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.

Profiles of early career insecurity and its outcomes in adolescence: A four-wave longitudinal study.

This study investigated the developmental profiles of perceived early career insecurity (ECI) and their outcomes among adolescents (n = 1416) during a critical educational transition from basic education to upper secondary education. We found three distinct latent profiles with varying amounts of ECI: Profile 1: Moderate and decreasing ECI before the transition (57%); Profile 2: Low-decreasing ECI before the transition but increasing ECI after the transition (31%); and Profile 3: High and stable ECI during the transition (12%). Moreover, the ECI profiles related to school and life satisfaction as well as to school stress and dropout intentions in a meaningful way consistent with the stressor hypothesis. Chronically high and increasing ECI was related to negative outcomes.

Effects of overnight military training and acute battle stress on the cognitive performance of soldiers in simulated urban combat.

Understanding the effect of stress, fatigue, and sleep deprivation on the ability to maintain an alert and attentive state in an ecologically valid setting is of importance as lapsing attention can, in many safety-critical professions, have devastating consequences. Here we studied the effect of close-quarters battle (CQ battle) exercise combined with overnight military training with sleep deprivation on cognitive performance, namely sustained attention and response inhibition. In addition, the effect of the CQ battle and overnight training on cardiac activity [heart rate and root mean square of the successive differences (RMSSD)] during the cognitive testing and the relationship between cardiac activity and cognitive performance were examined. Cognitive performance was measured with the psychomotor vigilance task (PVT) and the sustained attention to response task (SART). Altogether 45 conscripts participated in the study. The conscripts were divided into control (CON) and experimental (EXP) groups. The CON completed the training day after a night of sleep and the EXP after the overnight military training with no sleep. Results showed that the effect of the overnight training on cognitive performance and the between-group difference in heart rate (HR) and heart rate variability (HRV) depended on the cognitive test. Surprisingly, the cognitive performance was not largely affected by the CQ battle. However, as expected, the CQ battle resulted in a significant decrease in RMSSD and an increase in HR measured during the cognitive testing. Similarly, the HR parameters were related to cognitive performance, but the relationship was found only with the PVT. In conclusion, fatigue due to the overnight training impaired the ability to maintain sufficient alertness level. However, this impairment in arousal upregulation was counteracted by the arousing nature of the SART. Hence, the conscripts' cognitive performance was mainly preserved when performing a stimulating task, despite the fatigue from the sleep loss of the preceding night and physical activity.

Intensified job demands, stress of conscience and nurses' experiences during organizational change.

BACKGROUND: Nurses frequently face ethically demanding situations in their work, and these may lead to stress of conscience. Working life is currently accelerating and job demands are intensifying. These intensified job demands include (1) work intensification, (2) intensified job-related planning demands, (3) intensified career-related planning demands, and (4) intensified learning demands. At the same time, many healthcare organizations are implementing major organizational changes that have an influence on personnel. AIM: The aim of the study was to investigate the association between intensified job demands and stress of conscience, and whether their association is moderated by organizational change experiences among nurses. Experiences of organizational change may expose employees to stress of conscience or serve as a buffer because employees appraise, involve, and cope with changes differently. RESEARCH DESIGN: Questionnaires measuring stress of conscience, intensified job demands, and organizational change experiences were completed by nurses (n = 511) in a healthcare district undergoing a major organizational change. ETHICAL CONSIDERATIONS: Throughout, the study procedures were implemented according to the guidelines of the Finnish National Board on Research Integrity and the 1964 Helsinki Declaration and its later amendments. According to the Finnish regulations, because participation was voluntary, informed consent was requested, and participants were advised of their right to withdraw from the study at will. No permission from an ethics committee was necessary. FINDINGS: Work intensification and personal worry considering organizational change were associated with more severe stress of conscience among nurses. Nurses' experiences of managements' competent handling of organizational change buffered the association between work intensification and stress of conscience. CONCLUSIONS: During organizational changes, management may alleviate nurses' stress of conscience by proper communication and support procedures.

