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12.10.2015
Promoting nurses’ well-being at work is a common responsibility
 
It is most essential to understand that nurses’ well-being, leadership and quality of care go “hand in hand”. Nurses are in general the ones who provide nursing care and have the biggest impact on the quality of service received by the patients. Promoting nurses’ well-being at work is essential for present and future individual patients, their families and the whole society. The key elements in well-being at work are: nurses’ personal motivation and experience of doing valuable and significant work, relationships at work and leadership and management at work and in the organisation. In this article we discuss issues challenging and supporting nurses’ well-being at work.
At present, people talk a lot about health at work, well-being and working conditions. The financial crisis and ongoing technological innovations cause new challenges that may increase the workload. Employees are more dissatisfied with their current working conditions and working environments have changed and still change very rapidly. Furthermore being able to participate in organisational decision-making has been reported to be more limited compared to previous times.

Long-term dissatisfaction with the working environment can lead to severe health problems including burnout and long-term sickness absences due to several different causes. The reason of burnout is usually emotional stress of the employee which may lead to disregard towards work. In the worst case this leads to malpractice in the caring industry and nurses quitting their job.

Employees working in the private sector find their job generally more satisfying than employees working in the public sector. This might be explained by the constant changes in public health care and the increasing instability in the labour market. There are also differences in job satisfaction between men and women. Studies show that men generally respond more positively to their job compared to women.
 
The challenge of being a newly graduated nurse
New nurses often experience work-related stress during the first months of practice due to rejection by senior colleagues. This has physiological outcomes in the health of a nurse, such as mental exhaustion, insomnia and weight-loss. During the first months of practice new nurses often need more support because at this time nurses experience a lack of self-confidence, role conflicts and lack of support.

Work-related stress is one of the causes for newly registered nurses leaving or intending to leave their jobs. Other causes relate to not getting enough counselling and social support at their new jobs, and feeling that they don’t have possibilities for career development in their job. New nurses leaving their job and changing their career is a major challenge for both the health care field and the whole society as new nurses represent future knowledge and workforce.

Studies have also shown that poorly managed student-to-nurse transitions are fatal to the organisations because nurses easily leave their jobs and seek jobs which match their values and aspirations better. This can be costly for the organisation.

Through changes in the work environment an organization can improve new nurses’ job satisfaction. These changes mainly focus on improving teamwork and reducing job difficulties and demands. A new nurse also requires strong support from the supervisor. Furthermore, studies show that good orientation to the job can improve new nurses’ job satisfaction.
 
Well-being at work affects the quality of care
Consequences of poor well-being at work and job-related stress are alarming for the individual nurse but also for the patients and the quality of care. Stress weakens the nurses’ ability to accomplish tasks and causes lack of concentration which can at worst lead to serious malpractice. With time the nurse’s motivation can decrease and lead to apathy and anxiety.

Job-related stress also causes abuse of alcohol and drugs, smoking and eating poorly, all of which can lead into negative health conditions on nurses and in terms of patients, this means worse quality of care. Researchers have recently become interested in that long-term job-related stress can also have consequences on the physical health of nurses, causing for example migraines, heart diseases etc. For an organisation this means loss of productivity and working hours and occupational accidents.

Nurses are in a very considerable position when talking about positive patient outcomes, because positive outcomes depend more on the nursing quality than technology. It has been studied that nurses’ decision-making has a significant influence on the quality of care and it is most essential on the organisational level to invest in nurses’ professional development. Nurses are in general the ones who provide the nursing care and have the biggest impact on the quality of service received by the patients. Quality is closely related to nurses’ work well-being and the leadership and team management. Moreover, leaders are responsible of providing nurses’ resources to practice and provide high-quality care to patients.
 
Methods to promote well-being at work
Work has different meanings to different people. Motivation towards work can come from the outside, such as the need to provide basic economy for one’s family or from the inside such as feelings of the work being rewarding. If motivation towards work weakens, the employee easily becomes bored with the work and it’s of utmost importance to recognise the elements that give individual employees rewarding feelings and promotes their motivation toward the work. By noticing and reasserting these elements employees can cope with an occasionally boring or disagreeable job.

A job should form a meaningful combination because too much rush at work causes distress and too little work causes frustration. The highest risk for burnout is when a big struggle produces just a small result.

Employees often feel emotionally more satisfied and respond to their job more sensibly when they experience that they are doing valuable and significant work. Nurses have a high risk to contract physical and emotional fatigue, or contract some somatic or emotional disease compared to several other professions. This is at least partly explained by nurses’ tendency to take care of patients and other people rather than themselves. This is why it’s very important for individual nurses as well as working teams and leaders to be sensitive toward early detection and intervention in cases where well-being at work may be decreasing. Health care workers often wish that they would have enough time to work with the heart of the matter that is development and success with the patient. This creates meaningfulness to the worker and increases satisfaction with the job. The development in the medical and nursing sciences has created extra work in the hospital and this creates more pressure to the employees. Employees would like this to be noticed in the organisation in increasing the number of employees.

Two important issues in job satisfaction are the amount of support given by the organisation and trust between the organisation and health care. Trust relationships have an influence on health care workers’ motivation and performance and this directly affects patients feeling comfortable and their quality of care. Nurses who perceive autonomy in their job are usually more satisfied with their job than nurses perceiving less autonomy.

Many factors that are related to job satisfaction are the company’s field of business and the nature of work. Hospitals have many inconvenient factors that are related to working conditions, such as shift work, unexpected situations, rush, heavy physical work, responsibility and accurate distribution of work among workers. This creates unequal division of work among the health care workers.

