The crisis is already here – the question is who has time to take care of it?

Paula Mulinari

For many healthcare workers, crisis is already an everyday reality – and it is getting worse. Not only because they encounter people during periods of crisis in their lives but also because their own working conditions are characterised by what could be called a permanent care crisis – a crisis that is highly gendered. It is mainly women who perform care work, both paid and unpaid, and it is their time that is being exhausted. What, according to the employees themselves, is needed to create temporal justice in healthcare? How can we organise a welfare system based on social resilience rather than gendered temporal inequality?

We cannot have any more cuts to healthcare. People are getting older and older, and that requires greater care; that’s how we have to think about it. Instead of cuts, we need to expand. Workloads must be reasonable. They talk about production, but when you work in healthcare, you can’t talk in terms of production – we don’t produce anything. That’s the first mistake people make when they talk about this.

(nurse)

An essay on not having the time and opportunities for greater temporal justice

Do you have a second? In the workplace, especially in the healthcare sector, the answer to that question is all too often no (Socialstyrelsen, 2023; Sveriges Radio, 2023; Ventovaara et al., 2024). Do you even have time to read this text because it (hopefully) seems interesting and not because you must? Some may find this question a little trivial as an introduction to a text about preparedness and resilience. Do we even have time to think about time when other major emergencies such as war, environmental disasters, economic crises and genocide are ever present? At the same time, time, or more specifically the lack of time, is an everyday challenge for many employees, not least women in the public sector.

Stories about ‘not having time for what is really important at work’ (Vision, 2023), as well as experiences of patients and users being exposed to risks (Inspektionen för vård och omsorg, 2023), are recurring themes in studies of the public sector. Individual and collective descriptions of insufficient time to take breaks or recover outside of work are also common (Aronsson, Astervik & Gustvasson, 2013; Selberg, Sandberg & Mulinari, 2021; Grip, 2025). These temporal inequalities pose significant challenges for welfare societies. In addition, these inequalities are gendered. Firstly, inequality between women and men is increasing both within and outside paid work. Secondly, long periods of sick leave, especially among women in the public sector (AFA Insurance, 2023), pose a challenge for individuals, their families and society at large. Thirdly, temporal inequalities make it more difficult to recruit workers in key areas of society such as healthcare. Finally, gendered temporal inequality makes it more difficult to seriously create a resilient healthcare and social care sector. This is because the employees at its core are already too few and overworked, both physically and emotionally, even before a crisis has struck.

In this essay, I will discuss how issues relating to the organisation of working hours are central to increasing resilience in healthcare. The essay is based on interviews conducted as part of a research project together with sociologist Rebecca Selberg and health scientist Magnus Sandberg, which aimed to study why nurses and social workers leave their jobs and what could make them stay.

Staff in healthcare and social care have proven to be incredibly resilient, but they pay a heavy price. The Swedish Social Insurance Agency’s report Analys av skillnader i nyttjande av sjukförsäkringen (Analysis of differences in the use of health insurance; 2025) shows that there are significant differences between women and men when it comes to sick leave. Women are more than twice as likely as men to take extended sick leave due to stress-related mental ill health. The report also shows that women still take greater responsibility for unpaid work in the home. Women’s higher risk of sick leave is explained by a combination of a lack of gender equality in their private lives and shortcomings in their organisational and social working environment. Women are also at greater risk of being on sick leave due to mental ill health. This is partly because women are more likely to work in so-called contact services within the welfare sector. It is in these professions that we see a marked increase in sick leave due to mental ill health. It is also the case that, regardless of profession, women are more than twice as likely as men to take sick leave due to stress-related mental ill health (Försäkringskassan, 2024).

In other words, women pay a high price for today’s working life – with their health, their time and their lives. In this sense, the crisis is already here. It is a welfare crisis but also a gender equality crisis. One could say that what is actually most ‘resilient’, in terms of resistance to pressure, is gender inequality in and outside working life (Acker, 2006).

This essay is based on the premise that it is employees themselves who, through their experience, know what needs to be done – both to enable people to work and to make them want to work in a key area of society. What are their visions for building a care sector that takes into account the needs of both patients and staff? How can we create a welfare sector that is sustainable? At a time when we are constantly fed dystopias – both current and future – I want to highlight the importance of thinking about alternative approaches to organising time. I believe the concept of temporal justice can help us to do just that.