Intensified job demands in healthcare and their consequences for employee well-being and patient satisfaction: A multilevel approach.

AIMS: Intensified job demands (IJDs) and their effects on employee burnout, work engagement and patient satisfaction were investigated across different work units and occupational groups in a healthcare setting. DESIGN: A multilevel study. METHODS: One thousand twenty-four healthcare employees responded to a survey in 2019 and rated their experiences of IJDs, burnout and work engagement. Nine hundred fifty-one patients rated their satisfaction with care received from healthcare staff. RESULTS: Work units and occupational groups who shared more experiences of increased time pressure and multitasking reported higher exhaustion. Shared perceptions of increased planning and performing one's work autonomously correlated with higher exhaustion and lower patient satisfaction at the work-unit level. Moreover, work intensification was found to be highest in emergency care and among nurses, while job-related planning demands were highest in leadership services. CONCLUSION: IJDs are a shared risk to employee well-being among heterogeneous healthcare staff and relate negatively to customer-rated patient satisfaction. We found that high time-pressure demands increase the shared risk of burnout-especially among nurses and healthcare staff working in emergency care. Furthermore, increased independence and self-determination in planning and executing work tasks also increase the shared risk of burnout especially among those in leadership services. This can lead to lower customer/care satisfaction among patients. IMPACT: With the accelerating pace of socio-economic change, the pace of work is also getting faster. Our findings help understand how IJDs are experienced among heterogeneous healthcare staff. Because different occupational groups and work units had different demands, this research shows that attempts to mitigate the negative effects of IJDs need to be planned and implemented in a context-specific way. It seems crucial to pay more attention especially to adequate nurse staffing so that the adverse effects of IJDs could be mitigated among them.

Illegitimate tasks in health care: Illegitimate task types and associations with occupational well-being.

AIMS AND OBJECTIVES: The aims of the study were to identify content categories of unreasonable and unnecessary illegitimate tasks and to investigate how unreasonable and unnecessary tasks relate to occupational wellbeing. BACKGROUND: Illegitimate tasks are a common stressor among healthcare professionals, and they have been shown to have negative associations with occupational well-being. Despite this evidence, research has not yet uncovered what kinds of tasks healthcare professionals consider illegitimate. DESIGN AND METHOD: The data gathered by means of an online survey consisted of 1024 municipal healthcare organisation employees. A theory-driven qualitative content analysis was used to analyse freely reported illegitimate tasks. For occupational well-being associations, a mixed-methods approach was used (ANCOVA and linear regression analysis). The STROBE statement-checklist for cross-sectional studies was used. RESULTS: Eight content categories were found for illegitimate tasks. For unreasonable tasks, these were (1) tasks outside one's occupational role (78% of all unreasonable tasks), (2) conflicting or unclear demands (9%), (3) tasks with insufficient resources (8%) and (4) tasks with difficult consequences (5%), and for unnecessary tasks, these were (1) impractical or outdated working habits (31% of all unnecessary tasks), (2) tasks related to dysfunctional technology (30%), (3) unnecessary procedures (27%) and (4) tasks related to bureaucratic demands (12%). Unreasonable and unnecessary tasks were associated with higher levels of burnout and lower work engagement and the meaningfulness of work. CONCLUSIONS: Our findings support the theory that illegitimate tasks are an occupational stressor with negative effects on burnout, work engagement and meaningfulness of work. RELEVANCE TO CLINICAL PRACTICE: The study offers insights into the types of tasks health care employees see as illegitimate and highlights the importance of good job design in promoting occupational well-being in health care.

Do Aging Employees Benefit from Self-Regulative Strategies? A Follow-Up Study.

