Nursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied. The aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction. Multilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied. Regarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied. We conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries.

To investigate associations between nurse work practice environment measured at department level and individual level work-family conflict on burnout, measured as emotional exhaustion, depersonalization and personal accomplishment among Swedish RNs. A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analysed here is based on a national sample of 8,620 RNs from 369 departments in 53 hospitals. Generally, RNs reported high values of personal accomplishment and lower values of emotional exhaustion and depersonalization. High work-family conflict increased the risk for emotional exhaustion, but for neither depersonalization nor personal accomplishment. On department level adequate staffing and good leadership and support for nurses reduced the risk for emotional exhaustion and depersonalization. Personal accomplishment was statistically significantly related to staff adequacy. The findings suggest that adequate staffing, good leadership, and support for nurses are crucial for RNs' mental health. Our findings also highlight the importance of hospital managers developing policies and practices to facilitate the successful combination of work with private life for employees.

Purpose: The first objective was to contribute to a better understanding of the contrasting and paradoxical results in studies of work environment factors and sickness presence and sickness absence. A second objective was to examine if, and under what conditions, employees choose to replace sickness absence with sickness presence, i.e., so-called substitution. Methods: The study utilizes a large body of cross-sectional questionnaire data (n = 130,161) gathered in Sweden from 2002 to 2007 in connection with a comprehensive health promotion initiative. Health and motivation were analyzed as mediators of the effects of five job factors, job control, job support, job demand, role conflict and “work to family conflict” on sickness presence and absence. Results: The results concerning job demands indicate substitution in that increased job demands are associated with increased presenteeism and reduced absenteeism. The direct effect of higher job support was increased absenteeism, but via the health and motivation paths, the total effect of more social support was health-promoting and associated with a reduction in sickness absence and sickness presence. High job control emerged as the most pronounced health-promoting factor, reducing sickness presenteeism as well as absenteeism. More role conflicts and work-to-family conflicts were directly and indirectly associated with decreased health and increased absenteeism as well as presenteeism. earlier research. Conclusion: The mediation analyzes shed light on some of the paradoxes in research on sickness presenteeism and sickness absenteeism, especially regarding job demands and job support. The substitution effect is important for workplace policy and occupational health practice.

Objectives The three constructs of work–family conflict, emotional exhaustion and performance-based self-esteem are all related to tremendous negative consequences for the individual, the organization as well as for society. Even though there are studies that connect two of those constructs, the prospective relations between all three of them have not been studied yet. Methods We explored the prospective relations between the three constructs in a large Swedish data set representative of the Swedish workforce. Gender differences in the relations were investigated. Longitudinal data with a 2-year time lag were gathered from 3,387 working men and women who responded to the 2006 and 2008 waves of the Swedish Longitudinal Occupational Survey of Health. Four different cross-lagged models were analysed. Results In the best fitting model, higher levels of work–family conflict at time 1 were associated with an increased level of performance-based self-esteem at time 2, but not with emotional exhaustion, after controlling for having children, gender, education and age. Also, relationships between emotional exhaustion at time 1 and work–family conflict and performance-based self-esteem at time 2 could be established. Furthermore, relationships between performance-based self-esteem time 1 and work–family conflict and emotional exhaustion time 2 were found. Multiple-group analysis did not show any differences in the relations of the tested constructs over time for either men or women. Conclusions We conclude that the three constructs are interrelated and best understood through a reciprocal model. No differences were found between men and women.

Researchers have suggested that psychological factors at work contribute to early retirement due to disability pension in the general working population. Disability pension is a problem that shortens working careers among nursing professionals and personal care or related workers, but few researchers have focused on these occupational groups. Also, a need for studies based on measurements of specific work exposure instead of combined measures has been identified. The aim was to study the potential influence of work-related psychosocial risk factors on the future risk of disability pension among nursing professionals and care assistants in Sweden. Those occupational groups are compared to all other occupations in Sweden. A specific aim was to describe differences in associations to cause-specific disability, and how the results were modified by occupation categories. A representative sample of 79,004 women and men in Sweden comprising 2,576 nursing professionals, 10,175 care assistants and 66,253 workers in other occupations. Factors of the psychosocial work environment were obtained from questionnaire data of the Swedish Work Environment Surveys (SWES) 1993-2013. Information on cause-specific disability pension during follow-up was added from the Social Insurance Agency's database (1994-2014). We calculated Cox's proportional hazards with 95% confidence intervals. During a mean follow-up time of 11.1 years, 6.6% of nursing professionals and 9.4% of care assistants, as compared to 6.1% among all other occupations, received disability pension. Among nursing professionals and care assistants, high quantitative job demands and low social support, but not job control, were associated with future disability pension also after controlling for age, year of interview, socio demographic conditions, and physical work factors. An increase in risk was also noticeable among nursing professionals and care assistants who reported an active job in combination with low social support. An increased risk for disability pension due to mental diagnosis was found among care assistants who reported high job demands. In all other occupations, low social support was associated with an increased risk for disability pension under any condition of job strain (high strain, low strain, active, and passive jobs). Based on the results we conclude that high quantitative job demands and poor social support are predictors of future disability pension.

Objectives: Earlier studies suggest that imbalance between effort and reward at work associates with exhaustion. Others have found that exhaustion increases turnover intentions; an important precursor of actual turnover that also associates with counterproductive work behaviors. Few, however, have studied the associations between effort-reward imbalance (ERI) and employees’ intentions to leave their current employment, and whether exhaustion is underpinning that relationship. Here, we investigate the mediating role of exhaustion in the effort-reward imbalance – turnover intentions relationship. Methods: Data from three waves covering a time span of four years from the Swedish Longitudinal Occupational Survey of Health (SLOSH) were analysed using structural equation modeling. Cross-lagged mediation analyses were conducted to estimate if associations from ERI to subsequent turnover intentions were mediated by exhaustion. Other causal directions (direct and reversed direct effects, reversed mediation) were also examined. Results: A direct path from ERI T1 to turnover intentions T2 was found, but not from ERI T2 to turnover intentions T3. Additionally, results showed that ERI at time points T1/T2 associated significantly with exhaustion two years later (T2/T3). Also, exhaustion at T1 showed a small but statistically significant direct association with turnover intentions at T2 (no association was found between exhaustion T2 and turnover intentions T3). A small, but statistically significant indirect effect from ERI to turnover intentions was found (estimate 0.005; 95% CI 0.002-0.010). Conclusions: Providing a good balance between effort and reward for workers is essential to protect employee health and help retain employees in the organization.