Nurses' practice environment and work-family conflict in relation to burn out: a multilevel modelling approach

Healthy work environment: A systematic review informing a nursing professional practice model in the US Military Health System

AIM

The aim of the study was to develop recommendations for creating a healthy work environment based on current literature for nurses working within the US Military Health System (MHS). However, our findings would likely benefit other nursing populations and environments as well.

DESIGN

Systematic literature review.

DATA SOURCES

We conducted a systematic literature search for articles published between January 2010 until January 2024 from five databases: PubMed, Joanna Briggs, Embase, CINAHL and Scopus.

METHODS

Articles were screened, selected and extracted using Covidence software. Article findings were synthesized to create recommendations for the development, implementation and measurement of healthy work environments.

RESULTS

Ultimately, a total of 110 articles met the criteria for inclusion in this review. The articles informed 13 recommendations for creating a healthy work environment. The recommendations included ensuring teamwork, mentorship, job satisfaction, supportive leadership, nurse recognition and adequate staffing and resources. Additionally, we identified strategies for implementing and measuring these recommendations.

CONCLUSIONS

This thorough systematic review created actionable recommendations for the creation of a healthy work environment. Based on available evidence, implementation of these recommendations could improve nursing work environments.

IMPACT

This study identifies methods for implementing and measuring aspects of a healthy work environment. Nurse leaders or others can implement the recommendations provided here to develop healthy work environments in their hospitals, clinics or other facilities where nurses practice.

REPORTING METHOD

PRISMA 2020 guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Art of Designing Work: Work/Family Interface as a Mediator in the Relationship between Work Design, Burnout, and Performance

Because of the massive changes experienced within work contexts over the last decades, work design has received renewed attention both from scholars and practitioners interested in carefully balancing job demands with employees' needs, aiming to boost performance. Hence, work design, meant as a strategic human resource management tool to craft job context and content, has been proven to impact on work performance and burnout. However, despite this evidence, the literature clearly explaining the paths through which work design might lead to positive or negative organizational outcomes is still scarce. To address this gap, the present study investigated the contribution of work-family interface aspects (i.e., work-family conflict and work-family enrichment) as mediators in this relationship. The participants were 160 white-collar employees, invited to fill in an online survey encompassing socio-demographical information (e.g., age, gender, education, and professional role) and individual self-report responses on the study variables (i.e., work design, work/family conflict, work/family enrichment, burnout, and work performance). The path analyses were conducted to investigate the direct and indirect relationships among constructs. The results showed that work-family conflict mediated the relationships between some work design characteristics and burnout, whereas work-family enrichment had a mediating role in the paths leading both to burnout and to work performance. The implications for research and practice were discussed with respect to an evidence-based human resource management perspective.

The association between burnout and multiple roles at work and in the family among female Japanese nurses: a cross-sectional study

Female nurses experience work-family conflict due to performing multiple roles, leading to burnout. Thus, this study aimed to verify the association between burnout and the multiple work and family roles performed among Japanese female nurses. The data for 2,255 nurses at 23 Japanese hospitals obtained from the Work Environment for Nurses Study in Japan were used. The variables included burnout, demographic information, additional work roles, and child-rearing or caregiving. Half of the nurses were categorized under the "no-role" group (NRG), approximately a quarter under the "work-role" group (WRG), 16% under the "family-role" group (FRG), and 7.3% under the "multiple-role" group (MRG). Compared to the NRG, the FRG and MRG showed statistically lower emotional exhaustion (B=-0.79, p<0.05; B=-0.94, p<0.05, respectively) and depersonalization (B=-0.80, p<0.05; B=-1.09, p<0.05, respectively). Personal accomplishment was not statistically different among the four groups. Burnout was relatively low among nurses with family roles, suggesting that family roles may have a positive spillover effect on work-related emotions.

Work-related use of information and communication technologies (W_ICTs) and job satisfaction of kindergarten teachers: A moderated mediation model

The high turnover rate of kindergarten teachers has become a global problem. Job satisfaction is regarded as a contributing factor that can reduce turnover intention. We sought to examine the relationship between work-related use of information and communication technologies after hours (W_ICTs) and kindergarten teachers' job satisfaction, as well as the mediating role of emotional exhaustion and the moderating role of perceived organizational support in the link between W_ICTs and emotional exhaustion. A sample of 434 participants of kindergarten teachers completed questionnaires on W_ICTs, job satisfaction, perceived organizational support and emotional exhaustion. Results indicated that kindergarten teachers' emotional exhaustion played a partial mediating role in the relationship between W_ICTs and job satisfaction. In addition, perceived organizational support moderated the association between W_ICTs and emotional exhaustion. Specifically, W_ICTs had a greater impact on emotional exhaustion for kindergarten teachers with low perceived organizational support.

Work-family conflict and the professional quality of life and their sociodemographic characteristics among nurses: a cross-sectional study in Tehran, Iran

Background

Nurses are exposed to work-family conflict (WFC) due to specific occupational conditions, such as exposure to patients and shift work, which can affect the professional quality of life (ProQoL). The aim of the present study was to determine the relationship between different levels of work-family conflicts and professional quality of life and their sociodemographic characteristics among the nurses in two hospitals in Tehran, Iran.

Methods

This cross-sectional study included 234 nurses from two hospitals. Data were collected using a three-part questionnaire, including items related to nurses’ demographic characteristics, the WFC questionnaire, and the ProQoL questionnaire.

Results

There was a significant positive correlation between conflict in terms of time and behavior with compassion satisfaction and between the three types of conflict with job burnout (p < 0.05). The results indicate that the WFC and ProQoL scores and the mean WFC were higher among women, people who had a disabled family member, and nurses who worked equal to or more than 175 hours a month. Regarding the dimensions of ProQoL, the mean compassion satisfaction was lower among people who lived with their parents, people who had a second job had a child younger than one-year-old, and a disabled family member had higher means of job burnout. Also, those who had younger children experienced less PTSD. Furthermore, the mean of WFC and burnout among single nurses was significantly lower than among married and divorced/widowed nurses. Additionally, the mean of WFC and burnout among nurses living in rental houses and nurses reporting the level of satisfying relationships with co-workers as ‘bad’ were significantly more than for other nurses.

Conclusion

Stable mental and emotional conditions are of great importance for nurses to provide safe and quality services to their patients. The results also revealed that nurses’ compassion satisfaction and job burnout were associated with different types of conflict. The WFC of nurses is related to their ProQoL and affects their job satisfaction and burnout. Reducing conflict may improve the nurses’ satisfaction and thus improve patient care and healthcare services.

Work-Family Conflict, Organizational Identification, and Professional Identification Among Chinese Nurses From a Resource Perspective

BACKGROUND

The miserable work conditions faced by many nurses around the world make them particularly prone to work-family conflict.

PURPOSE

This study was designed to explain from a resource perspective how and when nurses experiencing work-family conflict are more likely to exhibit decreased levels of organizational identification and professional identification.

