In healthcare settings, nurses’ workload, burnout, and job satisfaction are associated to the patient–nurse ratio. Whether this ratio also affects their intention to leave the nursing profession, along with the underlying stress pathway, remains unclear. This study aimed to investigate the effects of the patient–nurse ratio on nurses’ intention to leave and considering the mediating roles of burnout and job dissatisfaction. The study analyzed the data of two pooled cross-sectional surveys collected in 2013 and 2014. Measures were obtained by a structure questionnaire, which queried the average daily patient–nurse ratio (ADPNR), nurses’ personal burnout, client-related burnout, job dissatisfaction, intention to leave, and other demographics. ADPNRs were standardized according to hospital levels. Multiple regression models examined mediation hypotheses, and a percentile bootstrap confidence interval was applied to determine the significance of indirect effects. A total of 1409 full-time registered nurses in medical and surgical wards of 24 secondary or tertiary hospitals in Taiwan completed self-administered questionnaires. Most of the participants were female (97.2%), and the mean age was 29.9 years. The association between the standardized ADPNR and intention to leave their job was significantly mediated by personal burnout, client-related burnout, and job dissatisfaction. Higher standardized ADPNRs predicted higher levels of personal burnout, client-related burnout, and job dissatisfaction, each of which resulted in higher levels of intention to leave the current job. The results highlight that appropriate patient–nurse ratio standards may be further discussed by selecting personal burnout, client-related burnout, and job dissatisfaction as indicators.

Purpose Nurses are exposed to a poor psychological work environment; this may cause poor mental health, which is a risk factor for suicidal ideation. We investigated the association between psychological work environment and suicidal ideation among hospital nurses in Taiwan. Design We conducted a cross‐sectional survey in Taiwan female nurses using stratified sampling by region (north, central, south, and east) to select representative centers for this study. Methods A self‐report questionnaire including items on demographic data, the psychological work environment, and suicidal ideation was sent to nurses working in hospitals. Multiple logistic regression and population attributable risk analyses were performed to assess the effect of the psychological work environment on suicidal ideation. Findings A total of 2,734 eligible questionnaires (76.8%) were returned. The prevalence of suicidal ideation was 18.3%, and higher risk was found to be associated with the educational level of junior college or below, higher personal burnout, higher client‐related burnout, and always feeling stressed at work. Estimation of population attributable risk showed that higher personal burnout, client‐related burnout, and always feeling stressed at work were the most crucial factors among nurses, accounting for 19.4%, 8.6%, and 10.5% of suicidal ideation, respectively. Conclusions A considerable proportion of nurses developed suicidal ideation. A poor psychological work environment was a relevant factor for suicidal ideation. Clinical Evidence This study provides relevant knowledge for nursing management levels in preventing the development of suicidal ideation among nurses. Not only for nurses’ mental health, but for patient safety and care quality, further studies in improving nurses’ psychological work environment are warranted.

Although nurses work in stressful environments, stressors in such environments have yet to be clearly assessed. This study aimed to develop a Nurses' Occupational Stressor Scale (NOSS) with high reliability and validity. Candidate questions for the NOSS were generated by expert consensus following focus group feedback, and were used to survey in 2013. A shorter version was then developed after examination for validity and reproducibility in 2014. The accuracy of the short version of the NOSS for predicting nurses' stress levels was evaluated based on receiver operating characteristic curves to compare existing instruments for measuring stress outcomes, namely personal burnout, client-related burnout, job dissatisfaction, and intention to leave. Examination for validity and reproducibility yielded a shorter version of NOSS with only 21 items was considered sufficient for measuring stressors in nurses' work environments. Nine subscales were included:(1) work demands, (2) work-family conflict, (3) insufficient support from coworkers or caregivers, (4) workplace violence and bullying, (5) organizational issues, (6) occupational hazards, (7) difficulty taking leave, (8) powerlessness, and (9) unmet basic physiological needs. The 21-item NOSS proved to have high concurrent and construct validity. The correlation coefficients of the subscales for test-retest reliability ranged from 0.71 to 0.83. The internal consistency (Cronbach's α) coefficients ranged from 0.35 to 0.77. The NOSS exhibited accurate prediction of personal burnout, client-related burnout, job dissatisfaction, and intention to leave.

Results There is strong evidence for an association between high exposure to ionising irradiation and stroke, from studies on patients undergoing therapeutic x-tray treatment and atomic bomb survivors. The evidence for an association with occupational exposure to ionising irradiation is limited. There is moderate evidence for an increased risk among smelter workers, and limited evidence for carbon disulfide. The evidence for dynamite, motor exhaust and other combustion products is insufficient. Conclusions This review identified limited evidence for an association between several chemical and physical occupational exposures and stroke. The few available studies on smelter workers all showed indications of an increased risk of stroke, and this association needs further investigation. 0252OCCUPATION AND SURGERY FOR SUBACROMIAL IMPINGEMENT SYNDROME -A NATIONWIDE DANISH COHORT STUDY Objectives Little is known about the time window for accumulation of occupational exposures and shoulder disorders. We aimed to evaluate cumulative occupational shoulder exposures as risk factors for surgery for subacromial impingement syndrome (SIS), and to examine how long the relevant exposure time period is. Method We conducted a nationwide register study of all persons born in Denmark (1933Denmark ( -1977, with at least 5 years of full-time employment (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007). In the follow-up period (2003)(2004)(2005)(2006)(2007)(2008), first-time events of surgery for SIS were identified. Cumulative exposure estimates for a 10-year period were obtained by linking occupational codes with a job exposure matrix. Exposure estimates were expressed according to the pack-year concept of smoking (e.g. arm-elevation-years). We used logistic regression equivalent to discrete survival analysis with a one year time lag, adjusting for age, sex, region, and calendar year, and compared the ORs for exposure time windows of increasing length. Results The adjusted OR (ORadjusted) for surgery for SIS reached 2.0 for arm-elevation-years, repetitive-movement-years, and force-years, and the ORadjusted for hand-arm-vibrationyears reached 1.5. We found an increase in ORadjusted from 1.0 to 2.1 when expanding the exposure time window from 2 to 10 years back in time. Conclusions Our findings suggested that upper arm-elevation, repetitive movements, forceful exertions, and hand-arm-vibration were risk factors for surgery for SIS, and indicated a cumulative exposure effect within a 10 year time span. Objectives Commuting accidents are accidents occurring while travelling to and from work, and in the course of work. Effort to reducing commuting accidents is important in managing occupational accidents. In Malaysia, the number of claims for commuting accident has showed an increased of 28.3% (17 170 to 22 036) from 2001 to 2010, compared to a decreased in number workplace accident claims by 31.8% (61 163 to 35 603). This increase was despite the total number motor vehicle casualties decreased by...