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Original article

Vol. 150 No. 0708 (2020)

Temporal work stressors and satisfaction with work, life and health among health professionals in Switzerland

  • Klarissa Siebenhüner
  • Edouard Battegay
  • Oliver Hämmig
DOI
https://doi.org/10.4414/smw.2020.20175
Cite this as:
Swiss Med Wkly. 2020;150:w20175
Published
21.02.2020

Summary

BACKGROUND

Working in a hospital can be both rewarding and stressful. Whether one or the other is dominant depends on a number of factors ranging from shift work, physical demands, responsibilities and time pressure to job autonomy, work climate and leisure time.

AIM

This study aimed to examine associations between temporal work stressors and satisfaction with work, life and health among health professionals in general, and nurses and physicians in particular. Associations were further investigated for possible mediating and intervening factors.

METHODS

Cross-sectional survey data on 1232 health professionals at three public hospitals and two rehabilitation clinics were collected in 2015/2016. Stepwise multiple linear regression analyses were used to estimate the standardised effects (beta coefficients) of temporal work stressors (overtime and time pressure), and organisational and personal resources (job autonomy, work climate, internal control belief) on general stress as the assumed mediator and finally on satisfaction with work, life and health.

RESULTS

Temporal work stressors were found to strongly predict general stress symptoms among health professionals (β = 0.25) and particularly physicians (β = 0.30), independently of the observed stress-buffering effects of organisational resources such as job autonomy (β = −0.09) or work climate (β = −0.22). Associations between temporal work stressors (as predictors) and satisfaction with work, life and health (as outcomes) turned out to be mostly indirect, mediated by general stress. General stress in turn was observed to be the strongest predictor of domain-specific satisfaction (β = −0.17 to −0.34), sometimes only surpassed by resources such as work climate or internal control belief. Explained variance of the three satisfaction outcomes in the fully specified regression or explanatory models ranged between 14% and 45% depending on the (sub-)sample (nurses, physicians, all health professionals) or the outcome. Control belief was revealed to be a strong and independent personal resource, particularly regarding satisfaction with life and health in general (β = 0.25/0.21).

CONCLUSION

Satisfaction and well-being of health professionals are strongly affected by job stressors such as frequent or excessive overtime work or permanent time pressure at work. Negative consequences of temporal work stressors are attenuated by organisational and personal resources such as a high level of job autonomy, a good work climate or a strong internal control belief.

