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.

Workers not Paid for Sick Leave after Implementation of the New York City Paid Sick Leave Law.

This study examined factors associated with being paid for sick leave after implementation of the New York City (NYC) paid sick leave law. A random sample of NYC residents was surveyed by telephone multiple times over a 2-year period. Participants (n = 1195) reported socio-demographics, awareness of the law, income, work hours per week, and payment for sick time off work. In the year after implementation of the law, part-time workers were significantly more likely to attend work while sick than full-time workers (relative risk = 1.25, 95% CI = 1.1, 1.4). Seventy percent of workers who missed work due to illness (n = 249) were paid for sick leave. Part-time workers, respondents not aware of the benefit (30% of workers), and workers without a college degree were the least likely to be paid for sick days. More than one third (37%) of persons not paid for sick leave worked in retail, food service, or health care. Although 70% of respondents were paid for sick leave after implementation of the law, part-time workers and workers with low education were least likely to access the benefit and more likely to work while sick. The disparity in paid sick leave may have public health consequences as many persons not paid for sick leave had occupations that carry a high risk of disease transmission to others.

Physicians, sick leave certificates, and patients' subsequent employment outcomes.

I analyze how general practitioners (GPs) indirectly affect their patients' employment outcomes by deciding the length of sick leaves. I use an instrumental variables framework where spell durations are identified through supply-side certification measures. I find that a day of sick leave certified only because the worker's GP has a high propensity to certify sick leaves decreases the employment probability persistently by 0.45-0.69 percentage points, but increases the risk of becoming unemployed by 0.28-0.44 percentage points. These effects are mostly driven by workers with low job tenure. Several robustness checks show that endogenous matching between patients and GPs does not impair identification. My results bear important implications for doctors: Whenever medically justifiable, certifying shorter sick leaves to protect the employment status of the patient may be beneficial.

Sustained return to work and work participation after a new legislation obligating employers to notify prolonged sickness absence.

AIMS: Return to work (RTW) after prolonged sickness absence benefits both the individual and society. However, the effectiveness of legislation aiming to improve RTW remains uncertain. We examined whether sustained RTW and work participation were different before and after a legislative change enacted in 2012 (i.e. an intervention) that obligated employers to give notice of prolonged sickness absence to occupational health services. METHODS: Two random samples (2010 and 2013) of the Finnish working aged population (70%, ~2.6 million each) were drawn. Using survival analysis, we assessed sustained RTW (≥28 consecutive working days) during a two-month follow-up after a sickness absence minimum of 30 calendar days in the pre- and post-intervention period. We also identified pathways for RTW with cluster analysis and calculated relative gain in work participation in the total sample and by several population subgroups. RESULTS: In the total sample, sustained RTW was 4% higher and the mean time to sustained RTW was 0.42 days shorter in the post- than in the pre-intervention period. The estimates were larger among women than men and among those with mental disorders compared with other diagnoses. Changes in the pathways for sustained RTW indicated a 4.9% relative gain in work participation in the total sample. The gain was larger among those who lived in areas of low unemployment rate (20.6%) or worked in the public sector (11.9%). CONCLUSIONS: From 2010 to 2013, RTW and work participation increased among the employees with prolonged sickness absence, suggesting that the legislative change enhanced RTW. The change in work participation varied by population subgroup.

Staff who work long shifts more likely to call in sick, according to new research.

Nurses who work 12-hour shift patterns are more likely to take sickness leave, new research shows.

Ventilation in day care centers and sick leave among nursery children.

Several studies have reported poor indoor air quality (IAQ) in day care centers (DCCs), and other studies have shown that children attending them have an increased risk of respiratory and gastrointestinal infections. The aim of this study was to investigate whether there is an association between ventilation in DCCs and sick leave among nursery children. Data on child sick leave within an 11-week period were obtained for 635 children attending 20 DCCs. Ventilation measurements included three proxies of ventilation: air exchange rate (ACR) measured with the decay method, ACR measured by the perfluorocarbon tracer gas (PFT) method, and CO2 concentration measured over a 1-week period. All but two DCCs had balanced mechanical ventilation system, which could explain the low CO2 levels measured. The mean concentration of CO2 was 643 ppm, exceeding 1000 ppm in only one DCC. A statistically significant inverse relationship between the number of sick days and ACR measured with the decay method was found for crude and adjusted analysis, with a 12% decrease in number of sick days per hour increase in ACR measured with the decay method. This study suggests a relationship between sick leave among nursery children and ventilation in DCCs, as measured with the decay method.