METHODS

A time-separation research design was used, and data were collected from 322 nurses in five hospitals in China. All of the hypotheses were tested using conduct structural equation modeling.

RESULTS

The results showed that work-family conflict had negative effects on organizational identification and professional identification via emotional exhaustion. In addition, job meaningfulness may have a buffering effect on the negative impact of work-family conflict on emotional exhaustion, organizational identification, and professional identification.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results advance knowledge on how and when work-family conflict damages organizational identification and professional identification. Providing family support, relieving emotional exhaustion, and enhancing job meaningfulness are necessary to support the organizational and professional identification of nurses.

Relationship between Job Satisfaction and Workload of Nurses in Adult Inpatient Units

Among Nursing and Psychology professionals, the job satisfaction of those in Adult Inpatient Units is analyzed, with a new scale to measure nursing workloads validated. Objective: The objective of this study was to relate nursing workloads to professional job satisfaction. Methods: This is an observational, analytical, descriptive, concurrent and quantitative study, which used the Overall Job Satisfaction scale and subscales therein, to identify global satisfaction-intrinsic or related to motivational factors and extrinsic or associated with hygienic factors-in nursing professionals (n = 104) from eight Inpatient Units of Internal Medicine and Surgery, in four hospital centers, to describe job satisfaction in the professionals studied and to find statistically significant associations between job satisfaction and workload (measured with the scale MIDENF^®) in the inpatient units where they work. Results: There were higher levels of satisfaction in the variables "relationship with immediate boss" and "relationship with fellow workers", and lower levels in "relationship with senior management" and "organizational system of the unit". In the inferential analysis, the scores were 75.63 for overall satisfaction, 35.28 for intrinsic satisfaction, and 40.36 for extrinsic satisfaction. Conclusions: There is a close relationship between workload and job satisfaction, showing more dissatisfaction regarding organizational aspects and professional recognition.

Relationship between work–family conflict, sleep quality, and depressive symptoms among mental health nurses

Background

Nursing has a reputation for being one of the most stressful occupations. As a result of their work, many nurses suffer from anxiety and depression. Nurses are also at risk of poor sleep owing to their work nature. This study aimed to examine the relationship between work–family conflict, sleep quality, and depressive symptoms among mental health nurses. A descriptive cross-sectional study design was utilized in this study. Setting/sample: This study was conducted at El Azazi Hospital for Mental Health, Al-Sharkia Governorate on 139 mental health nurses. Four tools were used in this study: Socio-demographic data sheet, Work–Family Conflict Scale, Arabic Pittsburgh Sleep Quality Index, and Arabic Center for Epidemiologic Studies Depression Scale.

Results

Results revealed that, a significant percentage of mental health nurses suffered from poor sleep quality and depressive symptoms, there were highly statistically significantly positive correlations between work–family conflict (WFC) and both of Pittsburgh Sleep Quality Index (PSQI) and depressive symptoms among nurses.

Conclusions

Working with psychiatric patients affected their nurses, which disturbed their sleep quality and led to depressive symptoms. As well, increasing work–family conflict in mental health nurses leads to poor sleep quality and depressive symptoms. Family interference with work, sleep quality, and work interference with family were statistically significant predictors of depressive symptoms.

Impacts of Nursing Work Environment on Turnover Intentions: The Mediating Role of Burnout in Ghana

Background. The nursing practice environment supports excellence and decent work and has the influence to entice and retain the quality nursing workforce. Appreciating the dynamics that affect the turnover intention of RNs offer reasonable solutions to the challenges of the nursing shortage, which directly influence the quality of nursing care. There is a paucity of information on the impacts of these concepts among RNs in Sub-Saharan African. The study therefore aimed at determining the impacts of work environment and burnout on turnover intentions among RNs in Ghana. Methods. A descriptive cross-sectional design using a simple random and proportionate stratified sampling with a sample of 232 RNs from Municipal and Regional Hospitals, Sunyani, West-Central part of Ghana completed validated instruments measuring work environment, burnout, and turnover intentions. Descriptive analysis was done to find out RNs’ perceptions of their work environment and turnover intentions. Mediation analysis by Baron and Kenny’s approach was used to determine the mediating effect of burnout on the relationship between the domains of PPE and the turnover intention of RNs. STROBE checklist was used as the reporting tool. Results. While most RNs had a positive perception about their work environment, greater number of them had turnover intentions. There were significant associations between some nursing work environment facets and turnover intention. The results also showed a statistically significant relationship between nurse-physician relation (β = .353, t = 5.476, $p$  ≤ .001), nurse manager leadership (β = −0.485, t = −8.192, $p$  ≤ .001), nursing foundation for quality care (β = .400, t = 7.059, $p$  ≤ .001), staffing and resource adequacy on (β = 0.485, t = 8.183, $p$  ≤ .001), and turnover intention as mediated by burnout. Conclusion. Burnout resulting from an unsafe work environment impact RNs’ turnover intention. This phenomenon can potentially affect the human resource management and quality of nursing care. Policy strategies aimed at ensuring a professional practice environment and decreased burnout can therefore improve retention of RNs at their workplace.

Work from home today for a better tomorrow! How working from home influences work‐family conflict and employees' start of the next workday

Drawing on the resource (drain) perspective in work-family spillover theory and conservation of resources theory, the current paper studies the daily consequences of working from home for employees' work-home interface and well-being. We build an intraindividual model that investigates how working from home influences experiences of time pressure, work-family conflict, and work-related employee well-being on a daily basis. A total of 34 professional workers participated in our study and were asked to respond to 10 daily surveys in the morning, afternoon and evening, across two consecutive workweeks. In line with our hypotheses, results indicated that on days when employees worked from home, they experienced less time pressure and, in turn, they reported lower levels of work-family conflict on that particular day. Moreover, we found that experiences of work-family conflict predicted individuals' next morning engagement and exhaustion levels and affective states towards the organization they work for. We recommend organizations to encourage a work-from-home protocol aimed at protecting employee well-being.

Group-Treatment for Dealing with the Work-Family Conflict for Healthcare Professionals

Healthcare professionals' exposure to work-family conflict negatively affects the health and well-being of the whole family and organizational outcomes. Specified workplace interventions are lacking. Therefore, the aim of the study was to evaluate the feasibility of a two-day group-treatment specifically designed for the needs of healthcare professionals with family responsibilities concerning participation, satisfaction with the intervention and family- and individual-related outcome variables. 24 mostly female (85.7%) participants of a community hospital in southern Germany attended the treatment. Data were collected at baseline (T0), directly after the treatment (T1) and two months later (T2). A two-factor analysis of variance with repeated measures showed a statistically significant time x group effect for self-efficacy (F = 5.29, p = 0.011). Contrasts displayed substantial pre-post (T1-T0, T2-T0) increases of self-efficacy in the intervention group as compared with the control group. Non-parametric Mann-Whitney-U tests are in line with these findings. The results indicate that the group-treatment adapted to the needs of healthcare professionals has the potential to boost self-efficacy among healthcare professionals and that participants were predominantly satisfied. Perspectives for future research and practical implications are discussed in the light of the manifest lack of healthcare professionals.

