A cross exploratory analysis between nursing working conditions and the occurrence of errors in the northeast region of Brazil.

OBJECTIVES: Analyze and verify the association between working conditions and the occurrence of errors in nursing work. BACKGROUND: Many of the known errors in nursing are based on the structural failure of the complex health service system. Our study addresses the question "Is there an association between errors made by nursing workers and working conditions?" METHODS: The study was carried out through a cross-sectional exploratory analysis of 19 ethical-disciplinary processes focused on errors made by nursing workers. The articles were processed, judged, and archived at the Regional Nursing Councils of the Northeast Region of Brazil from 2000 to 2018. The chi-square test or Fisher's exact test was used to verify the relationship between the variables through multivariate analysis. RESULTS: The analyzes show that working conditions can interfere at occurrence in error. This increases the chance of an "inconsequential" error occurring for the patient in poor/very poor working conditions. The most serious errors, "with consequences irreversible" for the patient, only occur from more severe working conditions. Adversely, it was found that there is no statistically significant difference in the frequency of errors in hospitals (33.33 %) compared to "other places" (28.58 %) when these occurred in poor working conditions. When conducting the incident in poor working conditions, there was a minimum of 52 % protection OR = 0.48 % [0.16; 11.80]; (1-0.48)) against these errors in general in the nursing area. CONCLUSION: The strong association was exposed in working conditions classified as bad/very bad/very bad, resulting in the most serious errors and with irreversible consequences for patients. However, a level of protection for different types of workers was noticed in the field, which shows that there is hope that if the work environment changes with more organization, management, and standards of care, we can prevent future errors.

The impact of the COVID-19 pandemic on the well-being, work conditions, and education of early career psychiatrists in the WHO Eastern Mediterranean Region: study protocol.

Background: The COVID-19 pandemic placed great strain on healthcare professionals, leading to a substantial impact and a redistribution of the workforce. Despite the active involvement of the Eastern Mediterranean Region Office (EMRO) and the World Health Organization in managing mental health crises, there is a knowledge gap concerning the working conditions and training opportunities available for early career psychiatrists (ECPs) during the pandemic period. Objectives: This study aims to investigate the impact of the COVID-19 pandemic on ECPs and how it affected their well-being, employment, and educational opportunities. Methods: A mixed methods study has been conducted in Iran, Egypt, and Tunisia, three EMRO member countries. It includes a cross-sectional survey with self-reported questions, and a qualitative study with individual in-depth interviews. Discussion: The findings of this study will raise awareness to the working conditions of ECPs within the EMRO region and its member societies, both during the COVID-19 pandemic and beyond. The results will serve as a basis for encouraging supervisors and policymakers to mitigate the pandemic's impact on psychiatric training, strengthen healthcare systems' preparedness, and equip early career psychiatrists with the necessary skills to deal with the mental health consequences of the COVID-19 pandemic.

'We need to get paid for our value': Work-place experiences and role definitions of peer recovery specialists/community health workers.

Despite growing research on peer recovery specialists and community health workers (CHWs) in fields such as substance use disorder (SUD) treatment and recovery support, their workplace experiences are little understood. Through semi-structured interviews with 21 CHWs and peer recovery specialists working within substance use disorder treatment and/or traditional health care settings, we identified six prevalent themes: Benefits/Pleasures of the Role; Reciprocity; Challenges; Duality of Lived Experience; Relationships with Medical Professionals and Supervisors; and Defining Metrics. These themes reveal a complex narrative of system failures, organizational hierarchies, and experiential realities in which shared experiences and personal connections with clients undergird both positive and negative aspects of the role. In the words of one study participant: "We have not taken a vow of poverty, we need to get paid for our value."

Compassionate Care: A Qualitative Exploration of Nurses' Inner Resources in the Face of Burnout.