[Social Support as a Resource for Work Ability]. / Soziale Unterstützung als Ressource für Arbeitsfähigkeit.

PURPOSE: The study examined the association of social support with subjective work ability, subjective prognosis of gainful employment and general health perception. METHODS: The analysis considered cross-sectional data from a sample of 2,983 employees (40-54 years) with sickness benefits in 2012. The postal survey was conducted in May 2013. RESULTS: After adjustment for socio-demographic and work-related characteristics as well as personality factors low social support was significantly associated with lower work ability (b=- 2,7; 95% CI:-3,4 to 1,9), higher odds of poor employment prognosis (OR=2,0; 95% CI: 1,5 to 2,6) and poorer health perception (b=- 8,0; 95% CI:-10,1 to-5,9). CONCLUSIONS: Low social support is potentially an independent predictor of lower work ability, employment prognosis and general health perception. To confirm causal relationships longitudinal data are needed, which will be assessed in 2015 and 2017.

Exploring the relationship between age and tenure with length of disability.

BACKGROUND: The aging of the workforce, coupled with the changing nature of career tenure has raised questions about the impact of these trends on work disability. This study aimed to determine if age and tenure interact in relating to work disability duration. METHODS: Relationships were investigated using random effects models with 239,359 work disability claims occurring between 2008 and 2012. RESULTS: A 17-day difference in the predicted length of disability was observed from ages 25 to 65. Tenure moderated the relationship between age and length of disability. At younger ages, the length of disability decreased as tenure increased, but at older age, the length of disability increased as tenure increased. DISCUSSION: Results indicate that although there is a relationship between length of disability and tenure, age makes a greater unique contribution to explaining variance in length of disability. Future research is needed to better understand why specifically age shows a strong relationship with length of disability and why that relationship varies with age.

Sickness benefit cuts mainly affect blue-collar workers.

AIMS: To analyse the impact of sick-pay cuts on the use of sickness absence by employees of different socioeconomic groups. In 2009 cuts in sick pay were implemented in reaction to an economic crisis in Estonia. METHODS: Nationwide health survey data from the years 2004, 2006, 2008, and 2010 were used to evaluate sickness absence among blue-collar and white-collar workers. The dataset comprised 7,449 employees of 20-64 years of age. Difference in prevalence of absentees before and after the reform was assessed using the chi-squared test. Odds ratios (OR) for sickness absence were calculated in a multivariate logistic regression model. RESULTS: After the reform, the proportion of blue-collar workers who had been on sick leave decreased from 51% to 40% (p<0.001) and among white-collar employees from 45% to 41% (p=0.026). This reduction had a similar pattern in all the subgroups of blue-collar employees as stratified according to gender, age, self-rated health, and presence of chronic disease, especially among those with low incomes; in white-collar employees it reached statistical significance only in those with good self-rated health (p=0.033). In a multivariate model the odds of having lower sickness absence were highly significant only in blue-collar employees (OR 0.63; 95% confidence interval 0.51-0.77, p<0.001). CONCLUSIONS: The cuts in sickness benefits had a major impact on the use of sickness absence by blue-collar employees with low salaries. This indicates that lower income was a major factor hindering the use of sick leave as these employees are most vulnerable to the loss of income.

Short-term economic evaluation of physical activity-based corporate health programs: a systematic review.