References

  1. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21. doi:.https://doi.org/10.1016/S0140-6736(09)61424-0
  2. Smith R. Why are doctors so unhappy? There are probably many causes, some of them deep. BMJ. 2001;322(7294):1073–4. doi:.https://doi.org/10.1136/bmj.322.7294.1073
  3. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–58. doi:.https://doi.org/10.1016/S0140-6736(10)61854-5
  4. Morse T, Fekieta R, Rubenstein H, Warren N, Alexander D, Wawzyniecki P. “Doing the heavy lifting: health care workers take back their backs”. New Solut. 2008;18(2):207–19. doi:.https://doi.org/10.2190/NS.18.2.j
  5. Shan Z, Li Y, Zong G, Guo Y, Li J, Manson JE, et al. Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: results from two large US cohorts of female nurses. BMJ. 2018;363:k4641. doi:.https://doi.org/10.1136/bmj.k4641
  6. Jackson EJ, Moreton A. Safety during night shifts: a cross-sectional survey of junior doctors’ preparation and practice. BMJ Open. 2013;3(9):e003567. doi:.https://doi.org/10.1136/bmjopen-2013-003567
  7. Hansen J. Night Shift Work and Risk of Breast Cancer. Curr Environ Health Rep. 2017;4(3):325–39. doi:.https://doi.org/10.1007/s40572-017-0155-y
  8. Weigl M, Müller A, Vincent C, Angerer P, Sevdalis N. The association of workflow interruptions and hospital doctors’ workload: a prospective observational study. BMJ Qual Saf. 2012;21(5):399–407. doi:.https://doi.org/10.1136/bmjqs-2011-000188
  9. Bellandi T, Cerri A, Carreras G, Walter S, Mengozzi C, Albolino S, et al. Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses. Ergonomics. 2018;61(1):40–7. doi:.https://doi.org/10.1080/00140139.2017.1349934
  10. Bochatay N, Muller-Juge V, Scherer F, Cottin G, Cullati S, Blondon KS, et al. Are role perceptions of residents and nurses translated into action? BMC Med Educ. 2017;17(1):138. doi:.https://doi.org/10.1186/s12909-017-0976-2
  11. Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations--a questionnaire study. BMJ. 1997;315(7107):520–3. doi:.https://doi.org/10.1136/bmj.315.7107.520
  12. Matthys J, Elwyn G, Van Nuland M, Van Maele G, De Sutter A, De Meyere M, et al. Patients’ ideas, concerns, and expectations (ICE) in general practice: impact on prescribing. Br J Gen Pract. 2009;59(558):29–36. doi:.https://doi.org/10.3399/bjgp09X394833
  13. Cannavò M, La Torre F, Sestili C, La Torre G, Fioravanti M. Work Related Violence As A Predictor Of Stress And Correlated Disorders In Emergency Department Healthcare Professionals. Clin Ter. 2019;170(2):e110–23.
  14. Sattler A. [Multimorbidität in der stationären Versorgung – Sichtweise internistischer Ärztinnen und Ärzte: Behandungsziele, Schwierigkeiten und Optimierungspotential]. Dissertation an der Medizinischen Fakultät der Universität Zürich. 2017.
  15. Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, Garnier A. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts. Ann Intern Med. 2017;166(8):579–86. doi:.https://doi.org/10.7326/M16-2238
  16. Meyer B, Rohner B, Golder L, Longchamp C. Administrativer Aufwand für Ärzte steigt weiter an. Begleitstudie im Auftrag der FMH: Auswirkungen der neuen Spitalfinanzierung. Schweiz Arzteztg. 2016;97(1):6–8.
  17. Mansukhani MP, Kolla BP, Surani S, Varon J, Ramar K. Sleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature. Postgrad Med. 2012;124(4):241–9. doi:.https://doi.org/10.3810/pgm.2012.07.2583
  18. Papp KK, Stoller EP, Sage P, Aikens JE, Owens J, Avidan A, et al. The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study. Acad Med. 2004;79(5):394–406. doi:.https://doi.org/10.1097/00001888-200405000-00007
  19. Gander P, Purnell H, Garden A, Woodward A. Work patterns and fatigue-related risk among junior doctors. Occup Environ Med. 2007;64(11):733–8. doi:.https://doi.org/10.1136/oem.2006.030916
  20. Hasselhorn HM, Tackenberg P, Kuemmerling A, Wittenberg J, Simon M, Conway PM, et al. Nurses’ health, age and the wish to leave the profession--findings from the European NEXT-Study. Med Lav. 2006;97(2):207–14.
