Factors related to work ability among nursing professionals from urgent and emergency care units: A cross-sectional study

Abstract

BACKGROUND:

Nursing professionals are on the front line of health systems in Brazil as well as worldwide. Studies on the work ability of nursing professionals are especially relevant as care demands increase and health care workforce shortages are expected. As the population of Brazil ages, the need for nursing care will increase.

OBJECTIVE:

To identify levels and predictors of work ability among Brazilian nursing professionals.

METHODS:

A cross-sectional study with 267 nursing professionals (72 nurses and 195 nursing technicians and nursing auxiliary) from public emergency and urgent care units was conducted. Measures included the following: Work Ability Index; Questionnaire of Socio-demographics, Lifestyle and Work and Health Aspects; and Violence at Work questionnaire. Generalized linear regression and Poisson models were used for data analysis.

RESULTS:

The mean work ability was 40.4 (range: 22 to 49). Almost 79.6% (n = 211) of participants reported good or excellent work ability, and 20.4% (n = 54) reported moderate or poor work ability. Better perceptions of health and job satisfaction, absence of health issues (past 15 days), lower stress levels, and having a partner were associated with better work ability. Victims of workplace violence were less likely to have good or excellent work ability than non-victims (prevalence ratio = 0.80; 95% CI 0.72 to 0.90). Professionals with cumulative experiences of workplace violence were less likely to report better work ability.

CONCLUSIONS:

The prevalence of good or excellent work ability was 79.6%. Our findings indicate that the following factors are predictors of work ability: self-reported perception of health, health issues in the last 15 days, workplace violence, job satisfaction, stress, and marital status.

Keywords

Work capacity evaluation nursing staff occupational health emergency nursing health workforce

1 Introduction

The aging of population worldwide has intensified discussions regarding the need to keep workers performing their professional duties and responsibilities longer [1, 2]. With more people in more advanced stages of life, greater demands for nursing care and health care are expected [3]. By 2030, it is estimated that the shortage of health care professionals in the world will exceed 14 million [4]. A report published by the Pan American Health Organization highlights the shortage of physicians and nurses, especially in more vulnerable areas within large cities and remote areas [5]. The limited number of health care professionals affects the ability of health systems to provide universal health care [5].

Within this context, many countries are being challenged to prolong as well as improve the professional lives of their workers [1]. Given this challenge, the concept and measurement of work ability has become particularly important [1]. Work ability was defined in the 1980s as “how good is the worker at present, in the near future, and how able is he or she to do his or her work with respect to the work demands, health and mental resources?” [6]. The concept of work ability involves a balance between the professionals’ personal resources (e.g., health, functional capacity, knowledge, professional skills) and the work demands (e.g., work conditions, work organization, supervisory support) [6 –8]. Good work ability supports workers’ well-being and quality of life during their working age and after retirement [7]. For nurses, studies have demonstrated that an (im)balance between work demands and personal resources is associated with work-related quality of life [9], turnover intention [10 –12], and job satisfaction [12]. Each of these factors can affect the nursing workforce and the well-being and professional careers of nursing staff [9 –12].

In a 2016 national study conducted in Brazil, approximately 75% of the study participants were nursing professionals 45 years of age and younger [13]. This group of young nursing professionals can be followed and targeted to support and promote work ability [1 , 15]. The individual, institutional, and social consequences associated with an early departure from work may be avoided by continually analyzing work demands and personal resources over time with the goal of achieving a balance between the individual’s personal resources and work demands [7 , 16]. Studies in which researchers evaluate work ability and define its predictors in different professional groups are especially important because better interventions to promote work ability need to be identified and understood [7].

Although previous Brazilian studies have assessed work ability among nursing professionals working in hospitals [17, 18], studies that specifically describe work ability and predictors among professionals working in hospital or non-hospital urgent and emergency care units are needed. In literature, factors such as exposure to workplace violence or to traumatic events [17, 19], high work pressure [20] and high quantitative demands [21] have been reported in emergency units. These factors can affect work ability [6 –8] and should be examined. Therefore, the aim of the present study was to identify levels and predictors of work ability among a sample of Brazilian nursing professionals. The research questions included: What is the work ability of Brazilian nursing professionals working in urgent and emergency care units of public hospitals? What factors influence work ability in a sample of Brazilian nursing professionals? A better understanding of work ability and its predictors may contribute to the design and implementation of culturally appropriate preventive strategies.

2 Methods

2.1 Study design and sampling

A quantitative cross-sectional survey was conducted from 2015 to 2017. The sample included 267 nursing professionals who worked in seven public urgent and emergency care units in Brazil. The units included one hospital emergency unit and four emergency and urgent care units located in a city in the interior of the state of São Paulo (Southeast region) and two emergency and urgent care units of a municipality in the interior of the state of Santa Catarina (South region). In Brazil, the nursing workforce includes nurses, nursing technicians, and nursing auxiliary staff who are responsible for different care activities on the nursing team. Nurses provide care and participate in the planning, execution and evaluation of care plans. Nursing technicians and nursing auxiliary staff are typically more numerous in Brazilian nursing teams and participate in the provision of nursing care in an auxiliary manner, e.g., hygiene and comfort care, and evaluating and recording vital signs.

