In this study, the experiences of the interviewed RNs and ENs varied, but taken together these experiences are extensive and also cover different health care units. This variation and range of experiences must be regarded a strength of the study, since they provide an understanding of the content of care. The interview situations were characterized by openness, as well as the nurses' willingness and interest in talking about their experiences, which facilitated understanding the interviewees. On the other hand people in the interview situation can choose to say what they want or feel to say at the moment, which could be seen as a limitation of the interview method [44
]. Therefore attempting was made to control the interviews in order to gain answers to the questions still with maintenance of openness.
Consequently, the content of the interviews is rich. The interviewer has personal experience working as a nurse, both on day and night shifts, and was thus able to better understand the nurses' situation, which facilitated the interview situation considerably. This could also be seen as a weakness of the study, because some information could have been taken for granted and not penetrated further. In addition, the analysis may have been affected by the researcher's prior understanding of the work and competence needs of RNs and ENs. However, during the analysis process, the awareness of prior understanding was constantly present to minimize this risk. The analysis was validated by the authors' discussion of the findings during manuscript preparations [44
The result of the present study shows that the night staff experiences its work as being largely invisible and unknown and not always appreciated by the day staff, although nursing care continues 24 hours a day. Many regard night work as less qualified [50
] and surrounded with myths [34
]. According to the interviewees, these myths about night work, for example, that the night staff sleeps on duty, still exist among day staff and patients. The day staff's false notions about working at night, found in this study, were also revealed in an earlier study [51
]. Health care has been developing with regard to technical, medical as well as organizational matters [23
], therefore the night work is increasingly beginning to resemble the day work. In this study, it was shown that the duties at night have to be performed under difficult conditions, such as working in silence with the lights dimmed, and making decisions when fatigue threatens. According to the night staff, the main goals of the work are:
• To provide the patients with rest to enable them to restore their strength for healing and treatment.
• To provide qualified care in which the RN has the medical responsibility for independent assessments.
• To put the ward in order for daytime activities and to hand it over in the best possible state.
Although the night work assignments are, according to the night staff, similar to those in the daytime, they are carried out by fewer staff. In this study, it was found that RNs and ENs appreciated their team work and relied on each other's competences and responsibilities to carry out the tasks that need to be done. This result contradicts the results from a study of nurses' roles in the daytime, where it was found that the distinction between the work roles of ENs and RNs was unclear [16
The manning of the wards at night has increased over time at the hospital studied, despite cost savings and periodic employment freezes. However, does this mean the patients' secure and safe medical care has also increased or has the work load decreased? A previous study showed a relation between increased manning and decreased complications, as well as instances of death [54
]. However, the results of this study indicate no such positive relation between more nurses and either increased care quality or decreased complications. Nevertheless, the results point to the importance of manning with regard to the patients' health status, as well as nursing and caring needs. The increased work load in combination with low manning at night could affect the nurses' experiences of their own health, which has been shown in a study about the staff's own health experiences during downsizing [26
]. That study revealed that nurses working alone at night felt insecure, because they did not have any colleagues to consult in situations where they had to make assessments and decisions. According to Hertting and explicit colleagues, more substantial demands were put on the nurses at the same time as new methods of treatments were being introduced, and increasingly more advanced nursing care was being required by the patients. The results of this study indicate that work duties had been added over time, partly to occupy the night staff (RNs as well as ENs) and partly to facilitate the duties of the day staff. The higher proportion of service tasks at night has been shown in an earlier study [29
]. Many of the service tasks performed at night are of the kind that should be cheaper to execute during the daytime, or by less qualified, thus less expensive, nursing staff at night. However, the night staff not only carried out service tasks for the day staff, but also prepared patients for surgery or treatment. This kind of preparation work was also included in a description of night watch activities at a post-anesthesia care unit [55
As shown in the results, the RNs make medical assessments about whether or not to call the doctor or carry out any other treatments. This medical responsibility becomes particularly emphasized during the night when the RNs do not have a colleague close by to consult. The physician who RNs may need to consult when a patient's health status changes can be an unfamiliar doctor with whom the RN has no working relationship. A negative or intimidating relationship between a physician and a nurse has been found to be a risk factor for the safe and secure care of patients [56
]. It is known that the quality of nurse-physician relationships affects the job satisfaction of nurses [57
]. Does this imply that the lack of a satisfactory working relationship also means that the patients are placed in hazardous situations?
The increase in medical development and nursing demands, mentioned above, further magnifies the responsibility of having to make correct medical assessments. This additional responsibility should influence nursing education. It has been argued that a preparation program for the care of the aging population also needs to include the requirements of night shift work [58
]. Consequently, the Swedish descriptions of RNs' competence [8
] have to be questioned with regard to them not making any distinction between day and night work.
Nurses working at night also have the responsibility of informing new staff members, as well as judging their actual competence necessary to carry out the collaborative night work. The duties incumbent upon the RNs at night differ from the Swedish descriptions of RNs required competence [8
]. Based on a holistic and ethical attitude, RNs are expected to have theoretical and practical nursing competences (nursing and caring), as well as nursing research, teaching and leadership skills. However, in this study, the night nurses' descriptions only include images of nursing and caring, and, apart from some information given to relatives, the RNs' pedagogical function is lacking in the descriptions. A previous Swedish study revealed that RNs do not provide information to patients at night [30
]. Furthermore, they do not devote themselves to research, development and preventive work, or staff management. It could be argued that not using their entire range of competences might jeopardize RNs' nursing skills and cause difficulties when they change from night to daytime work. This kind of self-imposed competence limitation could be one reason for the survival of the night nursing myths.