Temporal inequality, temporal justice and crises

According to Robert E. Goodin (2010), we often understand equality as something that can be measured in monetary terms, for example inequality is often measured in terms of differences in income. However, control over one’s time and the freedom to use it as one wishes are crucial aspects of democracy, he argues (2010). Unequal distribution of time shapes people’s everyday lives and futures, affects their bodies, health and finances, and, not least, fundamentally affects the possibilities for creating a more equal society. Achieving temporal justice not only means a more equal distribution of time but also changing how people’s time is valued, so that some people’s time (and thus work) is not seen as more important than that of others. In her book The Problem with Work: Feminism, Marxism, Antiwork Politics, and Postwork Imaginaries (2011), Kathy Weeks emphasises that time is a central dimension of power, especially in relation to work, reproduction and the possibility of living a meaningful life. For Weeks, time is not just something we have or lack – it is something that is shaped, valued and controlled politically. Weeks argues that one problem in today’s society is that working hours function as a normative framework: being ‘busy’ with work is seen as virtuous, while leisure time is often viewed with suspicion – especially if it is not filled with something considered ‘meaningful’. Weeks emphasises that, from a gender equality perspective, the demand for better working conditions needs to be complemented by demands for less paid work, not more. Today, however, research shows that the opposite development is occurring: paid work is spilling over into people’s time outside work, meaning that more and more of people’s time is tied up in paid work (Grip, 2025). Meanwhile, more and more wage earners are finding it difficult to balance their lives, especially single mothers, known as the ‘working poor’ (Carlén & de los Reyes, 2024). Weeks believes that being able to imagine other ways of relating to time is essential. Thinking about time from a utopian perspective should therefore not be seen as dreaming, she argues, but rather as something that captures the problems that exist in today’s working life and imagining how things could be different.

With regard to work in healthcare, several researchers have highlighted that care is a practice that is difficult to define in terms of the clock time that usually governs work (Hämäläinen et al., 2024; Håkansson, 2024; Palmqvist, 2020). Karen Davies (1994), for example, developed the concept of ‘process time’ to highlight those aspects of care work that cannot be captured by linear, standardised clock time. Process time is instead non-linear, context-bound and difficult to schedule: comprising simultaneous events, fluid boundaries and waiting. It differs from ‘task-oriented time’ in that it emphasises how work is embedded in social relationships. Lack of time and the invisibility of care fundamentally reflect what philosopher Nancy Fraser refers to as the ‘crises of care’ (2016). Fraser argues that capitalist societies create a ‘crisis of care’ through their dependence on socially reproductive work, while at the same time undermining the conditions that make this work possible. This results in a crisis in the reproductive sphere, i.e. the sphere, institutions and relationships required to care for people (e.g. caring for children, older adults and the sick, housework, emotional support and education). This crisis can take many forms, from those working in care professions being forced to do more in less time and with fewer staff, to cuts in public services and more and more reproductive work being placed on individuals rather than collective institutions.

In the Nordic countries, austerity policies are not a temporary measure but a permanent state of affairs. While temporary austerity measures aim to deal with short-term crises, permanent austerity is a response to a ‘chronic’ crisis – one that is politically manufactured (Seymour, 2014). Permanent austerity means that concepts such as cost-effectiveness, production and outcomes permeate the healthcare process and influence values and understanding of what healthcare is. In Against Austerity, Seymour argues that austerity is not a necessary response to economic crises but rather an ideological strategy aimed at restructuring the economy to benefit capital at the expense of the working class. He argues that the economic crisis was used as a pretext to implement reforms and privatisations (see Lapidus in this publication), which in various ways undermine the Welfare state. Perhaps the key is not to think in terms of one crisis but rather several interconnected ones. The concept of a ‘polycrisis’ reflects the fact that not only are we living in a time of multiple crises but that they are intertwined and mutually reinforcing. Economic crises, social crises and geopolitical crises cannot be understood in isolation but rather must be understood as interwoven. A major challenge is that welfare institutions, the workplaces where many women work, are often expected to respond to multiple social problems simultaneously. It is also the case that women are often the hardest hit by crises (Khosla et al., 2024). The question is therefore whether the healthcare sector is in a permanent crisis, with employees constantly forced to compensate for this through their work.