OBJECTIVES: Corporate health programs (CHPs) aim to improve employees' health through health promotion strategies at the workplace. Physical activity (PA) plays a crucial role in primary prevention, leading many companies to implement PA-based CHPs. However, there is limited examination in the scientific literature on whether PA-based CHPs (PA-CHPs) lead to economic benefits. This systematic review aimed to summarize the available literature on the economic aspects of PA-CHPs. METHODS: A systematic review was conducted to identify studies focused on PA-CHPs targeting healthy sedentary workers and reporting at least one economic outcome, such as return on investment (ROI), costs, or sick leave. RESULTS: Of 1036 studies identified by our search strategy, 11 studies involving 60 020 participants met the inclusion criteria. The mean (±SD) cost per capita for PA-CHPs was estimated as 359€ (±238€) (95% CI, 357-361€). In 75% of the studies, the net savings generated by PA-CHPs in 12 months were reported, with an average of 1095€ (±865€) (95% CI, 496-1690€). ROI was assessed in 50% of the included studies, with an average of 3.6 (±1.41) (95% CI, 2.19-5.01). CONCLUSIONS: In addition to promoting a healthy lifestyle, PA-CHPs have the potential to generate significant economic returns. However, the heterogeneity among the existing studies highlights the need for standardization and accurate reporting of costs in future research.

Absenteeism amongst health workers--developing a typology to support empiric work in low-income countries and characterizing reported associations.

The contribution of inadequate health worker numbers and emigration have been highlighted in the international literature, but relatively little attention has been paid to absenteeism as a factor that undermines health-care delivery in low income countries. We therefore aimed to review the literature on absenteeism from a health system manager's perspective to inform needed work on this topic. Specifically, we aimed to develop a typology of definitions that might be useful to classify different forms of absenteeism and identify factors associated with absenteeism. Sixty-nine studies were reviewed, only four were from sub-Saharan Africa where the human resources for health crisis is most acute. Forms of absenteeism studied and methods used vary widely. No previous attempt to develop an overarching approach to classifying forms of absenteeism was identified. A typology based on key characteristics is proposed to fill this gap and considers absenteeism as defined by two key attributes, whether it is: planned/unplanned, and voluntary/involuntary. Factors reported to influence rates of absenteeism may be broadly classified into three thematic categories: workplace and content, personal and organizational and cultural factors. The literature presents an inconsistent picture of the effects of specific factors within these themes perhaps related to true contextual differences or inconsistent definitions of absenteeism.

The association between shift work and sick leave: a systematic review.

Shift work is associated with a number of negative health outcomes, although it is not known whether it is associated with sick leave. This systematic review therefore aimed to determine whether an association exists between shift work and sick leave. A systematic literature search was conducted in six databases on observational studies. Two reviewers independently selected relevant articles and appraised methodological quality. Data extraction was performed independently by review couples. Articles were categorised according to shift work characteristics and summarised using a levels of evidence synthesis. In total, the search strategy yielded 1207 references, of which 24 studies met the inclusion criteria. Nine studies were appraised as high quality and used in the levels of evidence synthesis. Two high quality longitudinal studies found a positive association between fixed evening shifts and longer sick leave for female healthcare workers. The evidence was assessed as strong. Evidence was inconclusive for rotating shifts, shift work including nights, for fixed night work, and for 8-hour and 12-hour shifts. The association found between evening work and sick leave in female healthcare workers implies that the association between shift work and sick leave might be schedule and population specific. To study the association further, more high quality studies are necessary that assess and adjust for detailed shift work exposure.

The occupational role of dental conditions among a consecutive sample of Spanish workers.

OBJECTIVES: To assess the occupational impact of the mouth in terms of days of work loss in the last year and the perception of the working performance disturbance because of the oral conditions. STUDY DESIGN: A consecutive sample (n=269) of the Regional Government staff of the province of Granada (Spain) was recruited. Participants were asked about work loss related to health problems in the past 12 months, capturing the aetiological entities, the frequency of the work absent and the total days loss. Also subjects reported if they believed that mouth affects their occupational performance, and if they have perceived difficulties for carrying out work because of the mouth. Data on sociodemographic, behavioural and clinical factors were also gathered. Chi-squared test, Odds ratio (OR) and relative risk (RR) of perceived occupational role were used to quantify the effect of the modulating factors. RESULTS: Almost 40% of individuals were absent from work during the last year spending on average 5.4 days for recovering. Colds and musculoskeletal pathology were the major causes of sick leave. Dental disease caused short work absences (4 days on average) only in 2.8% of participants. However most of workers (62.5%) considered mouth to influence their occupational performance, mainly because of the pain-related events (61.7%), but only 4.1% of workers reported difficulties in carrying out their work in the past 12 months. Females (RR=1.3), participants attending regular dental visits (RR=1.4) and denture wearers (RR=2.5) were shown to have significantly higher risk of perceiving an occupational role of the mouth. Those workers reporting that mouth influences their work have significantly poorer oral health than counterparts. CONCLUSIONS: Most workers considered that mouth influences their occupational performance but dental disease has demonstrated to be a minor occupational cause of sick leave in terms of prevalence and magnitude of work loss.