The study sample size was calculated based on the method for estimation of a proportion considering a finite population [22, 23]. A proportion of 0.50 (maximum variability in the binomial distribution) and an error and a significance level of 5% were used in the calculation, which resulted in a minimum sample of 201. This estimate was expanded by about 30% to account for potential missing data, and the final sample included 267 nursing professionals. In calculating the sample, the number of professionals in each unit and in the professional categories of registered nurse or nursing technician and nursing auxiliary was considered. The sampling plan was probabilistic, with stratification into units and professional categories and a random sample of respondents. Lists provided by health care facilities that included the names, professions and work shifts of nursing professionals were used to access the studied population as a whole. The professionals listed were previously organized into units and professional categories and numbered. Subsequently, a random numerical list was generated by a statistician to guide data collection, indicating which professionals would be invited to participate. The invitation to participate was based on this random numerical list and sampling plan. The inclusion criteria for the study were as follows: being a registered nurse, nursing technician or nursing auxiliary staff for at least three months in the units surveyed and at least 18 years of age. Professionals on vacation or leave when data collection was performed were excluded, and another professional was invited to participate according to the random numerical list created for the study. The lead author went to each of the units and approached nursing professionals in person with an invitation to participate.

2.2 Data collection

Cross-sectional survey data were collected at each unit via printed survey. The respondents completed their surveys during free time at work or elsewhere and returned them to the investigator in the workplace on the same date or on a future, agreed-upon date. The lead author was present to answer any clarifying questions if needed.

2.3 Measures

The study survey included the following measures: 1) Work Ability Index (WAI) [24, 25]; 2) Questionnaire of Socio-demographics, Lifestyle and Work and Health Aspects (QSETS) [26]; and 3) Violence at Work questionnaire [27].

The WAI was developed in Finland and includes seven items that are used to assess self-reported work ability [24]. The WAI items include: 1) current work ability compared to the best of a lifetime (1 question, score from 0 to 10 points); 2) work ability with regard to the job demands (2 questions, 2 to 10 points); 3) number of current diagnostic diseases by physician (1 question, 51 diseases, 1 to 7 points); 4) estimated loss to work due to illness (1 question, 1 to 6 points); 5) absence from work due to illness in the last year (1 question, 1 to 5 points); 6) proper prognosis of work ability 2 years from now (1 question, ranging from 1, 4 or 7 points); and 7) mental resources (3 questions, 1 to 4 points) [24]. Potential scores can range from seven to 49 points; the higher the score, the better the work ability [24, 25]. The WAI includes four categories that indicate level of work ability: poor (7–27), moderate (28–36), good (37–43) and excellent (44–49) [24, 25]. Researchers tested the reliability and validity of the Brazilian version of the WAI and reported Cronbach’s alpha coefficient equal to 0.72 [28]. In the current study, Cronbach’s alpha for WAI was 0.70.

The QSETS includes 44 total items related to general identification (10 items, e.g., profession, age, marital status); education levels (1 item); work characteristics (11 items, e.g., work time, have another job, work overtime, job satisfaction); satisfaction with current life (1 item); health aspects (9 items, e.g., sleep well after work, self-reported health perception, health problem in the last 15 days); housework (1 item); physical activities (1 item); leisure activities (1 item); future plans (1 item); contact with work-related risk factors (1 item); stress (1 item); and illnesses and sick leave (6 items) [26]. The QSETS [26] as well as the Violence at Work questionnaire [27] were used to describe the sample characteristics and predictors of work ability.

The Violence at Work questionnaire measured experiences of verbal abuse, sexual harassment, or physical violence at work in the previous year as either a victim or witness [27]. The measure includes 54 items in five sections: 1) physical violence at work (17 items, e.g., experience of physical violence as a victim or witness, number of times, characteristics of the event and registration, contributing factors); 2) verbal abuse at work (16 items, e.g., experience of verbal abuse as a victim or witness, number of times, characteristics of the event and registration, contributing factors); 3) sexual harassment at work (15 items, e.g., experience of sexual harassment as a victim or witness, number of times, characteristics of the event and registration, contributing factors); 4) other types of violence at work (3 items, e.g., worker’s perception regarding other violence suffered at work and consequences); and 5) preventing and reducing violence at work (3 items, e.g., identifies prevention and protection measures in the worker’s perception) [27]. Face validation has been established by Brazilian authors [27]. In the current study, nursing professionals who suffered verbal abuse, sexual harassment, or physical violence at work at least once in the previous year were classified as victims of violence. Based on a previous study, the types and frequency of workplace violence (e.g., one type of violence; two or more types) that the nursing professional had suffered in the previous year was also assessed [10].