  21. Bolliger C, Golder L. [Der Ausstieg aus der kurativen ärztlichen Tätigkeit. Eine Umfrage im Auftrag des Verbands der Schweizerischen Assistenz- und Oberärztinnen und -ärzte (VSAO) und der Verbindung der Schweizer Ärztinnen und Ärzte (FMH)]. Bern: Büro Vatter & gfs; 2016.
  22. Kivimäki M, Jokela M, Nyberg ST, Singh-Manoux A, Fransson EI, Alfredsson L, et al.; IPD-Work Consortium. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015;386(10005):1739–46. doi:.https://doi.org/10.1016/S0140-6736(15)60295-1
  23. Mayor S. Working long hours is associated with higher risk of stroke, study shows. BMJ. 2015;351:h4523. doi:.https://doi.org/10.1136/bmj.h4523
  24. Edwards N, Kornacki MJ, Silversin J. Unhappy doctors: what are the causes and what can be done? BMJ. 2002;324(7341):835–8. doi:.https://doi.org/10.1136/bmj.324.7341.835
  25. Karasek R. Job Demands, Job Decision Latitude, and Mental Strain: Implications for Job Redesign. Adm Sci Q. 1979;24(2):285–308. doi:.https://doi.org/10.2307/2392498
  26. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol. 2001;86(3):499–512. doi:.https://doi.org/10.1037/0021-9010.86.3.499
  27. Mayerl H, Stolz E, Großschädl F, Rásky É, Freidl W. The moderating role of personal resources in the relationship between psychosocial job demands and health: a cross-sectional study. BMJ Open. 2017;7(8):e015710. doi:.https://doi.org/10.1136/bmjopen-2016-015710
  28. Jimenez P, Dunkl A. The Buffering Effect of Workplace Resources on the Relationship between the Areas of Worklife and Burnout. Front Psychol. 2017;8:12. doi:.https://doi.org/10.3389/fpsyg.2017.00012
  29. Darshani R. A Review of Personality Types and Locus of Control as Moderators of Stress and Conflict Management. Internal Journal of Scientific Research Publications. 2014;4(2):??.
  30. Rotter JB. Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr. 1966;80(1):1–28. doi:.https://doi.org/10.1037/h0092976
  31. Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Sermeus W ; RN4CAST Consortium. Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. Int J Nurs Stud. 2013;50(2):143–53. doi:.https://doi.org/10.1016/j.ijnurstu.2012.11.009
  32. Williams ES, Skinner AC. Outcomes of physician job satisfaction: a narrative review, implications, and directions for future research. Health Care Manage Rev. 2003;28(2):119–39. doi:.https://doi.org/10.1097/00004010-200304000-00004
  33. Hämmig O. Explaining burnout and the intention to leave the profession among health professionals - a cross-sectional study in a hospital setting in Switzerland. BMC Health Serv Res. 2018;18(1):785. doi:.https://doi.org/10.1186/s12913-018-3556-1
  34. Häusler N, Bopp M, Hämmig O. Effort-Reward Imbalance, Work-Privacy Conflict, and Burnout Among Hospital Employees. J Occup Environ Med. 2018;60(4):e183–7. doi:.https://doi.org/10.1097/JOM.0000000000001287
  35. Häusler N, Bopp M, Hämmig O. Informal caregiving, work-privacy conflict and burnout among health professionals in Switzerland - a cross-sectional study. Swiss Med Wkly. 2017;147:w14552.
  36. Kristensen TS, Hannerz H, Høgh A, Borg V. The Copenhagen Psychosocial Questionnaire--a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438–49. doi:.https://doi.org/10.5271/sjweh.948
  37. Kovaleva A. The IE-4: Construction and Validation of a Short Scale for the Assessment of Locus of Control. GESIS - Leibnitz-Institut für Sozialwissenschaften. 2012:https://nbn-resolving.org/urn:nbn:de:0168-ssoar-371199.
  38. Elo AL, Leppänen A, Jahkola A. Validity of a single-item measure of stress symptoms. Scand J Work Environ Health. 2003;29(6):444–51. doi:.https://doi.org/10.5271/sjweh.752
  39. SHS. Swiss Health Survey 2012. Overview. Available at: https://www.bfs.admin.ch.
  40. SILC. Statistics on Income and Living Conditions (SILC). Available at: https://www.bfs.admin.ch/bfs.
  41. SHP. Swiss Household Panel (SHP). Available at: https://forsbase.unil.ch/project/study-public-overview/15632/0/.
  42. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82. doi:.https://doi.org/10.1037/0022-3514.51.6.1173
  43. McCall TB. The impact of long working hours on resident physicians. N Engl J Med. 1988;318(12):775–8. doi:.https://doi.org/10.1056/NEJM198803243181210
