188 M. Ha¨ ggstro¨m et al. Both the ICU nurses and the ward nurses felt that the decisions for the patient needed to be well documented, and that the physician had to write the prescriptions so that the ward nurses could more easily take control. Written nursing documentation was an important tool in this situation. There were differences in the hospitals’ documentation systems. One of the hospitals had a single overall system for the hospital, which enabled the ward nurses to be able to read about their patients in ICU. Ward nurses prepared by reading the patients’ medical story before receiving a new patient in the ICU. By doing this, the nurses could more easily achieve control. This preparation was not performed at the other hospital; the ward nurses were not given the oppor- tunity to read the ICU journals and, therefore, knew little about the patients. If they were receiving an ICU patient with extended care needs, the ward nurses expressed that one important tool for them was an adequate number of staff. This was vital for the both patients’ security as well as for nurses’ safety. The informational tools were also communicated in a verbal report between the ICU nurse and the ward nurse. The ward nurses often thought that the verbal reports were too long and extensive and often possessed a medical focus that did not always seem needed. The ICU nurses were driven by a need to hand over all the information. They felt that the ward nurses needed to know the many things that occurred during the patients’ ICU care. The ICU nurses partly used the same language when reporting to other ICU nurses; sometimes, it was difficult for them to change their way of communication. I think that we much too often speak our medical language when reporting to the ward nurses. (ICU nurse) Relying on or questioning ones own ability. It was important that the ICU and ward nurses felt confident in their abilities to care for the patients. Most participants in the study expressed a wish to gain control, which was often connected to their feelings of their competence in caring for the patients. In the hospitals, there were differences in how ward nurses experienced unfamiliar things in the care of their patients. If educational support was provided for the ward nurses, feelings of trust were visible, and they relied on their competence more easily. With support and education, the ward nurses felt curious about developed care and were also proud of their competence. I think that our ward has quite an intense educational approach! . . . Our chief is providing time for education, and you can really feel that . . . . We think that new things are nice to see, and our attitude is that developing is good! This is an environment that encourages knowledge. (Ward nurse) If the ward nurses sensed a lack of control, their feelings of unsafeness and insecurity could aggravate the collaboration between the departments, and if so, the gap remained. Hence, if this support and an educational environment were absent, feelings of insecurity emerged if a patient from ICU needed new and unusual care. This insecurity and frustra- tion made the collaboration with the ICU nurses more difficult, since the ward nurses were less willing to receive such a patient from the ICU. The ward nurses sometimes felt frustration about differences in their authority compared with the ICU nurses, and felt insecurity when they were told to do things that they did not usually do. These things could, for example, be that they were told to take away supplements from the patient, or perform controls that they did not usually do. I can be confused when I am getting a patient from the ICU, there is a nurse just like me that is reporting, but we can do different kinds of things, they are doing things that for us must be pre- scribed by an physician . . . they are working so much more independently . . . I mean, what if we are doing something wrong! (Ward nurse) Nurses often leaned on collegial support when they were confronted with new situations. If their colleagues’ competence was not enough support, they questioned their own competency in the ward and feelings of insecurity emerged. Occasionally, the ward nurses went to visit the nurses at the ICU and learn in advance if there were unusual elements of care that would need to be handled. One of the nurses’ suggestions for handling the negative differ- ences concerned the nurses’ competence, was that the ward nurses should be given opportunities to visit the ICU and work with an ICU nurse for a few days. This experience could improve their under- standing of each other and, above all, the patients’ experience in the ICU transitional journey. Seeking assurance of the patients’ ability. Both the ICU nurses and the ward nurses sought assurance that the patients were able to handle the altered level of care, as this was of great importance for the nurses’ feelings of control and competence. The nurses wished that the level of care should be adjusted to the patients needs. They wanted to be certain that the patients’ recoveries were sufficient for the