2.4 Data analysis

The data was manually entered into a database by the lead author. Data analyses were performed using the Statistical Package for the Social Sciences (SPSS) for Windows^®, version 24.0 and the Statistical Analysis System (SAS)^® version 9.4. In order to describe the characteristics of the sample data and the sample’s work ability, descriptive measures were used. Chi-square, Fisher’s, Mann-Whitney, and Kruskal-Wallis tests were applied as the data did not adhere to the normal distribution as demonstrated by the Kolmogorov-Smirnov and Shapiro-Wilk tests.

Preliminary data analysis supported the construction of two statistical models to identify the predictors of work ability: generalized linear regression and a modified Poisson regression with a robust error variance. Variables that were significant at the p < 0.20 were included in the regression models as independent variables, and in each analysis step, a new block containing these variables was inserted [29, 30]. The independent variables with statistical significance were kept in the model as the steps progressed [29]. Respondents who did not complete some items were not excluded from the study. This explains the variation in the number of respondents for each analysis. Both models had the minimum sample size needed based on calculations. The models were adjusted for age, sex, and workplace. The level of significance was set at 5% (p < 0.05).

2.5 Ethical considerations

The study was approved by the Institutional Review Board of the University in 2015 (protocol # 977.885), with a modification in 2016 (1.600.763), and was conducted according to national ethical considerations for research with people. Authorization to conduct the research was obtained from all participating health institutions. Nursing professionals were invited to participate voluntarily, and those who freely agreed signed an informed consent form. Questionnaires were anonymous, and participant identity was protected through the use of a numeric code.

3 Results

The sample included nurses (27%; n = 72), nursing technicians (39%; n = 104) and nursing auxiliary staff (34%; n = 91). The mean age of the respondents was 39.2 years (standard deviation (SD) = 9.9) and ranged from 21 to 68 years. The mean reported WAI score was 40.4 points (SD = 5.5) and ranged from 22 to 49 points. Of the respondents, 46.8% reported good work ability, and 32.8% reported excellent work ability. Among respondents with poor or moderate work ability, 33.3% were 39 years or younger (n = 18). Other data are described in Table 1.

Table 1
Data on sample characteristics (N = 267)

Variable n(%)

Type (n = 267)

Nurse 72(27.0)

Nursing technician 104(39.0)

Nursing auxiliary staff 91(34.1)

Age in years (n = 262)

<30 43(16.4)

30–39 102(38.9)

40–49 76(29.0)

50–59 34(13.0)

60 or more 7(2.7)

Work ability (n = 265)

Excellent 87(32.8)

Good 124(46.8)

Moderate 47(17.7)

Poor 7(2.6)

Victims of workplace violence in the previous year (n = 257)

One type of violence 110(42.8)

Verbal abuse and physical violence 30(11.7)

Verbal abuse and sexual harassment 7(2.7)

Sexual harassment and physical violence 1(0.4)

Three types of violence 8(3.1)

Witness of workplace violence in the previous year (n = 249)

One type of violence 78(31.3)

Two or more types of violence 103(41.4)

Variable	n(%)
Type (n = 267)
Nurse	72(27.0)
Nursing technician	104(39.0)
Nursing auxiliary staff	91(34.1)
Age in years (n = 262)
<30	43(16.4)
30–39	102(38.9)
40–49	76(29.0)
50–59	34(13.0)
60 or more	7(2.7)
Work ability (n = 265)
Excellent	87(32.8)
Good	124(46.8)
Moderate	47(17.7)
Poor	7(2.6)
Victims of workplace violence in the previous year (n = 257)
One type of violence	110(42.8)
Verbal abuse and physical violence	30(11.7)
Verbal abuse and sexual harassment	7(2.7)
Sexual harassment and physical violence	1(0.4)
Three types of violence	8(3.1)
Witness of workplace violence in the previous year (n = 249)
One type of violence	78(31.3)
Two or more types of violence	103(41.4)

Note: Respondents who did not complete some items were not excluded from the study. This explains the variation in the number of respondents for each analysis.

Generalized linear regression and Poisson models were used to examine predictors of work ability. In both models, the perception of health compared to that of other people of the same age, self-reported health problems in the past 15 days, and workplace violence were noted to be predictors of work ability (Tables 2 and 3). In the generalized linear regression model, job satisfaction and stress were also identified as predictors (Table 2). In the Poisson regression model, marital status was identified as a predictor (Table 3).

