Work Organisation, Work Characteristics and their Effects on Health and Well Being of Nurses

ORP 2004

Using a cross-sectional research design, questionnaires about organizational, work and nurse reaction variables were distributed to 1855 nurses working in general (response rate = 68%). Correlational and hierarchical multiple regression analysis showed decision authority to predict social support and autonomy, and job satisfaction and intrinsic work motivation. Indications for a mediating role of some work characteristics in the relationships between organizational factors and health and wellbeing were found. The findings support the conclusion that the incorporation of organizational factors in models of health and wellbeing of nurses extends our understanding.

Palabras Clave:

organizational factors, nursing work

Autor principal:

Jan Albert

Landeweerd

Landeweerd, Jan Albert

Faculty of Health Sciences / University Maastricht / PO Box 616 / 6200 MD Maastricht, Netherlands 31 43 3881592 / a.landeweerd@beoz.unimaas.nl

ABSTRACT

Keywords

Organizational factors, nursing work

INTRODUCTION

The health care sector has become an area of growing interest for researchers that study occupational risks for health and well-being. Approximately 900,000 people are working in this sector in the Netherlands, which is about 13 per cent of the employed population. The biggest group probably is the nursing profession. Health care work is “people-processing” work, indicating that the work process is focused on working with, and on people. This “people-processing” nature makes health care workers more vulnerable to occupational stress than other occupational groups. At the same time, health care organisations are being confronted with a changing environment (such as more diversity in the patient population), and with new organisational principles or designs. In order to investigate work-related and individual determinants of employees’ psychological work reactions, a huge amount of research has been done in the field of work and organisational psychology (see, for instance, [5], [8], [10], [17]. Examples of frequently studied work characteristics in this context are workload, social support, job control, and job feedback, while personal and personality factors have often been investigated as individual determinants for employees’ well-being and health.

Although considerable progress has been made in understanding these psychosocial

risk factors and their possible consequences in the workplace, and although, at the same time, this area of research is still developing (for example, the application of sophisticated methodologies, and combination of theories), only limited attempts have been made until now to investigate organisational determinants of such psychological work reactions.

In organisation science on the other hand, the main fields of interest in this context seem to be the role of organisational characteristics in the prediction of “economic measures” of organisational effectiveness, such as efficiency and productivity. The influence of organisational characteristics on “social measures” of organisational effectiveness (such as intrinsic work motivation or burnout) has rarely been studied, although it is obvious that they are interconnected. For instance, a client-oriented organisational principle might induce more co-operation that might enhance employees’ job satisfaction and/or work motivation. Consequently, and in addition to work characteristics, organisational characteristics may play a role in employees’ psychological work reactions. So, in organisation science, employees’ well-being and health are seldom mentioned as indicators for organisational effectiveness. At the same time, in work and organisational psychology, such organisational characteristics as mentioned in organisation science have rarely been studied as determinants of employees’ psychological work reactions. These are the reasons that we started a research project to integrate theories from these different research approaches, and to investigate the “missing link” between them.

A number of studies have been conducted to investigate the relationship of organizational characteristics with work characteristics and psychological work reactions in nursing work. The PhD dissertation of Gladys Tummers and MA theses of a number of students give a detailed report of such studies. In this lecture an example will be presented of such studies. The example concerns a questionnaire study on the relationships between organizational characteristics, work characteristics and work reactions in nursing.

In order to select the study variables, the contingency approach of organisations and the Demand-Control-Support (DCS) model (often used in work epidemiology and psychology) were used as theoretical frameworks.

Organizational characteristics

A number of organisational characteristics seem to be important. We selected both structural (i.e., decision authority) and environmental characteristics (i.e., complexity and uncertainty) to represent the work organisation in nursing.

Complexity refers to the complexity of care, that is, characteristics of the patients (such as changes in patient's health), and characteristics of the environment (e.g., the intense interdependencies between other care disciplines.

Uncertainty refers to the difference between the amount of information required to perform the task and the amount of information already possessed by the organisation. It involves the time span for feedback in situations where turbulence and change are high The concept of uncertainty we use encompasses workflow uncertainty and task uncertainty.

