Timo Sinervo

Job demands and job control as correlates of early retirement thoughts in Finnish social and health care employees

Given the ageing workforce, there is an increasing interest in understanding the retirement process. This study examined whether early retirement thoughts can be explained by job demands, job control and their interaction, a hypothesis derived from the job demand-control model of Karasek (1979). The moderated hierarchical regression analyses of early retirement thoughts were based on a sample of 274 male and 2798 female employees aged 20 to 65 years in Finnish social and health care. Our results suggest that job demands and job control are independent predictors of early retirement thoughts even when adjusted for age, gender, educational level and self-rated health. Furthermore, our results offered support for the interaction effect of job demands and job control on early retirement thoughts. Among people over 45 years old, these associations were even stronger, compared to the whole sample. This indicates that one way to reduce the number of people taking early retirement would be to put the emphasis on psychosocial factors, such as job control, affecting the older workers.

Nursing working conditions in relation to restraint practices in long-term care units

Objectives:This study examined the effects of nursing working conditions on the use of physical restraints and antipsychotics as restraints in long-term care units for elderly residents. Design:Cross-sectional data were obtained in Finland in 2002 from long-term care units that used the Resident Assessment Instrument (RAI) system and participated in a survey on working conditions. Setting:A sample of 91 inpatient units in 31 facilities (23 residential homes and 8 health centers). Participants:Data included 2430 resident assessments and 977 nursing staff survey responses. Measurements:We measured unit-level mean scores of physical restraint and antipsychotics use as restraints and resident characteristics (activities of daily living, cognitive impairment, and daily behavioral problems) based on the RAI system as measured by the Minimum Data Set 2.0. Head nurses reported the structural factors (nurse staffing levels and unit size). Nursing working conditions were measured by the Job–Demands and Job–Control Scales in the staff survey questionnaire. Results:Controlling for resident characteristics, nurses’ job demands and control had a combined effect on restraint practices. Job demands strongly increased the risk of physical restraint use in units where nurses reported low job control (odds ratio [OR] = 13.31, 95% confidence interval [CI] 1.55–114.30, P = 0.019), but not among high-control units (OR = 0.23, 95% CI 0.04–1.29, P = 0.090). Although the use of antipsychotics was not related to job demands in units with low control (OR = 1.11, 95% CI 0.26–4.99, P = 0.891), the antipsychotics use in particular decreased when high job demands were coupled with high job control (OR = 0.17, 95% CI 0.03–0.91, P = 0.038). Conclusion:The results suggest that restraint use can be reduced by enhancing working conditions so that the nursing staff has possibilities for skill usage and decision-making.

Health, psychosocial factors and retirement intentions among Finnish physicians

BACKGROUND Early retirement among physicians is a worldwide problem and all efforts to try to minimize it are of importance. AIMS To investigate whether characteristics of work, organization factors and health factors might be associated with retirement intentions among physicians. METHODS Cross-sectional survey data from the Finnish Health Care Professional Study was used. A random sample of Finnish physicians included 682 women and 701 men aged 45-65 years. A three-level retirement intention score was constructed based on responses to two questions asking about (i) willingness to continue working or retiring and (ii) pension-applying considerations. Health indicators used were self-rated health, work ability and sickness absence during the past 12 months. Karaseks job control and Colquitts organizational justice were measured. Ordinal logistic regression models were used to analyse the data. RESULTS Self-reports of poor health [odds ratio (OR) 2.17, 95% CI 1.84-2.56], low work ability (OR 2.18, 95% CI 1.12-1.46), taking sickness absence (OR 1.28, 95% CI 1.12-1.46), low job control (OR 1.71, 95% CI 1.50-1.95) and organizational injustice (OR 1.27, 95% CI 1.17-1.39) all independently increased the likelihood of retirement intentions. Low job control strengthened the associations of poor health and low work ability with retirement intentions. In addition, organizational injustice strengthened the associations of poor health and sickness absences with retirement intentions. CONCLUSION Low job control and organizational injustice may intensify the effect of poor health on retirement intentions. Promoting control opportunities and organizational justice might help to decrease early retirement among physicians.

Organisational injustice and impaired cardiovascular regulation among female employees

Objectives: To examine the relation between perceived organisational justice and cardiovascular reactivity in women. Methods: The participants were 57 women working in long term care homes. Heart rate variability and systolic arterial pressure variability were used as markers of autonomic function. Organisational justice was measured using the scale of Moorman. Data on other risk factors were also collected. Results: Results from logistic regression models showed that the risk for increased low frequency band systolic arterial pressure variability was 3.8–5.8 times higher in employees with low justice than in employees with high justice. Low perceived justice was also related to an 80% excess risk of reduced high frequency heart rate variability compared to high perceived justice, but this association was not statistically significant. Conclusions: These findings are consistent with the hypothesis that cardiac dysregulation is one stress mechanism through which a low perceived justice of decision making procedures and interpersonal treatment increases the risk of health problems in personnel.

Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators

BACKGROUND The present study examined whether there are differences in job-related attitudes and well-being among physicians working in private sector and public sector. In addition, we examined whether psychosocial factors (organizational justice and job control) could mediate these possible differences in different sectors. METHODS Cross-sectional survey data from the Finnish Health Professional Study was used. A random sample of Finnish physicians included 1522 women and 1047 men aged 25-65 years. Outcome variables were job satisfaction, organizational commitment, psychological distress, work ability and sleeping problems. Job control and organizational justice were measured using established questionnaires. Series of regression analyses were performed and the mediational effects were tested following the procedures outlined by Baron and Kenny. RESULTS Physicians working in private sector had higher levels of job satisfaction and organizational commitment and lower levels of psychological distress and sleeping problems when compared with physicians working in public sector. Private physicians also had higher levels of organizational justice, which acted as a mediator behind more positive attitudes and better well-being in private sector. Private physicians had higher levels of job control but it did not act as a mediator. CONCLUSIONS Private physicians feel better than public physicians and this is partly due to higher organizational justice in private sector. Public health care organizations should invest effort to increase the fairness in their organizations and management and pay more attention in improving the well-being of their employees, which could possibly increase the attractiveness of public sector as a career option.

Psychosocial stressors at work, psychological stress and musculoskeletal symptoms in the care for the elderly

Abstract This study was conducted in order to determine how occupational stressors (psychosocial stressors and physical load) are related to psychological stress (symptoms) and musculoskeletal symptoms among staff of Finnish residential homes, nursing homes and home help services (n = 204). Data obtained from questionnaires was used to test two hypotheses: that psychosocial stressors (time pressure, troublesome patients with dementia) are associated with psychological stress, and that musculoskeletal disorders are associated with physical load. The authors also tested whether psychological stress has a mediating effect between psychosocial stressors and musculoskeletal symptoms. The findings supported the hypothesis regarding the mediating effect of psychological stress.

The effects of ownership, staffing level and organisational justice on nurse commitment, involvement, and satisfaction: A questionnaire study

BACKGROUND Elderly care systems have undergone a lot of changes in many European countries, including Finland. Most notably, the number of private for-profit firms has increased. Previous studies suggest that employee well-being and the quality of care might differ according to the ownership type. OBJECTIVE The present study examined whether the ownership type and the staffing level were associated with organisational commitment, job involvement, and job satisfaction. In addition, we examined the potential moderating effect of organisational justice on these associations. DESIGN Cross-sectional questionnaire study. PARTICIPANTS AND SETTING 1047 Finnish female staff members aged 18-69 years working in sheltered housing or nursing homes (units n=179). METHODS The relationships were studied with analyses of covariance (ANCOVA), adjusting for the effects of age and case-mix. RESULTS Organisational commitment and job satisfaction levels were low in for-profit sheltered homes when justice levels were low, but when justice levels were high, for-profit sheltered homes did not differ from other ownership types. Similarly, organisational justice acted as a buffer against low commitment resulting from low staffing levels. Staffing levels were lowest in public sheltered homes and highest in not-for-profit sheltered homes. CONCLUSION The results show that organisational justice can act as a buffer against low organisational commitment that results from low staffing levels and working in for-profit sheltered homes. Increasing justice in regard to the management, outcomes, and procedures in the organisation would thus be important.

Effects of job characteristics, team climate, and attitudes towards clinical guidelines:

The aim of this study was to form and test a model of the antecedents and possible moderators of the use of clinical guidelines among healthcare professionals. A postal questionnaire survey of all workers in six health centres around Finland. was carried out in April 1996. The health centres were selected to represent all different areas of Finland. A total of 748 (65.5%) of the healthcare workers completed and returned the questionnaire. Of the respondents 95% were women, 16% physicians or dentists, 31% registered nurses, and 27% practical nurses. It was hypothesized that besides positive attitudes towards guidelines, job characteristics and team climate affect the use of guidelines. Three alternative models of possible main and moderating effects of attitudes, job characteristics, and team climate were formed and tested. These models were tested using hierarchical regression analysis and structural equation modelling (LISREL8). All of the hypothesized main effects and the moderating effect of job characteristics between attitudes towards and the use of guidelines were supported. According to our results important factors behind the general positive or negative attitudes towards guidelines are the usefulness, reliability, practicality, and availability of the guidelines. Also, the overall individual, team, and organizational competence to follow the procedures recommended, seemed to be vital. Moreover, those whose job motivation potential was high were more ready to use clinical guidelines even when their attitudes towards guidelines were the same.

Developing a short measure of organizational justice: a multisample health professionals study

Objectives: To develop and test the validity of a short version of the original questionnaire measuring organizational justice. Methods: The study samples comprised working physicians (N = 2792) and registered nurses (n = 2137) from the Finnish Health Professionals study. Structural equation modelling was applied to test structural validity, using the justice scales. Furthermore, criterion validity was explored with well-being (sleeping problems) and health indicators (psychological distress/self-rated health). Results: The short version of the organizational justice questionnaire (eight items) provides satisfactory psychometric properties (internal consistency, a good model fit of the data). All scales were associated with an increased risk of sleeping problems and psychological distress, indicating satisfactory criterion validity. Conclusion: This short version of the organizational justice questionnaire provides a useful tool for epidemiological studies focused on health-adverse effects of work environment.

The association of distress and sleeping problems with physicians' intentions to change profession: the moderating effect of job control.

The present study examined whether job control moderated the association between stress indicators (distress and sleeping problems) and intentions to change profession among 2,650 Finnish physicians. Ordinal logistic regression analysis was applied. The authors found that high levels of distress and sleeping problems were associated with higher levels of intentions to change profession, whereas high job control was associated with lower levels of intentions to change profession even after adjusting for the effects of gender, age, and employment sector. In addition, high job control was able to mitigate the positive association that distress and sleeping problems had with intentions to change profession. Our findings highlight the importance of offering more job control to physicians to prevent unnecessary physician turnover.