Influence of nursing staff working hours on stress levels during the COVID-19 pandemic: A cross-sectional online survey

Under pressure - Nursing staff's perspectives on working hours and recovery during the COVID-19 pandemic: A qualitative study

Background

The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions.

Objectives

The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being.

Design

A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences.

Methods

Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study.

Results

The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes.

Conclusion

The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.

The impact of increased computer screen time during the COVID-19 pandemic on the occurrence of upper part of musculoskeletal diseases among health personnel

Health personnel who played a key role in the fight against the pandemic stayed during it burdened with increased working time using a computer. We analyzed the impact of increased computer working time during the COVID-19 pandemic on the occurrence of the upper part of musculoskeletal diseases among health personnel. The study group consisted of 418 health personnel, divided according to the time they worked at the computer during the pandemic: up to 2 h a day, from 3 to 5 h a day, and more than 6 h a day. The ICF profile analyzed symptoms of dysfunction of structures of the upper part of the musculoskeletal system (head and cervical spine, shoulder girdle, elbow joint, wrist joint). Employees working more than 6 h daily had a higher risk of developing restrictions in tone of isolated muscles and muscle groups p < 0.001), range of motion of the shoulder girdle (p < 0.001), increased tension of paraspinal muscles (p < 0.001), weakened shoulder girdle muscle strength (p < 0.001), elbow joint pain (p = 0.016), wrist joint pain (p < 0.001), coordination disorders (p = 0.004), difficulties in arm and hand use (p < 0.001), lifting and carrying objects (p = 0.008) and paraesthesia (p < 0.001) compared to those working less than 2 h daily. Additionally, working for 3-5 h and above 6 h compared to health personnel working up to 2 h was associated with a greater risk of headaches and cervical spine pain (p < 0.001), shoulder girdle pain (p < 0.001), limited mobility in the wrist joint (p = 0.003), and tremors (p < 0.001), that working below 2 h. Prolonged computer working time among health personnel during the COVID-19 pandemic is significantly associated with an increased risk of dysfunction and pain in structures of the upper part of the musculoskeletal system. Effective preventive measures are necessary to improve the functioning of the musculoskeletal system during extended periods of computer use.

Identification of the risk factors for insomnia in nurses with long COVID-19

PURPOSE

To investigate the prevalence of insomnia among nurses with long COVID-19, analyze the potential risk factors and establish a nomogram model.

METHODS

Nurses in Ningbo, China, were recruited for this study. General demographic information and insomnia, burnout, and stress assessment scores were collected through a face-to face questionnaire survey administered at a single center from March to May 2023. We used LASSO regression to identify potential factors contributing to insomnia. Then, a nomogram was plotted based on the model chosen to visualize the results and evaluated by receiver operating characteristic curves and calibration curves.

RESULTS

A total of 437 nurses were recruited. 54% of the nurses had insomnia according to the Insomnia Severity Index (ISI) score. Eleven variables, including family structure, years of work experience, relaxation time, respiratory system sequelae, nervous system sequelae, others sequelae, attitudes toward COVID-19, sleep duration before infection, previous sleep problems, stress, and job burnout, were independently associated with insomnia. The R-squared value was 0.464, and the area under the curve was 0.866. The derived nomogram showed that neurological sequelae, stress, job burnout, sleep duration before infection, and previous sleep problems contributed the most to insomnia. The calibration curves showed significant agreement between the nomogram models and actual observations.

CONCLUSION

This study focused on insomnia among nurses with long COVID-19 and identified eleven risk factors related to nurses' insomnia. A nomogram model was established to illustrate and visualize these factors, which will be instrumental in future research for identifying nurses with insomnia amid pandemic normalization and may increase awareness of the health status of healthcare workers with long COVID-19.

Psychosocial interventions for healthcare workers during the COVID-19 pandemic: rapid review and meta-analysis

This rapid review was conducted by following a predefined protocol developed by the Cochrane Rapid Reviews Methods Group. A total of 172 potential reviews and 167 primary studies of interest were found. AMSTAR II was used to assess the quality of the included reviews and the JBI Checklist for Randomized Controlled Trials for primary studies. Overall, four studies were included in this review. The study quality ranged from 5 to 12 out of 13 possible stars. No robust evidence was found that psychosocial interventions can reduce psychological distress. No significant effect could be found regarding post-traumatic stress. Two studies on anxiety were identified, one which showed an effect and another which did not. The psychosocial intervention had no beneficial effect on burnout and depression, whereas providing a mindfulness- or relaxation-based intervention resulted in a significant improvement in sleep quality. By considering the secondary results and results of previous reviews, a combination of training and mindfulness seems to be beneficial for decreasing anxiety and stress in home care workers. In summary, the evidence-based recommendations are still limited and, therefore, more evidence is needed to make a general statement of high certainty about the effects.