SOC-strategies (selection, optimization, and compensation) are crucial for well-being and adaptation throughout the life course. The workforce is aging rapidly, thus the age-conditional premises of SOC theory require attention. This study explored (1) whether older employees used SOC strategies more often (compared to younger employees), and (2) whether older employees benefited more from SOC strategies in relation to occupational well-being (job burnout, work engagement). The study was based on follow-up data including three occupational subsamples of different age (N = 1,020). There were no significant age-conditional differences in the take-up of SOC strategies. However, older (white-collar) employees benefited more from compensation and elective selection in relation to occupational well-being. Moreover, older employees also benefited more from using all SOC strategies concerning occupational well-being. Strengthening older employees' SOC strategies needs more attention as the workforce is aging.

Profiling a Spectrum of Mental Job Demands and their Linkages to Employee Outcomes.

Working life is becoming more mentally demanding and intense due to technological acceleration. The present study explored employees' experiences of different mental job demands (MJDs) and their outcomes (job burnout, job performance, and meaning of work). We focused on intra- and inter-individual variations and possible harmful combinations of MJDs, which we explored via latent profile analysis (LPA). To identify harmful combinations of MJDs, we also investigated how the profiles of MJDs related to the outcomes of interest. The study was based on a diverse sample of Finnish employees (n = 4,583). LPA showed that both intra-individual and inter-individual variation characterized MJDs as we identified five latent profiles of MJDs. The most harmful profile, which predicted the most negative outcomes (particularly job burnout), was characterized by employees' scoring high on all MJDs. A profile characterized by low learning demands and moderate level of other MJDs was also a harmful combination in terms of outcomes. In contrast, a profile characterized by moderate level of learning demands and low level of other MJDs did not relate to negative outcomes. Altogether, the findings suggest that different MJDs may co-occur implying risks to employee well-being and performance. However, MJDs simultaneously form a complex spectrum that may differ within and between individuals.

Intensified job demands and job performance: does SOC strategy use make a difference?

We examined intensified job demands (IJDs) and selecting-optimizing-compensating (SOC) strategies as predictors of job performance (task performance, organizational citizenship behavior). We also investigated SOC strategy use as a moderator in the linkages between IJDs and performance. We sampled three disparate occupational groups (N=4,582). We found that certain dimensions of IJDs showed significant associations with the indicators of job performance but there were also scale-based variations in these linkages, depending on the type of performance and on the sub-scale of IJDs. Specifically, some dimensions of IJDs (e.g., work intensification) related to poorer task performance whereas some other dimensions (e.g., intensified job-related learning demands) related to higher organizational citizenship behaviour. However, SOC strategy use benefitted both types of job performance. Relationships also differed between occupational groups as none of the moderator effects were consistent across the sub-samples.

Emotional labour and work engagement among nurses: examining perceived compassion, leadership and work ethic as stress buffers.

AIM: The study examined whether three resources, that is, compassion, transformational leadership and work ethic feasibility, buffer against the negative effects of emotional labour on work engagement. BACKGROUND: Emotional labour is a common job stressor among nurses, but little is known about whether certain personal and work resources buffer against it in relation to work engagement. Revealing buffers of emotional labour would help organizations to design tailored interventions. DESIGN: Cross-sectional online survey conducted in 2014. METHODS: Participants were 3466 Finnish nurses. Hypotheses were tested via hierarchical moderated regression analyses. RESULTS: Higher emotional labour related to lower engagement. Two interaction effects were found. First, work ethic feasibility buffered against emotional labour: the nurses who perceived work ethic feasibility as high in a situation of high emotional labour, scored higher on engagement compared with those nurses who in this stress situation perceived work ethic feasibility to be low. Second, high compassion was detrimental to engagement in the presence of high emotional labour. Transformational leadership did not act as a buffer but showed a positive relationship with engagement. CONCLUSION: Work ethic feasibility (being able to work according to high ethical standards) is an important resource in nursing as it protects an employee against the negative effects of emotional labour and as it also directly promotes engagement. However, compassion may not always be beneficial in nursing, especially if co-occurring with high job stress. Transformational leadership has potential to improve engagement in nursing although it may not operate as a stress buffer.

The effects of unemployment and perceived job insecurity: a comparison of their association with psychological and somatic complaints, self-rated health and life satisfaction.

