Occupational Precariousness of Nursing Staff in Catalonia's Public and Private Nursing Homes

The relationships between precarious employment, having a calling, and occupational well-being among young nurses: a cross-sectional study

BACKGROUND

Working in the healthcare sector seems less interesting than other sectors: the salary is low relative to the demands of the labour involved, and working conditions as well as management are perceived as poor. These factors may have an impact on the well-being of nurses in the healthcare sector. This study aims to explore the relationship between precarious employment and occupational well-being, in addition to the moderating effect of having a calling in this relationship among younger and older nurses.

METHODS

Cross-sectional survey data were collected among Finnish nurses (n = 5867) between October and November 2020. Data were collected on demographics, occupational well-being, precarious employment, and having a calling in the field. Multiple linear regression analyses were used to explore the associations.

RESULTS

Younger nurses perceived lower levels of occupational well-being and calling, and higher levels of precarious employment compared to older nurses. Precarious employment had a negative relationship with occupational well-being, and having a calling showed a positive relationship with regard to occupational well-being. No interaction effect of precarious employment and having a calling with occupational well-being was found.

CONCLUSIONS

Young nurses' occupational well-being, precarious employment, and calling should be studied further because they are in a weaker position in working life. Using a qualitative approach should be considered in order to obtain more in-depth information.

The impact of precarious employment on the commitment of registered nurses

AIM

To investigate the association between precarious employment and commitment among registered nurses.

BACKGROUND

The nursing profession faces numerous challenges, and precarious employment (PE) has emerged as a significant issue affecting nurses' well-being and professional status.

METHODS

In spring 2023, we conducted a cross-sectional survey involving members of a healthcare workers' trade union in Finland. The study encompassed data from 2,370 registered nurses representing various healthcare sectors nationwide. Regression analysis was used to explore the relationship between PE and nurses' commitment. STROBE guidelines were used to report the study.

RESULTS

The modified PE scale demonstrated a good fit. Among the various dimensions of PE, nurses perceived the highest level of precariousness in terms of inadequate training opportunities, followed by unpredictable and nonstandard working hours, low wages, and disempowerment. Vulnerability arising from authoritarian management exhibited the most significant and negative association with nurses' commitment (B = -0.233).

DISCUSSION

The findings of this study underscore that PE is a pressing concern within the nursing profession, and it has a detrimental impact on nurses' commitment. While precariousness in nursing is associated with issues related to empowerment and fair leadership, it appears that conventional challenges related to working hours, typical of the nursing profession, do not significantly affect nurses' commitment.

IMPLICATIONS FOR NURSING AND NURSING POLICY

To enhance nurses' commitment, healthcare institutions and managers must actively promote leadership practices that empower and support employees. Also, employees' legal work-related rights have to be respected in organizations. Addressing these aspects can contribute to a more resilient and dedicated nursing workforce.

The effects of precarious employment and calling on the psychosocial health and work well-being of young and older workers in the care sector: a longitudinal study

OBJECTIVE

Employment conditions in the care sector are changing, and precarious employment (PE) is becoming more widespread, manifesting as undervaluation, adverse leadership, work overload, and inadequate control over work. This study aimed to examine changes in psychosocial health, work well-being, PE, and calling over time and explore the effects of PE and calling on psychosocial health and work well-being.

METHODS

The longitudinal study collected follow-up panel data in the three time points (2020, 2022, and 2023) from care workers (n = 1502), linear mixed effects models.

RESULTS

PE decreased (β =  - 0.02), and perceived work well-being increased (β = 0.04), but there were no change in psychosocial health (β =  - 0.01) and calling (β = 0.01) during the three-year period. Younger (< 39) care workers perceived higher levels of PE and had poorer psychological health. Moreover, PE had a negative effect on psychosocial health (β =  - 0.63) and work well-being (β =  - 0.68) and calling had a positive effect on psychosocial health (β = 0.41) and work well-being (β = 0.49) in multivariate models.

CONCLUSION

PE conditions affect work performance and employee well-being and may threaten patient care; therefore, it should be further investigated in the care sector. It is noteworthy that calling still seems to be central in care work. The results deepen the understanding of the current shortage crisis in health and social care workplaces but can also provide keys to resolving the crisis.

