Effects of Job Strain, Hospital Organizational Factors, and Individual Characteristics on Work-Related Disability among Nurses Principal investigator(s): Judith Shamian (Mount Sinai Hospital), Linda O’Brien-Pallas (University of Toronto) Co-investigator(s): Mickey Kerr, Mieke Koehoorn, Sheilah Hogg-Johnson (Institute for Work and Health); Harry Shannon (McMaster University), Donna Thomson (Mount Sinai Hospital), Linda Aiken, Julie Solchoski (University of Pennsylvania) Institution: Mount Sinai Hospital For more information about this study please contact the study team at e-mail: nru.info@utoronto.ca Results The study found the following: Almost half of nurses (44%) reported missing work due to illness at least once in the preceding three months. High emotional exhaustion was experienced by more than 36% of nurses surveyed. A substantial number of nurses reported experiencing musculoskeletal pain most or all of the time during the preceding week (16% for back pain and 17% for neck pain). Over the nine years examined, nurses had consistently higher injury claim rates compared to non-nurses. Musculoskeletal claims comprised the majority of hospital claims. Musculoskeletal injury rates dropped by only 39% for nurses, even though there was a 61% decrease in the musculoskeletal claim rate for non-nurses between 1990 and 1998. Hospital-level regression analyses revealed that the probability of a hospital having a high RN lost-time claim rate increased when RNs worked more than one hour of overtime per week. RNs who worked more than one hour of overtime also reported more occasions of sick time than average. The probability of a hospital having a high RN musculoskeletal lost-time claim rate decreased with improvements in nurses’ relations with physicians. At the same time, the probability of a hospital having a high RN musculoskeletal lost-time claim rate increased, with RNs reporting more occasions of sick time than average. While the majority of nurses ranked adequate staffing levels and reasonable workload as interventions that would improve their workplace health and safety, most did not believe that these variables were currently present or likely to happen in their hospital. To reduce injuries, nurses suggested improving the physical environment. Stakeholders also suggested improving the physical work environment, and offering education to nurses. To decrease stress levels, nurses most frequently suggested improving benefits, staffing levels and respect for nurses. Stakeholders also suggested increasing respect and improving benefits. Finally, to reduce absenteeism, nurses most often suggested improving benefits, while stakeholders offered improved benefits, changes in policy and reduced workload as potential solutions. Conclusions Injuries among nurses are costly to hospitals in terms of lost productivity, disruption to work flow and claims paid, as well as to nurses in terms of pain, stress and possible loss of employment. There are further implications for the retention of qualified nursing personnel in the workforce and the delivery of quality patient care. One of the key elements of the future recruitment and retention of the nursing workforce will be protection of the health of employees from disabling injuries. Recommendations Since nurse injury rates are high, they need to be reduced through workplace improvements. The study’s report makes specific recommendations for hospitals, WSIB, government and future research. Objectives This study examined how job strain (including staffing and workload indicators, organizational factors and individual nurse characteristics) affects the health of nurses. It did this by describing nurses’ health status, examining trends in injury compensation claims and determining factors contributing to claims. The study team also asked nurses to rank interventions aimed at improving their workplace health and safety, and gathered input from nurses and hospital stakeholders on factors related to nurse injuries, stress and absenteeism. The study addressed the following questions: 1) What is the general self-reported health status of nurses in acute care hospitals in Ontario, and what is the prevalence of self-reported health-related work absence, burnout, back pain and neck pain? 2) What are the main trends in WSIB claims for nurses in acute care hospitals in Ontario over the past nine years? 3) To what extent can individual and job strain factors explain variation in WSIB claims rates among participating hospitals? 4) What additional factors, from the staff nurses’ perspective and from an organizational perspective, should be included to develop effective workplace interventions to improve the health of nurses? Method This study included both quantitative and qualitative components. The quantitative aspects involved both cross-sectional and time-series analyses. Data from three 1998/9 Ontario data sources were linked together at the hospital-level into one database: a survey completed by acute-care nurses about their work life, the MoH hospital submissions, and WSIB lost-time claim rates. WSIB claim rates were examined for a nine-year period, from 1990/1 to 1998/9. The qualitative component involved analyses of data obtained from focus groups with nurses and interviews with hospital stakeholders at 10 Ontario hospitals. The study focused exclusively on acute care hospitals due to the availability of existing nurse survey and MoH data. Publications Bruce, S., Sale, J., Shamian, J., O'Brien-Pallas, L., and Thomson, D. (2002). “Musculoskeletal injuries, stress and absenteeism.” Canadian Nurse 98(9):12-17. Disclaimer