BackgroundNurses’ intention to leave their profession is a worldwide concern. Studies have shown that it can take the form of a chain reaction: many nurses first leave the unit, then the hospital, and finally the profession. Organisation and other labour factors, personal and conjunctural, have been associated with the intention to quit nursing. This study aimed to examine the factors associated with the intention to leave the profession among registered nurses (RNs) at large public hospitals in Brazil.MethodsThis was a cross-sectional study, conducted from 2010 to 2011: all RNs at Rio de Janeiro’s 18 largest public hospitals (>150 beds) were invited to participate. The study sample comprised 3,229 RNs (82.7% of those eligible), who answered a self-completed, multidimensional paper questionnaire. The outcome was defined as thoughts of leaving the profession sometimes a month or more. We based the analyses on hierarchical logistic regression models, considering three blocks of determinants: socio-demographic data (block I), occupational factors (block II), and health conditions (block III).ResultsOf the study population, 22.1% indicated the intention to leave the profession. In the final model after adjustment, the variables associated with the intention to leave were as follows: male sex (odds ratio [OR] = 1.65), not holding a leadership position (OR = 1.28), highly demanding work (OR = 2.49), passive work (OR = 2.10), effort-reward imbalance (OR = 2.00), poor self-rated health (OR = 1.92), over-commitment to the job (OR = 1.87), and poor supervisor support (OR = 1.33). The likelihood of expressing the intention to leave increased with age (OR = 0.98 for the oldest).ConclusionsSelf-rated health and factors connected with the work environment, particularly those that generate psychosocial strain, were most strongly associated with the intention to leave the profession. From the profiles of nurses who wished to leave the profession, we found that for many people who go into nursing—especially men and younger entrants—their prospects of remaining in the profession are poor. The potential role of psychosocial job characteristics and self-rated health indicates the need for long-term action involving all stakeholders, i.e. managers, employers, and workers.

Resumo: Este artigo trata, em um primeiro momento, de fatores subjacentes às diferenças individuais quanto à tolerância ao trabalho em turnos e noturno. Associadas a esses fatores, também são apresentadas caracterís-ticas do trabalho que podem ou não favorecer a tolerância ao trabalho em turnos. Em um segundo momento, apresenta-se medidas de intervenção que visam minimizar as dificuldades enfrentadas pelos trabalhadores quanto à saúde e ao bem-estar orgânico e social. Palavras-chave: trabalho em turnos; organização do trabalho; ergonomia.Abstract: This article first addresses the underlying factors determining the varying tolerance of individuals to swing and night shifts. Also discussed are features of specific jobs that may or may not favor the tolerance to variable and evening shifts. The second part of this article proposed measures to improve workers' health and physical and social well-being. tualmente, existem no Brasil cerca de 64 milhões de pessoas com 10 anos ou mais ocupadas em vários tipos de trabalho, conforme dados obtidos pelo recenseamento realizado no ano 2000. 1 Quase a metade dessa população (cerca de 28 milhões) trabalha mais que as 44 horas semanais, previstas na Constituição de 1988 como a jornada máxima de trabalho semanal. Para que essa jornada semanal seja cumprida, parece bastante razoável supor que, pelo menos no caso de parte desses trabalhadores, o trabalho seja exercido além do horário diurno. Há, portanto, uma parcela da população economicamente ativa que, além de trabalhar mais que o núme-ro de horas semanais previstas em lei, ainda o faz em horário noturno.Adiciona-se a essa parcela de trabalhadores os que, embora não trabalhem mais que 44 horas semanais, o fazem em horários não usuais e obtém-se o número de trabalhadores em turnos e noturnos da população brasileira. Infelizmente, não há dados oficiais sobre o tamanho dessa população em nível nacional. Em 1994, levantamento da Fundação SEADE na área metropolitana de São Paulo caracterizou como trabalhador em turnos ou noturno 8,6% da população (Fischer et al., 1995). Valendo-se desses dados, estima-se haver cerca de 10% da população brasileira ativa que trabalha em turnos ou à noite. Acredita-se que essa porcentagem seja até maior, uma vez que o oferecimento de serviços disponíveis muitas horas por dia, durante os dias de semana e fins de semana, vêm aumentando nos últimos anos. Pode-se citar, como exemplos, todos os serviços de telecomunicações, de processamento bancário, de distribuição de correspondência rápida, os centros de compras (shopping centers, supermercados), hotéis, lazer (cinemas, restaurantes, academias de ginás-tica, clubes sociais e esportivos), serviços educacionais. Em outras palavras, além dos serviços essenciais há uma quantidade cada vez maior de produção de bens e prestação de serviços que funcionam ininterruptamente. Para que esses bens sejam produzidos e os serviços prestados vem ocorrendo aumento da população que trabalha em turnos, em horário noturno ou em horários irregulares.A demógrafa americana Harr...