There is a universal shortage of nurses, with a current needs-based shortage of 5.9 million. This is not solely a recruitment issue but one of retention, triggered by high levels of work-induced stress, burnout, and reports of low job satisfaction resulting in poor care delivery. Some of the health repercussions on nurses include anxiety, insomnia, depression, migraines, irritability, absenteeism, and sometimes alcoholism and drug abuse. To tackle some of these costly issues, a qualitative exploration into how inner resources is used by nurses to cope with stress at different points of their careers is proposed. Through the lens of grounded theory, semi-structured interviews will be carried out with two distinct sets of participants: (1) Student nurses registered at the University of the Illes Baleares between 2022-2025. (2) Experienced nurses on the Balearic nursing register. Interviews will be coded and then analysed using Atlas.ti. Expected results will inform curriculum improvements that will benefit the well-being of (student) nurses, from the outset of their training, pre-empting potential psycho-social risks before they arise in the workplace. This is vital as it addresses nurses' mental health as well as chronic issues of retention and absenteeism.

Increasing levels of burnout in Swedish midwives - A ten-year comparative study.

PROBLEM: Midwives' levels of burnout seem to be increasing worldwide. BACKGROUND: Previous research show a high prevalence of burnout in midwives. AIM: To compare levels of burnout in two national Swedish samples of midwives completing a similar survey. METHODS: A comparative study of two cross-sectional national surveys directed at midwives in 2012 and 2022. To measure burnout in midwives, the Copenhagen Burnout Inventory with 19 items was used. FINDINGS: The sample consisted of 2209 midwives: 466 from 2012 and 1743 from 2022. Personal burnout showed an increase from 39.5 % to 53.6 % over the years; work burnout increased from 15.5 % to 49.2 % and client burnout increased from 15 % to 20.9 %. Personal burnout was associated with working shift. Work burnout was associated with length of work experience and working rotating shifts; and client burnout was associated with shorter work experience. DISCUSSION: The highest increase in burnout was found in the work domain in 2022 compared to 2012. Notable in the present study is the increase in client burnout, which could be a sign of midwives becoming less caring and more cynical. CONCLUSION: This study showed that self-reported levels of burnout among Swedish midwives increased over the ten-year period studied. The largest increase was found in the subscale work burnout. Midwives with shorter work experience and those with shift work were the most vulnerable to burnout. Improved organisation of midwifery services needs to be designed to ensure healthy working conditions for midwives.

"Valorar el trabajo de farmworkers": A thematic analysis of input from farmworkers, advocates, and students in a community documentary project about the future of farm work.

Farm work is one of the nation's most hazardous occupations, and migrant and seasonal farmworkers face significant health inequities. Awareness and understanding of the needs of this population are crucial in assuring they receive appropriate support. Documentary programs can raise awareness of community member views to better inform services and advocacy efforts. Visions for the future of farm work were collected from farmworkers and persons supporting them through a community-based, participatory documentary project led by Student Action with Farmworkers (SAF) from 2021 to 2022. Seventy-nine submissions from participants in North and South Carolina, including text responses and file uploads, were collected and thematically analyzed. Five themes were identified: (1) employment benefits and conditions, (2) living conditions, (3) health access and quality, (4) dignity and visibility of farm work, and (5) policy change for a better future. The visions for the future of farm work expressed by these agricultural workers, advocates, and students raise important implications for agricultural communities, public health practitioners, researchers, funders, and policymakers. Application of these findings in the development and delivery of public health services for farmworkers has the potential to positively impact the morbidity and mortality rates of this at-risk population.

At-Risk Drinking and Workplace Conditions among Latino Day Laborers.

Background: Latino Day Laborers (LDL) face a variety of factors which have been associated with at-risk drinking. The objective of this study was to assess the association of at-risk drinking with measures of work site conditions. Methods: Data from surveys conducted with 307 LDL in Houston, TX in 2015 were analyzed. Sociodemographic information and measures of exposures to hazardous products at the worksite, adverse working conditions, and work stressors were collected. Measures of positive working climate at the jobsite and a climate that promoted jobsite safety were also included. Participants were administered the Hazardous Use items from the Alcohol Use Disorders Identification Test of Consumption (AUDIT-C). Participants were classified as low-risk or at-risk drinkers based on AUDIT-C score. Logistic regression models were run to assess the associations of the sociodemographic and worksite related variables with drinking status. Results: One-hundred-five (34.2%) participants were classified as at-risk drinkers. At-risk drinking was associated with past-month income, being formerly married (compared to having never married), and lack of housing. At-risk drinking was also associated with measures of a positive working climate and a climate that promoted jobsite safety. Conclusions: One-third of our participants were classified as at-risk drinkers. At-risk drinking was associated with stressors in the form of lack of housing and no longer having a spouse but was also associated with increased income and with positive workplace factors. At-risk drinking was thus a function of both stressors and positive factors, including a positive work site.

