Which resources moderate the effects of demanding work schedules on nurses working in residential elder care? A longitudinal study

Abstract

Background

Shiftwork is a major job demand for nurses and has been related to various negative consequences. Research suggests that personal and job resources moderate the impact of work schedules on stress, health and well-being.

Objectives

This longitudinal study examined whether the interactions of personal and job resources with work schedule demands predicted work engagement and emotional exhaustion in nursing.

Design

This longitudinal study included two waves of data collection with a one year follow-up using self-report questionnaires among 247 nurses working shifts or irregular working hours in residential care for the elderly in the Netherlands.

Methods

Moderated structural equation modelling was conducted to examine the interactions between personal and job resources and work schedule demands. Two work schedule demands were assessed: type of work schedule (demanding vs. less demanding) and average weekly working hours. Two personal resources, active coping and healthy lifestyle, and two job resources, work schedule control and the work schedule fit with nurses’ private life, were assessed.

Results

Results showed that the work schedule fit with nurses’ private life buffered the relationship between work schedule demands and emotional exhaustion one year later. Furthermore, the work schedule fit with nurses’ private life increased work engagement one year later when work schedule demands were high. Work schedule control strengthened the positive relationship between work schedule demands and emotional exhaustion one year later. The personal resources, active coping and healthy lifestyle were no moderators in this model.

Conclusion

Nurses suffer less from decreasing work engagement and emotional exhaustion due to work schedule demands when their work schedules fit with their private lives. Work schedule control did not buffer, but strengthened the positive relationship between weekly working hours and emotional exhaustion one year later. Job resources appeared to be more important for nurses’ well-being than personal resources. These findings highlight the importance of the fit of a work schedule with nurse's private life, if the work schedule is demanding.

Introduction

Shiftwork is a major job demand experienced by many nurses (Demerouti et al., 2000, McVicar, 2003). It has been related to negative consequences, such as burnout, health problems, decreased motivation, high turnover, decreased work ability, cardiovascular disease, problems with recruitment and retention (Brown et al., 2009, Burch et al., 2009, Jamal, 2004, McVicar, 2003, Nabe-Nielsen et al., 2010, Puttonen et al., 2010, Samaha et al., 2007, Wisetborisut et al., 2014).

Research suggests that personal resources, such as coping styles, good sleep quality and physical activity, moderate the impact of work schedules on stress, subjective health, cardiovascular disease and burnout (Caruso et al., 2006, Puttonen et al., 2010, Taylor et al., 1997). A cross-sectional study indicated that the fit of the work schedule with nurses’ private life moderates the impact of work schedule demands on subjective health (Peters et al., 2011). Because it may be difficult to change work schedule systems, especially in the short term, another way to limit negative effects on health and well-being is to pinpoint the resources that help workers tolerate demanding schedules (McVicar, 2003, Pallesen et al., 2010, Samaha et al., 2007). However, research on how personal and job resources moderate the negative effects of work schedule demands are scarce (Caruso et al., 2006).

This study concentrates on the specific demands of work schedules and its effect on emotional exhaustion and work engagement. Job demands refer to those physical, psychological, social or organizational aspects of work that require sustained physical or psychological (cognitive and emotional) effort or skills. They may turn into stressors when poorly designed jobs or chronic job demands (e.g. work overload, emotional demands) exhaust employees’ mental and physical resources, leading to the depletion of energy and, in turn, health problems such as emotional exhaustion. Although there is debate about which work schedules cause more negative consequences, rotating three-shift systems, irregular schedules and nightshifts have been found to have more negative consequences than other work schedules (Garrosa et al., 2011, Jamal, 2004, Muecke, 2005, Winwood et al., 2006). Another important work schedule demand is the duration of working hours (Lipscomb et al., 2002). Long working hours are positively related to negative mental and physical health indicators (Dall’Ora et al., 2015, De Raeve et al., 2007, Geiger-Brown et al., 2004, Jansen et al., 2003, Lipscomb et al., 2002, Stimpfel et al., 2012).