Working time arrangements that require shift work or other non-standard working hours have significant potential to encroach on time that is highly valued for family, social and leisure activity. This can often result in workers experiencing poorer work-family or work-life balance. Based on an extensive literature search and expert knowledge, primary risk factors were identified including shift work; long, irregular and unpredictable working hours; and work on evenings and weekends (in combination and independent of shift work). On the other hand, flexibility, in the form of adequate worker control over work schedules, may be a protective factor. In addition, workers experiencing excessive work-life conflict are likely to reduce their working hours, reflecting a reciprocal relationship between working hours and work-life balance. Workers' families are also affected by shift work and non-standard working hours. Parents' shift work is associated with poorer emotional and developmental outcomes for their children, and to a greater likelihood of risky behavior in adolescence. Additionally, the risk of separation or divorce is increased, especially for parents working night shifts. Due to relationships such as those above, the consequences of shiftwork and non-standard working hours on family and social life are largely dependent on a complex interaction between specific work schedules, other aspects of work organization, and family and individual worker characteristics. This article provides an overview of current evidence regarding the relationships between working time arrangements and various social and family variables, and concludes with shift scheduling and intervention recommendations to improve work-life balance and social well-being.

The effort-reward imbalance (ERI)

OBJECTIVE:To identify combinations of two models of psychosocial stress at work among nursing teams and their associations with self-rated health. METHODS:This was a cross-sectional study among workers at three public hospitals in the municipality of Rio de Janeiro, Southeastern Brazil (N = 1307). In 2006, a multidimensional questionnaire including two scales for measuring stress at work (demand-control and effort-reward imbalance models) was administered. Partial and complete (including social support at work) demand-control models were considered, along with partial and complete (including excessive commitment to work) effort-reward models. Multiple logistic regression models were used to estimate adjusted odds ratios and their respective 95% confi dence intervals. RESULTS:The dimensions of both models were independently associated with self-rated health, with odds ratios between 1.70 and 3.37. The partial demandcontrol model was less associated with health (OR = 1.79; 95%CI 1.26;2.53) than was the partial effort-reward imbalance model (OR = 2.27; 95%CI 1.57;3.30). Incorporation of social support and excessive commitment to work increased the strength of the demand-control and effort-reward imbalance models, respectively. Increased strength of association was observed when the two partial models were combined. CONCLUSIONS:The results indicate that the effort-reward imbalance model performed better for this specifi c group and for the outcome evaluated, and that there was an advantage in using complete models or combinations of partial models.