Working Experiences of Care Aides in Long-Term Care Institutions Following the Relaxation of COVID-19 Regulations in Taiwan: A Qualitative Study

Care aides in long-term care (LTC) institutions care for older disabled residents at high risk for COVID-19. However, they experienced many stressors during the COVID-19 pandemic. This study aims to explore the working experiences of care aides in LTC institutions following the relaxation of COVID-19 regulations in Taiwan. This qualitative descriptive study included 20 care aides who had cared for residents with COVID-19. Data were obtained via semi-structured interviews. Caring for residents with COVID-19 and the difficulties, resources and teamwork, and impact of care aides' work on their lives were discussed. Consequently, four themes were identified. First, difficulties in care, which included physical limitations by protection, workload, and impact of work schedule on the lives of the care aides. Second, psychological impact, such as worry, social isolation, and burnout. Third, interpersonal relationships with supervisors, colleagues, residents, and their families. Fourth, infection control policy from the institution and government. When infection control policies were relaxed, care aides had difficulties in caring for residents; furthermore, their family and social lives were also affected. They were required to learn knowledge of and skills for COVID-19 management. Institutions were required to provide support in materials, care processes, environment, and management.

Perceived Work Environment, Educational Status, Staffing Levels, and Work Outcomes in Long-Term Care Settings During COVID-19

OBJECTIVES

Coronavirus disease (COVID-19) has severely affected older residents in long-term care (LTC) settings. However, care workers' perceptions of their work environment and potential impact on their work outcomes during the pandemic is not well known. This study examined associations between care staff's perceived work environment, educational status, and facility staffing levels and work outcomes of care staff in LTC settings during the COVID-19 pandemic.

DESIGN

This study employed a cross-sectional, observational, correlational design.

SETTING AND PARTICIPANTS

A total of 207 care staff were conveniently recruited from 30 LTC settings in South Korea.

METHODS

The perceived work environment, educational status of care staff, and facility staffing levels (ie, beds-to-registered nurse [RN] and beds-to-nursing assistant [NA] or care worker ratios), as well as their work outcomes (ie, general and COVID-19 specific outcomes) were collected using questionnaires. Multivariable binary logistic regressions were conducted, controlling for the characteristics of care staff (ie, age, sex, occupation, and career length) and facilities (ie, location, bed size, ownership, and residents' disease and care profiles).

RESULTS

Approximately 45% of the participants were either NAs or care workers, and 38% were RNs. More than half (53.14%) perceived their work environment to be good. LTC staff who perceived their work environment to be poor were more likely to be dissatisfied with their work [odds ratio (OR) 20.88), experience high burnout (OR 8.63), intend to leave the facility within a year (OR 5.00), and experience increased overtime work (OR 3.58) and work-life imbalance (OR 1.93) due to COVID-19.

CONCLUSIONS AND IMPLICATIONS

LTC work environments should be improved and government-led initiatives for ensuring such improvements should be implemented to enable a better response to future public health crises and maintain the quality of care for and safety of residents in LTC settings.

Changes in work-related stressors before and during the COVID-19 pandemic: differences by gender and parental status

PURPOSE

The COVID-19 pandemic changed people's working conditions worldwide and research suggests increases in work stressors. However, it is not known to what extent these changes differ by gender or parental status. In the present study, we investigate trends in work stressors and whether these differ by gender and parental status.

METHODS

We used cross-sectional time series data of the European Working Conditions Survey of 2015 and Living, Working and COVID-19 survey of spring 2020 to examine trends in work stressors by gender and parental status. Work stressors were working in leisure time, lack of psychological detachment and work-life conflict. We applied three-way multilevel regressions reporting prevalence ratios and reported predicted probabilities and average marginal effects to show trends and differences in changes in work stressors.

RESULTS

Our multilevel regression results showed elevated prevalence ratios during the pandemic for working leisure time (PR: 1.43, 95% CI 1.34-1.53), psychological detachment (PR: 1.70, 95% CI 1.45-1.99) and work-life conflict (PR: 1.29, 95% CI 1.17-1.43) compared to before the pandemic. Except for working in leisure time, the increase was more significant among women and mothers. The proportion of work-life conflict in 2020 was 20.7% (95% CI 18.7-22.9) for men and 25.8% (95% CI 24.0-27.6) for women, equalling a difference of 5.1% (p < 0.001).

