Work-Related Disability in Canadian Nurses

Characteristics of Occupational Injuries among Spanish Nursing Workers

Introduction: Nursing professionals face a multitude of daily occupational hazards that can cause occupational accidents. AIM: The objective of this work is to analyze the personal variables included in official accident reports, to evaluate their influence on occupational accidents suffered by nursing and nursing assistant professionals. Methodology: A total of 187,821 occupational accidents recorded in Spain from 2011 to 2019 were analyzed in the sector using contingency tables, chi-square, and corrected standardized residuals. Results: The results showed that the older the professional, the probability that once the accident had occurred, its severity would be more serious. Regarding gender, men are more likely to suffer more serious accidents compared to accidents registered by women. Results about the length of service and nationality did not reach statistical significance in the group of accidents analyzed. Conclusions: The planning of preventive measures must be adapted to the profiles of the workers in the most vulnerable sector.

Stress and Coping in Nurses Taking Care of People Living with HIV in Hunan, China: A Descriptive Qualitative Study

BACKGROUND/PURPOSE

Nurses engaged in the care of people living with HIV (PLWH) are commonly exposed to workplace stress. This study aimed to explore the stress experiences and coping strategies among nurses taking care of PLWH in China.

METHODS

Nurses were recruited from the AIDS department of a public, general, third-grade class-A hospital, which has the largest HIV care department in the Hunan Province of China. Thirty-three nurses working in the AIDS Department were recruited in this qualitative study. Eight nurses participated in a focus group and 25 nurses underwent in-depth individual interviews aimed at characterizing the nurse's feelings and struggles with stress during caregiving for PLWH. The interviews were audio-recorded, transcribed verbatim, anonymized, and imported into NVivo 8.0 software. The data were coded and subjected to thematic analysis.

RESULTS

Concerns about occupational exposure, heavy workload, mental health problems and risk behaviors of patients, and discrimination towards nurses caring for PLWH were the four main sources of stress. The negative impact of stress included problems with emotion regulation, somatic health and sleep, and work performance. Some participants also reported a positive impact of work stress on their mental health. Using personality strengths, problem-solving, help-seeking, concealing and avoiding/suppression were common coping strategies employed by nurses caring for PLWH.

CONCLUSION

Our findings help characterize the stress experienced by nurses caring for PLWH in the Chinese cultural context, and may inform specific interventions to help manage stress and promote mental health of nurses.

Stress Management Interventions for Nurses: Critical Literature Review

Background: The nursing literature contains numerous studies on stress management interventions for nurses, but their overall levels of evidence remain unclear. Holistic nurses use best-available evidence to guide practice with self-care interventions. Ongoing discovery of knowledge, dissemination of research findings, and evidence-based practice are the foundation of specialized practice in holistic nursing. This literature review aimed to identify the current level of evidence for stress management interventions for nurses. Method: A systematic search and review of the literature was used to summarize existing research related to stress management interventions for nurses and recommend directions for future research and practice. Results: Ninety articles met the inclusion criteria for this study and were categorized and analyzed for scientific rigor. Various stress management interventions for nurses have been investigated, most of which are aimed at treatment of the individual versus the environment. Contemporary studies only moderately meet the identified standards of research design. Issues identified include lack of randomized controlled trials, little use of common measurement instruments across studies, and paucity of investigations regarding organizational strategies to reduce nurses' stress. Conclusion: Future research is indicated to include well-designed randomized controlled trials, standardized measurement tools, and more emphasis on interventions aimed at the environment.

The association between long working hours and work-related musculoskeletal symptoms of Korean wage workers: data from the fourth Korean working conditions survey (a cross-sectional study)

Background

It has been reported that long working hours are hazardous to the workers’ health. Especially, work-related musculoskeletal disorders (WMSDs) have been considered as one of the significant health issues in workplace. The objective of this study was to identify the association between long working hours and work-related musculoskeletal symptoms.

Methods

The analysis was conducted using data from the Fourth Korean Working Conditions Survey (KWCS). Subjects of this study were 24,783 wage workers and divided into three groups according to the weekly working hours, which were ≤ 40, 41–52 and > 52 h. The relationship between long working hours and work-related musculoskeletal symptoms was analyzed by multivariate logistic regression method after adjusting for general, occupational characteristics including specific working motions or postures and psychosocial factors.

