people. Rights, in association with duties and
responsibilities (15, 18, 19), are based on ethics and legis-
lation (18, 20, 21). Duties and responsibilities refer to the
professional imperative in nursing practice that nurses
use as a guide to ensure high-quality care to their
patients (22). Duties and responsibilities combined with
rights are the pillars of professional autonomy (18, 23,
24). Rights act as moral safeguards for individuals or
groups, when they pursue their goals in a society. In the
case of nurses, they have rights as a professional group
that are confined to the members of this group (25, 26).
Rights can provide freedom and power when making in
decisions regarding one’s own affairs and offer require-
ments in relation to other people or the society (27).
Nurses’ rights, as pillars of professional autonomy,
involve both the society in general and in the field of
older people care, in particular. Therefore, nurses are
professionals, who can influence the form and content of
their work (8, 9, 11). Despite their fundamental role (15,
19, 21, 28, 29), nurses’ rights are marginally dealt with
in nursing literature (15, 19, 30–32). As we shall see in
this study, the role of nurses’ rights in the context of
older people care is even more relevant.
Based on previous literature, nurses’ rights include
employment rights, professional rights and human rights,
even though all these types of rights are closely related
to one other. Nurses’ employment rights are based on
legislation and working contracts (15, 18). They are pri-
marily directed towards employees and consist of rights
such as the right to practice their profession, the right to
regulated working time and compensation, and the right
to safety and healthy working conditions (18, 30, 31).
Nurses’ professional rights involve practicing their right
to practice their profession in an environment that is
safe, healthy and ethical, and use their expertise to con-
tribute to patient care (18, 20, 21, 24, 33). Par excel-
lence, nurses have human rights – that is, the right to
respect and work without being harassed or treated
unequally (8, 10, 18, 21).
Nurses’ rights are a very topical issue especially in
gerontological nursing. The global concern is that work-
ing in the field of older people care has rarely been seen
as an attractive choice for students (2), thus making it
difficult to recruit new gerontological nurses (2, 10, 34,
35). Also retention (2, 10), early exit (10) and high turn-
over rates among nurses (34, 35) are linked to issues
regarding nurses’ autonomy and rights (2, 3). There is
evidence that nurses’ autonomous role and a clear work-
ing profile play a key role in nurses’ well-being. With
regard to the working environment, nurses have the
potential to work both autonomously and in collabora-
tion with other health professionals (9) and to develop
their skills and competences, and consequently also their
professional careers by specialising in older people care
(6, 7).
Aim
The aim of this study was to gain deepen understanding
of gerontological nurses’ rights. The specific research
question was: ‘How do gerontological nurses describe
their rights in older people care?’
Methods
A qualitative hermeneutical approach was chosen as a
research method (36). The hermeneutic approach, devel-
oped by philosophers of phenomenology such as Heideg-
ger (1962) and Gadamer (1977), used the lived
experience of participants to gain better understanding of
the phenomenon in its natural context (34, 36–38).
Understanding is by nature hermeneutic circle; it refers
to the circular interpretation of a text (i.e. transcribed
interview) in the contextual sense (37) to interpret par-
ticipants’ world within their given context (34).
Participants and context
This study was conducted in two public municipal older
people care organisations on two mid-range towns in
Finland. These organisations provide long-term unit care
and home care services for older people. Researchers
informed nurse executives about the study, and nurse
executives gave an information letter regarding the study
to their nursing staff. Participation in the study was vol-
untary, and the total number of volunteers was 29; one
of them was male. All nurses were educated registered
nurses. Their working experience in the community set-
ting varied from 1 to 39 years.
Data collection
Interviews were an appropriate method for data collec-
tion, with a presupposition of conceptually reaching the
research phenomenon (36). In total, 29 nurses were
interviewed in 11 interviews. Small focus groups (39) as
well as pair and individual interviews were conducted.