Labor market affiliation after deployment: Danish soldiers fare well, but face increased risk of long-term sickness absence when returning from Afghanistan.

Objectives Little is known about the employment prospects of formerly deployed soldiers (FDS) after returning from military deployment. The few studies that exist reported mixed results, and even fewer undertook comparisons with a civilian control population. This study compared labor market transitions of FDS within five years of returning from their first international deployment with those of a closely matched general-population control group. Methods Danish FDS (N=6653) returning from their first ever peacekeeping in Kosovo or Iraq, or more intense combat in Afghanistan (period 2002-2012), were matched with non-deployed controls from the general population (N=62 281). We modelled time-to-event using Cox models, for transitioning from employed to unemployed and back, and from work to long-term sickness absence and back. Each analysis adjusted for age and level of education and was stratified for the region of residence and the underlying period. Results Independent of deployment country, FDS had a lower risk of becoming unemployed [hazard ratio (HR) 0.55-0.73] and a higher chance of obtaining employment (HR 1.19-1.31) than matched controls. FDS returning from Afghanistan had a higher risk of long-term sickness absence (HR 1.66), while those returning from Kosovo had a higher chance of returning to work (HR 1.24). Conclusion Independent of deployment country, FDS fared better in the labor market within five years of returning home compared to non-deployed controls. However, deployment to Afghanistan was related to a higher risk of long-term sickness absence, suggesting that some soldiers have worse outcomes than the general population.

[Sick-pay trends of the National Health Insurance Fund of Hungary between 1997 and 2017]. / Az Egészségbiztosítási Alap táppénzes trendjei Magyarországon 1997 és 2017 között.

INTRODUCTION: The role of sick-pay is to compensate for loss of wage in case of incapacity for work, to ensure that there will be no break in the existential state of the incapacitated person. AIM: The purpose of our research was to examine data on sickness benefit and payroll data for the period 1997-2017. DATA AND METHODS: Our research was based on the data of the National Health Insurance Fund of Hungary, the Hungarian Central Statistical Office, the State Audit Office of Hungary and the Hungarian State Treasury as well as on the background reports of the European Commission's Social Protection Committee and the Organisation for Economic Co-operation and Development (OECD), and it is based on the legal environment of sick-pay. RESULTS: In 1997, there were 119 000 of 3.558 million, in 1998 114 000 of 3.530 million, in 1999 115 000 of 3.433 million, in 2000 112 000 of 3.465 million, in 2006 100 000 of 3.523 million, in 2012 55 000 of 3.769 million entitled people on sick leave on average per day. In 2017, the number of entitled persons increased to 4.018 million, while the average number of sick days per day was 70 000. According to data from gender and age-based analysis, in most cases, women with childbearing were on sick-leave, the proportion of males was higher in relation to industrial accident. Between 2014 and 2016, the proportion of women on sick leave per day was 59-60%, while the major reason for sick-pay among men was the industrial accident. The distribution by age did not change significantly. In 2014-2015, the age-group 30-34, while in 2016 the age-group 35-39 had the highest utilization of sick-pay. CONCLUSION: We can conclude that the use of sick-pay is affected by the employment rate, legal changes affecting the amount of sick-pay and social trends like substitution difficulties due to labor shortages and fear of losing jobs. Orv Hetil. 2019; 160(Suppl 1): 37-42.

Outbreak Protection and the Importance of Paid Sick Leave.

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to the column's editor, Meghan McGinty, PhD, MPH, MBA, at mmcginty@naccho.org.