Determining minimum number of valid days for accurate estimation of sedentary behaviour and awake-time movement behaviours using the ActivPAL3 in nursing home residents

INTRODUCTION

Scarce evidence is available about the minimum number of valid days wearing the activPAL3 to obtain a precise estimate of sedentary behaviour (SB) and awake-time movement behaviours (ATMB) in nursing home (NH) residents. The study aimed to determine the minimum number of valid days required for accurately estimate SB and ATMB using the activPAL3 device in NH residents. It also investigated how the starting point of a day (the 24-h period) impacted reliability.

METHODS

Participants wore an activPAL3 for 7 consecutive days. The data was classified in two-time blocks (00:00 Ante Meridiem (AM)-00:00 AM midnight vs 12:00 Post Meridiam (PM) -12:00 PM midday) and the sample was stratified into two groups according to their capacity to stand and walk, to examine if timing of sampling or physical functioning affected minimum wear time. SB, ATMB, sociodemographic, and health-related variables were collected. Sensitivity of the time-blocks were tested through the dispersion frequencies and differences between blocks through Kolmogorov-Smirnov test for normality; parametric variables through two-related means T-test and Wilcoxon test for non-parametric data. Reliability was assessed with the Cronbach's Alpha and the intra-class correlation coefficient (ICC), using a one-factor model estimating the reliability for each measurement day loading in the same latent factor.

RESULTS

Ninety-five NH residents (81.1% women; age = 85.8 ± 7.2 years) were included. The midnight block had higher reliability, sensitivity and no statistically significant differences between days were found. At least three consecutive days of monitoring were necessary to achieve a reliability of ICC ≥ 0.8 for those NH residents able to stand and walk and six days for those unable.

CONCLUSIONS

NH residents who are able to stand and walk require a minimum of three consecutive days wearing the device, while those who are unable require at least six days due to their highly homogenous daily routines and sensitivity to PA events. Regardless of the activPAL3 recording start time, data processing should reference the midnight time block.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships

BACKGROUND

According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately.

OBJECTIVE

Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships.

DESIGN, SETTING, AND PARTICIPANTS

An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'.

METHODS

The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling.

RESULTS

The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern.

CONCLUSIONS

Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate.

TRIAL REGISTRATION NUMBER

DRKS.de (DRKS00015241); August 9, 2018.

TWEETABLE ABSTRACT

Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

Risk factors for developing symptomatic COVID-19 in older residents of nursing homes: A hypothesis-generating observational study

Objectives

To identify which risk factors were associated with developing Coronavirus Disease-19 (COVID-19) infection, with symptoms, in institutionalized older people.

Methods

A 1-year longitudinal multi-center study was conducted in 5 nursing homes (NHs) over the period December 2019 to March 2021. Inclusion criteria included being a permanent resident in the NH, aged 65 years or older, and a positive diagnosis of COVID-19 objectively confirmed by a diagnostic test. A descriptive and bivariate analysis was performed, calculating relative risk (RR) with 95% confidence intervals and statistical significance at p<0.05.

Results

Of the total sample of 78 individuals who tested positive for COVID-19, the mean age was 84.6 years (SD=±7.8), 62 (79.5%) were female; 40 (51.3%) participants presented with COVID-19 symptoms. Living in a private NH (RR=3.6, 95% CI [1.2-11.0], p=0.023) and having suffered a stroke (RR=4.1, 95% CI [1.1-14.7], p=0.033) were positively associated with developing COVID-19 infection with symptoms.

Conclusions

Having suffered a stroke and living permanently in a private NH were positively associated with symptomatic COVID-19 in this sample of institutionalized older people.Clinical Trials ID: NCT04297904.

High hiring rate of nurses in Catalonia and the rest of Spain hides precarious employment from 2010 to 2019: a quantitative study

Aim

This study aims to describe the hiring of nurses in Catalonia and the rest of Spain over 10 years.

Background

Precarious employment (PE) has negative consequences for nurses' quality of life and work performance.

Methods

Quantitative study using a retrospective, longitudinal, descriptive design. We analysed publicly available employment data from Catalonia and the rest of Spain.