Potential effects of the nursing work environment on the work-family conflict in operating room nurses

BACKGROUND

The nursing working environment is an important subsystem in the hospital environment. A good working environment could have a positive impact on nurses. However, the work-family conflict and unsatisfactory working environment could significantly reduce their working enthusiasm, efficacy as well as the overall quality of the nursing, increase their fatigue, and thereby compromise their career status.

AIM

To explore the possible status quo and to analyze the correlation between work environment perception and the work-family conflict among nurses in the operating room.

METHODS

A total of 312 operating room nurses from two first-class hospitals at Grade 2 and two first-class hospitals at Grade 3 in China from May to September 2017 were included in this research using the cluster sampling method. The data, including the general information questionnaire, the practice environment scale of the nursing work index (PES-NWI), and the work-family conflict scale, were systematically collected. Pearson correlation analysis was applied to analyze the correlation between the two scores, with influencing factors analyzed by hierarchical regression analysis.

RESULTS

A total of 312 questionnaires were issued, and the response rate and effective questionnaire rate were both 96.15% (300/312). The total scores of the PES-NWI scale and the work-family conflict scale were 3.07 ± 0.43 (vs maximum up to 4 points) and 52.32 ± 8.79 (vs maximum up to 90 points), respectively. The scores of the PES-NWI scale were negatively correlated with that of work-family conflict scale (all P < 0.05). The perception of the nursing work environment and the number of night shifts per month were the major factors contributing to the work-family conflict (all P < 0.05).

CONCLUSION

The nursing work environment and the work-family conflict among nurses in the operating room were both found at a medium level with a negative correlation between the two.

Effect of Sleep Quality and Depression on Married Female Nurses' Work-Family Conflict

Married female nurses experience work–family conflict (WFC) as they manage excessive work and various working-hour types while rearing children and tending household chores, and as a result, they continuously constantly deliberate over quitting their job or moving to a different workplace. Married nurses were found to have shorter sleep duration and sleep latency compared to single nurses, and high job stress not only hinders their family life but also causes sleep problems. Depression is a classic negative emotion experienced by married working women who must manage both work and family. This study aims to examine WFC in married female nurses and investigate its predictors, namely depression and sleep quality. A total of 229 married female nurses completed a Google questionnaire link consisting of the Work–Family Conflict Scale, Sleep-Quality Scale, and the Center for Epidemiologic Studies Depression Scale (CES-D). Data were analyzed by descriptive statistics, t-test, ANOVA, LSD post hoc test, Pearson’s correlation coefficients, and multiple regression using the SPSS/WIN 26.0 program. The average WFC score was 4.84 ± 1.12 (range 1–7); WFC showed a statistical difference according to a stage of the lifecycle (F = 7.12, p = 0.001) and perceived health (F = 12.01, p < 0.001). WFC was low among those in the non-parenthood stage of the lifecycle (β = −0.26, p < 0.001), those with good (β = −0.18, p = 0.011) or moderate perceived health (β = −0.15, p = 0.023), and those without turnover intention (β = −0.13, p = 0.016). On the other hand, WFC was high among those who were extremely dissatisfied with their job (β = 0.16, p = 0.008) and those who had a high level of depression (β = 0.22, p = 0.002); these variables explained 20.2% of WFC (F = 7.663, p < 0.001). Based on these results, subsequent studies should develop and implement coping programs that help reduce WFC and improve depression and sleep quality in married female nurses.

The Bottom-Line Mentality of Leaders in Education and Training Institutions: Where to Go for Innovation?

According to the social exchange theory, this study analyzed how a bottom-line mentality (BLM) among leaders affects teachers' innovative behavior and how this relationship is mediated by relative deprivation and psychological safety and moderated by person-organization values fit. Using two stages of data collection, 491 responses from teachers were obtained and analyzed. The results revealed that leader BLM significantly negatively affected teachers' innovative behavior, and relative deprivation and psychological safety both partially mediated this influence of leader BLM. Person-organization values fit negatively moderated the positive effect of leader BLM on teachers' relative deprivation and the negative effect of leader BLM on teachers' psychological safety. This study enriches the current literature about BLM and tests the influence of leader BLM on teacher's innovation in the Chinese education and training institutions, and provides insights into favorable educational management practices.

Using Dyadic Modeling in Nursing Research: Introduction of Theory and Application

Use of dyadic modeling in nursing has theoretical and practical importance, as the interpersonal processes related to health behaviors can be captured. Theoretical models focusing on dyadic coping with chronic illness and illness management are established in family nursing. However, few studies utilized dyadic designs in empirical research, as most studies are patient-centric or care partner-centric. With theoretical elaborations and examples, we first review how conventional health models have been extended using a dyadic perspective and then briefly review the major dyadic frameworks in nursing. Five frequently used dyadic models are described with examples from health and nursing research fields. Statistical applications and cultural considerations are reviewed. We conclude that dyadic modeling provides a useful lens for nursing research but continues to be underutilized.

Job and family demands and burnout among healthcare workers: The moderating role of workplace flexibility

Burnout is a growing problem among healthcare workers. Whereas there are numerous predictors of burnout, this article explores the compounding effects of job and family demands among nurses and Patient Care Associates (PCA). This study used the 2018 survey data of the Boston Hospital Health Workers Study (BHWHS) to assess the relationship of job and family demands, workplace flexibility, and burnout (N = 874). In addition, it aimed to evaluate the moderating effect of workplace flexibility and job and family demands on burnout. Results of the study demonstrate that active and high strained healthcare workers are associated with higher odds of experiencing burnout as well as workers who reported perceived low workplace flexibility. In addition, workplace flexibility is associated with reduced odds of experiencing burnout. Workplace flexibility moderated the relationship of childless married healthcare workers and burnout. The study shows that workplace flexibility plays a critical role in potentially reducing odds of burnout in the healthcare worker population. Assessing the perception and accessibility to workplace flexibility among workers is imperative to improve worker well-being and the quality of care provided to patients especially the current effects to worker's health during a pandemic.

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Burnout is an increasing concern among healthcare workers.

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We examined the buffering effects of workplace flexibility on the compounding effects of job and family demands on burnout.

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Workplace flexibility is associated with lower odds of burnout.

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Healthcare workers who are categorized as active and high-strained are associated with higher odds of burnout.

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Workplace flexibility moderated the relationship of married healthcare workers without children and burnout.

Measuring perceived adequacy of staffing to incorporate nurses' judgement into hospital capacity management: a scoping review

BACKGROUND

Matching demand and supply in nursing work continues to generate debate. Current approaches focus on objective measures, such as nurses per occupied bed or patient classification. However, staff numbers do not tell the whole staffing story. The subjective measure of nurses' perceived adequacy of staffing (PAS) has the potential to enhance nurse staffing methods in a way that goes beyond traditional workload measurement or workforce planning methods.

