Stress of conscience in healthcare in turbulent times: A longitudinal study.

BACKGROUND: Healthcare workers frequently face ethically demanding situations in their work, potentially leading to stress of conscience. Long-term work intensification (more and more effort demanded year after year), organizational change and COVID-19 may be risk factors concerning stress of conscience. AIMS: The main aim was to investigate the relationship between long-term work intensification and stress of conscience among the personnel in a healthcare organization. Organizational change management was considered a mediator and COVID-19-related work stress a moderator in the association between work intensification and stress of conscience. RESEARCH DESIGN, PARTICIPANTS AND CONTEXT: A total of 211 healthcare district employees participated in a longitudinal survey using questionnaires collected in 2019 (major organizational change in the planning stage) and 2021 (organizational change completed). ETHICAL CONSIDERATIONS: The study was implemented according to the guidelines of the Finnish National Board on Research Integrity. The Finnish instructions were that no review by an ethics committee was necessary because participation was voluntary, informed consent was requested, participants were assured that they were free to withdraw from the longitudinal study at any time and no health data were collected. FINDINGS: Long-term work intensification was associated with more severe stress of conscience. Long-term work intensification was partially mediated through change management to stress of conscience. High COVID-19 stress strengthened the association between long-term work intensification and stress of conscience. CONCLUSIONS: Long-term work intensification must be addressed to reduce stress of conscience in healthcare, otherwise the healthcare system will be vulnerable to changes and crisis. Extra resources for personnel and management should be allocated because of work intensification during organizational change and health crises like the COVID-19 pandemic to alleviate stress of conscience.

A new approach to stress of conscience's dimensionality: Hindrance and violation stressors and their role in experiencing burnout and turnover intentions in healthcare.

AIMS: To identify a valid, longitudinally invariant factor model for stress of conscience and to investigate how stress of conscience dimensions associate with burnout and turnover intentions. BACKGROUND: There has been a lack of consensus about the number and content of stress of conscience dimensions, and a lack of longitudinal studies on its development and outcomes. DESIGN: A longitudinal, person-centred survey study using the STROBE checklist. METHODS: Healthcare personnel (n = 306) rated their stress of conscience in 2019 and 2021. Longitudinal latent profile analysis was used to identify different subgroups based on the employees' experiences. These subgroups were then compared in terms of burnout and organisational/professional turnover. RESULTS: Five subgroups were identified, where participants experienced: (1) hindrance-related stress (14%), (2) violation-related stress (2%), (3) both stress dimensions increasing over time (13%), (4) both high yet decreasing over time (7%), and (5) stable levels of low stress (64%). When both hindrance- and violated-related stress were high, it was a significant risk for burnout and turnover. Shortened, 6-item, two-dimensional scale for stress of conscience was found to be reliable, valid, and longitudinally invariant. CONCLUSION: On its own, hindrance-related stress (e.g. lowering one's aspirations for high-quality work) is less detrimental to well-being than when it is combined with violation-related stress (e.g. being forced to do something that feels wrong). IMPLICATIONS FOR THE PROFESSION PATIENT CARE: To prevent burnout and staff turnover in healthcare, different risk factors for stress of conscience need to be identified and addressed. PUBLIC CONTRIBUTION: Data were collected among public sector healthcare workers. RELEVANCE TO CLINICAL PRACTICE: If healthcare workers are forced to ignore their personal values at work, it poses a significant risk for their well-being and retention.

Do intensified job demands predict burnout? How motivation to lead and leadership status may have a moderating effect.

Objectives: The aim of this longitudinal study was to investigate how intensified job demands (job-related planning demands, career-related planning demands, and learning demands) are associated with burnout. We explored whether affective-identity motivation to lead moderates this association and, thus, functions as a personal resource regardless of leadership status. We further investigated whether the possible buffering effect is stronger for those professionals who became leaders during the follow-up. Methods: Our sample consisted of highly educated Finnish professionals (n = 372): part of them (n = 63, 17%) occupied a leadership position during the 2-year follow-up while the rest maintained their position without formal leadership duties. Results: The results of hierarchical linear modeling indicated that intensified learning demands were associated with later burnout. High affective-identity motivation to lead was not found to buffer against the negative effects of intensified job demands - instead, it strengthened the connection of intensified job- and career-related demands to burnout. Nevertheless, among the whole sample, professionals with high affective-identity motivation to lead reported lower burnout when job demands were not highly intensified. The leadership status also played a role: High affective-identity motivation to lead strengthened the connection of career-related demands to burnout in those professionals who became leaders during the follow-up. Conclusions: Altogether, we propose that in certain circumstances, affective-identity motivation to lead might help professionals, with and without formal leadership duties, to be more ready to lead their own work and well-being. However, in order to promote sustainable careers, the vulnerability role of high affective-identity motivation to lead should be considered as well.