A public sector in transition – a permanent crisis for employees

Researchers, inspired in part by Nancy Fraser (2016), are increasingly discussing whether we are in a social care crisis, even in the Nordic welfare states (Hansen et al., 2022; Selberg & Mulinari, 2022; Wrede, 2008). These countries have previously been described as women-friendly welfare states, but according to several studies, the trend towards neoliberal governance and business-inspired management models has worsened conditions for workers in social care (Sundsbø et al., 2023). In the book A Care Crisis in the Nordic Welfare States? Care Work, Gender Equality and Welfare State Sustainability, authors Hansen, Dahl and Horn (2022) argue that there is a specific care crisis in the Nordic context. The care crisis, they argue, is evident in what have been identified as the most gender-equal welfare models. The authors highlight extensive underfunding of the care sector, which makes it increasingly difficult to recruit and retain care staff. Changes in the governance of social care, with more detailed control and new forms of management, have resulted in increased workloads and stress among staff. This, in turn, affects care quality and makes recruitment more difficult. The authors of the book note that the care crisis is characterised by a lack of resources, deteriorating quality, poor working conditions and insufficient time for care workers to take care of themselves and others. The crisis is also clearly gendered, as women make up the majority of both formal and informal carers. The resistance of care to being subsumed into the logic of economics, especially its physical and relational dimensions, makes it a field where economics and politics are in constant conflict (Tronto, 2014).

The dismantling of the welfare state has meant that reproductive work has intensified (Ulmanen, 2015), while demands for profitability and capacity to work have increased and stress in working life has grown. A painful example of how this equation affects people is that while the life expectancy of the population as a whole is increasing (at least for those whose life expectancy can be calculated), the life expectancy of working-class women is decreasing (Klepke, 2018). Temporal inequalities are also clearly shaped by a labour market in which racialised workers are more likely to have precarious employment (Mulinari, 2024). The working class in Sweden today is increasingly made up of racialised workers (Neergaard, 2021). Racialisation is a process in which people are attributed particular characteristics or treated in a certain way, often based on their skin colour and perceptions of race. Within medical care and nursing, many of these people are women, although now they increasingly include men. The temporal inequality within the medical- and nursing sector is therefore not only gendred but also racialised.

An important change that has affected working conditions in the public sector is the implementation of New Public Management (NPM). A significant body of research has identified the introduction of NPM as a key reason for increased workloads and growing dissatisfaction among welfare workers (Mustosmäki et al., 2020). Within medical care and nursing, NPM has shifted focus from patients to administration and budget constraints and from employees to managers. It has also placed greater emphasis on organisational professionalism at the expense of occupational professionalism (Selberg & Mulinari, 2022).

The concept of resilience, discussed in the introduction, has many different meanings. In healthcare, for example, it can mean the capacity to manage crises, adapt to change and recover from stress. Resilience is thus seen as a key factor for sustainability and patient safety in times of increasing demands, staff shortages and societal crises – not least during the COVID-19 pandemic. One problem that became apparent during the COVID-19 pandemic is that resilience often depends on staff flexibility, loyalty and willingness to push personal boundaries (Montgomery et al., 2024). This can lead to resilience being romanticised, obscuring the actual costs for those working on the frontline – especially women, who make up the majority of care staff globally. As much research showed during the pandemic, many workers in healthcare were expected to compensate for systemic failures – by working overtime, being available during crises and coping with increased demands, despite insufficient resources (Abay, 2024; Wall & Bergman, 2021). In the short term, this may contribute to maintaining a ‘functioning system’, but in the long term, it risks undermining staff wellbeing, contributing to burnout and exacerbating staff turnover.

