Organizational climate and occupational health outcomes in hospital nurses

OBJECTIVE: The objective of this study was to determine relationships between organizational climate (OC) factors and occupational health outcomes (lost workdays, musculoskeletal injury, blood and body fluid exposures, injuries, and burnout) among hospital-based nurses. METHODS: Measures were obtained through a self-administered, anonymous survey distributed in 13 New York City hospitals. Multivariate models appropriate for clustered data were developed. These analyses controlled for nurse and employment characteristics. Independent effects of OC factors were examined. RESULTS: Surveys from 2047 predominantly registered nurses were obtained (response rate 50%). More than 75% reported lost workdays due to illness in the previous 4-month period and over one third reported experiencing some type of injury. OC factors were independently associated with injuries and measures of burnout (P < or = 0.05). CONCLUSIONS: OC is significantly associated with the health and well-being of hospital nurses.     

Stress in nursing

The general purpose of this exploratory research was to understand the stress in different nursing occupations, aiming at determining the meaning of stress to nurses, identifying the stressors regarding different nursing occupational activities and investigating if the nurses' occupational activity is perceived as stressful. The sample consisted of three groups of Nurses (clinical, managers and professors) working in the public service of the city of Brasília and data were collected through semi-structured interviews. Although the concept of stress is not clear among nurses, they do experience diverse stressors; related to intrinsic job factors, to relationships at work, to their roles and to the organizational structure.     

护士核心能力的关联性研究

目的探讨护士职业应对自我效能、职业压力源及核心能力的关联性。方法采用护士职业压力源量表、护士职业应对自我效能量表、中国注册护士核心能力量表等,对493名执业护士进行调查。结果职业应对自我效能均值为3.55±0.71,职业压力源均值为2.66±0.51,评判性思维及科研能力均值为2.616±0.62。核心能力多重线性回归分析显示工龄、职业应对自我效能、班次、职业压力源的工作量及时间分配是护士核心能力的影响因素。结论基于职业应对自我效能的核心能力培训,合理安排护士排班,保证护士配置,可以提高护士的核心能力。     

Assessment of nurses' work climate at Alexandria Main University Hospital

Work climate is indicative of how well the organization is realizing its full potential. An accurate assessment of work climate can identify the unnecessary obstacles to nurses interfering with their best performance. The present study aims to assess nurses' work climate at Alexandria Main University Hospital. The study sample included all nurses (N=400) who were working in inpatient medical and surgical units at the Alexandria Main University Hospital who were available at the time of data collection. A structured questionnaire was developed to assess nurses' perceptions regarding the dimensions of work climate. Data was collected by individual interview using the structured questionnaire. Results indicated that the highest percentages of nurses in medical and surgical units perceived that their work climate is characterized by good way of performance management, feeling of responsibility, warmth and supportive relationships, quality of communication, morale, organizational clarity and feeling of identity and belongness to the hospital. Nurses perceived that they are lacking work climate conducive to conflict resolution, participation in decision making, opportunity for training and development, fair rewards and recognition, calculated risks, sufficient resources, effective leadership and teamwork. There were no significant difference between nurses perceptions in medical and surgical units regarding all dimensions of work climate. The highest percentage of nurses in all units were satisfied only with the feeling of responsibility, way of performance management, and quality of communication. Conflict and identity were perceived as the most important areas that need improvement in the hospital. Based on the results recommendations were given to enhance work climate through designing compensation and recognition systems, and negotiate their requirements and accomplishment based on established standards and outcomes measures. Also, encouragement of and planning for participative decision making, teamwork, in-service training program and open communication are recommended to be present in the work units.     

Occupational health nursing in the United States

This article is a summary of information about occupational health nurses and occupational health nursing in the United States. The article provides demographic, education, credentialing, role, and other data based on secondary analysis of occupational health nurses' responses to the 2008 National Sample Survey of Registered Nurses. Current issues affecting the U.S. work force and businesses are addressed and high-risk business and industrial sectors are noted. Occupational health nurse practice opportunities are highlighted and practice areas where occupational health nursing research is currently focused are discussed. The article also examines the challenges facing the next generation of occupational health nurses.     