Finally, decision authority refers to the way in which the authority to make decisions as to “who is going to do what and when” is distributed among members of a ward. The concept of decision authority as we use it, refers to kinds of tasks to be performed, and the decentralisation of decision-making.

Work characteristics

In the current study, we use the Demand-Control-Support (DCS) model of Karasek and Johnson as our conceptual framework for the selection of the work characteristics and the psychological work reactions. This model focuses on three work characteristics, viz., job demands (e.g., workload), job control (e.g., autonomy), and social support. It is frequently being used and tested in nursing (e.g. [11], [6], [13]. We added role stressors, namely, role conflict and role ambiguity to our framework, because research has shown that these variables are important organisational stressors that may cause job dissatisfaction and feelings of job-related strain. Besides, role stress can be a particular problem for employees who are in direct contact with people, as in nursing.

Workload gives an indication how difficult the work is with respect to e.g., mental load, and the pace of work.

Autonomy refers to the opportunity workers have to determine several elements of their direct work situation and is mostly defined in terms of self-determination, discretion, and freedom [5].

Social support refers to overall levels of social transactions available on the job from both supervisors and colleagues.

Role conflict refers to the extent to which employees have to carry out conflicting tasks that are in conflict with their own norms and values. Role conflict implies incompatible goals with the result of problematic goal attainment. At the same time, since it is clear that the organisation does expect some results, this leads to a loss of control over task performance, which in its turn may lead to stress.

Role ambiguity refers to lack of clarity regarding what exactly employees are supposed to do during work and the subsequent performance evaluation. For example, work goals and procedures may be poorly specified and necessary feedback may be lacking. As a result, all work activities may become problematic, while at the same time employees know that they have to attain some results. This may amount to a completely unmanageable working situation, which can lead to serious strains.

Psychological work reactions

As to the outcomes variables, the DCS model does not outline specific psychological stress reactions as potential work reactions. In this study, we selected four different variables with regard to the psychological work reactions: burnout, psychosomatic health complaints, job satisfaction, and intrinsic work motivation.

Burnout is generally conceptualised as a syndrome of emotional exhaustion, depersonalisation, and reduced personnel accomplishment that can occur among individuals who do 'people work' of some kind. Emotional exhaustion is generally seen as the core dimension of burnout. It refers to feelings of being totally depleted, a lack of energy and a feeling that one's emotional resources are used up.

In this study, therefore, we selected emotional exhaustion to represent the concept of burnout.

Psychosomatic health complaints refer to the general feelings of health complaints, which are an expression of the tendency to somatise psychosocial stress conditions, like fatigue and back. We selected burnout, and psychosomatic health complaints for several reasons. First, due to the increasing job demands (e.g., inadequate staffing, work overload, low salary, low career opportunities, and high physical work load), nurses are an occupational group that shows burnout and psychosomatic complaints levels that are above average risk. Another reason to include burnout and psychosomatic health complaints is that workload, autonomy, social support, role conflict and role ambiguity have often been found to be predictors of burnout and,

although to a lesser extent, to psychosomatic health complaints.

Intrinsic work motivation is generally considered as an important issue in nursing work. Nurses often seem to choose a job in nursing because of intrinsic values, such as recognition, patient contact and task content. We selected intrinsic work motivation as an outcome variable because it reflects the intrinsic work values, mentioned above, and it refers to the growth dimension of the DCS model. In our study, intrinsic work motivation is viewed as the work motivation that exists when esteem, feelings of growth, and competence are tied to performance. It thus refers to the extent to which the work drives the behavioural actions of the worker, resulting in, for instance, feelings of challenge.

Finally, job satisfaction is included in the current study because research has shown that work characteristics, like autonomy and social support were related to job satisfaction. Job satisfaction, refers, just like intrinsic work motivation, to the growth dimension of the DCS model; it is the satisfaction of nurses with their work and working conditions.

METHODS

The aim of the present study was threefold (see also Fig. 1).

First, we explored the relationships between the abovementioned features of the work organisation and work characteristics (A).

Second, we investigated the relationships between the organizational characteristics and the psychological work reactions and what role the work characteristics might play in this relationship (B and B1).

Finally, we explored relationships between the work characteristics and psychological work reactions (C).

Fig. 1. Research model