The integration of different interview data is relatively
common in nursing science, and it leads to an enhanced
description of the phenomenon′s structure and its essen-
tial characteristics (40), which also support our aim to
© 2013 Nordic College of Caring Science

deepen understanding of rights. Five (5) of the interviews
were small focus group interviews (with 3–4 participants)
and five (5) of the interviews were conducted as pair
interviews and one (1) as an individual interview. The
interaction during small focus groups interviews and pair
interviews was dialogical, free and open by nature. Par-
ticipants reacted to what others said and thereby deep-
ened the discussion and the interviewer generated
communicative and equal discussion (36).
The interviews consisted of two open-ended questions,
based on following interview questions: (i)’What do you
think about nurses’ rights?’ and (ii) ‘how do nurses’
rights play out in nursing practice?’ The interviews were
carried out between January and September 2010 during
the nurses’ working hours. All interviews were audio-
taped, and verbatim transcribed after several listening
sessions.
Data analysis
The data, consisting of a total of 158 A4 pages, were rich,
detailed and representative, focusing clearly on nurses’
perceptions of their rights in older people care. Data were
analysed by using inductive content analysis (36, 41).
The unit of the analysis of small focus group and pair
interviews were the contents of the whole group. The
form of interaction and relations between participants
was excluded from the analysis, which instead focused
on the contents of the phenomenon created by mutual
interaction (36). The text was reviewed and analysed
through the explicit meanings of a word, combination of
words, clauses, clause units or meaning units. Then,
analysis categories and content areas were created,
defined and named according to the focus content of the
connective units (41, 42). Furthermore, content areas
were connected to subcategories and main categories.
One of the researchers (MK) conducted the analysis until
the subcategories were formed and, subsequently, all cat-
egories were identified in a discussion with other investi-
gators (KU, A-MP): data were reread and categories
reorganised until they acquired their final structure.
Results
Based on our findings, nurses’ perceptions of their rights
in older people care can be divided into three categories:
(i) Nurses’ rights as older people care experts; (ii) Nurses’
rights in the organisation of older people care; and (iii)
Nurses’ rights related to well-being.
Nurses’ rights as older people care experts
Right to be regarded as an expert. According to nurses, the
basis for enabling their expertise in older people care is
the right to provide a professional contribution to older
© 2013 Nordic College of Caring Science
Gerontological nurses’ rights 349
people care. This included, as one participant described,
‘not only these nursing “tricks”, you know…but also
more comprehensively, to implement holistic nursing
care (5)’. The contribution to older people care also
included the right to plan, implement and evaluate
patient care. Nurses described themselves as having the
right to bring out nursing knowledge and to be heard,
regarded and respected as experts of nursing, without
being obliged to withdraw or retire. Nurses also emphas-
ised their right to get involved, advocate, attend to the
affairs of older people and speak up for them, as one of
the participants described: ‘Of course, it is our right, not
only our duty, to advocate for patients’ rights and make
sure that they are implemented (8)’. However, some-
times nurses found it difficult to obtain opinions and
expectations from of older people. Looking after the
rights of patients in best possible way required nurses to
act against relatives, physicians or organisations: nurses
pointed out that such kind of advocacy is not only their
duty, but also their right; especially when relatives refuse
to co-operative at the beginning.
The right to have sufficient knowledge. To achieve and
maintain their expertise in older people care, nurses
pointed out that they have the right to have sufficient
education. This referred to lifelong learning to keep up
and develop professional skills and personal expertise,
but also linked to their right to a properly oriented in the
case of a new job or position. According to one of the
participants, their new nurses ‘have the right to be intro-
duced and to later get some kind of mentor (1)’. Nurses
also mentioned that they have right to be sufficiently
informed about any ongoing changes in the care they
provide during their normal schedules. In addition, they
emphasised that they have the right to receive updated
information about the organisation. These comprised
rights that nurses believed they were entitled to, so that
they could focus on their career and make meaningful
plans for progressive lifelong learning education and
practical experience.
The right to have a clear position description. Nurses
reported that they have right to have clear position
description with a defined set of duties, responsibilities
and rights. Clear position descriptions were linked to
their right to practice as an educated nurse: ‘Yes, we
nurses do have the right to keep to our own tasks. Hey,
that’s one more right I discovered! (6)’. A clear position
description ensured job transparency in the unit and
improved co-operation not just within a single profes-
sion, but also among different professions, as described as
follows: ‘We also have to know the rights of practical
nurses, and vice versa. It would promote common under-
standing (9)’. In addition, one participant gave an apt
demonstration regarding the relationship between the
350 M. Kangasniemi et al.
nurses’ right to have clear position description and their
education: ‘that we are nurses and we want to be provid-
ing nursing care; if we were cooks, we would want to be
preparing gruel (1)’. A clear position description also
increased the certainty, dignity and pride of a profession.