Advocacy e condições de trabalho na universidade: Estratégia para o empoderamento do docente de enfermagem / Advocacy and working conditions at the university: A strategy for the empowerment of nursing teachers / Advocacy y condiciones laborales en la universidad: Estrategia para el empoderamiento del profesorado de enfermería

Resumo Enquadramento: No campo da enfermagem a advocacy procura contribuir no direito à saúde, que se insere no campo dos direitos humanos, pois está intrinsecamente relacionado ao direito de todos a uma vida saudável. Objetivo: Analisar a perceção de docentes sobre a advocacy na enfermagem e discutir as estratégias de promoção de advocacy para o trabalhador docente universitário de enfermagem. Metodologia: Estudo descritivo e exploratório, de abordagem qualitativa realizado em duas universidades públicas situadas no município do Rio de Janeiro, Brasil. Os participantes foram 14 docentes de enfermagem. Utilizou-se o grupo focal e os dados foram analisados à luz da técnica de análise de conteúdo. Resultados: Destaca-se a advocacy como atividade imperativa para alcançar a defesa dos interesses da categoria profissional, bem como a utilização das mídias como estratégia de divulgação do trabalho da enfermagem, incluindo os docentes de enfermagem. Conclusão: A advocacy é uma estratégia de promoção e valorização dos docentes de enfermagem em universidades sendo necessário o investimento nessa estratégia como importante recurso para a promoção da valorização profissional.

Abstract Background: In nursing, advocacy seeks to contribute to the right to health, which is intrinsically related to the human right to a healthy life. Objective: To analyze university teachers' perceptions of advocacy in nursing and discuss strategies to promote advocacy for university nursing teachers. Methodology: A descriptive and exploratory study with a qualitative approach was carried out in two public universities in Rio de Janeiro, Brazil. The participants were 14 nursing teachers. A focus group was conducted, and data were analyzed using the content analysis technique. Results: Advocacy stands out as a crucial activity to defend the professional category's interests, using the media as a strategy for disseminating nursing work, including nursing teachers. Conclusion: An investment in advocacy is needed as it is a strategy for valuing university nursing teachers and promoting their professional development.

Resumen Marco contextual: En el ámbito de la enfermería, la advocacy pretende contribuir al derecho a la salud, que se enmarca en el ámbito de los derechos humanos, ya que está intrínsecamente relacionado con el derecho de todos a una vida sana. Objetivo: Analizar la percepción de los profesores sobre la advocacy en la enfermería y debatir estrategias para promover la advocacy para el trabajador docente universitario de enfermería. Metodología: Estudio descriptivo y exploratorio de enfoque cualitativo realizado en dos universidades públicas localizadas en el municipio de Río de Janeiro, Brasil. Los participantes fueron 14 profesores de enfermería. Se utilizó el grupo focal y los datos fueron analizados con la técnica de análisis de contenido. Resultados: Se destaca la advocacy como actividad imprescindible para lograr la defensa de los intereses de la categoría profesional, así como la utilización de los medios de comunicación como estrategia de difusión del trabajo de enfermería, incluidos los docentes de enfermería. Conclusión: La advocacy es una estrategia de promoción y valoración del profesorado de enfermería en las universidades y es necesario invertir en esta estrategia como recurso fundamental para la promoción de la valoración profesional.

Clarity and adaptability of instructions preventing the spread of the COVID-19 virus and its association with individual and organisational factors regarding the psychosocial work environment: a cross-sectional study.