OBJECTIVES

To detect outcomes associated with nurses' PAS and the factors that influence PAS and to review the psychometric properties of instruments used to measure PAS in a hospital setting.

DESIGN AND METHODS

A scoping review was performed to identify outcomes associated with PAS, factors influencing PAS and instruments measuring PAS. A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Business Source Complete and Embase databases identified 2609 potentially relevant articles. Data were independently extracted, analysed and synthesised. The quality of studies describing influencing factors or outcomes of PAS and psychometric properties of instruments measuring PAS were assessed following the National Institute for Health and Care Excellence quality appraisal checklist and the COnsensus-based Standards for the selection of health Measurement INstruments guidelines.

RESULTS

Sixty-three studies were included, describing 60 outcomes of PAS, 79 factors influencing PAS and 21 instruments measuring PAS. In general, positive PAS was related to positive outcomes for the patient, nurse and organisation, supporting the relevance of PAS as a staffing measure. We identified a variety of factors that influence PAS, including demand for care, nurse supply and organisation of care delivery. Associations between these factors and PAS were inconsistent. The quality of studies investigating the development and evaluation of instruments measuring PAS was moderate.

CONCLUSIONS

Measuring the PAS may enhance nurse staffing methods in a hospital setting. Further work is needed to refine and psychometrically evaluate instruments for measuring PAS.

Job Characteristics, Emotional Exhaustion, and Work-Family Conflict in Nurses

The purpose of this study is to identify whether emotional exhaustion, a component of burnout, mediates the relationship between job demands, job resources, and work-family conflict (WFC). A cross-sectional design was used with survey data. A total of 1,202 nurses in eastern Canada participated in this study. Data were collected via an online survey and analyzed using mediation analysis. The results indicated that job demands and emotional exhaustion predicted WFC. Moreover, emotional exhaustion partially mediated the relationship between job demands, supervisor support, and WFC. This model also showed that younger nurses had increased WFC. Our study indicates that there are several direct and indirect pathways leading to WFC. Moreover, workplace resources can reduce emotional exhaustion, which, in turn, may help maintain work-family balance in nurses. These findings contribute to the existing knowledge on the precursors and consequences of burnout symptoms.

Do preceptorship and clinical supervision programmes support the retention of nurses?

BACKGROUND

The reasons for nurse shortages are the ageing healthcare workforce, increasing demand for services, employee dissatisfaction, life-work imbalance and burnout.

AIM

To review the literature to find out whether there is evidence to support preceptorship and clinical supervision programmes in retaining nurses, and particularly newly qualified nurses (NQNs), in clinical practice.

METHODS

A search of databases, as well as other sources, was carried out, with six studies selected for data analysis.

FINDINGS

Thematic analysis was used to synthesise the results and produced seven themes: increase satisfaction, gain competence and feel more confident; competencies of preceptors and supervisors; framework or model required; the challenge to the programmes; intention to stay and staff retention; voluntary withdrawal from the nursing profession; and further support for development.

CONCLUSION

Training (preceptorship and clinical supervision programmes) is effective in retaining NQNs, increasing satisfaction, improving skills and competency and staff engagement; however, more support for both preceptors/supervisors and NQNs is needed to maximise the success of these programmes in the future.

Causes of nursing staff burnout: Exploring the effects of emotional exhaustion, work-family conflict, and supervisor support

AIM

Nursing staff burnout threatens not only nurses' health but also the safety and health of their patients. Organizations should be aware of how work-related conflict can affect this burnout. This study examined the effect of supervisor support and work-family conflict on resource loss and burnout.

METHODS

A cross-sectional method and quantitative approach were adopted. A total of 300 questionnaires were distributed to clinical nursing staff in two regional teaching hospitals, and 239 valid questionnaires were returned.

RESULTS

Work-family conflict had a mediating effect on the relationship between supervisor support and emotional exhaustion. Emotional exhaustion fully mediated the relationships between depersonalization, work-family conflict, and reduced professional efficacy.

CONCLUSION

The mediating effect of emotional exhaustion in work-family conflict results from depersonalization and reduced professional efficacy, whereas work-family conflict mediated the effect of supervisor support on emotional exhaustion. The findings indicate that the medical industry should implement supervisor support strategies to reduce nursing staff work-family conflict and improve interventions for emotional exhaustion.

Factors associated with family cohesion and adaptability among Chinese registered nurses

AIM

To identify determinants of family cohesion and adaptability among Chinese registered nurses.

BACKGROUND

In China, the shortage of registered nurses imposes a higher physical and emotional workload, which will aggravate their work-family conflicts. Therefore, it is easy for nurses to ignore the importance of family, which is undeniably detrimental to healthy self-development and providing better care to patients.

DESIGN

With a cross-sectional and observational study design (see the STROBE checklist and Supplementary File 1).

METHODS

The Family Cohesion and Adaptability Scale was administered to registered nurses (N = 825) from 10 hospitals throughout China. Multiple linear regression was used to analyse the related factors for family cohesion and adaptability.

RESULTS

The multiple regression analysis revealed that inharmonious relationship with spouse's parents, discordant nurse-patient relationship, parents live in countryside, and poor leadership was found to be important risk predictors of family cohesion, and inharmonious relationship with spouse's parents, discordant nurse-patient relationship, high education, feel overworked and poor leadership was found to be important risk predictors of family adaptability.

CONCLUSION

Hospital managers need to pay attention to the risk factors that affect nurses' family cohesion and adaptability. To achieve this, they should employ targeted measures to enhance these aspects in time, which will help improve nurses' family life and promote their participation and role in family decision-making. This will not only help them create a better external environment for their healthy self-development but also allow them to maintain a better mood and energy to take care of patients.

RELEVANCE TO CLINICAL PRACTICE

Family cohesion and adaptability are important for nurses, as they may affect nurses' healthy self-development and quality of service provided to patients. Hospital managers should pay attention to the risk factors of nurses' family cohesion and adaptability, such as poor nurse-patient relationship, and consider employing corresponding measures to help them.

Burnout in nursing: a theoretical review

BACKGROUND

Workforce studies often identify burnout as a nursing 'outcome'. Yet, burnout itself-what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients-is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout.

METHODS

We searched MEDLINE, CINAHL, and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce.

RESULTS

Ninety-one papers were identified. The majority (n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout. As hypothesised by Maslach, we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence, and general health were effects of burnout; however, we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature were low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity. Among the outcomes of burnout, we found reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave.

CONCLUSIONS

The patterns identified by these studies consistently show that adverse job characteristics-high workload, low staffing levels, long shifts, and low control-are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach's theory, but some areas are insufficiently tested, in particular, the association between burnout and turnover, and relationships were found for some MBI dimensions only.