Several participants reckoned that a profession with
recognised rights was perhaps more independent, both
on an individual and group level. A major awareness of
one’s rights strengthened motivation and professional
empowerment.
The right to refuse to provide a treatment. The nurses who
took part in our study reported that in fact, nurses have
the right to refuse to provide a specific treatment. They
felt that, in today’s practice, they often discuss about
their right to refuse giving treatment but also talk about
the issues raised by conflict between refusal and their
duty to care. They explained that they would have the
right to refuse if they felt they did not have sufficient
education or skills. In addition, they explained that they
have right to refuse to provide care when inadequate
working conditions pose a risk for their own health or
well-being, but also when tasks do not fall within the
scope of nursing, but of another profession (e.g. physi-
cians or care assistants). Nurses also reported that they
have the right to limit their work whenever they are
overloaded or have insufficient resources in terms of time
and staffing. The nurses who took part in our study also
claimed to have the right to refuse to provide care if the
patient misbehaved or if the situation in the unit or at
home was hazardous or dangerous either for nurses or
for the patients: ‘If I have to visit a family where there is
dangerous situation, I have the right to refuse to go there
and provide care (4)’. As nurses’ pointed out, there is an
ethical dilemma between their own right for health and
well-being at work and the patient’s right to be treated.
Participants described that they try to balance it with the
support of their colleagues, giving advice for patients, for
example, on better behaviour, or wait for a while until
the situation is settled. One participant described this
kind of situation: ‘We have the right to walk away, we
do not have to listen to a patient who is yelling and
being abusive… and I’ll come back once she has calmed
down (6)’.
Nurses’ rights in the organisation of older people care
The right to be treated equally. According to nurses, they
have the right to be treated equally and without discrimi-
nation by nurse managers. However, they pointed out
that, in practice, rights are contextual by nature: rights
vary between nurses according to workplace, employer, or
municipality and are also based on trade union member-
ship, education, position and tasks at work. They also had
experiences in practice that there is the tendency of gender
bias: male nurses have more rights compared to female
nurses: ‘A man is a man and has more rights; it is linked to
the treatment of women in general (2)’. According to
nurses, they also have a right to equally divide the strain
of their work, as one participant described: ‘…and what is
the nurses’ right, if you feel that you have too much work
compared to the resources (4)’. This was also connected to
patient safety: in the case of a treatment injury, nurses
have the right to take the context into account, that is, in
relation to staff resources, workloads and working condi-
tions: ‘In the case of a patient injury… it is inspected as a
separate issue, not as part of a chaotic nursing situation…
So nurses have no rights in that case. (1)’.
The right to have organisational support. The nurses
described that ‘the law of patients’ rights (Finnish Law
1992/785) ‘obliges us (to provide good care), so we must
have rights as nurses that enable us to complete our task
(10)’. In that sense, due to the legal tasks of nursing and
health care, nurses reported that they have the right to
have sufficient resources to provide safe and high-quality
older people care. Nurses believed that the right to organ-
isational support in older people care should be an inte-
gral part any management plan. This refers to their right
to have both a physically and mentally close connection
to nurse managers in terms of support, advocacy and right
to be heard. Practical support from the nurse manager
mainly consists in the nurses’ right to expect the nurse
manager’s intervention and benefit of his or her support
to settle conflicts and risky situations, as one of partici-
pants described: ‘To get that backup, so that working con-
ditions are such that it’s possible to do your job (2)’.
Nurses’ rights related to their own well-being
Right to be treated with dignity. Nurses reported that they
also have rights that promote their own well-being at
work, where the main aspect is the right to be treated
with dignity: nurses emphasised that they have the right
to a respectful and appreciative interaction with older
people care without fearing violence or misbehaviour
when communicating with patients, relatives and col-
leagues. That was illustrated in the following quotation:
‘Every nurse ought to be aware that they do not have to
put up with too much (inappropriate treatment) (8)’.