BACKGROUND: In Sweden, older people in residential care had the highest mortality rates, followed by those who received home care, during the coronavirus disease 2019 (COVID-19) pandemic. Staff working in the care of older people assumed responsibility for preventing the spread of the virus despite lacking the prerequisites and training. This study aimed to investigate the psychosocial work environment during the COVID-19 pandemic among staff in the care of older people and examine the factors associated with staff's perceptions of the clarity of instructions and the ability to follow them. METHODS: A cross-sectional study design was employed using a web survey. The staff's perceptions of their psychosocial environment were analysed using descriptive statistics. The association between organisational and individual factors, as well as the degree of clarity of the instructions and the staff's ability to follow them, were assessed using multivariate (ordinal) regression analysis. RESULTS: The main findings show that perceptions of the clarity and adaptability of the instructions were primarily correlated with organisational factors, as higher responses (positive) for the subscales focusing on role clarity, support and encouragement in leadership at work were associated with the belief that the instructions were clear. Similarly, those indicating high job demands and high individual learning demands were less likely to report that the instructions were clear. Regarding adaptability, high scores for demands on learning and psychological demands were correlated with lower adaptability, while high scores for role clarity, encouraging leadership and social support, were associated with higher adaptability. CONCLUSIONS: High job demands and individual learning demands were demonstrated to decrease the staff's understanding and adoption of instructions. These findings are significant on an organisational level since the work environment must be prepared for potential future pandemics to promote quality improvement and generally increase patient safety and staff health.

Well-being of veterinarians in rural and urban areas.

Introduction: The field of veterinary medicine is characterized by a variety of challenging working conditions. The alarmingly low mental well-being of veterinarians has been examined from various perspectives. However, the influence of work location on the well-being of veterinary professionals has scarcely been investigated. The aim of the study was therefore to analyze the well-being of German veterinarians and to determine whether there is a correlation between well-being and work location. Methods: As part of a cross-sectional study, 999 veterinary professionals answered questions regarding their work location (self-designed questions) and well-being (WHO-Five Well-being Index, WHO-5). A differentiation was made according to work location: urban cities (population > 100,000), medium/small cities (population < 100,000 inhabitants), and rural areas. Results: Overall, the surveyed veterinarians had low well-being (ranging from 56.8% in rural areas to 61.3% in medium/small towns). The results of the general linear model indicated a significant difference in the WHO total score among veterinarians from different work locations (p < 0.001). However, when sex, age, type of employment, and field of specialization were included in the analysis, no significant between-subject effects were found. Conclusion: According to the results, work location does not seem to have a significant influence on the well-being of veterinarians and therefore may be of lower priority in the development and implementation of interventions. However, further investigation of work-related predictors of the mental health of veterinarians is recommended, as the results indicate a low well-being among these professionals.

Racial, Ethnic, and Immigrant Generational Disparities in Physically Strenuous and Hazardous Work Conditions.

Despite the importance of work in adult life, research on the social determinants of health often ignores its effects. We examine race/ethnic, immigrant generational, and gender differentials in exposure to work conditions associated with poor health outcomes, using a nationally-representative sample of adults. On average, Latino 1st generation workers are more exposed to strenuous and hazardous work conditions than other workers, even after adjusting for sociodemographic differences. Exposure is lower for 2nd and 3rd generation Latinos. In contrast, Asian 1st generation men often have the lowest exposure levels of all groups and Asian 2nd and 3rd generation men have higher levels of exposure than the first generation, primarily due to intergenerational differences in education. Asian 1st generation women have higher exposures than those in the 2nd or 3rd generation. These results illustrate the importance of considering work conditions in research and policy related to the social determinants of health.

Nursing Development should Now Become a Priority for Health Systems in Europe.

The vast majority of European countries are struggling to embrace nursing as a profession and as a science. There are still not enough nurses with bachelor's degrees and advanced practical skills, and clinical specialisations for nurses are being developed at the master's level. Attention should be paid to recognising nurses as an equal healthcare workforce who need to be empowered to advance their profession and be provided with professional development opportunities. Changes needed include improving pay and working conditions, providing opportunities to improve skills and professional recognition, empowering nurses to deliver care, and harnessing the power of technology to better support nurses. The declining interest in nursing education and the often stereotypical and condescending view of the role and work of nurses on the healthcare team should be a warning signal to all who are working on healthcare reform.