Table 2

Generalized linear model of the relationship between independent variables and work ability

Independent variables	Step 1
	Coefficient	Confidence interval (95%)		p-value
		Lower limit	Upper limit
Intercept	41.29	38.02	44.56	<0.0001
Marital status (With partner)	1.24	–0.22	2.70	0.0966
Step 2
Intercept	38.71	35.26	42.16	<0.0001
Compared health (Equal)	5.07	2.70	7.44	<0.0001
Compared health (Better/much better)	6.39	4.08	8.69	<0.0001
Health problem in the last 15 days (Yes)	–2.65	–4.31	–1.00	0.0017
Step 3
Intercept	36.27	31.60	40.93	<0.0001
Compared health (Equal)	4.16	1.86	6.46	0.0004
Compared health (Better/much better)	4.92	2.63	7.22	<0.0001
Health problem in the last 15 days (Yes)	–1.72	–3.32	–0.11	0.0359
Satisfaction with current life (Satisfied)	1.47	–0.73	3.67	0.1913
Satisfaction with current life (Very satisfied)	2.21	–0.27	4.69	0.0805
Tiredness and/or dismay after work (Yes)	–1.54	–2.96	–0.12	0.0333
Sleep well after work (Yes)	2.00	0.40	3.60	0.0141
Stress (0–10)*	0.35	0.07	0.62	0.0138
Step 4
Intercept	35.75	30.21	41.29	<0.0001
Compared health (Equal)	3.80	1.56	6.05	0.0009
Compared health (Better/much better)	4.75	2.52	6.97	<0.0001
Health problem in the last 15 days (Yes)	–2.05	–3.64	–0.46	0.0116
Tiredness and/or dismay after work (Yes)	–1.33	–2.72	0.07	0.0620
Sleep well after work (Yes)	0.97	–0.67	2.61	0.2455
Stress (0–10)*	0.31	0.04	0.57	0.0220
Profession (Nursing technician/Nursing auxiliary)	–0.45	–1.88	0.99	0.5411
Satisfaction with the current job (Neither satisfied nor dissatisfied)	1.89	0.25	3.53	0.0243
Satisfaction with the current job (Satisfied/very satisfied)	2.93	0.81	5.04	0.0066
Work shift (Night)	–0.50	–1.83	0.84	0.4653
Overtime (Yes)	0.08	–1.35	1.51	0.9128
Accident at work in the last year (Yes)	–2.05	–3.92	–0.17	0.0324
Institution time (In years)	–0.09	–0.22	0.03	0.1557
Estimated total working time (In years)	–0.10	–0.25	0.04	0.1694
Step 5.1
Intercept	38.43	34.51	42.36	<0.0001
Compared health (Equal)	4.25	2.03	6.48	0.0002
Compared health (Better/much better)	5.28	3.12	7.44	<0.0001
Health problem in the last 15 days (Yes)	–1.96	–3.52	–0.41	0.0134
Stress (0–10)*	0.25	–0.02	0.52	0.0657
Satisfaction with the current job (Neither satisfied nor dissatisfied)	2.66	1.09	4.24	0.0009
Satisfaction with the current job (Satisfied/very satisfied)	3.75	1.72	5.78	0.0003
Accident at work in the last year (Yes)	–1.66	–3.53	0.20	0.0810
Suffered one of the types of workplace violence	–1.31	–2.81	0.20	0.0897
Suffered two or more types of workplace violence	–2.62	–4.58	–0.65	0.0090
Witnessed one of the types of workplace violence	1.44	–0.40	3.27	0.1241
Witnessed two or more types of workplace violence	0.20	–1.61	2.00	0.8308
Step 5.2
Intercept	38.40	34.45	42.35	<0.0001
Compared health (Equal)	3.83	1.59	6.06	0.0008
Compared health (Better/much better)	5.09	2.91	7.26	<0.0001
Health problem in the last 15 days (Yes)	–1.85	–3.43	–0.28	0.0212
Stress (0–10)*	0.30	0.03	0.56	0.0306
Satisfaction with the current job (Neither satisfied nor dissatisfied)	2.54	0.95	4.13	0.0018
Satisfaction with the current job (Satisfied/very satisfied)	3.77	1.71	5.83	0.0003
Accident at work in the last year (Yes)	–1.78	–3.68	0.11	0.0647
Suffered workplace violence (Yes)	–1.78	–3.24	–0.32	0.0169
Witness of workplace violence (Yes)	0.78	–0.89	2.46	0.3603

Note: (n = 206 considering missing data) and adjusted for age, sex and workplace. ^*0 = I’m totally stressed out at 10 = I’m not stressed out. Marital status (without partner)(Reference group). Compared health (worse/slightly worse)(Reference group). Health problem in the last 15 days (no)(Reference group). Satisfaction with current life (little satisfied/neither satisfied nor dissatisfied)(Reference group). Tiredness and/or dismay after work (no)(Reference group). Sleep well after work (no)(Reference group). Profession (nurse)(Reference group). Satisfaction with the current job (dissatisfied/little satisfied)(Reference group). Work shift (commercial/morning/morning and afternoon/afternoon)(Reference group). Overtime (no)(Reference group). Accident at work in the last year (no)(Reference group). How many types of workplace violence have been suffered (not suffered)(Reference group). How many types of workplace violence were witnessed (not witnessed)(Reference group). Suffered workplace violence (no)(Reference group). Witnessed workplace violence (no)(Reference group).

