Health issues among nurses in Taiwanese hospitals: National survey

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Abstract

Background

Few, if any, studies have compared the health issues of nurses working in different hospital settings. The objective of this study was to compare the health status and work-related health hazards among nurses working in different hospital units in Taiwan.

Methods

This study was a cross-sectional survey. The study participants were 21,095 full-time employees with a professional background in nursing, working at 100 hospitals across Taiwan. The study participants responded to a structured questionnaire from May to July, 2011.

Results

After adjustment for age, sex, educational level, accredited hospital level, and certification as a health promoting hospital, nurses who worked in administration and in outpatient clinics reported better overall health than nurses who worked in operating rooms/delivery rooms, and these nurses reported better overall health than nurses who worked in emergency rooms/intensive care units and general wards. Depressed mood followed the same trend. Nurses who worked in the operating rooms/delivery rooms, wards, and emergency rooms/intensive care units were at higher risk for occupational incidents than nurses who worked in outpatient clinics and administration. The most prevalent health hazards among nurses were low back pain, sprained/strained muscles, cuts, and verbal or sexual harassment/violence.

Conclusions

Nurses who worked in emergency rooms/intensive care units and in wards had worse health and more depressed moods than nurses in other hospital units. Work-related health hazards were common and varied among nurses working in different hospital units. Worksite-based health promotion programs should take these differences into consideration to tailor wellness programs for nurses working in different hospital settings.

Introduction

Nursing shortages are serious issues in many countries around the world (Hayes et al., 2012). In Taiwan, there has been an increasing demand for nurses because of increases in the elderly population and universal access to medical care under the national health insurance scheme (NHIS). Nonetheless, an emphasis on reducing the costs of the health care workforce driven by global budgets of the NHIS in the past decade has resulted in deterioration of the work environment for nurses (Kao, 2011). A survey in 2010 reported that about 40% of nurses in Taiwan felt their workload was heavier than 3 years previously and 35% felt the overall quality of nursing care had declined (Lu et al., 2010). One in four new nurses left their jobs as hospital nurses, and the mean duration of nursing practice was only 7.67 years (Chang and Yu, 2010). Recruitment and retention of nurses is a contemporary concern in Taiwan.

Declines in nurses’ health status impact medical errors and incidents, thus diminishing the quality of health care (Arakawa et al., 2011, Arimura et al., 2010). Studies reported that work-related stress, shift work schedules, extended work hours, and stressful work environments affect the health status of nurses (Arimura et al., 2010, Josten et al., 2003, Sveinsdottir et al., 2006, Trinkoff et al., 2006). Arimura et al. (2010) found that sleep and mental health among Japanese hospital nurses were relatively poor. They reported that 65% of the study nurses had poor mental health, indicated by a General Health Questionnaire (GHQ)-28 score greater than 6. Sleep quality among the study nurses was generally poor, indicated by a mean Pittsburgh Sleep Quality Index score of 6.8 (>5 indicates poor quality sleep). Ruggiero (2005) reported that 41% of the critical care nurses in the US had clinical depression, indicated by a Beck Depression Inventory-II score above the cutoff score; and 65% had poor sleep quality, indicated by a Pittsburgh Sleep Quality Index score greater than 5 (Ruggiero, 2005). McKee et al. (2010) reported that 24% of hospital nurses in England reported significant distress (GHQ-12 > 4), compared with 18% in an age- and gender-matched sample of the general population (Bromley and Shelton, 2010).

Work-related injuries such as needle-stick injuries, cuts, and musculoskeletal problems are common among nurses (Butsashvili et al., 2012, Clarke et al., 2002, Hignett, 1996). Rates of injury and illness for nurses rank among the highest across all occupations (McNeely, 2005). Despite the fact that contemporary nursing takes place in many different venues for care, few studies have compared the health issues of nurses working in different settings. Researchers in a UK study suggested that the incidence of significant stress among nurses working in a healthcare telephone advice service were similar to that of the general population, but was considerably lower than that of hospital-based nurses (Farquharson et al., 2012). Sveinsdottir et al. (2006) reported more strenuous conditions among Icelandic hospital nurses than among nurses working outside the hospital setting. Medical errors and incidents were higher among Japanese nurses working in the wards than nurses working in outpatient departments (Arakawa et al., 2011).

The World Health Organization launched the health promoting hospital (HPH) project in 1988, and it has since become a global initiative (The International HPH Network, 2012). The goal of the HPH project is to support hospitals in placing more emphasis on health promotion and disease prevention (The International HPH Network, 2012). The standards for the HPH project include a hospital policy aiming at improving health outcomes of staff and promoting a healthy workplace (World Health Organization regional office for Europe, 2006). The Taiwan HPH Network modeled after the HPH was first established in 2005. The HPH approach directed Taiwanese hospital leaders’ attention to staff health (Lee et al., 2012). Hospitals voluntarily participated in the HPH standards evaluation and were certified by the Taiwan Bureau of Health Promotion if they passed the evaluation. As part of the HPH promotion efforts, the Taiwan Bureau of Health Promotion conducted a national survey of full-time employees in hospitals to assess the health needs of hospital staff. Since the Taiwan HPH Network is still developing and expanding, the participating hospitals were not confined to the certified HPH. This study used the survey data with a focus on nurses.

About 70% of practicing nurses in Taiwan work at hospitals. Nurses constitute the largest professional group working at hospitals. Hospital-based health promotion presents opportunities to safeguard the health of nurses and may be helpful in recruiting and retaining nurses (Chan and Perry, 2012). We expect the study results could serve as a basis to design health promotion programs for nurses working in various hospital settings. Previous studies of occupational health among nurses included only a few hospitals and generally had limited sample sizes. The objective of this study was to compare the health status and work-related health hazards among nurses working in different hospital units using survey data collected from nurses working at 100 hospitals across Taiwan.

Section snippets

Design and participants

This study was a cross-sectional survey. According to the records of the Department of Health, there were 487 hospitals (23 medical centers, 85 regional hospitals, and 379 district hospitals) in 2010 in Taiwan, of which, 66 were certified HPH (6 medical centers, 45 regional hospitals, and 15 district hospitals). We planned to include all 66 certified HPH and used a 1:1 (certified: non-certified) ratio to draw a random sample of non-certified hospitals based on the distribution of accredited

Results

The study nurses had a mean age of 31.78 (SD = 7.20) years. The majority (98%) were women. About 60% of the nurses held a university or post-graduate degree. About 65% of the nurses worked at regional hospitals, followed by medical centers (27.2%) and district hospitals (7.9%). More than half of the nurses worked at a certified HPH (56.4%). There were significant differences in age, sex, educational level, and accredited hospital level among nurses working in different hospital units. Nurses

Discussion

Under the NHIS in Taiwan, the volume of services and medical expenditures increased significantly between 2000 and 2010 (Department of Health, 2011). The ratio of nurses to patients in Taiwan is high (Kao, 2011). The related changes have increased stress in the health-care environment and resulted in a high turnover rate and a severe shortage of nurses because of heavier workloads, long working hours, irregular work schedules, challenging work conditions, and an inadequate number of staff.

Conclusions

The health status of nurses varies by hospital work unit. Nursing managers can use our findings to form policies that reflect proper nursing human resource management. For example, a decrease in work hours and work stress with special emphasis on ER/ICU and ward nurses is implicated. Stress management skills should be essential in nursing education. Work-related health hazards are prevalent and vary among nurses working in different hospital units. Strategies for nurses to prevent and cope with

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