One noteworthy issue with new generation nurses is employers’ flexibility. Female nurses want to be able to work part-time and leave the work temporarily to raise a family. When an employee does not have to worry about losing her job it increases job satisfaction. Today, a good employer just has to adjust with the workers’ unique demands to be the best employer in the industry.
 
Good team spirit and good leadership are keys to good well-being at work
Research suggests that there’s a positive effect on the whole working climate when nurses have a positive attitude towards their duties. It’s not an insignificant phenomenon if only one person in the working environment frequently complains and communicates in a negative manner. It effects everybody in the working environment negatively.

All co-workers are responsible of respecting general customs and create and maintain a good, positive and open atmosphere in the ward. When employees trust, respect and help each other they work better and more efficiently. Also using humour in interaction improves nurses’ well-being at work. This has a direct link to customer satisfaction and work efficiency.

A working community should be open and confidential. Employees and managers should be able to openly discuss issues and affairs that are related to both work and private issues. A good team spirit helps to accept individual differences and the fact that people have different kinds of methods of doing their job. A good team spirit creates a positive working atmosphere as well as enables co-workers to share their workload and cooperate. Employees are also found to be more cooperative and less critical when the organisation invests in nurses’ empowerment. Every work community has their own conflicts and challenges. Problems don’t usually resolve by themselves and it’s important to create enough situations where workers can reflect on common problems together in a relaxed, safe environment. Unsolved conflicts generate emotional work dissatisfaction and may even lead to bullying at work and other serious problems. Studies have shown that when the relationships at work are good, employees respond more positively to their job and want to work more efficiently.

Good leadership motivates nurses to achieve goals through innovative ideas and strategies and contributes to better effectiveness and success. The key role in this is usually on the head nurse because they usually have the decisive influence on nurse staffing, efficiency, quality and motivation. A good nurse leader invests in the potential of the nurse and enables nurses’ participation in decision making.

Unfortunately this doesn’t always take place if the leader loses the sight of the main purpose of care. Leadership can sometimes be misunderstood as an independent function and lead to an unfavourable working environment for nurses. Studies have shown that bad leadership causes work-related stress on employees and is one of the reasons why nurse have reported to leave or consider leaving the profession. A good manager has been described as consistent, impartial and fair with the employees when giving orders at work. Employees satisfied with their employer also described their relation to their boss as easily accessible. Nurses also report that a good manager listens to problems concerning work and values the employees’ accomplishments. Organisations should invest in empowering nurses because it has been proved to improve the quality of care and higher levels of patient satisfaction. This means that organisations should empower access to information, opportunities, support and resources.
 
Suggested reading:
Downey, M.; Parslow, S. & Smart, M. 2011. The hidden treasure in nursing leadership: informal leaders. Journal of Nursing Management, Vol, 19, 517–521. d’Ettorre, G. & Greco, M. 2015. Healthcare work and organizational interventions to prevent work-related stress in Brindisi, Italy. Safety and Health at work. Volume 6, Issue 1, 35–38.

Flinkman, M. 2014. Young Registered Nurses’ Intent to Leave the Profession in Finland - A Mixed-Method Study. Turun Yliopisto. Saatavana https://www.doria.fi/handle/10024/95711.

Haapala, J. 2012. Työnohjaus ja työhyvinvointi: kyselytutkimus sairaanhoitajille. Itä-Suomen yliopisto. Saatavana http://epublications.uef.fi/pub/urn_nbn_fi_uef-20120591/urn_nbn_fi_uef-20120591.pdf.

Hinno, S., Partanen, P. & Vehviläinen-Julkunen, K. 2011. Hospital nurses’ work environment, quality of care provided and career plans. International Nursing Review 58, 255–262.

Lavoie-Tremblay, M., Wright, D., Desforges, N., Gelinas, C., Marchionni, C. & Drevniok, U. 2008. Creating a healthy workplace for new-generation nurses. Journal of nursing scholarship 40:3, 290–297.

Makkonen, I. 2011. Hoitohenkilökunnan työpaikkakiusaaminen ja siihen yhteydessä olevat tekijät. Tampere: Tampereen yliopisto. Saatavana https://tampub.uta.fi/bitstream/handle/10024/82541/gradu05031.pdf?sequence=1.

Mendes, L. & de Jesus Jose Gil Fradique, M. 2014. Influence of leadership on quality nursing care. International journal of health care. Vol. 27, No. 5, 439–450.

Moustaka, E. & Constantinidis, T.C. 2010. Sources and effects of work-related stress in nursing. Health Science Journal. Volume 4, Issue 4, 210–216.

Okello, R. O. D. & Gilson, L. 2015. Exploring the influence of trust relationships on motivation in the health sector: a systematic review. Human resources for health 13:16.

Purdy, N.; Laschinger, H.K.S.; Finegan, J. Kerr, M. & Olivera, F. 2010. Effects of work environments on nurse and patient outcomes. Journal of nursing management 18, 901–913.

Syväjärvi, A.; Lehtopuu, H.; Perttula, J.; Häikiö, M. & Jokela, J. 2012. 2012. Inhimillisesti tehokas sairaala: Työn mielekkyys henkilöstön kokemana. Rovaniemi: Lapin yliopisto.
 
Kirjoittaja(t):
Christina Savola, RN, public health nurse student & Camilla Laaksonen, PhD, Senior Lecturer