Can organizational support for technology influence job satisfaction?

The relationship between organizational support for telemedicine and nurses' job satisfaction in home health agencies (HHAs) is investigated in this study. Drawing from the theory of perceived organizational support, we propose that HHAs that provide strong support for telemedicine will have higher nurse job satisfaction levels than those that do not. Primary data were collected from 29 HHAs and 917 nurses from 2004 to 2005. The results of the analysis indicate a strong, positive, significant association between organizational support for telemedicine and home health nurses' job satisfaction. We conclude that technological implementation, with sufficient organizational support, can be a strong competitive strategy to attract and retain high-quality nurses.     

Work-related reproductive,musculoskeletal and mental disorders among working women--history,current issues and future research directions

According to the recent changes of working environments and socio-economical conditions, the proportion of working women are increasing in Japan. Characteristics of occupational workload and stress of Japanese working women are consistent with those in many industrialized countries except man-dominant culture. In this review we describe the history, current issues, and future research directions on occupational health of working women, especially focused on reproductive health, work-related musculo-skeletal disorders (WMSDs), and mental disorders. In the reproductive health survey, traditionally main concern was about pregnancy outcomes, then fecundity studies, such as time to pregnancy, became topics recently. Future research will be shifted to outcomes not only during pregnancy but also disorders of hormonal balance and climacterium or health conditions after menopause. WMSDs are reviewed on mainly gender difference and its causative factors. Historically, mental health of working women in Japan has focused on the job stress of nurses. We compare results with a lot of recent researches in Europe and U.S.A., where interaction between occupational stress and family roles were studied. It is not easy to predict the prospective status of female workers in Japan, but social, workplace and familial supports will enhance their health promotion.     

The motivation to care: application and extension of motivation theory to professional nursing work

PURPOSE: The purpose of this research is to describe a model of nurses' work motivation relevant to the human caring stance of professional nursing work. DESIGN/METHODOLOGY/APPROACH: The model was derived from selected theories of behavioral motivation and work motivation. Evidence-based theory addressing nurses' work motivation and nurses' motivational states and traits in relation to characteristics of organizational culture and patient health outcomes is suggested in an effort to make a distinct contribution to health services research. An integrated review of selected theories of motivation is presented, including conceptual analyses, theory-building techniques, and the evidence supporting the theoretical propositions and linkages among variables intrinsic to nurses' work motivation. FINDINGS: The model of the Motivation to Care for Professional Nursing Work is a framework intended for empirical testing and theory building. The model proposes specific leadership and management strategies to support a culture of motivational caring and competence in health care organizations. ORIGINALITY/VALUE: Attention to motivation theory and research provides insights and suggests relationships among nurses' motivation to care, motivational states and traits, individual differences that influence nurses' work motivation, and the special effects of nurses' work motivation on patient care outcomes. Suggestions for nursing administrative direction and research are proposed.     

Employee working conditions and healthcare system performance: the Veterans Health Administration experience

OBJECTIVE: The authors explored the association between health care employees' perceptions of their organizations and objective measures of system performance. METHODS: A national survey of employees conducted in 2001 by the Veterans Administration (VA) assessed employee perceptions of hospital organizational characteristics. The authors analyzed cross-sectional associations between these perceptions and objective measures of health care system performance--employee and patient care outcomes. RESULTS: Employee perceptions of organizational climate (indicators of the organizational culture) were strongly related to overall satisfaction and measures of system performance. Overall, change in perceptions of organizational climate by 1 standard deviation (SD) was potentially associated with changes of 2% to 35% in selected outcomes. CONCLUSIONS: Organizational climate, policies, and resultant working conditions in health care institutions appear to be strong drivers of system performance. Interventions directed toward improving care quality and safety should address these factors.     

