The impact of priority-setting in home-based palliative services: a qualitative study of Norwegian nurses

Abstract Background Home-based palliative care is increasingly emphasized as a way to support patient preferences for living and dying at home. However, municipal health services deliver such care under conditions of limited time, staffing shortages and growing case complexity. In this context, nurses’ everyday priority-setting plays a central role in shaping care quality, yet little is known about how prioritization unfolds in practice and with what consequences. Methods This qualitative exploratory study used focus group interviews to explore how Norwegian homecare nurses strive to safeguard home-dwelling patients requiring palliative care, and how prioritizations under prevailing organizational conditions shape care quality. Data were generated through three focus group interviews with 15 registered nurses working in home-based care across three Norwegian municipalities. Participants had experience caring for patients in the palliative phase. Data were analyzed using reflexive thematic analysis. Results Three interrelated themes were identified. First, time pressure eroded palliative care quality by narrowing nursing practice toward task completion at the expense of presence, observation and relational support, undermining safety and continuity. Second, prioritization under constrained conditions generated ethical and emotional strain, as nurses experienced moral distress when unable to deliver care aligned with professional values. Third, prioritizing patients at the end of life had repercussions for other service users and colleagues, as time and competence were redistributed, contributing to uneven care quality and internal tensions. Conclusions Priority-setting emerged as a key mechanism through which home-based palliative care was both safeguarded and constrained. When prioritization relies primarily on individual nurses’ judgement under conditions of scarcity, care quality becomes clinician-dependent and fragile, producing ethical spillover effects across services. Stronger organizational support and shared responsibility for everyday prioritization are needed to promote equitable care quality and protect nurses’ professional wellbeing.