The Swedish Association of Local Authorities and Regions (SALAR) estimates that the need for staff in care for older adults in Sweden will increase by 66,000 people by 2033 as a consequence of the ageing population (Sveriges Kommuner och Regioner, 2023). SALAR argues that an increase in full-time employment is one way to meet this need, as many people in the sector currently work part time. At the same time, research (see, for example, Grip, 2025) shows that full-time work often means increased time pressure, difficulties in balancing paid and unpaid work and increased demands on employees’ flexibility. Many people work part time in order to balance their lives. Research also shows that even those who formally work part time often work more than part time in practice, as a result of work having intensified, with much of it being unpaid to ‘keep up’ with what is expected (Selberg, Sandberg & Mulinari, 2021). These temporal inequalities in turn lead to reduced resilience in healthcare. It becomes more difficult to manage crises and recover from them when the central resource – employees – is exhausted even before a crisis has struck. During the pandemic, it became common in many countries to applaud healthcare workers. The OECD report Beyond Applause? Improving Working Conditions in Long-Term Care (2023) emphasises the need to go beyond applause and nice words and seriously address conditions for employees. It highlights that even before the pandemic, staff were working under very poor conditions. The need for labour, for example in care for older adults, is a global challenge: people want to work in a sector in which wages are low and working conditions poor. Applause is all well and good, but what is needed, according to the OECD, is respect : recognition, greater control over work, more resources, better pay, new technology, improved working conditions and training initiatives. One could add that what is also needed are other ways of organising working time. Suggestions for how this can be done are discussed below.

Collectivise the view of time

Time has long been at the centre of feminist theory and politics. The unequal distribution of time between paid and unpaid work is a fundamental aspect of gender inequality and affects all areas of life. The eight-hour working day is an institution that is over a hundred years old. During these hundred years, Swedish workers have not succeeded in shortening the working day, despite public debate and a number of attempts. Instead, women (especially working-class women) often work part time to allow them to combine paid work with unpaid care work for older adults and children. A report by the Swedish Association of Health Professionals from 2025 shows that 34% of its members work part time, of whom 57% state that they do so because they need rest to recover (Vårdförbundet, 2025). Among municipal workers, nearly six out of ten employees work part time (Kommunal, 2022).

One of the nurses we interviewed in our research project describes the difficulties of working full time:

I won’t be able to stay on as a nurse until I retire, I already know that. I work part time because of the enormous workload in the department. It’s impossible to work full time, you can’t cope, you’re constantly tired. Even so, I never have enough time at work. I don’t have time for my patients. I feel like I’m rushing in and out of patients’ rooms, and even though I want to sit down and talk to them about their situation or just ask if they want a cup of coffee, there’s no time for that.

One way to deal with this time conflict is to work part time, and many of the nurses we interviewed did just that, allowing them to act in line with what they themselves perceived as professional and ethical care. Another nurse describes the same scenario, saying that she does not see herself being able to work as a midwife until she retires:

Maybe I can manage a few more years, but in the long run – I won’t be working as a midwife or nurse when I retire. I’m absolutely certain of that. And it’s sad, because I’m really committed and love my job. I enjoy it, and I know I’m making a contribution, but under the current circumstances, staying on is not an option.

Interviewer: What could make you stay?

Half the workload and better pay [laughs]. Then I would definitely stay.

Nurses are left alone to deal with ‘lean organisations’ by working part time, planning for early retirement and limiting their free time. A central tension in care work thus arises from the different time logics that characterise care organisations: on the one hand, the logic of care that puts the patient at the centre and, on the other hand, a logic characterised by efficiency and ‘lean management’ (Keisu, Öhman & Enberg, 2016). Providing care involves a web of different actors but also a web of time, which one might call a ‘web of care time’. The interviews show that organisations operate on the assumption that employees will give of their time, a process of organisational time appropriation:

We were often called on: they wanted us to come in early if we had an evening shift, stay late if we had worked during the day [or] take an extra shift at the weekend because someone was ill. So even if I thought I had a day off, I was still contacted by work, and just the thought of putting colleagues in a position I wouldn’t want to be in myself, even if you say no, it’s still stressful.

The permanent understaffing is left to individual workers to resolve. It also obscures the fact that working time is collective time. Nurses’ working time is intertwined with the time of others: colleagues, patients, relatives. The temporal contradiction that arises in the workplace is thus also based on the organisational perception of time as something individual and separate, when in fact it is a relational and collective phenomenon. The problem is that neither workers’ nor patients’ time is at the centre of organisational logic. Highlighting the discrepancy between the time work actually takes and the time it is considered to take can therefore be seen as a way of increasing resilience in medical care and nursing, enabling patients, users, employees and their relatives to perform and receive the care they need. The struggle for time is in fact a struggle for a true utopia, where care work is allowed to take time and where time is recognised as a collective concern. For the public sector to change, it is necessary to recognise that care must be allowed to take time. Public sector employees (and indeed all workers) should have the opportunity, and organisations should have the resources, to devote time to care. Not only to perform basic care, but also, for example, to drink coffee with a patient or relative, listen to a patient’s story, reassure a new nurse, build relationships with other staff, talk to colleagues, reflect on the situation at work, rest, adapt and recover.