Condições de trabalho e biossegurança dos profissionais de saúde e trabalhadores invisíveis da saúde no contexto da COVID-19 no Brasil / Work conditions and biosafety of health professionals and invisible health workers in the context of COVID-19 in Brazil

Resumo O artigo versa sobre as condições de trabalho na saúde no contexto da pandemia no Brasil. Trata-se de estudo transversal que utilizou dados de recorte das pesquisas "Condições de trabalho dos profissionais de saúde no contexto da Covid-19 no Brasil" e "Os Trabalhadores invisíveis da saúde: condições de trabalho e saúde mental no contexto da Covid-19 no Brasil", objetivando conhecer as condições de trabalho e a biossegurança desses dois contingentes profissionais distintos e desiguais, socialmente. A análise dos dados comprova que as condições de trabalho foram extremamente afetas em função da infraestrutura inadequada, trabalho extenuante, biossegurança em risco, exaustão, medo da contaminação e da morte, fortes sinais de esgotamento físico e mental entre os trabalhadores. Aponta também para discriminação e desigualdades de direitos sociais e de valorização profissional que demarcam os mundos do trabalho apontados nas pesquisas, enfatizando as profundas desigualdades existentes no Brasil e em suas regiões. Conclui-se mostrando a importância de formulação de políticas públicas no âmbito da gestão do trabalho no SUS que assegurem a proteção, valorização e redução das desigualdades apontadas no artigo.

Abstract The present article addresses the work conditions in health in the context of the COVID-19 pandemic in Brazil. This is a cross-sectional study that used data from the surveys "Working conditions of healthcare professionals in the context of Covid-19 in Brazil" and "Invisible healthcare workers: work conditions and mental health in the context of Covid-19 in Brazil", seeking to better understand the working conditions and biosafety of these two distinct and socially unequal professional contingents. Data analysis proves that work conditions were extremely affected due to inadequate infrastructures, strenuous work, biosecurity at risk, exhaustion, fear of contamination and death, strong signs of physical and mental exhaustion, among workers. It also points out the discrimination and inequalities of social rights and professional development that mark the worlds of work highlighted in the surveys, emphasizing the profound inequalities that exist in Brazil and in its regions. It concludes by showing the importance of formulating public policies within the scope of work management in SUS, which ensures the protection, appreciation and reduction of inequalities pointed out in this article.

Condições de trabalho na atenção primária à saúde na pandemia de COVID-19: um panorama sobre Brasil e Portugal / Working conditions in primary health care in the COVID-19 pandemic: an overview of Brazil and Portugal

Resumo A pandemia de COVID-19 pressiona os sistemas públicos de saúde no mundo desde 2020. Este artigo pretende discutir as condições de trabalho na atenção primária à saúde (APS) no Brasil, dialogando também com os cuidados de saúde primários (CSP) em Portugal no cenário pandêmico. Para isso, apresentam-se dados da pesquisa "Condições de trabalho dos profissionais de saúde no contexto da COVID-19 no Brasil", para posterior discussão com o relatório das Unidades de Saúde Familiar - Associação Nacional (USF-AN) sobre os CSP em Portugal. No Brasil, no recorte amostral de 3.895 profissionais de saúde da APS, foram percebidos: múltiplos vínculos trabalhistas, falta de apoio institucional e de treinamentos específicos, convívio com fake news e falta de coesão política entre as autoridades sanitárias, com alterações significativas na saúde mental desses trabalhadores. Em Portugal, destacaram-se o aumento da carga horária de trabalho e presença de síndrome de burnout entre os profissionais das USFs. A pandemia impactou de forma significativa a saúde e o cotidiano de trabalho dos profissionais de saúde na APS e nos CSP. Porém, o contexto brasileiro foi mais adverso devido às fake news e às divergências na condução do combate à pandemia, pela atuação e negacionismo do governo federal.