The Mediating Role of Burnout in the Relationship between Perceived Patient-safe, Friendly Working Environment and Perceived Unsafe Performance in an Obstetric Unit

Medical errors in obstetric departments are commonly reported and may involve both mother and neonate. The complexity of obstetric care, the interactions between various disciplines, and the inherent limitations of human performance make it critically important for these departments to provide patient-safe and friendly working environments that are open to learning and participative safety. Obstetric care involves stressful work, and health care professionals are prone to develop burnout, this being associated with unsafe practices and lower probability for reporting safety concerns. This study aims to test the mediating role of burnout in the relationship of patient-safe and friendly working environment with unsafe performance. The full population of professionals working in an obstetrics department in Malta was invited to participate in a cross-sectional study, with 73.6% (n = 184) of its members responding. The research tool was adapted from the Sexton et al.'s Safety Attitudes Questionnaire - Labor and Delivery version and surveyed participants on their working environment, burnout, and perceived unsafe performance. Analysis was done using Structural Equation Modeling. Results supported the relationship between the lack of a perceived patient-safe and friendly working environment and unsafe performance that is mediated by burnout. Creating a working environment that ensures patient safety practices, that allows communication, and is open to learning may protect employees from burnout. In so doing, they are more likely to perceive that they are practicing safely. This study contributes to patient safety literature by relating working environment, burnout, and perceived unsafe practice with the intention of raising awareness of health managers' roles in ensuring optimal clinical working environment for health care employees.

Contextual Factors Associated with Burnout among Chinese Primary Care Providers: A Multilevel Analysis

Burnout is a common and growing phenomenon in the health care setting. The objective of the present study is to examine contextual factors in the workplace associated with burnout among primary care providers (PCPs) in Shandong Province, China. A cross-sectional survey was conducted among 951 PCPs nested within 48 primary health institutions (PHIs). Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). We used two-level random intercept linear regression models to examine individual- versus workplace-level risk factors for burnout. The result revealed that 33.12%, 8.83% and 41.43% PCPs were experiencing a high degree of emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PA). In multilevel analysis, the most significant and common individual-level predictors of burnout were lack of perceived work support and autonomy. At the institutional level, workload was positively related to EE (odds ratio (OR): 6.59; 95% confidence interval (CI): 3.46-9.72), while work support was related to higher PA (OR: 3.49; 95% CI: 0.81-6.17). Greater attention should be paid to the influence of the work environment factors (workload and work support) to prevent burnout. Strategies such as increasing human resources allocated to PHIs and establishing a supportive work environment are encouraged to prevent and reduce burnout among PCPs in China.

A comparative analysis of work-family conflict among staff, managerial, and executive nurses

BACKGROUND

Nurses frequently are caught between the demands of work and family. While studies have explored this issue among staff nurses, none have compared nurse leaders to staff nurses. This study compares work-family conflict (WFC) and family-work conflict (FWC) among staff, managerial, and executive nurses.

METHODS

In this survey design, 20% of registered nurses were randomly sampled across Florida with a 9% response rate. Survey questions included personal, professional, and work environment characteristics and perceptions of WFC/FWC. Analyses of variance tested the differences between- and within-group scores for WFC/FWC for staff, managerial, and executive nurses. Ordinary Least Squares regressions tested the relationships between personal, professional and work environment measures, focusing on the three different nursing roles, and WFC/FWC scores.

FINDINGS

Nurses experienced more WFC than FWC. Staff nurses experienced significantly less WFC than nurse managers and nurse executives (analysis of variance mean difference -0.881 and -2.693, respectively). Nonwhite nurses experienced more WFC and FWC than white nurses. Longer shift length predicted greater WFC. FWC was lower with paid leave for childbirth.

DISCUSSION

Higher WFC among nurse managers and executives may discourage nurses from taking on or staying in leadership roles. Efforts must be taken to decrease WFC/FWC among nurses in these roles.

Effects of job conditions, occupational stress, and emotional intelligence on chronic fatigue among Chinese nurses: a cross-sectional study

Purpose: Nurses are undertaking considerable emotional and physical work, which may lead to unrecoverable fatigue. This study aimed to evaluate the level of chronic fatigue and explore its associated factors among Chinese nurses in the hope of providing scientific evidence for fatigue-reduction strategies.

Methods: This cross-sectional study was carried out in Liaoning Province, China in 2018. The study recruited 700 nurses and collected 566 effective respondents. Chronic fatigue, demographic factors, job conditions, and emotional intelligence were assessed through questionnaires. Chronic fatigue was assessed with the Fatigue Scale 11, occupational stress with the Effort–Reward Imbalance Questionnaire, and emotional intelligence with the Wong and Law Emotional Intelligence Scale. Hierarchical multiple regression was used to explore factors related to chronic fatigue and to test the moderating effect of emotional intelligence on the association between occupational stress and chronic fatigue. Simple slope analysis was conducted to visualize the interaction.

Results: The mean score of chronic fatigue among the Chinese nurses was 17.14±6.16. Being married, having long weekly work time, working night shifts, and discontent with the nurse–patient relationship were positively associated with chronic fatigue. Effort:reward ratio, overcommitment, and emotional intelligence were important factors related to chronic fatigue. Emotional intelligence played a moderating role in the relationship between the effort:reward ratio and chronic fatigue. When emotional intelligence was higher, the effect of the effort:reward ratio on chronic fatigue became weaker.

Conclusion: Most nurses surveyed in China might have relatively high levels of chronic fatigue. Our results highlight the importance of interventions on these factors for the reduction of fatigue among nurses in China. Providing more opportunities and support and developing emotional intelligence are crucial strategies to reduce chronic fatigue among nurses in China.

The role of collective affective commitment in the relationship between work-family conflict and emotional exhaustion among nurses: a multilevel modeling approach

BACKGROUND

Work-family conflict (WFC) is a crucial problem in nursing because of the demanding conditions of the job, such as strenuous shifts, physical and emotional workload, and intense patient involvement. Using a multilevel approach, this study investigated the moderating role of collective affective commitment as a protective resource in the relationship between WFC and emotional exhaustion.

METHODS

The sample included 647 nurses from 66 working units in 4 Italian hospitals. A self-administrated questionnaire was administered to nurses. To analyze data, hierarchical linear modeling was used to examine cross-level relationships between variables.

RESULTS

The results indicated that emotional exhaustion increased with augmenting of WFC and that this relationship was stronger when collective affective commitment was low and weaker when it was high.

CONCLUSIONS

The study thus suggests that collective affective commitment may be considered a protective resource for nurses. Moreover, the results show that high work-family conflict should not represent a serious problem when nurses have high affective commitment. Interventions at both individual and group level are discussed in order to mitigate WFC, promoting collective affective commitment and thus reducing emotional exhaustion.