Results

Approximately 18.4% of subjects worked more than 52 h per week and 26.4 and 16.4% of male subjects and 33.0 and 23.4% of female subjects experienced work-related upper and lower limb pains, respectively, over the last 12 months. Moreover, the prevalence of upper and lower limb pain was increased in both genders as the weekly working hours increased. The odds ratios (ORs) of upper limb pain for those working 41–52 h and more than 52 h per week when adjusted for general, occupational characteristics including specific motions or postures and psychosocial factors were 1.36 and 1.40 for male workers and 1.26 and 1.66 for female workers compared to the reference group, respectively. Furthermore, ORs of lower limb pain for the same weekly working hour groups were 1.26 and 1.47 for male workers and 1.20 and 1.47 for female workers, respectively.

Conclusions

Long working hours were significantly related to work-related musculoskeletal symptoms in Korean wage workers and appropriate interventions should be implemented to reduce long working hours that can negatively affect workers’ health.

Hospital support services and the impacts of outsourcing on occupational health and safety

BACKGROUND

Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors.

OBJECTIVES

This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach.

METHODS

Worker's compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups.

RESULTS

Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P < 0.05) were observed in average costs per injury for cleaners post outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries.

CONCLUSIONS

This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers.

Needs-based human resources for health planning in Jamaica: using simulation modelling to inform policy options for pharmacists in the public sector

BACKGROUND

Planning for human resources for health (HRH) is central to health systems strengthening around the world, including in the Caribbean and Jamaica. In an effort to align Jamaica's health workforce with the changing health needs of its people, a partnership was established between Jamaican and Canadian partners. The purpose of the work described in this paper is to describe the development and application of a needs-based HRH simulation model for pharmacists in Jamaica's largest health region.

METHODS

Guided by a Steering Committee of Jamaican stakeholders, a simulation modelling approach originally developed in Canada was adapted for the Jamaican context. The purpose of this approach is to promote understanding of how various factors affect the supply of and/or requirements for HRH in different scenarios, and to identify policy levers for influencing each of these under different future scenarios. This is done by integrating knowledge of different components of the health care system into a single tool that shows how changes to different parameters affect HRH supply or requirements. Data to populate the model were obtained from multiple administrative databases and key informants. Findings were validated with the Steering Committee.

RESULTS

The model estimated an initial shortage of 110 full-time equivalent (FTE) pharmacists in the South East Region that, without intervention, would increase to a shortage of about 150 FTEs over a 15-year period. In contrast to the relatively small impact of a large enrollment increase in Jamaica's pharmacy training programme, interventions to increase recruitment of pharmacists to the public sector, or improve productivity - through, for example, the use of support staff and/or new technologies - may have much greater impact on reducing this shortage.

CONCLUSIONS

The model represents an improvement on the HRH planning tools previously used in Jamaica in that it supports the estimation of HRH requirements based directly on measures of population health need. Both the profession (pharmacists) and country (Jamaica) considered here are under-studied. Further investments by Jamaica's MoH in continuing to build capacity to use such models, in combination with their efforts to enhance health information systems, will support better informed HRH planning in Jamaica.

A systems perspective on nursing productivity

PURPOSE

Recent New Zealand reports have identified the nursing workforce for its potential to make a significant contribution to increased productivity in health services. The purpose of this paper is to review critically the recent and current labour approaches to improve nursing productivity in New Zealand, in a context of international research and experience.

DESIGN/METHODOLOGY/APPROACH

An examination of government documents regarding productivity, and a review of New Zealand and international literature and research on nursing productivity and its measurement form the basis of the paper.

FINDINGS

It is found that productivity improvement strategies are influenced by theories of labour economics and scientific management that conceptualise a nurse as a labour unit and a cost to the organisation. Nursing productivity rose significantly with the health reforms of the 1990s that reduced nursing input costs but impacts on patient safety and nurses were negative. Current approaches to increasing nursing productivity, including the "productive ward" and reconfiguration of nursing teams, also draw on manufacturing innovations. Emerging thinking considers productivity in the context of the work environment and changing professional roles, and proposes reconceptualising the nurse as an intellectual asset to knowledge-intensive health organisations.

PRACTICAL IMPLICATIONS

Strategies that take a systems approach to nursing productivity, that view nursing as a capital asset, that focus on the interface between nurse and working environment and measure patient and nurse outcomes are advocated.

ORIGINALITY/VALUE

The paper shows that reframing nursing productivity brings into focus management strategies to raise productivity while protecting nursing and patient outcomes.