PURPOSE: Research has provided convincing evidence for the adverse effects of both short- and long-term unemployment, and perceived job insecurity on individuals' health and well-being. This study aims to go one critical step further by comparing the association between short- and long-term unemployment, and perceived job insecurity with a diverse set of health and well-being indicators. METHODS: We compare four groups: (1) secure permanent employees (N = 2257), (2) insecure permanent employees (N = 713), (3) short-term unemployed (N = 662), and (4) long-term unemployed (N = 345) using cross-sectional data from the nationally representative Living Conditions Survey in Finland. RESULTS: Covariance analyses adjusted for background variables support findings from earlier studies that long-term unemployment and perceived job insecurity are detrimental: short-term unemployed and secure permanent employees experienced fewer psychological complaints and lower subjective complaints load, reported a higher self-rated health, and were more satisfied with their life compared to long-term unemployed and insecure permanent employees. Second, whereas unemployment was found to be more detrimental than insecure employment in terms of life satisfaction, insecure employment was found to be more detrimental than unemployment in terms of psychological complaints. No differences were found regarding subjective complaints load and self-rated health. CONCLUSIONS: Our findings suggest that (1) insecure employment relates to more psychological complaints than short-term unemployment and secure permanent employment, (2) insecure employment and long-term unemployment relate to more subjective complaints load and poorer health when compared to secure permanent employment, and (3) insecure employment relates to higher life satisfaction than both short- and long-term unemployment.

Work-family conflict and enrichment from the perspective of psychosocial resources: comparing Finnish healthcare workers by working schedules.

We examined work-family conflict (WFC) and work-family enrichment (WFE) by comparing Finnish nurses, working dayshifts (non-shiftworkers, n = 874) and non-dayshifts. The non-dayshift employees worked either two different dayshifts (2-shiftworkers, n = 490) or three different shifts including nightshifts (3-shiftworkers, n = 270). Specifically, we investigated whether different resources, i.e. job control, managers' work-family support, co-workers' work-family support, control at home, personal coping strategies, and schedule satisfaction, predicted differently WFC and WFE in these three groups. Results showed that lower managers' work-family support predicted higher WFC only among 3-shiftworkers, whereas lower co-workers' support associated with increased WFC only in non-shiftworkers. In addition, shiftworkers reported higher WFC than non-shiftworkers. However, the level of WFE did not vary by schedule types. Moreover, the predictors of WFE varied only very little across schedule types. Shiftwork organizations should pay more attention to family-friendly management in order to reduce WFC among shiftworkers.

Development of perceived job insecurity across two years: associations with antecedents and employee outcomes.

This 2-year longitudinal study among 848 university employees investigated the individual development of perceived job insecurity (JI) in the context of changes occurring in the Finnish universities during the follow-up time. Adopting a person-oriented approach through latent profile analysis, 8 classes of employees with similar mean levels and mean-level changes in JI were identified. Two of these classes (75% of the participants) indicated stable (low, moderately high) JI, and the remaining 6 classes (25% of the participants) showed change (decreasing, increasing, curvilinear) in the level of JI across time. We then examined possible differences between these classes with respect to individual antecedents and outcomes of JI. Of the antecedents, the type of employment contract distinguished best between the JI classes. Of the outcomes, moderately high stable JI was associated with low stable vigor and high stable levels of exhaustion and turnover intentions across time. In addition, it seemed that a decrease in JI was associated with a decrease in exhaustion and turnover intentions and vice versa. Altogether the findings suggest that developmental JI classes exhibit a substantial amount of heterogeneity, which is simultaneously reflected in occupational well-being.

Are the most dedicated nurses more vulnerable to job insecurity? Age-specific analyses on family-related outcomes.