Nurses pointed out that the recent shift from the role of
patient to that of a client in older people care has also
influenced interaction with all parties, in the sense that
patients (or relatives) are expecting ‘service’ instead of
‘care’. Nurses have also been treated as servants that do
not deserve respect. However, nurses emphasised that
they have the right to be treated with dignity and a right
to intimacy and integrity. They detailed that even in case
of dementia or other behaviour disorders, mistreatment
is understandable, but not acceptable, as one of
© 2013 Nordic College of Caring Science

participants reported: ‘It (mistreatment by patients) must
not be accepted, no matter what the diagnosis is (5)’.
Nurses also emphasised that ‘we do have human rights
in the workplace! (3)’. They pointed out that they have
the right to be treated with dignity also involves colleagues
and the working environment. They highlighted that they
have the right to be treated equally and fairly by their col-
leagues, in keeping with human rights and without dis-
crimination and unjustified rights. These appeared to
nurses as the right to have a good working atmosphere
with transparency, communication, open co-operation
and discussion based on facts. They found out that they
have the right to professional support and mutual commu-
nication, consulting and mentoring between colleagues.
The right to have safe working conditions. According to
nurses, their right to promote well-being at work also
includes the right to have safe working conditions in
wards as well as in homes. The right to have safe work-
ing conditions refers to the healthcare equipment they
use: they have the right to have sufficient and adequate
equipment, not just to provide high-quality patient care,
but also to the nurses’ rights to safeguard their own
health and work in an ergonomic environment. They
also pointed out that they have the right to have suffi-
cient space for their work in terms of suitable room for
the different tasks required by daily reports and medical
care, and satisfactory space for the provision of basic care
in homes: ‘Yes, it is a part of nurses’ rights to have a
quiet place for daily rapport and a quiet place where you
can call relatives, without being continuously interrupted
by physicians, cleaners, other nurses, or relatives (1)’.
They also have the right to safety in terms of having
emergency exits in offices.
Nurses’ rights related to good working conditions also
involve breathing clean indoor air, without exposure to
cigarette smoke or mould in homes. In particular, in cli-
ents’ homes, nurses reported their right to work in safety
conditions: ‘If you get asthma symptoms due to tobacco
smoke or damp air (in the home of a patient), it’s no
longer humane [to expect you] to visit a place like that
(8)’ and another participant described the situation dur-
ing a home visit: ‘There might be a bunch of drunk men
present when you go to a client’s home… but you do
have the right to safety at work (7)’. Pertaining to work-
ing air temperature, they emphasised their right to be
protected from extreme temperatures and sharp varia-
tions in temperature.
Nurses pointed out that, closely connected to their
rights to well-being at work, was their right to regulated
working hours. Despite official legislation provided rights
and the employment contract, their rights pertaining to
regulated working hours in everyday nursing were not
always respected by the organisation. There were often
situations that did not allow any time for breaks and
© 2013 Nordic College of Caring Science
Gerontological nurses’ rights 351
lunch, due to the busy and intensive nature of their
work with older people and lack of resources: ‘Our right
to breaks comes to naught - there you are with a piece
of bread in your mouth and the patient’s relative is there
standing by the door (6)’. In addition, they reported that
they have the right to carry out tasks only during work-
ing hours. In case of overtime, they reported their enti-
tlement to extra compensation.
Discussion
Based on our findings, nurses’ rights are an integral part
of everyday work and reflect their rights in the field of
older people care in relation to issues such as advocacy
for older people, but the rights also represent nurses’
rights in general. Nurses reported that rights supported
their professional expertise and their aim to achieve bet-
ter older people care. This demanded that nurses’ rights
have to be considered as a visible and fundamental part
of management. As professionals, nurses pointed out that
their rights are based on legislation and ethics, and their
rights involve colleagues, managers, organisation, and
patients and relatives. Nurses linked their promoted
rights to their own well-being at work, but they always
subordinated them to the ultimate aim of their profes-
sion: higher quality of older people care.
