Abstract
BACKGROUND: The structure and organisation of Swedish municipal healthcare has been criticised for being fragmented and inefficient. Municipal chief nurses hold overall responsibility for patient safety within municipal healthcare, yet they lack authority over finances and staffing. Their role and responsibilities have not been examined in previous studies. The aim of this study was therefore to explore municipal chief nurses' experiences of obstacles and possibilities in decision-making to ensure patient safety in municipal healthcare. METHODS: A qualitative descriptive design was used. Data were collected through 15 individual semi-structured interviews with municipal chief nurses, and the results were analysed via qualitative content analysis. RESULTS: The data analysis yielded an overall theme: Navigating decision-making to ensure patient safety. This overall theme comprised three underlying categories: Unclear role and understanding of the assignment; Impact of organisational level on decision-making mandate; and Knowledge, competence, and experience in patient safety work. CONCLUSION: There was a lack of clarity regarding the municipal chief nurses' assignments in the municipal healthcare organisation. The participants felt that their organisations had insufficient knowledge of healthcare, and it became evident that organisational placement and their own competence affected their decision-making regarding healthcare and patient safety. Some noted that the organisation's shortcomings could be advantageous, providing them with a scope for action. Consequently, the informants had to navigate in the system and find alternative ways to ensure patient safety. CLINICAL TRIAL REGISTRATION: Not applicable.