The working environment in Health Care — Does the working environment influence the psychosocial health of nurses and are modifications of this working environment needed?

Context: Ageing of the population and an increase of the life expectancy are worldwide phenomena that result in a growing demand for health care professionals. Future problems are expected in providing for this demand. Not only difficulties in attracting new potential professionals, but also difficulties in retaining the existing workforce are suspected to be a part in a possible future shortage of workforce. A statistical significant relationship exists between the working environment and the developmental level of the workforce. The working environment can therefore be interpreted as a key factor in the prevention of potential future problems. Setting: The work of nurses is often characterised as both mentally- and physically demanding. Properties of the working environment in health care like changing supervisors, colleagues, workplaces, working hours and tasks can intensify both the workload and psychosocial influences of this workload. Objectives: To describe the most common influences of the working environment on the psychosocial health status of nurses. Recommendations in order to modify the working environment will be given if necessarily. Design: Systematic review of relevant information from the following databases: Pubmed, Medline, Google Scholar, Blackwell Synergy, British Medical Journal, CINAHL, Embase, Esmerald Insight, Oxford Journals, ScienceDirect, Wiley InterScience. Main outcomes: The working environment influences: job satisfaction, emotional exhaustion, moral distress/stress of conscience (depersonalization), reduced personal accomplishment, overall burnout, work engagement, home life, sickness absence, leaving the profession. Recommendations: empowerment, creating a more attractive working environment through modifications of the organizational structure, management style, and interdisciplinary relations

Return to work of employees with low levels of education: The employers' role and perspective

BACKGROUND: To achieve adequate return to work (RTW) after sickness absence, Dutch legislation prescribes cooperation between absent employees and employers. Yet, we lack insight into how employees with low levels of education exercise influence over (i.e. self-direct) RTW. OBJECTIVE: This study aimed to enhance our understanding of: A) the role that employers play in the self-direction of employees with low levels of education over their RTW, B) how employers perceive these employees' efforts (or lack thereof) to self-direct their own RTW, and how employers understand and interpret the behaviours of these employees. Social cognitive theory served as a framework. METHODS: A qualitative study was conducted with 13 employer representatives using semi-structured interviews. Data were analysed in NVivo12 using a template approach. RESULTS: Employers tend to play a guiding, directive role in employees' RTW. According to employers, employees generally comply with the employers' decisions and suggestions, whether or not they have tried to realise their own preferences regarding mode and timing of RTW. Employers interpret such employee behaviours from the perspective of environmental (e.g. financial pressures to RTW) and person-related factors (e.g. sickness and RTW perceptions). CONCLUSIONS: Employers, rather than employees direct the employees' RTW. Employers should give voice to employees and enable them to have more control over their RTW. Future research should acquire more insight in the employees' perspective

Eigen regie over werkhervatting door verzuimende werknemers

Employers and return-to-work professionals consider self-direction by sick-listed employees an effective way to achieve work resumption. Yet, there is no unambiguous definition of 'self-direction by employees during sick leave'. Therefore, it is questionable whether professionals mean the same when they refer to self-direction. We argue that self-direction by sick-listed employees consists of satisfaction of their basic psychological needs. These are: autonomy involvement in decision making about their own work resumption), competence (being able to resume work), and connectedness (receiving support from their employers that matches their needs) (based on Deci & Ryan, 1985, 2000, 2008). We also argue that the Dutch Improved Gatekeeper Act provides sick-listed employees with possibilities to take self-direction in their work resumption processes. Yet, this Act does not optimally stimulate the self-direction by sick-listed employees. We base our argumentation on findings of an applied PhD research in the field of sick leave and return-to-work. Moreover, we provide advice to researchers and practice professionals who aim to support the self-direction by sick-listed employees. Finally, we reflect on applicability and feasibility of our conceptualization of self-direction

Empowering self-direction in return to work of employees with low and high levels of education: A qualitative comparative study

BACKGROUND: Dutch legislation encourages active participation of employees in their return-to-work (RTW) process. Empowering leadership may support employees' self-direction in this process (i.e. by allowing and enabling their involvement in decision-making). OBJECTIVE: Building upon a previous study, we aimed to study (1) how representatives of a university, i.e. an employer for employees with high levels of education (EH), manage RTW, (2) the similarities and differences between the RTW management of employers (or representatives thereof) of employees with low (EL) and high levels of education, and (3) the degree to which the employers' roles resemble empowering leadership. METHODS: Qualitative methodology was applied. A thematic analysis of interview transcripts (rq1) was followed by a comparison of themes (rq2) and pattern matching (rq3). RESULTS: (1) EH tend to engage in dialogue and accommodate their employees as much as possible. (2) EL and EH showed several similarities, such as aiming to meet legal requirements on RTW management. Compared to EL, EH tend to focus more on facilitating employees. (3) Empowering leadership seems to be more common among EH. CONCLUSIONS: Compared to employees with low levels of education, those with high levels of education may be granted more opportunity to self-direct their RTW. The study results provide starting points for employers for employees with both low and high levels of education who aim to enable employees' self-direction in RTW, and help them to develop empowering leadership styles

Empowering self-direction in return to work of employees with low and high levels of education:A qualitative comparative study

BACKGROUND: Dutch legislation encourages active participation of employees in their return-to-work (RTW) process. Empowering leadership may support employees' self-direction in this process (i.e. by allowing and enabling their involvement in decision-making). OBJECTIVE: Building upon a previous study, we aimed to study (1) how representatives of a university, i.e. an employer for employees with high levels of education (EH), manage RTW, (2) the similarities and differences between the RTW management of employers (or representatives thereof) of employees with low (EL) and high levels of education, and (3) the degree to which the employers' roles resemble empowering leadership. METHODS: Qualitative methodology was applied. A thematic analysis of interview transcripts (rq1) was followed by a comparison of themes (rq2) and pattern matching (rq3). RESULTS: (1) EH tend to engage in dialogue and accommodate their employees as much as possible. (2) EL and EH showed several similarities, such as aiming to meet legal requirements on RTW management. Compared to EL, EH tend to focus more on facilitating employees. (3) Empowering leadership seems to be more common among EH. CONCLUSIONS: Compared to employees with low levels of education, those with high levels of education may be granted more opportunity to self-direct their RTW. The study results provide starting points for employers for employees with both low and high levels of education who aim to enable employees' self-direction in RTW, and help them to develop empowering leadership styles