Abstract The COVID-19 pandemic has put pressure on public health systems worldwide since 2020. This article aims to discuss working conditions in Primary Health Care (PHC) in Brazil, while dialoguing with primary health care (CSP, Cuidados de Saúde Primários) in Portugal in the pandemic scenario. For that purpose, data from the study "Working conditions of health professionals in the context of COVID-19 in Brazil" are presented, for further discussion with the report produced by "Family Health Units - National Association (USF-AN, Unidades de Saúde Familiar - Associação Nacional)" on the CSP in Portugal. In Brazil, regarding the sample of 3,895 PHC health professionals, it was observed: multiple employment relationships, lack of institutional support and specific training, living with fake news and the lack of political cohesion between health authorities, with significant changes in these workers' mental health. In Portugal, the increase in the workload and the presence of Burnout Syndrome among FHU professionals was emphasized. The pandemic had a significant impact on the health and daily work of health professionals in PHC and CSP. However, the Brazilian context was more adverse due to fake news and divergences regarding conducts related to the fight against the pandemic, due to the actions and denialism by the federal government.

Decent work and the effect of the COVID-19 pandemic: A two-wave study1.

BACKGROUND: The world is going through a challenging historical moment, with the COVID-19 pandemic affecting billions of lives and communities worldwide. OBJECTIVE: Building on the widespread negative impact of the pandemic on the socio-economic context, and consequently on the labour market, the aim of this study was to analyse the effect of the COVID-19 pandemic on workers' perception of decent work. METHODS: The Decent Work Questionnaire was administered to 243 workers from seven Portuguese organisations at two-time points (before and during the pandemic). RESULTS: Results revealed a positive and significant effect of the COVID-19 pandemic on six of seven dimensions of decent work, particularly those related to Meaningful Remuneration for the Exercise of Citizenship and Health and Safety. CONCLUSION: The positive effects of social comparison processes are stronger than the negative effects of the adverse socio-economic context. Faced with the COVID-19 pandemic, workers may have compared their work situation with the condition of other workers, activating an increase in their subjective perception of the value of their current reality.

Stress, fear, and anxiety among construction workers: a systematic review.

Objectives: The aim of this review was to assess the possible risk factors arising from working conditions, that could have an impact on the stress, fear, and anxiety of construction workers. Methods: A systematic review was conducted following the PRISMA format in the Pubmed, Cochrane, Web of Science, Scopus, and PsycInfo electronic databases on February 3, 2023, using the following key words: anxiety, stress, fear, and construction workers. Methodological quality was assessed using the critical appraisal tools of the Joanna Briggs Institute. Results: A total of 35 studies were included. The results showed a number of conditioning factors for stress, anxiety, and fear among construction workers such as age, inappropriate safety equipment, safety culture, high workload and long working hours, physical pain, low social support from direct supervisor or co-workers, lack of organizational justice and lack of reward, financial situation, maladaptive coping strategies, and characteristics of the pandemic. Conclusions: There are a number of risk factors related to working conditions, organizations, and individuals that can affect the levels of stress, anxiety, and fear among construction workers, such as age, work hardship, safety culture and, especially, the long hours that construction professionals work. This may lead to an increase in the number of occupational accidents and higher associated fatality rates. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022367724, identifier: CRD42022367724.

Biomechanical analysis of wood processing work in tropical forest regions: A study in Midwest Brazil.

In the wood processing industry, working with machines exposes workers to occupational risks. This study evaluates the biomechanics of work activities carried out in a wood processing operation in tropical forest regions to identify risks associated with the development of musculoskeletal injuries. Data were collected in a wood processing industry from a tropical forest region in Midwest Brazil. Forty forest workers were evaluated, equivalent to 100% of the population of the company participating in the study. Biomechanical movements were measured using the Three-Dimensional Biomechanical Model for Predicting Stances and Static Forces. There was a risk of injury to the joints of the upper limbs (wrists and shoulders), as well as to the torso. When splitting and manually stacking wood, a risk of spinal injury was identified. All workers had a high risk of developing injuries in all joints evaluated in addition to a risk of serious spinal injury. In this way, the development of these activities without any ergonomic interventions makes the risk of developing musculoskeletal injuries in the workers involved imminent, with consequent early professional incapacity.

The Workaholism-Technostress Interplay: Initial Evidence on Their Mutual Relationship.