Stress causing psychosomatic illness among nurses

Stress in nurses is an endemic problem. It contributes to health problems in nurses and decreases their efficiency. Documenting the causes and extent of stress in any healthcare unit is essential for successful interventions

Disability management outcomes in the Ontario long-term care sector

INTRODUCTION

Optimal disability management practices supporting early and safe return-to-work involve the workplace adoption of formal policies and procedures to ensure the quality of disability management outcomes. In the Canadian province of Ontario, there are approximately 60,000 health care workers in 600 licensed facilities providing long-term residential care to approximately 75,000 elderly residents. Workers in this sector are exposed to high biomechanical demands arising from care-giving tasks and have a substantial risk of work-related disability. Over the period 2000-2006, many long-term care facilities in Ontario adopted disability management practices that encourage modified work arrangements. The objective of this study was to describe differences in modified work arrangements and disability outcomes in long-term care facilities in Ontario.

METHODS

Measures of disability episode outcomes are described for a representative sample of 32 Ontario long-term care facilities for two consecutive years 2005 and 2006. Data were obtained from a questionnaire survey of facilities, a survey of a representative sample of caregivers and administrative records from the provincial workers' compensation agency.

RESULTS

A total of 28,747 days of disability attributed to work-related conditions were experienced by 3,271 full-time equivalent staff in 2005 (28,034 days in 2006). Average total disability days were 922 per 100 full-time equivalent staff in 2005 and 889 per 100 full-time equivalent staff in 2006. Disability compensation expenditures, measured as wage replacement benefits received by disabled workers, were estimated to be $72,332 per 100 full-time equivalent staff in 2005 and $64,619 per 100 full-time equivalent staff in 2006. On average, approximately 60% of all disability days were managed by modified duty arrangements and the proportion of total disability days managed by modified duty arrangements for each facility was correlated between the two observation years.

CONCLUSIONS

Across facilities, there was no evidence that modified duty arrangements were associated with lower disability compensation expenditures and there was mixed evidence that modified duty was associated with a lower burden of disability. In this setting, disability days managed by modified duty arrangements were not accurately documented in worker's compensation claim records.

Associations between work schedule characteristics and occupational injury and illness

BACKGROUND

Nurses often endure working irregular day, night and evening shifts as well as mandatory overtime (i.e. employer-imposed work time in excess of one's assigned schedule). While these work characteristics are examined as potential risks for nurses' safety and health, it is not clear whether negative health impacts occur simply because of working long hours or in combination with other mechanisms.

AIM

This study investigates how these work characteristics are associated with nurses' work-related injury and illness over and above long work hours.

METHODS

In this cross-sectional study, questionnaire data were collected from a sample of 655 registered nurses in the Philippines. Multiple logistic regression was used to assess associations of shift work and mandatory overtime with four work-related health outcomes.

RESULTS

After weekly work hours, shift length and demographic variables were accounted for, non-day shifts were associated with work-related injury [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.07, 2.24] and work-related illness (OR = 1.48; 95% CI: 1.02, 2.16). Also, frequency of working mandatory overtime was associated with work-related injury (OR = 1.22; 95% CI: 1.06, 1.41), work-related illness (OR = 1.19; 95% CI: 1.04, 1.37) and missing more than 2 days of work because of a work-related injury or illness (OR = 1.25; 95% CI: 1.08, 1.44).

CONCLUSIONS

These findings suggest that non-day shifts and mandatory overtime may negatively impact nurses' health independent of working long hours. Mechanisms through which these work characteristics affect health, such as circadian rhythm disturbance, nurse-to-patient ratios and work-family conflict, should be examined in future studies.

Dare we speak of ethics? Attending to the unsayable amongst nurse leaders

There is increasing emphasis on the need for collaboration between practice and academic leaders in health care research. However, many problems can arise owing to differences between academic and clinical goals and timelines. In order for research to move forward it is important to name and address these issues early in a project. In this article we use an example of a participatory action research study of ethical practice in nursing to highlight some of the issues that are not frequently discussed and we identify the impact of things not-named. Further, we offer our insights to others who wish to be partners in research between academic and practice settings. These findings have wide implications for ameliorating misunderstandings that may develop between nurse leaders in light of collaborative research, as well as for participatory action research.