Table 3

Poisson regression model to estimate the probability of good or excellent work ability

Independent variables	Step 1
	PR*	Confidence interval (95%)		p-value
		Lower limit	Upper limit
Marital status (With partner)	1.16	1.01	1.33	0.0382
Step 2
Marital status (With partner)	1.19	1.04	1.35	0.0104
Compared health (Equal)	1.49	1.05	2.11	0.0237
Compared health (Better/much better)	1.66	1.18	2.34	0.0036
Health problem in the last 15 days (Yes)	0.73	0.59	0.91	0.0059
Step 3
Marital status (With partner)	1.18	1.03	1.35	0.0162
Compared health (Equal)	1.41	1.00	1.98	0.0476
Compared health (Better/much better)	1.51	1.08	2.13	0.0167
Health problem in the last 15 days (Yes)	0.79	0.64	0.99	0.0364
Satisfaction with current life (Satisfied)	1.11	0.81	1.52	0.5335
Satisfaction with current life (Very satisfied)	1.13	0.81	1.58	0.4845
Tiredness and/or dismay after work (Yes)	0.94	0.83	1.06	0.2871
Sleep well after work (Yes)	1.22	1.00	1.50	0.0494
Other job (Yes)	0.89	0.75	1.06	0.2015
Stress (0–10)**	1.02	0.99	1.05	0.3052
Step 4
Marital status (With partner)	1.19	1.04	1.36	0.0101
Compared health (Equal)	1.45	1.04	2.04	0.0300
Compared health (Better/much better)	1.58	1.13	2.21	0.0071
Health problem in the last 15 days (Yes)	0.73	0.59	0.91	0.0047
Sleep well after work (Yes)	1.15	0.94	1.41	0.1628
Profession (Nursing technician/Nursing auxiliary)	0.93	0.82	1.07	0.3097
Satisfaction with the current job (Neither satisfied nor dissatisfied)	1.10	0.90	1.35	0.3314
Satisfaction with the current job (Satisfied/very satisfied)	1.16	0.93	1.44	0.1878
Time in the institution (In years)	0.99	0.97	1.00	0.0740
Estimated total working time (In years)	0.99	0.98	1.00	0.1070
Step 5.1
Marital status (With partner)	1.20	1.05	1.36	0.0062
Compared health (Equal)	1.50	1.08	2.08	0.0165
Compared health (Better/much better)	1.66	1.20	2.31	0.0023
Health problem in the last 15 days (Yes)	0.75	0.61	0.93	0.0097
Suffered one of the types of workplace violence	0.86	0.76	0.96	0.0096
Suffered two or more types of workplace violence	0.69	0.56	0.85	0.0005
Step 5.2
Marital status (With partner)	1.18	1.04	1.34	0.0098
Compared health (Equal)	1.45	1.03	2.05	0.0314
Compared health (Better/much better)	1.62	1.16	2.28	0.0048
Health problem in the last 15 days (Yes)	0.76	0.61	0.94	0.0129
Suffered workplace violence (Yes)	0.80	0.72	0.90	0.0002

Note: (n = 220 considering missing data) and adjusted for age, sex and workplace. ^*Prevalence ratio. ^**0 = I’m totally stressed out at 10 = I’m not stressed out. Marital status (without partner)(Reference group). Compared health (worse/slightly worse)(Reference group). Health problem in the last 15 days (no)(Reference group). Satisfaction with current life (little satisfied/neither satisfied nor dissatisfied)(Reference group). Tiredness and/or dismay after work (no)(Reference group). Sleep well after work (no)(Reference group). Other job (no)(Reference group). Profession (nurse)(Reference group). Satisfaction with the current job (dissatisfied/little satisfied)(Reference group). How many types of workplace violence have been suffered (not suffered)(Reference group). Suffered workplace violence (no)(Reference group).

The generalized linear model showed an increase in work ability scores among professionals who reported better or much better health or equal health as other people of the same age and who were satisfied or very satisfied or neither satisfied nor dissatisfied with their work compared with respondents who described their health as worse/slightly worse and who were little satisfied or dissatisfied. A decrease in work ability equal to 1.96 and 1.85 points was noted among those who reported a health problem in the last 15 days; and for each point added to the stress scale score, there was an increase of 0.30, on average, in the work ability (95% CI 0.03 to 0.56). The stress score ranges from 0 = totally stressed to 10 = not stressed; thus, higher stress scores mean lower stress levels (Table 2).

This model also demonstrated that the work ability decreased by 1.78 points (95% CI –3.24 to –0.32) on average among respondents who suffered workplace violence compared to those who did not. Similarly, work ability decreased on average by 2.62 points in the group that suffered two or more types of violence (95% CI –4.58 to –0.65) compared to those who did not suffer violence (Table 2).

Table 3 highlights the results of the Poisson regression model in which the probability of good or excellent work ability was estimated. Similar to the generalized linear model, for respondents who considered their health equal or better/much better, the probability of good or excellent work ability was higher as compared to those respondents who self-reported their health as worse or slightly worse. The probability of good or excellent work ability was higher among professionals with partners compared to those without partners. Meanwhile, for respondents with self-reported health issues in the last 15 days, the probability of reporting good or excellent work ability was less as compared to the group without health problems.