During the pandemic, the occurrence of extreme working conditions (e.g., the sudden shift to remote work, isolation, and the slowdown of the work processes) exacerbated several phenomena, such as increased workaholism and stress due to technological devices; that is, technostress. Literature on the onset of these phenomena during the pandemic highlighted a possible interplay among them; however, there is still a dearth of knowledge about the direction of the relationship between workaholism and technostress. The present study assessed the relationship between workaholism and technostress through a two-wave cross-lagged study using path analysis in SEM (Structural Equation Modeling). The study was conducted in Italy during the pandemic, and a total of 113 Italian employees completed the online survey at each wave. Results showed that workaholism at Time 1 was a significant predictor of technostress at Time 2 (ß = 0.25, p = 0.049), while the reversed causation was not supported (ß = 0.08, p = 0.22). These findings may help employees and organizations to better understand the phenomena of technostress and workaholism and develop strategies to prevent the consequences of excessive and compulsive work and to improve the balanced use of technology for their daily activities.

Patient Outcomes and Hospital Nurses' Workload: A Cross-Sectional Observational Study in Slovenian Hospitals Using the RN4CAST Survey.

Introduction: Higher nursing workload increases the odds of patient deaths, as the work environment has a significant effect on patient outcomes. The aim of the study was to explore the relation between patient outcomes and nurses' working conditions in hospitals. Methods: Administrative data on discharges of surgical patients for the year 2019 in eight general hospitals and two university medical centres in Slovenia were collected to determine in-hospital mortality within 30 days of admission. The RN4CAST survey questionnaire was used to gather data from nurses in these hospitals, with 1,010 nurses participating. Data was collected at the beginning of 2020. The number of nurses per shift and the nurse-to-patient ratio per shift were calculated. Univariate, bivariate and multivariate statistical methods were used to analyse the data. Results: The 30-day in-hospital mortality for surgical patients was 1.00% in the hospitals sampled and ranged from 0.27% to 1.62%. The odds ratio for staffing suggests that each increase of one patient per RN is associated with a 6% increase in the likelihood of a patient dying within 30 days of admission. The mean patient-to-RN ratio was 15.56 (SD=2.50) and varied from 10.29 to 19.39. Four of the 13 tasks checked were not performed on patients during the last shift. Conclusion: The results are not encouraging, with an extremely critical shortage of RNs and thus a high RN workload. The number of patients per RN is the highest in Europe and also higher than in some non-European countries, and represents an extreme risk to the quality of nursing and healthcare as a whole. The recommendation for acute non-emergency internal medicine and surgery departments is four patients per RN per shift.

Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden.

OBJECTIVE: To investigate the separate and combined effects of overall heavy physical workload (PWL) and low decision authority on all-cause disability pension (DP) or musculoskeletal DP. METHODS: This study uses a sample of 1,804,242 Swedish workers aged 44-63 at the 2009 baseline. Job Exposure Matrices (JEMs) estimated exposure to PWL and decision authority. Mean JEM values were linked to occupational codes, then split into tertiles and combined. DP cases were taken from register data from 2010 to 2019. Cox regression models estimated sex-specific Hazard Ratios (HR) with 95% confidence intervals (95% CI). The Synergy Index (SI) estimated interaction effects. RESULTS: Heavy physical workload and low decision authority were associated with an increased risk of DP. Workers with combined exposure to heavy PWL and low decision authority often had greater risks of all-cause DP or musculoskeletal DP than when adding the effects of the single exposures. The results for the SI were above 1 for all-cause DP (men: SI 1.35 95%CI 1.18-1.55, women: SI 1.19 95%CI 1.05-1.35) and musculoskeletal disorder DP (men: SI 1.35 95%CI 1.08-1.69, women: 1.13 95%CI 0.85-1.49). After adjustment, the estimates for SI remained above 1 but were not statistically significant. CONCLUSION: Heavy physical workload and low decision authority were separately associated with DP. The combination of heavy PWL and low decision authority was often associated with higher risks of DP than would be expected from adding the effects of the single exposures. Increasing decision authority among workers with heavy PWL could help reduce the risk of DP.