CONCLUSIONS

There is evidence that work stressors increased disproportionately for women and mothers. This needs to be monitored and addressed to prevent widening gender inequalities in the quality of work.

Occupational relationships and working duties of nursing management staff during the COVID-19 pandemic: A qualitative analysis of survey responses

Aims

To reflect on the situation of nurse managers, examining their professional relationships and additional working duties during the second COVID‐19 wave.

Design

Cross‐sectional online survey with open questions.

Methods

Nurse managers from different healthcare institutions, for example, hospitals and nursing homes, were included. Data collection took place from November 2020 to March 2021. Open questions were analysed with qualitative content analysis.

Result

In total, 321 managers took part. With regard to professional relationships, four main themes were identified: cooperation, cohesion, communication and consequences. While cooperation and cohesion in the nursing and the interprofessional team were predominantly considered positive, communication was seen as challenging. Additional work duties arose in relation to fulfilling regulatory requirements, managing personnel and carrying out both organizational and informational tasks. Consequences of the pandemic were mentioned in two thematic categories (professional relations and additional work duties). Participants referred to a loss of image, a reduction in job satisfaction and mental stress.

Conclusion

The regulation of certain tasks by the central authority, such as the enrolment of employees to manage the use of personal protective equipment, would make the managers' duties simpler. This would enable them to direct their attention towards their teams and provide necessary support in other parts of their profession.

Impact

What problem did the study address? Nursing managers are important members of the nursing team and faced particular challenges during the pandemic. Nevertheless, their perspectives are rarely presented in research.

What were the main findings? Overall, communication was perceived as good, and cohesion was strengthened during the pandemic. However, heavy burdens were placed on nursing managers due to the numerous additional tasks.

On whom will the research have an impact? Facility managers and government representatives are called upon to provide supportive measures and clear information for nursing managers to relieve them from additional duties during the pandemic.

Stress among nursing staff and interventions in Austrian nursing homes: Results of a survey in the first and the second waves of COVID-19

Background

Most of the limited number of studies that have been carried out on COVID-19 in nursing homes have not included primarily nursing staff. Nevertheless, knowledge about staff experiences will help to provide recommendations for the future.

Aim

The aim of this study was to describe stress experienced and interventions performed by nursing staff and to identify factors that are associated to the perceived stress among Austrian nursing home staff during the first and the second waves of COVID-19.

Methods

A secondary data analysis of two cross-sectional surveys performed in 2020 and 2021 among nursing home staff was performed. We did descriptive analysis as well as univariate and multivariate logistic regression analyses.

Results

A total of 449 nurses participated in the first survey and 300 in the second survey. 12.7% experienced high stress levels in the first wave, while 26.0% experienced high stress levels in the second wave (p < 0.001). The analysis showed that nursing staff in the second wave had a 2.195-fold higher relative chance of experiencing a high stress level compared to nursing staff in the first wave (p < 0.001). Caring for COVID-19 residents (odds ratio [OR] 1.827; p = 0.007) and being female (OR 1.992; p = 0.018) also significantly increased the relative chance of experiencing a high stress level. Some protective interventions, such as the use of FFP masks, increased between the two waves, while others decreased, such as the practice of airing the residents' rooms.

Conclusion

Austrian nursing staff in nursing homes experienced more stress during the second wave, illustrating the heavy burden of the long pandemic on staff. Nursing management should plan appropriate supportive interventions such as psychological help, stress relief measures and financial incentives for nursing staff, especially for the identified high-risk groups.

Supplementary Information

The online version of this article (10.1007/s16024-022-00395-x) contains supplementary material, which is available to authorized users.

Healthcare Workers' Well-Being: A Systematic Review of Positive Psychology Interventions

Given persistent occupational stressors and multiple challenges in the delivery of healthcare, there is an increased focus on the well-being of healthcare workers. Responding to these challenges will require a multipronged approach, focusing on system level, organization, and individual actions. Positive psychology interventions (PPIs) represent a promising area for individual action. This systematic review indicates that PPI, delivered via many methods, holds promise for improving the well-being of healthcare workers, although there is a clear need for additional randomized controlled trials utilizing defined and standardized outcome measures. In this review, the most commonly evaluated PPIs were mindfulness-based or gratitude-based interventions. These were delivered via different methods, with many administered in the workplace and commonly in the form of courses ranging from two days to eight weeks. Researchers documented measurable improvements in multiple studied outcomes, noting reductions in symptoms of depression, anxiety, burnout, and stress. Some interventions increased well-being, job and life satisfaction, self-compassion, relaxation, and resilience. Most studies emphasized that these are simple, accessible, low-cost interventions. Limitations included some nonrandomized or quasi-experimental designs, alongside generally small sample sizes and varying methods of intervention delivery. Another concern is the lack of standardized outcome assessments and long-term follow-up data. As almost all studies included were performed before the pandemic, further research will be required post-pandemic. Overall, however, PPI shows promise as one arm of a multipronged approach to improving the well-being of healthcare workers.