An applied simulation model for estimating the supply of and requirements for registered nurses based on population health needs

Aging populations, limited budgets, changing public expectations, new technologies, and the emergence of new diseases create challenges for health care systems as ways to meet needs and protect, promote, and restore health are considered. Traditional planning methods for the professionals required to provide these services have given little consideration to changes in the needs of the populations they serve or to changes in the amount/types of services offered and the way they are delivered. In the absence of dynamic planning models that simulate alternative policies and test policy mixes for their relative effectiveness, planners have tended to rely on projecting prevailing or arbitrarily determined target provider-population ratios. A simulation model has been developed that addresses each of these shortcomings by simultaneously estimating the supply of and requirements for registered nurses based on the identification and interaction of the determinants. The model's use is illustrated using data for Nova Scotia, Canada.

Challenges in getting workforce research in nursing used for decision-making in policy and practice: a Canadian perspective

AIMS AND OBJECTIVES

This paper draws upon empirical research and other published sources to discuss nursing workforce issues, the challenges of using health human resource research in policy decisions and the importance of evidence-based policies and practices for nursing care and outcomes.

BACKGROUND

Increasing evidence points to the critical relationship between registered nurse care and improved patient outcomes. The negative impact that insufficient nurse staffing has on patient, nursing and system outcomes has influenced health human resource researchers to further examine nurses' work environments to determine factors that are amenable to policy change.

DESIGN

Survey of literature was conducted.

METHODS

Electronic databases were searched using keywords.

RESULTS

Sustained health human resource planning efforts by policy makers are difficult given changing governments and political agendas. The health human resource conceptual framework provides researchers and planners with a guide to decision-making that considers current circumstances as well as those factors that need to be accounted for in predicting future requirements. However, effective use of research depends on communication of findings between researchers and policymakers.

CONCLUSIONS

Health care managers and other decision-makers in health care organisations often lack an understanding of the research process and do not always have easy access to current evidence. Also, managerial decisions are often constrained by organisational requirements such as resource availability and policies and procedures.

RELEVANCE TO CLINICAL PRACTICE

Unless nursing workplace issues are addressed, the physiological and psychological stress in the work environments of nurses will continue. Effective health human resource policy and planning (at the macro level) and management strategies (at the micro level) would stabilise the nursing workforce and reduce job stress. Furthermore, the efficiency and cost-effectiveness of the health system could be enhanced through improved health outcomes of care providers and health care clients.

A review of work schedule issues and musculoskeletal disorders with an emphasis on the healthcare sector

Musculoskeletal disorders (MSDs) are a significant cause of morbidity in healthcare workers. The influence of shift work and long work hours on risk for MSDs is an area that needs further exploration. The purpose of this report is to assess research progress and gaps across studies that examined the relationship between demanding work schedules and MSD outcomes. A literature search identified 23 peer-reviewed publications in the English language that examined MSDs and long work hours, shift work, extended work shifts, mandatory overtime, or weekend work. Eight studies that examined long work hours and had some controls for physical job demands reported a significant increase in one or more measures of MSDs. Fourteen studies examining shift work had incomparable methods and types of shift work, and therefore, no clear trends in findings were identified. A small number of studies examined mandatory overtime, work on weekends and days off, and less than 10 h off between shifts. Given the complexity of the work schedule research topic, relatively few studies have adequately examined the relationship of work schedules and musculoskeletal outcomes. The review discusses research gaps including methodological issues and suggests research priorities.

Managing nurses through disciplinary power: a Foucauldian analysis of workplace violence

AIMS

This paper describes discipline as a specific technique of power which constitutes, in our view, a form of institutional violence.

BACKGROUND

The need to create and maintain safe and healthy work environments for healthcare professionals is well documented.

EVALUATION

Foucault's concept of disciplinary power was used to explore institutional violence from a critical perspective.

KEY ISSUE

Violence is identified as an important factor in the recruitment and retention of healthcare professionals. Given the shortage of such professionals, there is an urgent need to take a fresh look at their working environments and working conditions.

CONCLUSION

Power, surveillance and disciplinary techniques are used at all levels of hospital management to control and contain both human resources and costs.

IMPLICATIONS FOR NURSING MANAGEMENT

By associating common workplace practices with institutional violence, employers who have a policy of zero tolerance toward workplace violence will need to re-examine their current ways of operating.