Based on the findings of this study, we identified four
critical issues. The first issue was nurses’ current require-
ment to work under the external pressures of changing
services in older people care (2, 5, 6). Despite the
required and rapid older people care evolution, geronto-
logical nurses pointed out the importance of their rights
for organisational support. As nurses pointed out, the
right of one party is a duty for another: it is a duty of the
employer to ensure nurses’ rights (e.g. by offering rele-
vant information of resources in the organisation). They
also indicated their right to have clearly defined position
descriptions. Previous studies have emphasised additional
factors to achieve better care: distinctiveness of nurses’
tasks (34); adequate working conditions, a conducive or-
ganisational structure including sufficient equipment,
staff and other resources (43); and a clearly defined work
profile (44, 45). In our study, the nurses reported that
one of their fundamental rights was to offer a profes-
sional contribution to older people care. The results of
this study confirmed those of previous studies: nurses’
work has been traditionally seen as a duty or responsibil-
ity (46–49). In the context of older people care, a proper
perspective of nurses’ rights supports various endeavours
to establish gerontological nursing expertise (1, 8, 9); as
one of the participants reported, if older people have the
right to receive high-quality care, nurses have the right
to provide it, especially because older people are often
highly dependent and cognitively impaired. In that sense,
nurses’ and older people rights are not opposed to each
352 M. Kangasniemi et al.
other; on the contrary, established nurses’ rights promote
patients rights.
The second issue was nurses’ right to well-being at work.
In recent years, we have gained a major understanding of
nurses’ well-being at work (34, 35, 49, 50) and our study
opened up the right facets for it: nurses considered their
rights to well-being at work from their own perspective,
but also linked it to the aim and mission of their profes-
sion. Nurses linked their rights to relatively abstract well-
being-related issues and to a coherent career (49–51), dig-
nity, motivation and professional expertise. However, they
also described relatively practical rights in older people
care that are not always recognised and put into practice:
the right to clean internal air, sufficient and adequate work
equipment or breaks during their shifts. All these aspects
have to be taken into account when focusing on nurses’
rights in older people care. Nurses’ well-being at work and
quality of care are not separate issues (52), but are con-
nected to nurses’ rights and ensure a positive contribution
to the quality of care (18, 50).
The third issue is nurses’ rights and the new genera-
tion of gerontological nurses. Today, the nurses’ role as
an autonomous profession in older people care has
emphasised a traditional duty-based approach (11). For
the next generation of gerontological nurses, a duty-
based profession may not appear as a very appealing
career. Each generation has its own unique characteris-
tics of thinking that reflect on their perspectives of ethics
and work (34, 53). While senior nurses are highly com-
mitted to patient care (43), younger ones tend to give
more priority to individual values, such as autonomy,
rights and working conditions (49). Younger generations
have a major awareness and interest in their own values
(47); needs, interests, position (35, 47); and career-build-
ing (43, 47, 49). Therefore, a major recognition of their
perspective based on rights, combined with nurses’ power
(11) and empowerment (8), would fully open up both
nursing in general and gerontological nursing in particu-
lar as an appealing and autonomous profession. Accord-
ing to our findings, a major recognition and
implementation of nurses’ rights could be one of the
potential key factors that will boost the recruitment of
young nurses (2), retain nurses currently at work and in
general make healthcare professions more appealing.
However, the professional autonomy consists of both
rights and duties balanced with responsibilities. They are
never separated from each other.
The fourth issue was the current structure and concep-
tualisation of nurses’ rights in older people care. Based
on previous studies, the ethical and legal basis of nurses’
rights is well known (15, 18, 19, 29, 30); however, no
empirical knowledge about this exists. In our study, we
found that the focal issue of nurses’ rights was at the
conceptual level: nurses’ rights were inherently con-
nected with nurses’ gerontological expertise and
well-being at work in the twofold goal: on the one hand,
nurses’ rights supported their subjective professional
interest, on the other, their objective professional aim of
providing the best possible care. However, at the core is
the right to provide care, and not just a service, as one of
the participants aptly remarked. Nurses’ care oriented
approach to their rights contributes to the understanding
of the essence of their rights: rather than from the inter-
ests of individual workers or trade unions, the main idea
of nurses’ rights was drawn from professional ethics,
when nursing as an autonomous profession sought to
fulfil its role in the society – including its rights. From
this point of view, nurses’ rights are one of the key fac-
tors that create the conditions for a sustainable nursing
profession, not just in the specific context of older people
care, but also in all areas of nursing. In the future, there
is need to study nurses’ rights in relation to different
conceptual and theoretical frameworks of ethics and phi-
losophy as well as the emergence of rights throughout
history. Multidimensional study is required to deepen the
understanding of nurses’ rights.
