Health-Care Rx: Reducing work absences among Canadian nurses

Creating non-violent and supportive health-care workplaces might help prevent prolonged work absences among nurses. This is the upshot of a new study from the Institute for Work & Health.

With the health-care sector having the highest rate of lost-time claims and work absence in the country, disability managers in Canada’s health-care organizations may want to join forces with their counterparts in human resources to implement violence prevention and respectful workplace programs. A new study from the Institute for Work & Health (IWH) shows that emotional and physical abuse at work, as well as disrespectful and unsupportive work environments, are associated with prolonged work absences among nurses.

Our findings suggest that violence prevention is also work absence prevention, says IWH Adjunct Scientist Dr. Renée-Louise Franche, a clinical psychologist at Vancouver General Hospital who led the study looking at the impact of worker and workplace factors on absenteeism among nurses. According to our study, being abused or assaulted on the job is strongly associated with nurses having prolonged work absences. It is also indirectly connected by creating a poorer workplace culture and lower respect and support from co-workers, both of which are associated with increased work absence duration.

The study, published in the August 2011 issue of the Journal of Occupational and Environmental Medicine (vol. 53, no. 8, pp. 919-927), collected information on almost 12,000 female, direct-care Canadian nurses from Statistics Canada’s 2005 National Survey of the Work and Health of Nurses. Factors related to nurses’ personal health and their workplaces were examined relative to three categories of work absences: none, short-term (one to 10 work days) and prolonged (11 or more work days).

Worker health factors—namely pain that interfered with the ability to work, more severe pain, depression and having a higher number of chronic health conditions (such as arthritis, migraine and back pain)—had the biggest effect on the length of nurses’ work absences. Workplace factors had a smaller effect overall, with those having the most impact being emotional or physical abuse by a patient, visitor or co-worker, and low respect and low support at work.

The combined effect of worker and workplace factors was the most novel finding in this study, as few previous studies have examined this. Take pain-related work interference, for example, the factor most strongly associated with prolonged absences among nurses. It looks like pain interference is a product of both worker and workplace factors, says Franche. That is, the degree to which pain interferes with work may depend not only on a nurse’s pain level, but also on the demands, both physical and social, of the environment in which she works.

Potential strategies to reduce long absences

The study’s findings suggest a number of ways in which health-care organizations can help decrease time away from work among nurses. Franche points to these potential strategies:

  • Implement or augment violence prevention programs. Among those in the 2005 Statistics Canada nurses’ survey that were included in this study, 57 per cent reported being emotionally abused at work and 31 per cent reported being physically assaulted at work during the previous year. Abuse or assault at work by a co-worker was particularly common, with 55 per cent of nurses reporting abuse or assault by a co-worker, compared to 25 per cent reporting abuse or assault by a patient or visitor. Many health-care organizations have implemented violence prevention programs since then, says Franche. But they need to keep vigilant on this front.
  • Address respect, support and organizational culture. This includes nurses’ feelings of control over their practice and autonomy at work, as well as their relationships with doctors and co-workers.
  • Focus disability management practices on workers who are still on the job but struggling with multiple physical and mental health conditions.
  • Offer self-management programs that address pain and depression, focusing on the work environment. The workplace doesn’t have full control of workers’ pain and depression, but it can help deal with issues by offering self-management approaches, says Franche. For example, more workplaces are offering relaxation and meditation courses, and these could be extended to include strategies on how to manage symptoms and episodes at work.

 Source: At Work, Issue 66, Fall 2011: Institute for Work & Health, Toronto