  44. Williams ES, Rondeau KV, Xiao Q, Francescutti LH. Heavy physician workloads: impact on physician attitudes and outcomes. Health Serv Manage Res. 2007;20(4):261–9. doi:.https://doi.org/10.1258/095148407782219067
  45. Bae SH, Fabry D. Assessing the relationships between nurse work hours/overtime and nurse and patient outcomes: systematic literature review. Nurs Outlook. 2014;62(2):138–56. doi:.https://doi.org/10.1016/j.outlook.2013.10.009
  46. Lobo V, Fisher A, Peachey G, Ploeg J, Akhtar-Danesh N. Integrative review: an evaluation of the methods used to explore the relationship between overtime and patient outcomes. J Adv Nurs. 2015;71(5):961–74. doi:.https://doi.org/10.1111/jan.12560
  47. Tomioka K, Morita N, Saeki K, Okamoto N, Kurumatani N. Working hours, occupational stress and depression among physicians. Occup Med (Lond). 2011;61(3):163–70. doi:.https://doi.org/10.1093/occmed/kqr004
  48. Rosta J, Gerber A. Excessive working hours and health complaints among hospital physicians: a study based on a national sample of hospital physicians in Germany. Ger Med Sci. 2007;5:Doc09.
  49. vsao.ch. Bern: Verband Schweizerischer Assistenz- und Oberärztinnen und ärzte, [cited 2019 May 14]. Arbeitsbelastung der Assistenz- und Oberärztinnen und ärzte. Mitgliederbefragung 2017. Available from: https://www2.vsao.ch/fileupload/20174119517_pdf.pdf.
  50. Aalto AM, Heponiemi T, Josefsson K, Arffman M, Elovainio M. Social relationships in physicians’ work moderate relationship between workload and wellbeing-9-year follow-up study. Eur J Public Health. 2018;28(5):798–804. doi:.https://doi.org/10.1093/eurpub/ckx232
  51. Erbin-Roesemann MA, Simms LM. Work locus of control: the intrinsic factor behind empowerment and work excitement. Nurs Econ. 1997;15(4):183–90.
  52. Meier LL, Semmer NK, Elfering A, Jacobshagen N. The double meaning of control: three-way interactions between internal resources, job control, and stressors at work. J Occup Health Psychol. 2008;13(3):244–58. doi:.https://doi.org/10.1037/1076-8998.13.3.244
  53. Arnetz BB. Physicians’ view of their work environment and organisation. Psychother Psychosom. 1997;66(3):155–62. doi:.https://doi.org/10.1159/000289127
  54. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358–67. doi:.https://doi.org/10.7326/0003-4819-136-5-200203050-00008
  55. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987–93. doi:.https://doi.org/10.1001/jama.288.16.1987
  56. Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165(22):2601–6. doi:.https://doi.org/10.1001/archinte.165.22.2601
  57. Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997-2001. JAMA. 2003;289(4):442–9. doi:.https://doi.org/10.1001/jama.289.4.442
  58. Fletcher KE, Underwood W, 3rd, Davis SQ, Mangrulkar RS, McMahon LF, Jr, Saint S. Effects of work hour reduction on residents’ lives: a systematic review. JAMA. 2005;294(9):1088–100. doi:.https://doi.org/10.1001/jama.294.9.1088
  59. Clair C. Geschlecht in der Medizin: ein Thema mit vielen Facetten. Schweiz Arzteztg. 2017;98(50):1680–1. doi:.https://doi.org/10.4414/saez.2017.06269
  60. Merçay C, Burla L, Widmer M. [Gesundheitspersonal in der Schweiz. Bestandesaufnahme und Prognosen bis 2030 (Obsan Bericht 71)]. Neuchâtel: Schweizerisches Gesundheitsobservatorium; 2016.
  61. Cribari M, Holzer BM, Battegay E, Minder CE, Zimmerli LU. What makes internal medicine attractive for the millennial generation? A survey of residents in internal medicine in Switzerland. Swiss Med Wkly. 2018;148:w14696. doi:.https://doi.org/10.4414/smw.2018.14696
  62. Treister-Goltzman Y, Peleg R. Female Physicians and the Work-Family Conflict. Isr Med Assoc J. 2016;18(5):261–6.
  63. Dieser RB, Edginton CR, Ziemer R. Decreasing Patient Stress and Physician/Medical Workforce Burnout Through Health Care Environments: Uncovering the Serious Leisure Perspective at Mayo Clinic’s Campus in Rochester, Minnesota. Mayo Clin Proc. 2017;92(7):1080–7. doi:.https://doi.org/10.1016/j.mayocp.2017.03.017
  64. Aaron M, Levenberg P. The millennials in medicine: tips for teaching the next generation of physicians. Journal of Academic Ophthalmology. 2014;7:e17–20.

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