The Poisson model highlighted that respondents who suffered workplace violence in the last year were 20% less likely to have good or excellent work ability than those who did not suffer violence in the past year (PR 0.80; 95% CI 0.72 to 0.90). For respondents who suffered one type of violence, the probability of good or excellent work ability was 14% lower than for non-victims (PR 0.86; 95% CI 0.76 to 0.96). For respondents who suffered two or more types of violence, the probability of good or excellent work ability was 31% lower than for non-victims (PR 0.69; 95% CI 0.56 to 0.85) (Table 3).

4 Discussion

Most respondents (79.6%) in this sample reported good or excellent work ability according to self-reported WAI items. In the European Nurses Early Exit study (Belgian sample), researchers found that 81% of professionals had good or excellent work ability [11]. Data from another Brazilian cross-sectional study with hospital nurses indicated a prevalence of good or excellent work ability in almost 88% of the sample [18]. In the present study, respondents had various degrees of work ability (from poor to excellent), which may indicate the need for specific and tailored interventions focused on level of work ability [7, 24].

In the present sample, poor or moderate work ability more often occurred in professionals aged 40 or older. Several studies have shown a negative relationship between age and work ability [14 , 32], which suggests that the lack of initiatives to promote work ability throughout one’s professional life could affect the availability of a nursing workforce in the face of growing health demands [14 , 32]. It has also been noted that poor work ability is a risk factor for turnover among health care workers [11]. In the present sample, lower work ability was present in older and younger respondents, which supports the importance of age-specific interventions adapted to the needs of the age group [16].

Factors that influence work ability included two health related factors: self-reported perception of health and health issues in the past 15 days. Our results highlight that the health of respondents affected their work ability and support the findings of other researchers [2 , 34]. In a study in the Netherlands that included 8,364 health care employees, researchers evaluated work ability and its relation to common health problems, such as musculoskeletal, cardiovascular, respiratory, and mental problems [34]. They found that the risk of low work ability was higher among participants with common health problems, and these participants reported sick leave more frequently, especially long duration sick leave [34]. Other investigators noted that impaired work ability and poor health were related to dismissal from employment [33, 35]. These findings show the importance of an organizational culture in which initiatives that promote health and protect work ability are supported [2 , 35]. Organizational actions to improve the physical and psychosocial work environment and encourage healthy lifestyles can promote work ability [1 , 15].

Stress and satisfaction with the current job also predicted work ability in the present study. A reduction in stress was associated with an increase in work ability among our respondents. Researchers have described the damage to health caused by stress [36] and have identified health factors as predictors of work ability [2 , 34]. In addition, respondents who indicated more positive job satisfaction had higher work ability than those who reported being dissatisfied or having low satisfaction. Inner values, attitudes toward work, and motivation in one’s professional life have been described as factors that affect work ability [7]. In this way, initiatives to promote job satisfaction can contribute to work ability and retain professionals in the workforce [7].

Marital status was identified as another predictor of work ability in this study, and respondents with partner relationships had a higher probability for good or excellent work ability than those without partners. These findings support those from a previous study with surgeons in hospitals in Germany [37]. In studies conducted in Brazil and Germany, high social support and participation in family programs were associated with better reports of work ability [17 , 38]. Social support may be important area of interest for interventions for vulnerable workers to promote social relationships and protect work ability [38].

Approximately 60% of our respondents reported having suffered at least one act of workplace violence in the previous year. Researchers found that workplace violence in nursing is widespread and has been associated with many unfavorable outcomes [10 , 39]. For example, in this and other studies, the experience of workplace violence was associated with lower work ability [17, 32]. Work ability was lower among respondents who suffered workplace violence and markedly lower among those who suffered two or more types of violence in the last year than among those who did not experience workplace violence. Victims were less likely to report good or excellent work ability than non-victims, and this probability decreased with the increase in the number of types of violence experienced. The current study demonstrates that cumulative experiences of workplace violence affect the work ability of nursing professionals and that initiatives to prevent workplace violence are needed.

4.1 Limitations and suggestions

Limitations of the study include the “health worker effect” [40] and recall bias. The study was carried out with nursing professionals working in the units; professionals on vacation or leave were excluded. Researchers do not know if those on vacation or leave would have responded differently as compared to the study sample. In addition, many of the measures (e.g., workplace violence experiences, health issues in the past 15 days) were self-reported or based on recall. Participants were asked to recall recent situations and experiences as well as those that occurred with the past year. These experiences (e.g., accidents at work and workplace violence) may be serious and are more likely to be accurately recalled [41]. It is also worth noting that the sample calculation was estimated based on the proportion of workplace violence in the target population, which was one of the main objectives of the larger research project, of which the study presented here is an integral part. Finally, factors that act as mediators or moderators were not identified in this study. Future studies should be designed to identify these factors.

