Registered nurses' exposure to workplace aggression in Norway: 12-month prevalence rates, perpetrators, and current turnover intention

BACKGROUND

Identifying occupational health hazards among Registered Nurses (RNs) and other health personnel and implementing effective preventive measures are crucial to the long-term sustainability of health services. The objectives of this study were (1) to assess the 12-month prevalence rates of exposure to workplace aggression, including physical violence, threats of violence, sexual harassment, and bullying; (2) to identify whether the perpetrators were colleagues, managers, subordinates, or patients and their relatives; (3) to determine whether previous exposure to these hazards was associated with RNs' current turnover intention; and (4) to frame workplace aggression from an occupational health and safety perspective.

METHODS

The third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) was used to assess RNs' exposure to workplace aggression and turnover intention. A national sample of 8,800 RNs in Norway, representative of the entire population of registered nurses in terms of gender and geography, was analysed. Binary and ordinal logistic regression analyses were conducted, and odds for exposure and intention to leave are presented, with and without controls for RNs' gender, age, and the type of health service they work in.

RESULTS

The 12-month prevalence rates for exposure were 17.0% for physical violence, 32.5% for threats of violence, 12.6% for sexual harassment, and 10.5% for bullying. In total, 42.6% of the RNs had experienced at least one of these types of exposure during the past 12 months, and exposure to more than one of these hazards was common. Most perpetrators who committed physical acts and sexual harassment were patients, while bullying was usually committed by colleagues. There was a strong statistical association between exposure to all types of workplace aggression and RNs' intention to leave. The strongest association was for bullying, which greatly increased the odds of looking for work elsewhere.

CONCLUSIONS

Efforts to prevent exposure to workplace aggression should be emphasised to retain health personnel and to secure the supply of skilled healthcare workers. The results indicate a need for improvements. To ensure the sustainability of health services, labour and health authorities should join forces to develop effective workplace measures to strengthen prevention, mitigation, and preparedness regarding incidents of workplace aggression in health services and the response and recovery regarding incidents that could not be prevented.

Underreporting of Work-Related COVID-19 Cases in Norway

Background: This register-based study provides a profile of work-related Covid-19 cases reported by physicians to the Norwegian Labor Inspection Authority (NLIA). Methods: All the reports of work-related Covid-19 cases reported by a physician to the NLIAs Registry for Work-Related Diseases (RAS) between February 2020 and February 2022 were included. Descriptive statistics and the incidence rate of reported cases were computed for age, gender, and occupation. Results: Two hundred and seventeen work-related Covid-19 cases were reported to RAS during the study period. Sixty-five percent of the cases were females (n = 141), and 35 percent (n = 76) were males. Doctors, nurses, and ambulance personnel yielded higher incidence rates than other healthcare and nonhealthcare occupations. Conclusions: This study indicates that women aged 25-39 and employed in the healthcare sector had the highest reported incidence and number of work-related Covid-19 cases. Physician underreporting of work-related Covid-19 cases is an important finding. Plausibly, underreporting is more substantial for at-risk non-healthcare occupations such as waiters, bartenders, food couriers, and taxi drivers than occupations in healthcare.

The Norwegian version of the Copenhagen Psychosocial Questionnaire (COPSOQ III): Initial validation study using a national sample of registered nurses

BACKGROUND

Employers are legally obligated to ensure the safety and health of employees, including the organizational and psychosocial working environment. The Copenhagen Psychosocial Questionnaire (COPSOQ III) covers multiple dimensions of the work environment. COPSOQ III has three parts: a) work environment b) conflicts and offensive behaviours and c) health and welfare. We translated all three parts into Norwegian and evaluated the statistical properties of the 28 work environment dimensions in part a), using a sample of registered nurses.

METHODS

The original English version was translated into Norwegian and back translated into English; the two versions were compared, and adjustments made. In total, 86 of 99 items from the translated version were included in a survey to which 8804 registered nurses responded. Item response theory models designed for ordinal manifest variables were used to evaluate construct validity and identify potential redundant items. A standard confirmatory factor analysis was performed to verify the latent dimensionality established in the original version, and a more exploratory factor analysis without restrictions is included to determine dependency between items and to identify separable dimensions.

RESULTS

The measure of sampling adequacy shows that the data are well suited for factor analyses. The latent dimensionality in the original version is confirmed in the Norwegian translated version and the scale reliability is high for all dimensions except 'Demands for Hiding Emotions'. In this homogenous sample, eight of the 28 dimensions are found not to be separate dimensions as items covering these dimensions loaded onto the same factor. Moreover, little information is provided at the low and high ends of exposure for some dimensions in this sample. Of the 86 items included, 14 are found to be potential candidates for removal to obtain a shorter Norwegian version.

CONCLUSION

The established Norwegian translation of COPSOQ III can be used in further research about working environment factors and health and wellbeing in Norway. The extended use of the instrument internationally enables comparative studies, which can increase the knowledge and understanding of similarities and differences between labour markets in different countries. This first validation study shows that the Norwegian version has strong statistical properties like the original, and can be used to assess work environment factors, including relational and emotional risk factors and resources available at the workplace.

Why hospital physicians attend work while ill? The spiralling effect of positive and negative factors

Background

Recurrent reports from national and international studies show a persistent high prevalence of sickness presence among hospital physicians. Despite the negative consequences reported, we do not know a lot about the reasons why physicians choose to work when ill, and whether there may be some positive correlates of this behaviour that in turn may lead to the design of appropriate interventions. The aim of this study is to explore the perception and experience with sickness presenteeism among hospital physicians, and to explore possible positive and negative foundations and consequences associated with sickness presence.

Methods

Semi-structured interviews of 21 Norwegian university hospital physicians.

Results

Positive and negative dimensions associated with 1) evaluation of illness, 2) organizational structure, 3) organizational culture, and 4) individual factors simultaneously contributed to presenteeism.

Conclusions

The study underlines the inherent complexity of the causal chain of events affecting sickness presenteeism, something that also inhibits intervention. It appears that sufficient staffing, predictability in employment, adequate communication of formal policies and senior physicians adopting the position of a positive role model are particularly important.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1802-y) contains supplementary material, which is available to authorized users.