AIM: To examine the moderating roles of job dedication and age in the job insecurity-family-related well-being relationship. BACKGROUND: As job insecurity is a rather permanent stressor among nurses nowadays, more research is needed on the buffering factors alleviating its negative effects on well-being. METHODS: A total of 1719 Finnish nurses representing numerous health care organisations participated in this cross-sectional study. Moderated hierarchical regression analysis was used to examine the associations. RESULTS: Nurses' younger age and low job dedication operated as protective factors against the negative effect of high job insecurity on parental satisfaction. The effect of job dedication on family-related well-being was also age-specific: high job dedication protected younger nurses from the negative effect of job insecurity on work-family conflict and parental stress, whereas among older nurses those who reported low job dedication showed better well-being in the presence of high job insecurity. CONCLUSIONS: The most job-dedicated nurses were more vulnerable to job insecurity in relation to parental satisfaction. In addition, high job dedication combined with high age implied more work-family conflict and parental stress in the presence of high job insecurity. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should seek to boost younger nurses' job dedication and to prevent older nurses' over-commitment.

Association between vigor and exhaustion during the workweek: a person-centered approach to daily assessments.

The purpose of this quantitative diary study was to investigate daily vigor and exhaustion using a person-centered approach. The study also investigated whether and how experiences of vigor and exhaustion relate to a state of being recovered. A total of 256 Finnish employees filled in a diary questionnaire during five consecutive workdays. Vigor and exhaustion showed strong negative interdependence within and between days. However, by applying a person-centered analysis, we were able to differentiate three groups with meaningful variation in vigor and exhaustion. The groups were labeled as Constantly vigorous (n = 179), Concurrently vigorous and exhausted (n = 30) and Constantly exhausted (n = 43). The vigor-exhaustion groups were also characterized by their recovery experiences: The Constantly vigorous employees recovered well from work strain during the workweek whereas the Constantly exhausted group recovered poorly. Overall, while the results indicate that, typically, vigor and exhaustion are exclusive experiences, it is also possible for them to be experienced simultaneously from day to day at the moderate levels. Thus, positive and negative experiences may co-occur.

Does aging make employees more resilient to job stress? Age as a moderator in the job stressor-well-being relationship in three Finnish occupational samples.

OBJECTIVES: This study examined whether an employee's age moderates the relationships between job stressors (i.e. job insecurity, workload, work-family conflict) and self-rated well-being (i.e. work-family enrichment, life satisfaction, job satisfaction, vigor at work). METHOD: Analysis of covariance and moderated hierarchical regression analysis were used to examine the cross-sectional Finnish data collected among service sector employees (N = 1037), nurses (N = 1719), and academic employees (N = 945). RESULTS: In a situation of high job insecurity, the younger nurses reported higher work-family enrichment, job satisfaction, and vigor compared to their older colleagues. A similar result was also found among the service sector workers in relation to vigor at work. Thus, young age buffered against negative outcomes related to job insecurity. Moreover, older age buffered against the negative effect of high workload on job satisfaction among the service sector and against high work-family conflict on life satisfaction among the academic employees. CONCLUSION: More attention should be paid to the ability of younger employees to manage problems related to work-family imbalance and high workload, and to older employees' ability to cope with job insecurity. The findings of this study recommend different stress management interventions for older and younger employees.

Heart rate variability related to effort at work.

Changes in autonomic nervous system function have been related to work stress induced increases in cardiovascular morbidity and mortality. Our purpose was to examine whether various heart rate variability (HRV) measures and new HRV-based relaxation measures are related to self-reported chronic work stress and daily emotions. The relaxation measures are based on neural network modelling of individual baseline heart rate and HRV information. Nineteen healthy hospital workers were studied during two work days during the same work period. Daytime, work time and night time heart rate, as well as physical activity were recorded. An effort-reward imbalance (ERI) questionnaire was used to assess chronic work stress. The emotions of stress, irritation and satisfaction were assessed six times during both days. Seventeen subjects had an ERI ratio over 1, indicating imbalance between effort and reward, that is, chronic work stress. Of the daily emotions, satisfaction was the predominant emotion. The daytime relaxation percentage was higher on Day 2 than on Day 1 (4 ± 6% vs. 2 ± 3%, p < 0.05) and the night time relaxation (43 ± 30%) was significantly higher than daytime or work time relaxation on the both Days. Chronic work stress correlated with the vagal activity index of HRV. However, effort at work had many HRV correlates: the higher the work effort the lower daytime HRV and relaxation time. Emotions at work were also correlated with work time (stress and satisfaction) and night time (irritation) HRV. These results indicate that daily emotions at work and chronic work stress, especially effort, is associated with cardiac autonomic function. Neural network modelling of individual heart rate and HRV information may provide additional information in stress research in field conditions.