The Influence of Depression on the Psychometric Properties of the Maslach Burnout Inventory-Human Services Survey: A Cross-Sectional Study With Nursing Assistants

Background: The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) is the most commonly used instrument to assess burnout. Although various factors have been reported to influence its validity, the influence of major depressive disorder (MDD) has not been previously considered. We developed this study to investigate the influence of MDD on the psychometric properties of the MBI-HSS in nursing assistants. Results: From a sample of 521 nursing assistants, we found in those with MDD (n = 138, 24.56%) a degree of data misfit into the model, revealed by non-acceptable values for the root mean square error of approximation (RMSEA; 0.073; p = 0.004) and for the comparative fit index (CFI; 0.912), while in the non-MDD group these indices were acceptable and good, respectively, for RMSEA (0.048; p = 0.639) and for CFI (0.951). Also, we found higher coefficients of correlation among MBI-HSS factors and less items loading properly in their respective factors in the MDD subset, when compared to the non-MDD subset. For the total sample, while original 3-factor solution was an acceptable model, the bifactor model fitted data better. Conclusions: MDD may impair the construct validity of MBI-HSS subscales, by increasing measurement error and decreasing model fitness. Therefore, researchers and health professionals should be aware of potential changes in the psychometric properties of the MBI-HSS when applied in subjects with depression.

A Mind-Body Skills Course Among Nursing and Medical Students: A Pathway for an Improved Perception of Self and the Surrounding World

Despite increased recognition of self-care and self-awareness as core competences for health care professionals, little attention is paid to these skills during their education. Evidence suggests that a Mind-Body (MB) skills course has the potential to enhance self-care and self-awareness among medical students. However, less is known about the meaning of this course for students and how it affects their personal and professional life. Therefore, we examined the lived experiences with an MB skills course among Dutch medical and Swedish nursing students. This course included various MB techniques, such as mindfulness meditation and guided imagery. Guided by a phenomenological hermeneutical method, three main themes were identified: "ability to be more present," "increased perception and awareness of self," and "connection on a deeper level with others." Overall, participation in the MB skills course served as a pathway to inner awareness and supported connecting with others as well as with the surrounding world.

Organizational Factors and Burnout of Perioperative Nurses

BACKGROUND

Knowing the organizational factors that predict burnout in perioperative nurses is paramount for improving the care of patients and promoting nurses' psychosocial well-being and health.

OBJECTIVE

To determine the influence of organizational factors of the perioperative nurse's work environment on the three burnout dimensions: emotional exhaustion, despersonalization, and personal accomplishment.

METHOD

A cross-sectional study was conducted among 136 nurses in a perioperative care unit at a university hospital in Barcelona, Spain. Data were collected using a demographic data form, and the Spanish versions of the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory.

RESULTS

Findings showed emotional exhaustion in 43% (56) of nurses, depersonalization in 21% (28), and reduced personal accomplisment in 53% (69). The degree of general burnout was moderate.The work environment was considered unfavourable as only one factor of five was favourable (Nursing foundations of quality care). Multiple regression analyses showed three organizational factors were associated with all three dimensions of burnout: "Nurse manager ability, leadership, and support of nurses"; "Staffing and resources adequacy"; and "Nursing foundations of quality care".

CONCLUSIONS

In this study three organizational factors played a significant role in predicting burnout among perioperative nurses. We recommend hospital management implement policies to improve these organizational factors. Promoting positive leadership styles, providing necessary resources, and creating a positive climate in the work environment could increase psychosocial wellbeing and decrease burnout among perioperative nurses.

Do sleep disturbances mediate the association between work-family conflict and depressive symptoms among nurses? A cross-sectional study

WHAT IS KNOWN ON THE SUBJECT

Nurses are at a high risk for work-family conflict due to long and irregular work hours and multiple physical and psychosocial stressors in their work environment. Nurses report higher rates of depressive symptoms than the general public, leading to a high rate of burnout, absenteeism, and turnover. Work-family conflict is associated with negative consequences in nurses including physical illnesses and mental disorders.

WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE

Past research on this topic has not examined the mechanisms for the effect of work family conflict on depression. Studies rarely examine the influence of health behaviors such as sleep in explaining this association. Our study identified significant association of sleep disturbances with both work-family conflict and depressive symptoms in nurses. Our main contribution is reporting the important role of sleep disturbances in translating the effect of work-family conflict on depressive symptoms among nurses.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Nurses need to receive training in best practices for maintaining their own sleep and mental health. Organizations should include sleep health education and training in workplace health programs. Evidence-based interventions to promote healthy sleep practices such as cognitive behavioral therapy and complementary and integrative approaches should be evaluated for their effectiveness in addressing the impact of work-family conflict on the mental health of nurses. Healthcare organizations should incorporate mental health services as part of their Employee Assistance Program for nurses and include psychological and sleep disorders screening, counseling, and follow-up.

ABSTRACT

Introduction Depression has been identified as the leading cause of disability worldwide. Nurses report higher rates of depression than the general public. Work-family conflict is challenging for nurses and may lead to depression and poor health. However, the mechanisms for the effect of work-family conflict on depression have not been well understood. Aim The objective is to use a cross-sectional design to examine the role of sleep disturbances in the association between work-family conflict and depressive symptoms in nurses. Methods Questionnaires, measuring working conditions, work-family conflict, sleep disturbances and depressive symptoms were collected from 397 nurses at a not-for-profit community hospital in the north-eastern United States. Results We observed a significant association between work-family conflict and depressive symptoms (β = 2.22, p < .001) among nurses. Sleep disturbances partially mediated this association by 40.54%. Discussion Sleep disturbances play an important role in translating work-family conflict into depressive symptoms. Implications Evidence-based interventions to promote healthy sleep practices should be evaluated for their effectiveness in addressing the impact of work-family conflict on mental health. Organizations should include sleep education and training as a component of workplace health promotion and employee assistance programmes to mitigate the effect of work-family conflict and promote overall health in nurses.

Work-Family Conflict, Sleep, and Mental Health of Nursing Assistants Working in Nursing Homes

Work-family conflict is challenging for workers and may lead to depression, anxiety, and overall poor health. Sleep plays an important role in the maintenance of mental health; however, the role of sleep in the association between work-family conflict and mental health is not well-studied. Questionnaires were collected from 650 nursing assistants in 15 nursing homes. Multivariate linear regression modeling demonstrated that increased work-family conflict was associated with lower mental health scores (β = -2.56, p < .01). More work-family conflict was correlated with more job demands, less job control, less social support, and longer work hours. Poor sleep quality, but not short sleep duration, mediated the association between work-family conflict and mental health. Workplace interventions to improve nursing assistants' mental health should increase their control over work schedules and responsibilities, provide support to meet their work and family needs, and address healthy sleep practices.

Long-term benefits by a mind-body medicine skills course on perceived stress and empathy among medical and nursing students

BACKGROUND

A significant number of medical students suffer from burnout symptoms and reduced empathy. This controlled, quasi-experimental study aimed to investigate whether a mind-body medicine (MBM) skills course could reduce perceived stress and increase empathy and self-reflection in medical and nursing students.

