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AIM: To investigate the effects of psychological contract breach and psychological safety on health and well-being outcomes among nurses. DESIGN: A cross-sectional study. METHODS: Data were gathered from members of the Finnish social and healthcare workers' trade union (n = 4575) in February 2023. This study focused on data from 3260 nurses. Structural equation modelling was employed to firstly explain burnout and work engagement and subsequently health and well-being outcomes in relation to perceived psychological contract breach and psychological safety. RESULTS: Younger male nurses, those with lower-level university degrees, and nurses employed in public hospitals reported experiencing more psychological contract breaches. Conversely, older nurses and those working in private organizations perceived a higher level of psychological safety. Psychological contract breaches were associated with increased burnout and reduced work engagement, while psychological safety contributed to lower burnout and higher work engagement. Moreover, burnout was linked to health problems and diminished mental well-being, whereas increased work engagement led to fewer health problems and improved mental well-being. The final model demonstrated excellent fit. CONCLUSION: Breaches in the psychological contract, followed by distrust, and anger significantly burden nurses, detrimentally affecting their well-being at work. Psychologically safe working environments, consequently, improve nurses' well-being at work and should be promoted within work teams. IMPLICATIONS FOR THE PROFESSION: Nursing managers could receive training to understand the consequences of, and practices for supporting, a beneficial psychological work climate. IMPACT: The study examined psychological burden and resource factors at work, finding that psychological contract breaches increased burden and led to negative well-being outcomes. In contrast, psychological safety emerged as a positive resource for health and well-being. These results offer benefits for nurses, managers and organizations. REPORTING METHOD: The study was reported following the Strengthening of the reporting of observational studies in epidemiology guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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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.
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The study examines former home care workers' reasons for leaving their jobs from the perspective of reforms in public services and eldercare policies impacted by New Public Management (NPM) in Finland. Written narratives from former home care workers (n = 39) were collected online and analyzed using thematic content analysis. Former home care workers' reasons for leaving their jobs were connected to four interconnecting themes: mismatch between needs and resources, measurement-driven practices, unbalancing work-life, and ethical burden. These reasons reflected critical changes in the organization of care work and the work environment in older adults' home care. Contradictions between needs, resources, and values lead to ethical dilemmas and push away from the workforce in eldercare. To improve care workers' willingness to remain in the eldercare sector, changes are needed in the resourcing and organization of home care, including managerial support in everyday care work.