Results

Nurses are among the health professionals with the lowest proportion of open‐term (permanent) contracts, 25% during the first 4 years of employment. During the study period, each nurse hired had an average of 3.44 contracts per year. The proportion of nurses with a fixed‐term (non‐permanent) contract shrank from 25.3% in 2006 to 20.5% in 2012 and grew rapidly to 38.7% in 2018. We estimate that 14,800 nurses signed fixed‐term contracts in 2018 without ever having registered as unemployed in nursing.

Conclusion

High rates of fixed‐term hiring and the high number of contracts per nurse are evidence of a high level of PE for nurses in Catalonia.

Implications for Nursing Management

When policymakers and workforce planners design recruitment and retention programmes for nurses, they should consider improving working conditions by extending more open‐term contracts to combat PE and, indirectly, the shortage of nurses.

Registered nurses' perceptions of having a calling to nursing: A mixed‐method study

Aim

To explore how nurses perceived having a calling to nursing.

Design

A mixed‐method study.

Methods

Survey data collected in autumn 2020 and semi‐structured individual interview data collected in spring 2021. The 7925 survey respondents were care professionals and 414 of them were registered nurses. The 23 interview participants were registered nurses who responded to the survey. We examined the survey results using analysis of variance and t‐tests and the interview data with qualitative thematic analysis.

Results

Registered nurses had a lower calling than other care professionals. Based on the interviews, having a calling to nursing produce four key findings. Nurses with a calling experienced their work as meaningful. They also adopted a humane and holistic approach to their work. However, their calling could change during their professional career. Due to its historical roots, having a calling was seen as a risk for the nursing profession, as it meant nurses had an oppressed position in society and nurses associated it with poor working conditions and low pay.

Conclusion

Our study showed that having a calling to nursing had multidimensional benefits for the individual nurse, their patient, colleagues, organization and society, but showed strong association between calling and nurses' poor working conditions and low pay.

Impact

We found that nurses had a lower calling than other care professionals. Calling still exists, but it can produce tension in modern nursing. Organizations and society need to focus on how calling can be seen as a more positive attribute of nursing and improve nurses' working conditions and pay.

An international scoping review of rangers’ precarious employment conditions

Protecting wildlife and other natural resources requires engaging and empowering local communities, ensuring compliance with rules, and ongoing monitoring and research. At the frontline of these efforts are rangers. Despite their critical role in maintaining the integrity of parks and protected areas, rangers across the world are exposed to precarious employment conditions and hazardous work environments. We conducted an international scoping review to understand which employment and working conditions are examined in the context of the ranger occupation and to assess whether the concept of precarious employment is used in the conservation, criminological, and environmental sustainability literature on rangers. We reviewed publications from Web of Knowledge, Scopus, ProQuest, and Medline, and grey literature for relevant English language articles published between 2000 and 2021. Our findings are based on the analysis of 98 included studies. We found that the most commonly discussed aspect of rangers’ employment and working conditions was the hazardous social and physical work environment, although this was often accompanied by severe income inadequacy, employment insecurity, and a lack of social security, regulatory support, and workplace rights. Such employment and working conditions can cause adverse impacts on rangers’ mental and physical health, well-being, and safety, and are also detrimental to their ability to adequately protect biodiversity. We conclude by outlining the need for sustainable solutions and additional research based on established conceptualizations of the precarious employment concept and other related concepts. Lastly, we suggest that governments should acknowledge the importance of rangers through their recognition as essential workers and provide greater support to improve their employment conditions.

Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic?

BACKGROUND

Nurses and midwives play a critical role in the provision of care and the optimization of health services resources worldwide, which is particularly relevant during the current COVID-19 pandemic. However, they can only provide quality services if their work environment provides adequate conditions to support them. Today the employment and working conditions of many nurses worldwide are precarious, and the current pandemic has prompted more visibility to the vulnerability to health-damaging factors of nurses' globally. This desk review explores how employment relations, and employment and working conditions may be negatively affecting the health of nurses in countries such as Brazil, Croatia, India, Ireland, Italy, México, Nepal, Spain, and the United Kingdom.