The Relationships Among Occupational Safety Climate,Patient Safety Climate,and Safety Performance Based on Structural Equation Modeling

ObjectivesThe aim of the present study was to investigate the relationships among hospital safety climate, patient safety climate, and safety outcomes among nurses.MethodsIn the current cross-sectional study, the occupational safety climate, patient safety climate, and safety performance of nurses were measured using several questionnaires. Structural equation modeling was applied to test the relationships among occupational safety climate, patient safety climate, and safety performance.ResultsA total of 211 nurses participated in this study. Over half of them were female (57.0%). The age of the participants tended to be between 20 years and 30 years old (55.5%), and slightly more than half had less than 5 years of work experience (51.5%). The maximum and minimum scores of occupational safety climate dimensions were found for reporting of errors and cumulative fatigue, respectively. Among the dimensions of patient safety climate, non-punitive response to errors had the highest mean score, and manager expectations and actions promoting patient safety had the lowest mean score. The correlation coefficient for the relationship between occupational safety climate and patient safety climate was 0.63 (p<0.05). Occupational safety climate and patient safety climate also showed significant correlations with safety performance.ConclusionsClose correlations were found among occupational safety climate, patient safety climate, and nurses’ safety performance. Therefore, improving both the occupational and patient safety climate can improve nurses’ safety performance, consequently decreasing occupational and patient-related adverse outcomes in healthcare units.     

Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study

BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.     

Effects of hospital staffing and organizational climate on needlestick injuries to nurses

OBJECTIVES: This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. METHODS: We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals. RESULTS: Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses. CONCLUSIONS: Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries.     

Work activity analysis of Finnish occupational health professionals

BACKGROUND: Some Finnish studies have dealt with how occupational health nurses divide their working hours but other occupational health professionals have not been evaluated. AIMS: This study describes how occupational health professionals allocate their working hours between main tasks. METHODS: Questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms. The data were analysed by using frequencies, means and one-way analysis of variance test. RESULTS: Employee-oriented tasks accounted for roughly 50% of working hours from all occupational health professionals. The remaining working hours were shared between workplace visits, co-operation with partners, other occupational health care responsibilities and tasks in other health care fields, especially in the health care centres. These working hours varied greatly between the different occupational health professional groups. All units employed full-time occupational health nurses, but the services of physicians, physiotherapists and psychologists were usually provided part-time or even restricted to a few hours each week because these services were difficult to obtain. Occupational health nurses working in the municipal health care centres spent more time on workplace visits than other nurses. Employee-oriented tasks were emphasized more in physicians', physiotherapists' and psychologists' work, especially in private medical health care units and in the jointly owned health care units. CONCLUSIONS: The amount of time occupational health professionals are able to spend on workplace activities appears to be determined by the type of their employer.     

An exploration of workplace social capital as an antecedent of occupational safety and health climate and outcomes in the Chinese education sector

Purpose

It is widely acknowledged that teachers are at greater risk of work-related health problems. At the same time, employee perceptions of different dimensions of organizational climate can influence their attitudes, performance, and well-being at work. This study applied and extended a safety climate model in the context of the education sector in Hong Kong. Apart from safety considerations alone, the study included occupational health considerations and social capital and tested their relationships with occupational safety and health (OSH) outcomes.

Methods

Seven hundred and four Hong Kong teachers completed a range of questionnaires exploring social capital, OSH climate, OSH knowledge, OSH performance (compliance and participation), general health, and self-rated health complaints and injuries. Structural equation modeling (SEM) was used to analyze the relationships between predictive and outcome variables.

Results

SEM analysis revealed a high level of goodness of fit, and the hypothesized model including social capital yielded a better fit than the original model. Social capital, OSH climate, and OSH performance were determinants of both positive and negative outcome variables. In addition, social capital not only significantly predicted general health directly, but also had a predictive effect on the OSH climate–behavior–outcome relationship.

Conclusions

This study makes a contribution to the workplace social capital and OSH climate literature by empirically assessing their relationship in the Chinese education sector.     