This cross-sectional exploratory study involved health care workers of various skill types and levels. We tested the hypothesis that the prevalence of diseases, sleep complaints, and insufficient time for nonprofessional activities (family, leisure, and rest) are higher among night than day workers. Data collection was carried out in two public hospitals using questionnaires and other forms. Night work was explored as a risk factor, considering a night worker as one who had at least one night job on the occasion of the research. Data were assessed by a univariate analysis. The association between work schedule and the dependent variables--health conditions, sleep complaints, and insufficient time for nonprofessional activities--was evaluated through the estimation of the prevalence ratio, with a confidence interval of 95%. Two hundred and fifty-eight female nursing personnel participated; 41.5% were moonlighters, and only 20 worked a shift of less than 12h in length. Reports of migraine and need of medical care the 2 weeks before the survey were more prevalent among day than night workers (PR=0.71; CI=0.55-0.92 and PR=0.71; CI=0.52-0.95, respectively). Migraine headaches occurred less frequently among night than day workers as confirmed by comparing the reports of the night workers and day workers whose work history was always day shifts (PR = 0.74; CI = 0.57-0.96). Reports of mild emotional disorders (mild depression, tension, anxiety, or insomnia) were less frequent among night (PR=0.76; CI=0.59-0.98) and ex-night workers (PR=0.68; CI=0.50-0.91) than day workers who never had worked a night job. The healthy worker effect does not seem to explain the results of the comparisons between day and night workers. The possible role of exposure by day workers to some risk factors, such as stress, was suggested as an explanation for these results. No significant difference was observed between night and day workers as to sleep complaints, a result that may have been influenced by the nature of the shift-work schedule (no successive night shifts) and possibly nap taking during the night shift. Moreover, the long work hours and moonlighting of the healthcare workers, which is common in Brazil, may have masked other possible differences between the day and night workers. Among night workers, a significant relation was found between years working nights (more than 10 yrs) and high cholesterol values (PR = 2.58; CI = 1.07-6.27), a result that deserves additional study. Working nights more than four times per 2-week span was related to complaints about insufficient time for children (PR= 1.96; CI = 1.38-2.78) and rest/leisure (PR= 1.54; CI = 1.20-1.99). These results can be related to the "social value of time," as evenings and nights are when families usually spend time together. The complexity of the professional life and the consequent heterogeneity of the group of workers under shift-work schemes confound the results. More in-depth study of the questions raised here demands a more sophisticated epidemiological treatment an...

OBJECTIVE: To analyze factors associated with self-reported sickness absenteeism among nursing workers. METHODS:Cross-sectional study with 1,509 workers from three public hospitals in the city of Rio de Janeiro (Southeastern Brazil) in 2006. Absenteeism was classifi ed in three levels: no day, a few days (1-9 days) and many days (≥ 10 days), based on the answer to a question of the work ability index questionnaire. The logistic regression analysis considered a conceptual model based on distal (socioeconomic status), intermediate I (occupational characteristics), intermediate II (lifestyle characteristics), and proximal (diseases and health conditions) determinants. RESULTS:The frequencies of sickness absenteeism were 20.3% and 16.6% for a few days and many days, respectively. Those who reported more than one job, musculoskeletal diseases and rated their health as poor or regular had higher odds of absenteeism. Compared to nurses, nursing assistants were less likely to mention a few days, and technicians were more likely to have many days of absence. Higher odds of mentioning many days of absence were observed among public servants, compared to contract workers (OR = 3.12; 95%CI 1.86;5.22), and among married (OR = 1.73; 95%CI 1.14;2.63) and separated, divorced and widowed individuals (OR = 2.06, 95%CI 1.27;3.35), compared to singles. CONCLUSIONS:Different variables were associated with the two forms of absenteeism, which suggests its multiple and complex determination related to factors from different levels that cannot be exclusively explained by health problems.

OBJECTIVE:To assess factors associated with professional and total hours of work (work + home) among nursing staff. METHODS:Cross-sectional study conducted in a university hospital in the city of São Paulo, southeastern Brazil, between 2004 and2005. A total of 696 workers (nurses, nurse technicians and aids), mostly women (87.8%) working day and/or night shifts, participated in the study. A selfadministered questionnaire was used to collected information on demographic characteristics, and working and life conditions. Translated and adapted into Portuguese versions of the Job Stress Scale, Effort-reward imbalance, ShortForm-Health-related quality of life and the Work Ability Index were also administered. Logistic regression models were used for data analysis. RESULTS:Sole breadwinner, working night shifts and effort-reward imbalance were the variables associated with both professional (OR = 3.38, OR = 10.43, OR = 2.07, respectively) and total hours of work (OR = 1.57, OR = 3.37, OR = 2.75, respectively). There was no signifi cant association between the variables related to hours of work and low Work Ability Index. Inadequate rest at home was statistically associated with professional (OR = 2.47) and total hours of work (OR = 1.48). Inadequate leisure time was signifi cantly associated with professional hours of work (OR = 1.58) and barely associated with total hours of work (OR = 1.43). CONCLUSIONS:The sole breadwinner, working night shifts and effortreward imbalance are variables that need to be further investigated in studies on work hours among nursing staff. These studies should explore workers' income and the relationship between effort and reward, taking into consideration gender issues.