5 Conclusion

Nursing professionals are on the front line of health systems around the world; thus, the work ability of the nursing workforce is a particularly important issue for the provision of care and for the well-being of the greater community. This analysis highlights work ability in a sample of nursing professionals in Brazil, identifies predictors of work ability, and expands on factors that can be targeted for intervention. In conclusion, in both of our models, the perception of health, self-reported health problems in the past 15 days, and workplace violence predicted work ability. The health of nursing professionals and risk factors for poor physical and mental health within the workplace are areas for future study. In the current study, workplace violence was a predictor of work ability and initiatives to prevent or control it should be considered. Other predictors included satisfaction with current job, stress, and marital status, which suggests work-related issues (e.g., greater job satisfaction, less stress) and family support as possible protective factors. Moving forward, programs addressing work-related issues (e.g., culture of non-violence, health promotion, monitoring of job satisfaction and stress indicators) should be considered to support work ability among nursing professionals. Multi-level programs and strategies (individual, organizational/system) should be considered and may be low-cost. The results of this study inform the fields of nursing management and leadership, and reinforce the need to understand work ability in order to support the nursing profession and health care system.

Conflict of interest

The authors have no conflicts of interest to declare.

Footnotes

Acknowledgments

Not applicable.

Funding

This work was supported by Grant #2016/06128-7, São Paulo Research Foundation (FAPESP), Brazil; Grant #162825/2014-5, National Council for Scientific and Technological Development (CNPq), Brazil; and Grant #01-P-3481/2014, Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil.

Ethical approval

The study was approved by the Institutional Review Board of the University of Campinas (protocols #977.885 and #1.600.763).

Informed consent

The institutions agreed with the research and the participating professionals signed an informed consent form.

References

Oakman

, Neupane

, Proper

, Kinsman

, Nygård

. Workplace interventions to improve work ability: a systematic review and meta-analysis of their effectiveness. Scandinavian Journal of Work, Environment & Health. 2018;44(2):134–46.

Stimpfel

, Arabadjian

, Liang

, Sheikhzadeh

, Weiner

, Dickson

. Organization of work factors associated with work ability among aging nurses. Western Journal of Nursing Research. 2020;42(6):397–404.

Sherman

, Chiang-Hanisko

, Koszalinski

. The ageing nursing workforce: a global challenge. Journal of Nursing Management. 2013;21(7):899–902.

World Health Organization. Global strategy on human resources for health: workforce 2030. Geneva: World Health Organization; 2016.

Pan American Health Organization

Expanding the roles of nurses in primary health care

Washington, DC: Pan American Health Organization; 2018.

Ilmarinen

, Tuomi

, Seitsamo

. New dimensions of work ability. International Congress Series. 2005;1280:3–7.

Gould

, Ilmarinen

, Järvisalo

, Koskinen

. Dimensions of work ability. Results of the Health 2000 Survey. Helsinki: Finnish Centre for Pensions; The Social Insurance Institution; National Public Health Institute; Finnish Institute of Occupational Health; 2008.

Ilmarinen

. Work ability— a comprehensive concept for occupational health research and prevention. Scandinavian Journal of Work, Environment & Health. 2009;35(1):1–5.

Abbasi

, Zakerian

, Akbarzade

, Dinarvand

, Ghaljahi

, Poursadeghiyan

, et al. Investigation of the relationship between work ability and work-related quality of life in nurses. Iranian Journal of Public Health. 2017;46(10):1404–12.

10.

Bordignon

, Monteiro

. Predictors of nursing workers’ intention to leave the work unit, health institution and profession. Revista Latino-Americana de Enfermagem. 2019;7:.e3219.

11.

Derycke

, Clays

, Vlerick

, D’Hoore

, Hasselhorn

, Braeckman

. Perceived work ability and turnover intentions: a prospective study among Belgian healthcare workers. Journal of Advanced Nursing. 2012;68(7):1556–66.

12.

Tomietto

, Paro

, Sartori

, Maricchio

, Clarizia

, Lucia

, et al. Work engagement and perceived work ability: an evidence-based model to enhance nurses’ well-being. Journal of Advanced Nursing. 2019;75(9):1933–42.

13.

Machado

, Aguiar-Filho

, Lacerda

, Oliveira

, Lemos

, Wermelinger , et al. Características gerais da enfermagem: o perfil sociodemográfico. Enfermagem em Foco. 2016;7(Esp):9–14.

14.

Fassi M

, Bocquet

, Majery

, Lair

, Couffignal

, Mairiaux

. Work ability assessment in a worker population: comparison and determinants of Work Ability Index and Work Ability score. BMC Public Health. 2013;13, 305.

15.

Ilmarinen

, Rantanen

. Promotion of work ability during ageing. American Journal of Industrial Medicine. 1999;Sept(Suppl1):21–3.

16.

Sottimano

, Viotti

, Guidetti

, Converso

. Protective factors for work ability in preschool teachers. Occupational Medicine. 2017;67(4):301–4.

17.

Fischer

, Martinez

. Individual features, working conditions and work injuries are associated with work ability among nursing professionals. Work. 2013;45(4):509–17.

18.