Nurses' Expectations, Experiences and Attitudes towards the Intervention of a ‘No Lifting Policy’

The aim of the study was to evaluate expectations and attitudes towards a No Lifting Policy programme, the "No Lift system", among nurses at hospitals where an introduction of the intervention was planned (PreNLS hospitals), and to make a comparison with nurses' experiences and attitudes at one hospital where the intervention had already been implemented (NLS hospital). A cross-sectional study of nurses at two PreNLS hospitals and one NLS hospital was performed. Most nurses at both the PreNLS hospitals and the NLS hospital were positive or very positive to the intervention. The expected and experienced obstacles differed between nurses at the PreNLS hospitals and the NLS hospital; however, there was more agreement concerning benefits. The most frequently expected obstacles at the PreNLS hospitals were organisational issues and obstacles related to the facilities, while most obstacles identified at the NLS hospital concerned specific transfers or were patient-related. A decrease in the number of injuries was the most often considered benefit among most nurses. Nurses at the NLS hospital rated their physical exertion as lower in seven out of nine specific patient transfers compared with nurses at the PreNLS hospitals. They also reported increased well-being at work and an improved ability to manage their daily work. The comprehensive approach and participatory design, including all levels of staff and extensive support from the nurses' own union and management, is probably one important explanation for the positive attitudes and successful introduction of the intervention.

The nursing practice environment: measurement and evidence

Improvements in nurses' practice environments are essential to retain nurses and keep patients safe. The pace of improvements can accelerate if evidence is translated clearly for researchers, managers, and policymakers. This article evaluates the utility of published multidimensional instruments to measure the nursing practice environment. The assessment criteria are theoretical relevance, ease of use, and dissemination. This article also synthesizes the research that has used these instruments. Seven instruments and 54 studies are evaluated. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is proposed as the most useful instrument. Its content, length, and dissemination best satisfy the set of criteria. Researchers should use the PES-NWI to generate consistent and comparable evidence; expand the content to reflect all conceptual domains; develop a short form; test the instrument in different care settings; expand the evidence of the practice environment's influence on patient outcomes; and test interventions for practice environment improvements.

Extending work environment research into home health settings

Organizational attributes in work environments that support nursing practice are theoretically associated with superior nurse and patient outcomes, and lower frequencies of adverse events. This study explored associations between organizational support for nursing practice in home health care agencies and (a) the frequency of nurse-reported adverse events, (b) nurse-assessed quality of care, (c) nurse job satisfaction, and (d) nurses' intentions to leave their employing agency. Data were collected from a sample of 137 registered nurses employed as home health staff nurses in the United States and analyzed using descriptive techniques and bivariate correlation. As anticipated, organizational support for nursing was negatively associated with nurse-reported adverse patient events and intent to leave, and positively associated with nurse-assessed quality of care and job satisfaction. These findings may be helpful to nursing administrators who seek to create work environments in home health agencies that maximize patient outcomes and nurse satisfaction.

Disability management practices in Ontario health care workplaces

BACKGROUND

Workplace disability management programs are important in managing injury and disability.

METHODS

A stratified random sample of 188 employers in health care workplaces (71 hospitals, 48 nursing homes, 42 private clinics, and 27 community clinics) completed a mailed Organizational Policies and Practices (OPP) questionnaire. The OPP asked questions about eight workplace disability management practices. This article compares disability management practices across the four types of health care workplaces.

RESULTS

A one-way analysis of variance for each of the eight practices demonstrated significant differences across facility types for all practices, except ergonomic practices. For unionized versus non-unionized workplaces, there were significant differences in all practices, except ergonomic practices. For workplaces with formal policies versus those without policies, there were significant differences in all practices, except people-oriented culture and safety diligence.

CONCLUSION

Variations in disability management practices in health care workplaces need to be addressed to provide more effective prevention and treatment of work-related injuries and disability.

Competent patients' refusal of nursing care

Competent patients' refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a 'negotiated reliance' response where nurses and others tread as lightly as possible on the patient's autonomy while negotiating a compromise, but are obligated to match the patient's sacrifice by extending themselves beyond their usual professional practice.

Writing place: a comparison of nursing research and health geography

The concept of 'place', and general references to 'geographies of ...' are making gradual incursions into nursing literature. Although the idea of place in nursing is not new, this recent spatial turn seems to be influenced by the increasing profile of the discipline of health geography, and the broadening of its scope to incorporate smaller and more intimate spatial scales. A wider emphasis within the social sciences on place from a social and cultural perspective, and a wider turn to 'place' across disciplines are probably equally important factors. This trend is raising some interesting questions for nurses, but at the same time contributes some confusion with regard to imputed meanings of 'place'. While it is clear that most nurse clinicians and researchers certainly understand that place of care matters to their practices and patients, many diverse uses of 'place' are found within nursing literature, and contemporary understandings of the term 'place' within nursing are not immediately clear. It is in this context that this article plans to advance the discussion of place. More specifically, the aims of this paper are threefold: to critique 'place' as it appears in nursing literature, to explore the use of 'place' within health geography, whence notions of place and 'geographies of' have originated and, finally, to compare and contrast the use of 'place' in both disciplines. This critique intends to address a deficit in the literature, in this era of growing spatialization in nursing research. The specific questions of interest here are: 'what is "place" in nursing?' and 'how do concepts of place in nursing compare to concepts of place in health geography?'