Prospective relationships between career disruptions and subjective well-being: evidence from a three-wave follow-up study among Finnish managers.

OBJECTIVES: The objective of this study was to examine the prospective relationships between career disruptions and subjective well-being by using a three-way follow-up data with a 10-year time lag. Specifically, we investigated the causation and selection hypotheses by examining the directions of causal associations between career disruptions and subjective well-being. The causation hypothesis states that negative career changes will result in poorer well-being, whereas the selection hypothesis expects this linkage to be vice versa, that is, employees' well-being impacts their career line. METHODS: The sample consisted of Finnish managers (n = 528) who participated in this questionnaire study 3 times: in 1996 (T1), 1999 (T2), and 2006 (T3). Career disruptions covered the periods of unemployment, layoffs, and redundancies. Subjective well-being was assessed with sense of coherence (SOC) and psychosomatic symptoms (PSS). The causation versus selection hypotheses were tested with Structural Equation Modeling using a full-panel design, that is, the variables of career disruptions, SOC, and PSS were measured in each wave. RESULTS: Support was found for both the causation and selection hypotheses. First, career disruptions experienced before T1 predicted increased PSS at T1, providing support for the causation hypothesis. Second, low SOC in T2 predicted subsequent career disruptions 7 years later at T3, supporting the selection hypothesis. Furthermore, SOC and PSS showed high stability over time, whereas career disruptions accumulated over time: those who reported career disruptions at T1 had a higher risk to experience disruptions also at T2 and T3. CONCLUSIONS: Negative career changes seem to associate with low subjective well-being (PSS) on short term and, in turn, low subjective well-being (SOC) seems to associate with negative career changes on long term among managers. The different results depending on the well-being measure might relate to the conceptual differences between the well-being indicators used (PSS, SOC) and the different time frame needed for causation and selection. Thus, in examining the causation versus selection hypotheses, it is important to evaluate subjective well-being using different indicators and time lags. Managers may benefit from interventions targeting to enhance their mental resilience and employability in the cases of negative career changes.

Type of employment relationship and mortality: prospective study among Finnish employees in 1984-2000.

BACKGROUND: The study investigated the relationship between the type of employment (permanent/temporary) contract and mortality. Factors through which temporary employment was expected to be associated with increased mortality were the degree of satisfaction with the uncertainty related to temporary work situation (Study 1) and the voluntary/involuntary basis for temporary work (Study 2). METHODS: In Study 1 the data consisted of representative survey on Finnish employees in 1984 (n = 4502), which was merged with register-based follow-up data in Statistics Finland covering years 1985-2000. In Study 2 the data consisted of representative survey on Finnish employees in 1990 (n = 3502) with register-based follow-up data covering years 1991-2000. The relative risk of death was examined by conducting Cox proportional hazards analyses for the permanent and the two temporary employment groups, respectively. RESULTS: In Study 1 temporary employees feeling the insecure situation unsatisfactory had a 1.95-fold higher risk of mortality than permanent employees (95% CI 1.13-3.35) after adjusted for background, health- and work-related factors. In Study 2 employees in the position of having a temporary job on the involuntarily basis had a 2.59-fold higher risk of mortality than permanent employees (95% CI 1.16-5.80). CONCLUSIONS: The present study confirmed that temporary employees are not a homogeneous group, which holds true even for mortality. Those temporary employees, who either felt the insecure situation unsatisfactory or who worked in temporary work involuntarily, had higher risk of mortality than permanent employees.