MAIN BODY

Nurses' health is influenced by the broader social, economic, and political system and the redistribution of power relations that creates new policies regarding the labour market and the welfare state. The vulnerability faced by nurses is heightened by gender inequalities, in addition to social class, ethnicity/race (and caste), age and migrant status, that are inequality axes that explain why nurses' workers, and often their families, are exposed to multiple risks and/or poorer health. Before the COVID-19 pandemic, informalization of nurses' employment and working conditions were unfair and harmed their health. During COVID-19 pandemic, there is evidence that the employment and working conditions of nurses are associated to poor physical and mental health.

CONCLUSION

The protection of nurses' health is paramount. International and national enforceable standards are needed, along with economic and health policies designed to substantially improve employment and working conditions for nurses and work-life balance. More knowledge is needed to understand the pathways and mechanisms on how precariousness might affect nurses' health and monitor the progress towards nurses' health equity.

Health care workers and migrant health: Pre- and post-COVID-19 considerations for reviewing and expanding the research agenda

The main purpose of this article is to review several ways in which health care workers could either impact migrant health or be directly impacted by migration and, based on this, suggest the expansion of the current research agenda on migration and health to address a range of topics that are currently either neglected, insufficiently researched, or researched from different perspectives. To ground this suggestion and emphasize the complexity and significance of migrant health research, we start by briefly reviewing several migration-related notions including the process of migration and its key facilitators and benefits; existing barriers to the provision of migrant health care; and the intricate links between health systems, health professionals, and migrant health. The three areas of research examined in this article address (i) the specific role of health workers in providing care to migrants and refugees and their capacity to do so, (ii) the health problems experienced by health workers who become migrants or refugees, and (iii) the precarious employment conditions experienced by both migrant and non-migrant health care workers. After summarizing the current available evidence on these topics, we discuss key information gaps and strategies to address them, while also incorporating several relevant COVID-19 pandemic considerations and research implications. Expanding the focus of research studies on migration and health could not only enhance the results of current strategies by supplying additional information to support their implementation but also spearhead the development of new solutions to the migrant health problem.

Socioeconomic Factors Related to Job Satisfaction among Formal Care Workers in Nursing Homes for Older Dependent Adults

Population ageing is increasing the demand for dependent care. Aged care nursing homes are facilities that provide formal care for dependent older persons. Determining the level of job satisfaction among workers in nursing homes and the associated factors is key to enhancing their well-being and the quality of care. A cross-sectional survey was administered online to nursing home workers (n = 256) in an inland region of Spain over the period from February to May 2017. The questionnaire collected data on sociodemographic variables and others related to training and job satisfaction. The results show that most of the care is delivered by women with a medium level of education. A total of 68% of workers had received formal training, although a significant percentage (65%) thought this was not useful. The highest level of satisfaction was found to be related to users and co-workers. Our factor analysis revealed that the satisfaction components are decision-making, working conditions—e.g., schedule—and the work environment—e.g., relationship with coworkers—. Length of service and working with highly dependent persons are negatively associated with these components. Working in social health care is negatively related to decision-making and working conditions. Training, in contrast, is positively associated with these components. Care is a job that requires appropriate training and preparation to provide quality assistance and to guarantee workers’ well-being.

Factors Influencing Nurse Assistants' Job Satisfaction in Nursing Homes in Canada and Spain: A Comparison of Two Cross-Sectional Observational Studies

OBJECTIVES

To access associations between job satisfaction and supervisory support as moderated by stress.

METHODS

For this cross-sectional study, data collected from 591 nursing assistants in 42 nursing homes in Canada and Spain were analyzed with mixed-effects regression.

RESULTS

In both countries, stress related to residents' behaviors was negatively associated with job satisfaction, and, in Canada, it moderated the positive association between supervisory support and job satisfaction. Stress related to family conflict issues moderated the positive association of supervisory support and job satisfaction differently in each location: in Canada, greater stress was associated with a weaker association between supervisory support and job satisfaction; in Spain, this was also observed but only when supervisory support was sufficiently weak.

DISCUSSION

Stress was associated with lower job satisfaction and moderated the association of supervisory support and job satisfaction, reinforcing the importance of supervisors supporting nursing assistants, especially during the COVID-19 pandemic.