METHODS

The MBM course (consisting of experiential sessions of mind-body techniques and group reflections) was piloted among Dutch medical students and Swedish nursing students. Main outcome variables were perceived stress (PSS), empathy (IRI subscales perspective taking, fantasy, empathic concern, and personal distress), and self-reflection (GRAS). Participating and control students completed questionnaires at baseline, post-intervention, at 6 and 12 months follow-up.

RESULTS

Seventy-four medical and 47 nursing students participated in the course. Participating medical students showed significantly increased empathic concern [1.42 (95% CI 0.05, 2.78), p = 0.042], increased fantasy [3.24 (95% CI 1.58, 4.90), p < 0.001], and decreased personal distress [-1.73 (95% CI -3.04, -0.35), p = 0.010] compared to controls until 12 months follow-up. Participating nursing students showed significantly decreased levels of perceived stress [-5.09 (95% CI -8.37, -1.82), p = 0.002] and decreased personal distress [-5.01 (95% CI -6.97, -3.06), p < 0.001] compared to controls until 12 months follow-up.

CONCLUSIONS

This study demonstrated long-term beneficial effects of the MBM course on perceived stress and empathy in medical and nursing students.

[Compatibility of Work and Family Life of Employees in the Healthcare Sector: An Issue in Health Services Research]

Hintergrund/Ziele

Beschäftigte im Gesundheitswesen sind mit besonderen beruflichen Rahmenbedingungen und Anforderungen konfrontiert, die sich auf das Verhältnis von Familie und Arbeit/Beruf auswirken können und mittelbar auch die Qualität der Gesundheitsversorgung beeinflussen. Ziel des vorliegenden Beitrags ist es, einen Überblick über den Forschungsstand zu diesem Thema zu geben. Dieser ist für die Versorgungsforschung von Relevanz. Er kann als Ausgangspunkt dafür dienen, Strukturen im Gesundheitswesen (auch in ländlichen Regionen) dahingehend zu verändern, dass sie eine bessere Vereinbarkeit von Familie und Beruf ermöglichen.

Methode

Es wurde eine systematische nationale und internationale Literaturrecherche in Form eines Scoping Review durchgeführt, um den aktuellen Forschungsstand zur Vereinbarkeit von Familie und Gesundheitsberuf zu dokumentieren. Als inhaltliche Suchkriterien wurden definiert: Vereinbarkeit von Beruf und Familie (allgemein); Vereinbarkeitserleben und -konflikte bei Gesundheitsberufen; Vereinbarkeit von Familie und Gesundheitsberuf im ländlichen Raum; Interventionsansätze zur Förderung der Vereinbarkeit von Beruf und Familie. Im Ergebnis eines mehrstufigen Selektionsprozesses wurden 145 Publikationen in die inhaltliche Auswertung einbezogen.

Ergebnisse

Die dokumentierte Literatur bezieht sich schwerpunktmäßig auf die Berufsgruppen Ärzte und beruflich Pflegende, für andere Berufsgruppen liegen kaum Arbeiten vor. Die methodische Qualität der Studien ist meist niedrig, Metaanalysen liegen nicht vor. Mehrere Arbeiten dokumentieren eine Unzufriedenheit bei Ärzten und beruflich Pflegenden bzgl. Möglichkeiten der Vereinbarkeit von Familie und Beruf. Es konnten nur wenige Interventionsstudien zur Förderung der Vereinbarkeit von Familie und Beruf gefunden werden, diese sind wiederum nur teilweise spezifisch auf Gesundheitsberufe ausgerichtet. Defizite bestehen zudem hinsichtlich der Vernetzung mit Fragen der Verbesserung der Gesundheitsversorgung in ländlichen Gebieten.

Schlussfolgerung

Zur Thematik „Vereinbarkeit von Familie und Gesundheitsberuf“ existiert national wie international nur wenig systematische Forschung. Insbesondere zur Evaluation von Maßnahmen bestehen Defizite. Der Literaturüberblick ermöglicht die Ableitung von Ansatzpunkten, um eine Verbesserung der Vereinbarkeit von Familie und Beruf zu erreichen.

Insufficiently studied factors related to burnout in nursing: Results from an e-Delphi study

OBJECTIVE

This study aimed to identify potentially important factors in explaining burnout in nursing that have been insufficiently studied or ignored.

METHODS

A three-round Delphi study via e-mail correspondence was conducted, with a group of 40 European experts. The e-Delphi questionnaire consisted of 52 factors identified from a literature review. Experts rated and scored the importance of factors in the occurrence of burnout and the degree of attention given by researchers to each of the variables listed, on a six-point Likert scale. We used the agreement percentage (>80%) to measure the level of consensus between experts. Furthermore, to confirm the level of consensus, we also calculated mean scores and modes. Regardless of the degree of consensus reached by the experts, we have calculated the mean of the stability of the answers for each expert (individual's qualitative stability) and the mean of the stability percentages of the experts (qualitative group stability).

RESULTS

The response rate in the three rounds was 93.02% (n = 40). Eight new factors were suggested in the first round. After modified, the e-Delphi questionnaire in the second and third rounds had 60 factors. All the factors reached the third round with a consensus level above 80% in terms of the attention that researchers gave them in their studies. Moreover, the data show a total mean qualitative group stability of 96.21%. In the third round 9 factors were classified by experts as 'studied very little', 17 as 'studied little' and 34 as 'well studied'.

CONCLUSION

Findings show that not all the factors that may influence nursing burnout have received the same attention from researchers. The panel of experts has identified factors that, although important in explaining burnout, have been poorly studied or even forgotten. Our results suggest that further study into factors such as a lack of recognition of part of the tasks that nurses perform, feminine stereotype or excessive bureaucracy is needed for a better understanding of this syndrome and improve the quality of life in nurses.

Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: a time-lagged study

AIM

To test a hypothesized model linking new graduate nurses' perceptions of their manager's authentic leadership behaviours to structural empowerment, short-staffing and work-life interference and subsequent burnout, job satisfaction and patient care quality.

BACKGROUND

Authentic leadership and structural empowerment have been shown to reduce early career burnout among nurses. Short-staffing and work-life interference are also linked to burnout and may help explain the impact of positive, empowering leadership on burnout, which in turn influences job satisfaction and patient care quality.

DESIGN

A time-lagged study of Canadian new graduate nurses was conducted.

METHODS

At Time 1, surveys were sent to 3,743 nurses (November 2012-March 2013) and 1,020 were returned (27·3% response rate). At Time 2 (May-July 2014), 406 nurses who responded at Time 1 completed surveys (39·8% response rate). Descriptive analysis was conducted in SPSS. Structural equation modelling in Mplus was used to test the hypothesized model.