Among the workers interviewed, there were two suggestions on how this could be done: to give those working in the public sector more influence over operations and to allow care to take both time and money. Let those who provide care also have a say in how it is organised:

If I could suggest something... If it was up to me, I would get rid of all the managers and replace them with people who have worked on the floor themselves and know what the reality is like.

One of the nurses posed the key question: “What if we, the workers, took over?” What if? What would increased democratic control over public healthcare look like, beyond simply replacing managers or leadership styles? Many felt that it was nurses’ knowledge of the workplace that should shape organisational decisions and structures around social care work. The nurses interviewed felt strongly that their workplaces were a far cry from this ideal. Instead, they described a gap between their crucial role in providing care and their marginalised role in its organisation. Many expressed frustration that social care work – i.e. tasks that focus on improving or maintaining patients’ physical and/or emotional well-being – is neither recognised nor valued:

Everything revolves around money. But healthcare is — I mean, healthcare shouldn’t be about saving money. Healthcare should be about providing good care within reasonable limits. It’s political too, on so many levels, even on a personal level (among managers), but also higher up. There needs to be change [everywhere]. We’ve had enough.

While some of the nurses expressed that managerial positions should be eliminated entirely, others believed that managers and politicians should be replaced by people who genuinely care. It could be said that some formulated a utopian vision of a workplace governed by the workers themselves, while others imagined a real utopia in which managers still existed but with different priorities. Our material shows that many nurses feel that the problem is not that managers and politicians do not know what it is like on the floor, but that they do not want to know – and that they do not care.

Interviewer: If there is something you want to complain about, do you dare to do so?

Yes, I think so, absolutely, but then you always get these shitty answers, politicians’ answers, like: “We’ll look into it,” or “Yes, we know we have to do something about this,” and then nothing happens. ... We have a noticeboard on which you can write a note with a suggestion, and then they collect them and read them, but nothing ever happens with our suggestions. It feels like a way for them to avoid us complaining directly to them; instead, we have to write it down on a note, and then we’re supposed to be satisfied.

The problem, according to many nurses, was that no one listened to them. A central theme is the gap between nurses and managers, in terms of both means and goals. Nurses often emphasised that managers lack the knowledge required to organise daily work in an organisation for which the primary task is to provide care. According to many interviewees, this poses a direct threat to both patients and staff. Our material shows that healthcare staff rarely participate in the key decisions made by managers. Instead, they are forced to participate in meaningless activities that diminish their competence.

Allow social care to be visible and take time

In the opening quote, one of the interviewed nurses makes it clear that they do not produce anything, and that the first mistake made when talking about healthcare is to view it as a production unit rather than a place where people are provided care and treatment. When managers prioritise finances over care, nurses feel that they lack the time resources needed to provide care. One of the nurses highlighted how these priorities shape everyday working life:

The biggest problem is resources. For example, in our department, we are only allowed to spend ten per cent of our time meeting with patients who have been discharged, which means that we cannot do proper follow-ups... we cannot do what is actually important for patients. We are expected to live up to something that does not exist. There are no resources to allow us to live up to the goals that management sets for us. I think people think differently the higher up you go. Maybe they think about money: money is what’s important, it’s what controls everything. It’s about the budget. We get new managers and new demands, new demands for cutbacks, new budgets, and they refer to them all the time. They say: “we really appreciate what you’ve done, but we don’t have the resources for it”. It’s all about money. And I’m so tired of it, everything being about money. Healthcare is about healthcare, not about saving money. Healthcare should be about providing care, but instead they are cutting back on healthcare and on healthcare workers’ salaries. The whole idea is wrong.

As we have already described, austerity measures in the Nordic countries are not a temporary phenomenon. Permanent austerity means that much of the work that is part of nurses’ everyday lives becomes invisible – because it cannot be measured. What nurses themselves identify as important thus becomes unimportant to the organisation, forcing them to either do the work anyway (increasing their exploitation) or refrain from doing it (increasing feelings of ethical stress and reducing pride in their work).