An important challenge is to make nurses’ rights visible
and increase their awareness. It seems that that many par-
ticipants in this study were scarcely aware of their rights,
but as they pointed out, nurses themselves are also respon-
sible for familiarising rights and promoting them. The need
for a major awareness of nurse’s rights is also needed not
only among nurses, managers and educators, but also
patients and relatives. All stakeholders have their own
rights and duties, and current health care may highlight
the need to clarify them. When rights and duties that are
well formulated and highlighted in practice, they can pre-
vent misunderstandings or even legal issues concerning
the roles, but most of all they ensure ethically based
mutual interactions that foster higher quality of care.
Study limitations
Although the number of participants was appropriate for
the research method used, the results cannot be general-
ised. The interview questions were open-ended, allowing
participants’ to undertake an individual and inductive
approach to the research questions. In the future, more
structured research questions would provide more detailed
information on the specific nursing field. The weakness of
the integrating different interview methods was that the
systematic analysis of dynamic discussion during inter-
views was not possible (36, 54). However, the integration
of different interviews with the same data analysis enabled
the participation of all nurses willing to say something
about the research topic. Most of all the integration of dif-
ferent methods enabled to achieve more deepen under-
standing of the phenomenon (40). The data we collected
were well focused on the research question. This study
brought to light the multifaceted nature of rights, but was
© 2013 Nordic College of Caring Science
 Gerontological nurses’ rights 353

limited to the one field of nursing and to the nurses’ per-

sonal perspective. In the future, a multidimensional
knowledge framework, based on methodological triangu-
lation, would need to be developed for the various geron-
tological contexts, but also for other nursing fields.
Conclusions
The need for older people care services and gerontological
nursing expertise in the field of older people care is bound
to increase in the coming decades. Nurses’ rights are con-
nected to nurses’ professional expertise and well-being at
work, but as we observed in this study, nurses also linked
them to the aim and mission of their profession. Consid-
ered today’s global shortage of nurses linked to the diffi-
culty in the retention and recruitment of nurses especially
in older people care, nurses’ rights should be clearly identi-
fied and their awareness must be actively promoted in the
future. We believe that further insight into the multidi-
mensional nature of nurses’ rights in gerontological nurs-
ing, involving nursing education, and management in
older people care, will contribute to the active promotion
and recognition of nurses’ rights.
Author contributions
Ethical approval
Principles of research ethics were strictly observed
throughout the study. The research received administra-
tive approval by both of the primary care districts.
According to Finnish research regulation (The National
Advisory Board on Research Ethics 2002/2012) (55), this
type of study, involving only staff interviewing, does not
need approval from an official research ethics committee.
For purposes of data collection, however, informed con-
sent was obtained in compliance with ethical principles
(36). Participants were informed about the purpose of
the study and its voluntary nature. The interview data
were handled with confidentiality, so that nobody could
be identified in the research report. Interviews (n = 11)
were made anonymous by randomly running numbering
from 1 to 11, and due to the ethical reasons, the individ-
ual interview will not be identified on quotations. In
addition, we informed all participants that they were free
to leave the study at any time. All nurses gave their
written consent. To reduce potential subjective bias, all
the phases of the research process were discussed with
all the research group members, who thanks to their
multidisciplinary research expertise ensured a multidi-
mensional approach and understanding of the research
topic.

Mari Kangasniemi contributed to the study design and

data collection. Mari Kangasniemi, Kati Utriainen and Funding
Anna-Maija Pietil€a are responsible for data analysis and None.
manuscript writing.

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