Hilleshein

, Lautert

. Work capacity, sociodemographic and work characteristics of nurses at a university hospital. Revista Latino-Americana de Enfermagem. 2012;20(3):520–7.

19.

Adriaenssens

, Gucht

, Maes

. Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research. Int J Nurs Stud. 2015;52(2):649–61.

20.

, Yang

, Xie

, Wang

, Shan

, Shi

. Work experience of triage nurses in emergency departments during the prevalence of COVID-19. Int Emerg Nurs. 2021;56:101003.

21.

Rahman

, Abdul-Mumin

, Naing

. Psychosocial Work Stressors, Work Fatigue, and Musculoskeletal Disorders: Comparison between Emergency and Critical Care Nurses in Brunei Public Hospitals. Asian Nurs Res (Korean Soc Nurs Sci). 2017;11(1):13–8.

22.

Cochran

. Técnicas de amostragem (2nd ed) Portugal: Editora Fundo de Cultura; 1963.

23.

Medronho

, Carvalho

, Bloch

. Epidemiologia. Rio de Janeiro:Atheneu; 2008.

24.

Tuomi

, Ilmarinen

, Jahkola

, Katajarinne

, Tulkki

. Índice de capacidade para o trabalho. São Carlos: EdUFSCar 2010.

25.

Tuomi

, Ilmarinen

, Eskelinen

, Järvinen

, Toikkanen

, Klockars

. Prevalence and incidence rates of diseases and work ability in different work categories of municipal occupations. Scandinavian Journal of Work, Environment & Health. 1991;17(Suppl 1):67–74.

26.

Monteiro

. Questionnaire of socio-demographic, life style and work and health aspects – QSETS: two decades. In: Monteiro

, Iguti

, editors. Work, health and sustainability: an interdisciplinary international dialogue South – North. Campinas: BFCM-Unicamp; 2017. Available from: http://www.bibliotecadigital.unicambr/document/?code=80420&opt=1.

27.

Bordignon

, Monteiro

. Apparent validity of a questionnaire to assess workplace violence. Acta Paulista de Enfermagem. 2015;28(6):601–8.

28.

Martinez

, Latorre

MRDO

, Fischer

. Validity and reliability of the Brazilian version of the Work Ability Index questionnaire. Revista de Saúde Pública. 2009;43(3):525–32.

29.

Francisco

PMSB

, Bastos

, Costa

, Prado

MAMB

, Barros

MBA

. The use of medication and associated factors among adults living in Campinas, São Paulo, Brazil: differences between men and women. Ciência & Saúde Coletiva. 2014;9(12):4909–21.

30.

Barros

, Hirakata

. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Medical Research Methodology. 2003;3, 21.

31.

Rypicz

, Witczak

, Rosińczuk

, Karniej

, Kołcz

. Factors affecting Work Ability Index among Polish nurses working in hospitals - a prospective observational survey. Journal of Nursing Management. 2021;29(3):468–76.

32.

Schablon

, Wendeler

, Kozak

, Nienhaus

, Steinke

. Prevalence and consequences of aggression and violence towards nursing and care staff in Germany-a survey. International Journal of Environmental Research and Public Health. 2018;15(6):1274.

33.

Martinez

, Fischer

. Work ability as determinant of termination of employment: to resign or be dismissed? Journal of Occupational and Environmental Medicine. 2019;61(6):e272–81.

34.

van den Berg

, Burdorf

, Robroek

SJW

. Associations between common diseases and work ability and sick leave among health care workers. International Archives of Occupational and Environmental Health. 2017;90(7):685–93.

35.

Wagenaar

, Kompier

, Houtman

, van den Bossche

, Taris

. Who gets fired, who gets re-hired: the role of workers’ contract, age, health, work ability, performance, work satisfaction and employee investments. International Archives of Occupational and Environmental Health. 2015;88(3):321–34.

36.

Yuwanich

, Sandmark

, Akhavan

. Emergency department nurses’ experiences of occupational stress: a qualitative study from a public hospital in Bangkok, Thailand. Work. 2015;53(4):885–97.

37.

Mache

, Danzer

, Klapp

, Groneberg

. Surgeons’ work ability and performance in surgical care: relations between organisational predictors, work engagement and work ability. Langenbeck’s Archives of Surgery. 2013;98(2):317–25.

38.

Peters

, Spanier

, Radoschewski

, Bethge

. Influence of social support among employees on mental health and work ability-a prospective cohort study in 2013-15. European Journal of Public Health. 2018;8(5):819–23.

39.

Magnavita

, Heponiemi

, Chirico

. Workplace violence is associated with impaired work functioning in nurses: an Italian cross-sectional study. Journal of Nursing Scholarshi. 2020;2(3):281–91.

40.

Checkoway

, Pearce

, Kriebel

. Research methods in occupational epidemiology New York:Oxford University Press;2004.

41.

Fadnes

, Taube

, Tylleskär

. How to identify information bias due to self-reporting in epidemiological research. Internet J Epidemiol. 2009;7(2):1–10.