The correlation between working condition and health status of nursing personnel in nursing homes

Objective: To understand working conditions and potential occupational hazards among nursing personnel of nursing homes, and to formulate strategic plans for improvement.
Method: A self-administered questionnaire was used to identify the biological, physical and chemical, psychological, and ergonomic hazards in the work environment of nursing personnel of nursing homes. Chinese Job Content Questionnaire, Chinese Copenhagen Burnout Inventory, Chinese Nordic Musculoskeletal Questionnaire were used to measure the health status of nursing personnel in nursing homes. A total of 70 nursing homes hiring more than 10 registered nurses were recruited into the study. An expert focus group and 2 fields of nursing homes visits were performed to better understand the occupational hazard of nursing homes.
Results: A total of 477 elegible questionnaires were completed and returned by registered nurses and nurse assistants for final analysis. The mean age was 37.7 years among all respondents. As for biological hazards, 38 (8.0%) nursing personnel sustained at least one needlestick injury in the past 12 months, 86 (18.0%) had exposed to blood or body fluids, and 274 (57.4%) had to care for highly infectious patients. After controlling for demographic and work-related variables in regression analysis, needlestick injuries were associated with high job strain of registered nurses. In regard to physical and chemical hazards, having exposed to ionizing radiation through X-ray, angiography, caring for patients undergoing chemotherapy, or handling cancer therapeutic agents were relatively rare in nursing homes. However, 76.9% (n=367) of nursing personnel had contacted with disinfectants, and 45 (9.4%) of them suffered discomfort due to such contacts. As for psychosocial hazards, 56.6% (n=270) of respondents worked in shifts. 33.3% (n=159) of respondents exposed to low job control, 39.4% (n=188) were with high job demand, and 15.1% (n=72) were in high job strain. 44.4% (n=212) of respondents exposed to low workplace justice, and 32.5% (n=155) were with low employment security. After controlling for demographic and work-related variables in regression analysis, for registered nurses, low job control was associated with high personal burnout and client. High job demand was the risk factors of high personal burnout of registered nurses. As for registered nurses and nursing assistants, high job demand was related to high work burnout and musculoskeletal discomfort related to work. For registered nurses, the low level of employment security was the risk factor for high level of personal burnout. Moreover, it was also associated with high level of personal burnout, work burnout, and client burnout for nursing assiatants. The low level of workplace justice was the risk factor for high level of personal burnout, work burnout of registered nurses and nursing assistants. For nursing assistants, it was the risk factor of high client burnout as well. As for ergonomic hazards, the prevalence of musculoskeletal discomforts was 94.8% (n=452). In the terms of discomfort location, shoulder (84.4%) was the most commonly reported affected area, followed by neck (74.4%) and lower back (74.4%). In the multiple regression analysis, for registered nurses, standing for longer than 6 hours was highly associated with high level of job strain. Twisting waist more than 20 times during work was also the risk factor for musculoskeletal discomforts in the past year.

Conclusion: This study has identified that the work environment of nursing homes would affect health status of nursing personnel in different aspects, including biological, psychosocial, and ergonomic hazards. To minimize those health effects on nursing home staff, improving the working environment practically and designing educational programs in preventing occupationally induced harms are warranted. A periodical evaluation system is also suggested, to better understand the psychosocial conditions of nursing home nursing personnel.