The impact of nurse turnover on patient, nurse, and system outcomes: a pilot study and focus for a multicenter international study

Research about the economic impact of nurse turnover has been compromised by a lack of consistent definitions and measurement. This article describes a study that was designed to refine a methodology to examine the costs associated with nurse turnover. Nursing unit managers responded to a survey that contained items relating to budgeted full-time equivalents, new hires, and turnover, as well as direct and indirect costs. The highest mean direct cost was incurred through temporary replacements, whereas the highest indirect cost was decreased initial productivity of the new hire. The study allowed the identification of the availability of data and where further refinement of data definition of variables is needed. The results provided significant evidence to justify increased emphasis on nurse retention strategies and the creation of healthy work environments for nurses.

Innovations in health care delivery: responses to global nurse migration--a research example

Using data from a large survey of Canadian nurses, we examined how internationally born nurses (IBNs) in Canada experience their work environment. There are significant differences in demographics and in work status and practice environment. Significantly more IBNs are members of visible minorities than are their Canadian-born counterparts. IBNs work more hours, including more overtime, and are more likely to experience physician, verbal, and emotional abuse. Self-rated health status was worse for IBNs in physical and mental health. Changes are needed to improve the nursing work environment and nurses' perception of the effectiveness of care, and to improve their health status.

Towards an integrated approach for the management of ageing nurses

AIM

The objective of this study is to provide an overview of the ageing of the nursing workforce and to explore retention strategies centred on the entire professional life and on all age groups.

BACKGROUND

The presence of an increasing proportion of ageing workers presents a major challenge to the nursing profession. Evaluation Presentation of theories about the development of a healthy workplace leads to the identification of a framework on which managers can base their management decisions.

KEY ISSUES

Examples of incentives relating to the framework are presented which were expressed by both nurses under 50 years of age and those over 50.

CONCLUSIONS

Introducing incentives centred on all age groups provides an opportunity to create a healthy workplace for all generations of nurses.

The consequences of job stress for nurses' health: time for a check-up

The processes and outcomes of nurses' work are described extensively in studies about patient care, nursing education and training, job satisfaction, health care quality and management, and organizational behavior. These studies evaluate the relationship between nurses' behavior and organizational health (ie, productivity) or between nurses' behavior and patient health (ie, medical error). Fewer studies probe the association between the nature of nursing work and the status of nurses' health despite the logical connection between how well nurses feel and how well they perform, or even, whether they discontinue working altogether for health reasons. Yet, for many nurses working in today's health care environment, work is a stressful part of their lives. This article explores the connections between stressful work and nurses' health, especially given the restructuring of their work in the current health care system. The working conditions that give rise to stress and the potential health consequences from it are well described in the general stress literature and summarized herein. Moreover, studies about nurses' work and nurses' health are discussed in light of the limitations for connecting job stress to job changes or health outcomes over time. Current approaches for dealing with nurses' stress, such as the attraction to "Magnetism", may inadvertently impede progress in this area. Recommendations for the future are included.

Retaining Older Hospital Nurses and Delaying Their Retirement

Delaying the retirement of aging hospital nurses and making work-environment changes to support an older bedside nursing population are critical to stemming the exodus of experienced nurses from the work force. These issues were examined in this descriptive survey study of 1,553 hospital-based nurses in central New England.

The Importance of Work Environment

As the nation faces a growing nursing shortage, it is imperative that home care leaders implement evidence-based strategies to improve nurse recruitment and retention. Previous research indicates that characteristics of the work environment that support nursing practice enhance nurses' job satisfaction and reduce turnover. Yet, there is little evidence to assist in prioritizing initiatives to improve the work environment of nurses. In this nationwide survey, home care nurses were asked to rate the importance of specific agency work environment traits, as listed on the Nursing Work Index-Revised, in supporting their home care practice. The 10 agency traits rated as most important are presented, and evidence-based recommendations for creating a culture of nurse retention are discussed.