Finnish occupational physicians' and nurses' experience of work related stress management: a qualitative study

Work-related stress has a strong influence on the health of workers. Occupational health care has an important role in assessing and managing this stress in collaboration with enterprises. The methods to reduce stress can be directed at the individual and at the organization as a whole. There is little information about stress handling methods in occupational health practices. This study aims to investigate these practices in Finnish occupational health physicians' and nurses' work. The data were generated through semi structured interviews of ten voluntary occupational physicians and eight occupational nurses in the metropolitan area of Finland in June 2009. The work-related stress was experienced as difficult to handle. There was no specific protocol for handling work-related stress in practice. Stress reduction activities were mostly randomly directed at the individual or the organizational level. Activities remained mainly on the individual level and were rarely allocated to the organization. There is a need for structured guidelines on how to manage work-related stress to assure standardized action on both the individual and organizational level. The roles of the physician, nurse and psychologist should be clarified in teamwork. Their collaborative activities should be directed also to the organisational level.     

The global expansion of precarious employment, work disorganization, and consequences for occupational health: a review of recent research.

In this review of a range of studies on the health and safety effects of precarious employment in industrialized societies published since 1984, the authors examine the overall findings and methodological issues and identify areas in need of further research. Of the 93 published journal articles and monographs/book chapters reviewed, 76 studies found precarious employment was associated with a deterioration in occupational health and safety (OHS) in terms of injury rates, disease risk, hazard exposures, or worker (and manager) knowledge of OHS and regulatory responsibilities. Of the more than 25 studies each on outsourcing and organizational restructuring/downsizing, well over 90 percent find a negative association with OHS. The evidence is fairly persuasive for temporary workers, with 14 of 24 studies finding a negative association with OHS. The evidence is less strong for small business, and a handful of studies on part-time workers found no clear association with negative OHS outcomes (in some cases the reverse). Further research is needed to more clearly link health effects to particular business practices and neoliberal policies and to explore the regulatory implications of the growth of precarious employment. The authors suggest some ways to conceptualize the association between precarious employment and occupational health.     

Occupational Risk Factors for Upper-limb and Neck Musculoskeletal Disorder among Health-care Staff in Nursing Homes for the Elderly in France

This study investigated the relation between working conditions, in terms of physical and psychological demand, and upper-limb and neck musculoskeletal disorders (ULNMD) in female staff working in direct contact with the elderly in nursing homes. A cross-sectional survey was conducted in 105 nursing homes in France. Data on nursing-home working conditions were collected by questionnaire from occupational physicians and by self-administered questionnaire from staff. Psychosocial demand at work was assessed on Siegrist’s questionnaire and ULNMD on the Nordic questionnaire. 2,328 employees were included: 628 housekeepers, 1,372 nursing assistants and 328 nurses. During the previous 12 months, 50% of the subjects (1,160) had presented with a musculoskeletal complaint concerning the neck, 38% (881) the shoulders, 10% (246) the elbows and 22% (520) the wrists. 9% (219) reported effort/reward imbalance on the 2004 Siegrist questionnaire and 42% were in a situation of over-commitment. ULNMD complaints were associated not only with physical occupational factors but also with psychosocial factors (effort/reward imbalance and over-commitment), both before and after adjustment on individual and occupational factors. Prospective studies are needed to clarify the causal role of occupational, including, organizational, psychosocial factors in ULNMD outcomes. Preventive approaches should take account of both physical and psychosocial occupational factors.     

The relationship between hospital unit culture and nurses' quality of work life

Turnover rates for hospital nurses have been increasing in recent years, which is partially a result of increasing pressure on nurses from higher productivity expectations in a managed care environment. Improving nurse retention is a difficult challenge to managers since the bureaucratic cultural norm of hospitals, with its hierarchical structures, rules, and regulations, and heavy emphasis on measurement of outcomes and costs, may not be the culture most conducive to enhancing nurses' job satisfaction and commitment. Accordingly, this study investigates the relationships between unit organizational culture and several important job-related variables for nurse retention in the labor and delivery units of seven hospitals. Data analysis shows that unit organizational culture does affect nurses' quality of work life factors and that human relations cultural values are positively related to organizational commitment, job involvement, empowerment, and job satisfaction, and negatively related to intent to turnover. These findings suggest that although increasing recruitment of nurses and improved compensation and benefits strategies may offset hospital nurse shortages in the short term, improving quality of work life may be a more practical and long-term approach to improving hospital nurse retention.