When does a crisis become a crisis?

For many workers in medical care and nursing, the crisis is already an everyday reality. Not only because they encounter people in moments of crisis in their lives, but also because their own working conditions are characterised by what Nancy Fraser has called ‘a permanent crisis of care’ – a crisis that is highly gendered (2016). It is mainly women who perform social care work, both paid and unpaid, and it is their time that is being exhausted. The crisis is therefore already here – and it is deepening. To build a resilient healthcare system, gender equality work needs to be strengthened. This means, among other things, seriously rethinking how working hours are organised. Today, a lack of time is wearing down staff, both physically and emotionally. That is why the issue of crisis and resilience is also a gender equality issue. A society where women’s work continues to be undervalued, underpaid and, at the same time, time-consuming will find it more difficult to cope with crises. At the same time, the responsibility for managing the crisis is placed on these very women – who often cannot manage their own lives. Temporal justice can offer a path towards more sustainable welfare. It is about taking the ongoing crisis seriously – as the workers themselves express it. They are not just calling for resources, but pointing to something deeper: the need for time to do their work, time to recover and the resources to provide care with the compassion and professionalism required. Fundamentally, their testimonies raise a bigger question: Who should decide the content of work and the time it requires? What rationales should govern?

There is a tendency to view a crisis as something that will happen in the future – a state of emergency for which we can prepare. But in healthcare, crisis is already part of everyday life. It is not always visible in the headlines, but it is noticeable in the fact that staff do not have time to do their work as they would like, that patients do not receive the care they need and that relatives are having to take on increasing responsibility. We must start thinking of crises not just as sudden events but as protracted conditions. This applies, of course, to the climate crisis, but also to the care crisis. Workers are already carrying the resilience of the healthcare system on their shoulders – at the expense of their bodies, relationships and dreams for the future. If we are serious about building a sustainable healthcare system, we must listen to them. Applause does not create resilience. What is needed is time, resources and influence – giving greater control over one’s own life. This is crucial not only for gender equality, but also for maintaining a healthcare system that is not based on women’s unpaid overtime but on collective social responsibility.

In Michael Ende’s novel Momo (1980), the grey time thieves hunt people’s time. The grey gentlemen justify their constant theft of time with promises of increased efficiency and wealth. People are expected to gain more time by saving it – but ‘time is life,’ writes Ende, and the more you save, the less you have left and the poorer you become. Ende’s book about the girl Momo and her companion, the high-tech but slow turtle Cassiopeia, was published in 1973 and can be read as an early critique of the dehumanising nature of capitalism. It shows how increased demands for efficiency and productivity crowd out everything that is not considered paid labour, relegating other activities to meaninglessness – because they ‘only’ take time. Momo ends happily, when the four friends finally defeat the grey gentlemen, Ende writes:

"And the doctors had time to devote themselves to each patient in peace and quiet. The workers could work at a calm pace with love [...] Everyone could take exactly as much time for everything as they needed or wanted, because now there was once again plenty of it to go around."

(Ende 2003: 308)

The question is: What would we see if working hours in healthcare were actually changed?
What synergies would then become possible? In many ways, inequality is such a normalised crisis that it is rarely referred to as such. But for healthcare workers – and for all of us who at some point require care – the care crisis is a reality that is paid for with time and lives. At a time when resources are diminishing and needs are growing, the workload for staff and responsibility for relatives are increasing. It is an everyday crisis that must be taken more seriously. Otherwise, we risk continuing to place the responsibility for resilience on individuals – instead of building systems that actually support people in crisis and make it possible to meet them together.

Improving conditions for temporal justice is one of the major gender equality issues of our time.
If we seriously want a resilient welfare sector, we must also take the issue of gender equality more seriously. Temporal inequalities in the welfare sector are clearly gendered, and racialised and it is primarily women who are currently forced to juggle the care crisis with their own time, health and bodies.
We need new understandings of time in working life, understandings that recognise and allow time for care and recognise time as something collective and relational within the welfare sector. Developing and exploring new understandings and distributions of time would not only strengthen the resilience of welfare but also give people greater opportunities to live sustainable lives – both at work and outside of work.

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