RESULTS

The hypothesized model was supported. Authentic leadership had a significant positive effect on structural empowerment, which in turn decreased both short-staffing and work-life interference. Short-staffing and work-life imbalance subsequently resulted in nurse burnout, lower job satisfaction and lower patient care quality 1 year later.

CONCLUSION

The findings suggest that short-staffing and work-life interference are important factors influencing new graduate nurse burnout. Developing nurse managers' authentic leadership behaviours and working with them to create and sustain empowering work environments may help reduce burnout, increase nurse job satisfaction and improve patient care quality.

Certified Nursing Assistants Balancing Family Caregiving Roles: Health Care Utilization Among Double- and Triple-Duty Caregivers

PURPOSE OF THE STUDY

This study examines how certified nursing assistants (CNAs) balancing family caregiving roles-child care (double-duty child caregivers), elder care (double-duty elder caregivers), and both child and elder care (triple-duty caregivers)-utilize health care services relative to nonfamily caregiving counterparts (formal-only caregivers).

DESIGN AND METHODS

A sample of 884 CNAs from the Work, Family and Health Study was drawn on to assess the number of acute care (i.e., emergency room or urgent care facility) and other health care (i.e., outpatient treatment or counseling) visits made during the past 6 months.

RESULTS

Double-duty elder and triple-duty caregivers had higher acute care utilization rates than formal-only caregivers. CNAs with and without family caregiving roles had similar rates of other health care visits.

IMPLICATIONS

CNAs providing informal care for older adults have higher acute care visit rates. Given the increasing need for family caregivers and the vital importance of the health of the nursing workforce for the health of others, future research on how double- and triple-duty caregivers maintain their health amidst constant caregiving should be a priority.

Job Demands, Engagement, and Turnover Intentions in Polish Nurses: The Role of Work-Family Interface

Background: Poland has lower ratios of employed registered nurses per 1,000 inhabitants than the EU average. Polish nurses work under miserable conditions without assisting personnel, and they reconcile their professional demands with responsibilities for their families; 96% of them are women.

Rationale/Aims: This study uses Hobfoll’s conservation of resources (CORs) theory to explain the role of various resources in the improvement of work conditions in the nursing profession. Work-family conflict (WFC) and family work conflict (FWC) threaten to deplete nurses’ resources. This paper set out to (1) examine the extent to which perceived job demands (workload and interpersonal conflicts at work) and engagement (vigor, dedication, and absorption) are associated with turnover intentions (the intention to leave the present workplace and the intention to leave the nursing profession); (2) attempt to determine whether levels of WFC and FWC moderate these associations.

Design/Method: This study comprised 188 female registered nurses. The inclusion criterion was to live with a partner and/or have children.

Results: WFC was moderately related to FWC. Hierarchical regression analyses showed that only high job demands and low vigor were significantly associated with turnover intentions. WFC was experienced more intensively than FWC. Job demands, vigor, dedication, and turnover intentions had a strong effect on WFC, while absorption had a strong effect on FWC. However, levels of WFC and FWC did not significantly moderate these associations.

Originality/Conclusion: The study produces new knowledge by examining a constellation of job demands, work engagement and WFC, which reflect the management of personal resources. Results from such a constellation in nurses from countries with a post-transformational economic system have not previously been discussed in the light of COR theory. Most importantly, we conclude that WFC does not intensify turnover intentions.

Effects of work-family-school role conflicts and role-related social support on burnout in Registered Nurses: a structural equation modelling approach

AIM

To examine the effects of work-family-school role conflicts and role-related social support (RRSS) on burnout of nurses pursuing an advanced degree.

DESIGN

A predictive correlational cross-sectional study design was used.

BACKGROUND

Nurses were found to be a high-risk group for burnout, even more so among nurses pursuing an advanced degree. When nurses with a professional career marry and decide to become students, inter-role conflicts and burnout are possible outcomes of the resulting multiple roles.

METHODS

Using convenience sampling, data were collected from October 2011-May 2012. A questionnaire about work-family-school role conflicts, RRSS, burnout and general information was completed by 286 nurses pursuing an advanced degree at 12 hospitals in Korea. Data were analysed using SPSS and structural equation modelling with the Analysis of Moment Structures program.

RESULTS

The proposed model provided a good fit to the obtained data. Work-family-school role conflicts and social support exerted significant effects on burnout. Role-related social support was found to play a partial mediating role between work-family-school role conflicts and burnout.

CONCLUSION

The findings of this study imply that RRSS significantly directly and indirectly influences burnout among the nurses pursuing an advanced degree. It is necessary for nursing managers to consider implementing family- and school-friendly policies (e.g. flexible work schedules) to help nurses to manage their multiple roles and thereby decrease their burnout rate.

Attitudes toward child rearing in female clinical nurses working in three shifts

The balance between child-rearing and work may be one of the most challenging issues facing female clinical nurses, particularly those who work in three shifts. This study aimed to identify attitudes toward child-rearing in this particular cohort, female clinical nurses working three shifts. Q methodology, a research method concerned with individuals' subjective points of view, was used. Thirty-five selected Q statements from 51 participants were divided into a normal distribution using a nine-point bipolar scale, and the collected data were analyzed using the QUANL program. Three discrete factors emerged: Factor I: child-rearing is natural work (child-rearing and work are separate); Factor II: child-rearing is hard work (child-rearing and work are in conflict); and Factor III: child-rearing requires help from someone (child-rearing and work are balanced). The subjective viewpoints of the three identified factors can be applied to develop diverse strategies to support child-rearing in female clinical nurses.

[The Relationship Between Burnout Symptoms and Work Satisfaction Among Child Welfare Workers in Residential Care]

Working in residential care is associated with high demands and high stress. As a result, employees may develop symptoms of burnout. These symptoms lead to absence from work and have a negative effect on the continuity and quality of the residential care. Until now, little is known about burnout risks in child welfare workers, although children and adolescents are especially dependent on continuous relationships and healthy caregivers. A better understanding of the relationship between burnout symptoms and work satisfaction may help to identify starting points for prevention and intervention. The present study assessed symptoms of burnout in a sample of 319 social education workers in residential care in Switzerland using the burnout-screening-scales (BOSS). Work satisfaction was assessed with a newly developed questionnaire based on concepts of trauma-sensitive care. The questionnaire was tested for reliability and factorial validity in the present study. In order to estimate the relationship between burnout symptoms and work satisfaction, correlations and relative risks were calculated. Almost one fifth (18 %) of the sample showed a risk of burnout. The principal component analysis of the questionnaire on work satisfaction revealed four factors: support by superiors, participation and transparency; communication and support within the team; gratification in the work; and institutional structures and resources. All four factors as well as the total score showed significant correlations with burnout symptoms. Among employees with a comparably lower work satisfaction, the risk of burnout was 5.4 times higher than among employees with a comparably higher work satisfaction. It is discussed how work satisfaction could be promoted and how, as a result, the quality and continuity of care for the children and adolescents could be improved.