Development and Validation of the Soft Skills Questionnaire for Nurses

Introduction

Skills challenge has been given great attention for its impact on employees' performance. Various approaches have been put forward to design professional development programs that help in preparing nurses to work in the field and ongoing training programs to keep them up to each new method and technique at the interpersonal improvement level.

Objective

To develop and validate a questionnaire that tests the communication and management skills, emotional intelligence, and confidentiality of nurses in Lebanon.

Methods

The questionnaire, consisting of 25 statements, was generated and developed by experts in the field of nursing, soft skills, and questionnaire development. The items of the questionnaire were assessed using face, content, and construct validity and data validation was examined through psychometric properties at the final stage of the validation. Internal consistency and reliability were assessed through Cronbach alpha ( α ). Further analyses were carried out to decide on the number of factors to be extracted using Oblimin Rotation method. All statistical tests were performed using Statistical Package for the Social Sciences (SPSS 20.0).

Results

Nineteen items of the 25-item scale had an I-CVI of 1.00 and the remaining six items had an I-CVI of 0.87. The S-CVI/UA was 0.76 and the S-CVI/Ave was 0.97, which meant that the items were good for the underlying construct. For the psychometric measures, the results were quite accepted and satisfactory. The Kaiser-Meyer-Oklin measure of sampling adequacy and the significance for the Bartlett's test for the whole questionnaire were quite acceptable with 0.680 and 0.000, respectively. Furthermore, the Cronbach alpha (α) value was 0.824 indicating a high internal consistency between the items of the questionnaire. While obtaining exploratory factor analysis for each section, results showed that Oblimin Rotation method should be applied to the last section in which three items were eliminated to maintain a simple factor structure.

Conclusion

This study shows that the 25-item Soft Skills Questionnaire is a valid and reliable tool for evaluating the level of communication of nurses, their emotional intelligence, confidentiality, and management.

A Year in the Life of U.S. Frontline Health Care Workers: Impact of COVID-19 on Weight Change, Physical Activity, Lifestyle Habits, and Psychological Factors

Healthcare workers (HCWs) experienced significantly higher burdens and life demands due to the COVID-19 pandemic. This study sought to assess the longitudinal effects among HCWs throughout the pandemic. Qualtrics surveys collected self-reported data on weight changes, eating patterns, physical activity (PA), and psychological factors with data organized by timepoints prior to the pandemic (PP0—prior to March 2020), baseline (M0—January 2021), month 6 (M6—July 2021), and month 12 (M12—January 2022). Eating patterns were negatively impacted at the M0, with reported increases in snacking/grazing (69.7%), fast food/take-out consumption (57.8%), and alcohol (48.8%). However, by M6 and M12 there were no statistically significant differences in eating patterns, suggesting that eating patterns normalized over time. Mean weight increased from PP0 to M0 by 2.99 pounds (p < 0.001, n = 226) and from PP0 to M6 by 2.12 pounds (p < 0.027, n = 146), though the difference in mean weight from PP0 to M12 was not statistically significant (n = 122). PA counts decreased from 8.00 sessions per week PP0 to 6.80 by M0 (p = 0.005) before jumping to 12.00 at M6 (p < 0.001) and 10.67 at M12 (p < 0.001). Psychological factors comparing M0 to M12 found statistically significant differences for depression (p-value = 0.018) and anxiety (p-value = 0.001), meaning depression and anxiety were initially increased but improved by M12. Additionally, higher scores on depression and insomnia scales were associated with lower PA levels. These overall results imply that the COVID-19 pandemic had immediate effects on the eating patterns, weight changes, PA, and psychological factors of HCWs; however, routines and lifestyle habits appeared to have normalized one year later.

The Status of Occupational Stress and Its Influence on the Health of Medical Staff in Lanzhou, China

This study aimed to understand the status quo of occupational stress and its impact on the health of medical staff and provide a theoretical basis for relieving occupational stress and improving the health status of medical staff. The occupational stress and health status of medical staff in 14 hospitals in Lanzhou were studied using a general questionnaire, Effort-Reward Imbalance questionnaire, and Self-Rated Health Measurement Scale. A total of 2169 participants were included in the analysis, and 59.4% of the medical staff experienced occupational stress. The results of the occupational stress survey showed that the prevalence of occupational stress among medical staff aged 40-50, with a master's degree or above, senior professional title, working for 10-20 years, and working more than 48 h per week was higher than in the other groups. The health survey results showed that, compared with other groups, the scores of physical, mental, and social health were lower in medical staff with working years of 10-20 years and working hours of more than 48 h per week. The results show that working years and working hours per week affect not only the level of occupational stress but also physiological, psychological, and social health.

Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review

The COVID-19 pandemic has negatively impacted the well-being of healthcare workers (HCWs). HCWs are highly exposed to shift work and their work schedules have been subject to increasing unpredictability since the start of the pandemic. This review aims to: (1) map the studies providing information about factors associated with sleep characteristics in HCWs working in the context of the COVID-19 pandemic during the first and second waves and (2) examine the state of the evidence base in terms of the availability of information on the influence of atypical work schedules. A literature search was performed in PubMed. Studies containing information about factors (demographic; psychological; occupational; COVID-19-specific; work schedule; lifestyle; medical; or other) associated with various sleep characteristics among HCWs working in the context of the COVID-19 pandemic were included. Particular attention was paid to the availability of information on the role of atypical work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. Most studies were reports of quantitative cross-sectional surveys using self-report measures. Associations between female sex, frontline HCW status, psychological factors, and poorer sleep were observed. Six studies included a measure of shift work in their analyses, 5 of which reported an association between shift work status and sleep. A wide range of factors were investigated, with female sex, frontline HCW status, and psychological factors repeatedly demonstrating associations with poorer sleep. Sleep was predominantly measured in terms of self-reported sleep quality or insomnia symptoms. Few studies investigated the influence of atypical work schedules on HCW sleep in the context of the COVID-19 pandemic. Research on this topic is lacking in terms of reliable and consistent measurements of sleep outcomes, longitudinal data, and knowledge about the influence of covariates such atypical work schedules, comorbidity, and medical history on HCW sleep.

A structural equation model analysis of the association between work-related stress, burnout and job-related affective well-being among nurses in Saudi Arabia during the COVID-19 pandemic

AIM

To test a model that examines the direct and indirect effects of work-related stress on job-related affective well-being through compassion fatigue.

BACKGROUND

Despite the danger of infection, nurses' dedication to their work appears to be an innate desire to provide care for patients with COVID-19. Nonetheless, the universal effort to control the outbreak has led to extended work hours and workload, which has been defined as the primary contributor to work-related stress among nurses and might impact their job-related affective well-being.

METHOD

We used a cross-sectional exploratory design. Data were collected using an online survey from 161 nurses working in the Saudi health care system. The survey included obtaining information on demographics and work-related stress using Professional Quality of Life Scale version 5 to measure compassion fatigue as well as a job-related affective well-being scale.

RESULTS

Work-related stress had significant negative direct effects on job-related affective well-being and positive effects on compassion fatigue. Compassion fatigue had significantly negative direct effects on job-related affective well-being. Work-related stress exerted negative indirect effects on job-related affective well-being through compassion fatigue, which partially mediated the relationship.

CONCLUSION

The findings supported the model and added to our understanding regarding the impact of work-related stress on nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Stress reduction is an important element in improving staff outcomes as well as job-related affective well-being.

Impact of the COVID-19 Pandemic on the Hawai'i Nursing Workforce: A Cross-sectional Survey

The coronavirus disease (COVID-19) pandemic has placed extraordinary strain on health care systems. This has led to increased stress among health care workers, and nurses in particular, which has had a negative impact on their physical and psychosocial wellbeing. This is likely to negatively impact the nursing workforce at the state and national levels as the pandemic continues. The purpose of this study was to assess whether nurses licensed in Hawai'i have considered leaving the workforce. A cross-sectional online survey was conducted among Hawai'i nurses at all levels of licensure, with 421 responding. Of these nurses, 97 (23.0%) reported considering leaving the workforce, with safety (39.2%) and family/caregiver strain (32.0%) being the most common reasons. Reconsidering whether they should stay employed in their current roles (Odds ratio [OR] 2.05; 95% CI 1.56 - 2.69) and fear to continue providing direct patient care (OR 1.97; 95% CI 1.54 - 2.54) were associated with increased odds of having considered leaving the workforce. Based on these results, the State of Hawai'i and local health care organizations need to adjust their nursing workforce estimates and address how to alleviate nurses' stressors and safety concerns to mitigate a potential workforce shortage. Research is needed to develop interventions to support and empower nurses in their current roles but also address future emergency preparedness.