Given that work schedules are an on-going source of stress, personal and job resources can be expected to buffer the negative effects of work schedule demands on health (Caruso et al., 2004, Schaufeli and Taris, 2014, Tenkanen et al., 1998, Totterdell, 2005). According to the Conservation Of Resources (COR) theory, resources are entities that have intrinsic or instrumental value, including objects, conditions, personal resources, and energy resources (Gorgievski and Hobfoll, 2008). Job resources are those aspects of work that facilitate the achievement of goals and minimize the effects of job demands. They are functional in accomplishing work goals, and stimulate personal growth and development (Bakker and Demerouti, 2007). Personal resources are aspects of the self that are generally linked to resilience. They pertain to individuals’ ability to control and influence their environment successfully, especially during challenging circumstances (Hobfoll et al., 2003). Resources seem to particularly influence work engagement when demands are high (Bakker and Demerouti, 2007). There is evidence that the above mentioned resources are especially effective in protecting employees from the adverse effects of stressors when they are matched to the specific stressor (Van den Tooren and de Jonge, 2008, Zacher et al., 2012). For example Zacher et al. (2012) found that employees’ satisfaction with eldercare tasks buffered the negative relationship between demands and work performance. However, research on the effect of the interaction between work schedule demands and personal and job resources in relation to work engagement and burnout is scarce and longitudinal research is particularly needed (Caruso et al., 2006, Pallesen et al., 2010, Simpson, 2009).

In view of the specific demands of shift work, this study focuses on active coping and on healthy lifestyle as personal resources. There is considerable variability in the extent to which individuals adapt to shiftwork (Wilson, 2002). There are indications that personal resources of a more practical behavioural nature can be expected to moderate the negative consequences of work schedule demands (Beutell, 2010, Caruso et al., 2006, Peeters and Rutte, 2005, Tucker and Knowles, 2008).

Coping refers to behavioural and cognitive efforts to manage situations that are perceived to tax personal resources. Active coping, conceptualized as behaviour aimed at addressing problems at work by cognitively analysing the situation or by taking action to solve or overcome the problem (Schaufeli, 2001). Active coping is a key personal resource in COR theory as it reflects aspects of the self that are generally linked to resilience (Weigl et al., 2010). Active coping has been found to protect against burnout among nurses (De Rijk et al., 1998, Garrosa et al., 2010, Parkes, 1990, Sasaki et al., 2009) and has also been found to moderate the negative health effects of job demands on dimensions of burnout (De Rijk et al., 1998, Parkes, 1990).

Healthy lifestyle is a collective pattern of health-related behaviour (Siegrist and Rodel, 2006, Tenkanen et al., 1998) and is in line with the common sense idea that a healthy life is linked to resilience (Ten Brummelhuis and Bakker, 2012). It can be defined as personal behavioural resource and includes adherence to adequate physical activity, abstinence from smoking, consuming limited or no alcohol, and healthy eating (Pronk et al., 2010). In this study, quality of sleep was added as an indicator of shiftworkers’ capacity to adapt their behaviour to the demands of their work schedule. Adherence to a healthy lifestyle, according to some authors (Caruso et al., 2006, Heerkens et al., 2004), should be expected to moderate the effects of work schedule demands on health and may act as a personal resource (Hobfoll, 2001, Roe, 1999, Steffy et al., 1990) in three ways. First, it may improve health, thereby enhancing employees’ resilience and capacity to manage stress. Second, it may reduce the physiological arousal that typically occurs in stressful situations. Third, it may encourage relaxation either during or shortly after psychological and physiological arousal, thereby preventing a build-up of tension. Cross-sectional studies among nurses, and longitudinal studies among other occupational groups, show positive relationships between healthy lifestyle factors and less fatigue, less psychological distress, higher work performance and higher mental health (Bultmann et al., 2002, Pronk et al., 2010, Pronk et al., 2004, Samaha et al., 2007, Winwood et al., 2007). To date, there has been no published research focusing on the interaction between work schedule demands and healthy lifestyle in nursing.

Jobs can offer resources to nurses to assist them to withstand work schedule demands. This study focuses specifically on two job resources, work schedule control and the work schedule fit with the nurses’ private life.

Work schedule control (WSC) refers to the worker's ability to influence the duration, timing, and distribution of working hours (Harma, 2006). Perceived control is a resource that can diminish the impact of the work schedule on mental health and burnout, especially for female employees (Ala-Mursula et al., 2005, Bohle et al., 2011, Krausz et al., 2000, McNamara et al., 2011, Tucker and Knowles, 2008). In a large prospective cohort study of health care workers, the combination of shiftwork and moderate or low control over working time was associated with less vitality, worse mental health, and more somatic stress compared to high control over working time (Nabe-Nielsen et al., 2011).

Another aspect of the job concerns the extent to which the work schedule fits with nurses’ private life, particularly in relation to leisure time, family and social circumstances, sleep and work–leisure time balance (Beutell, 2010, Peters et al., 2009). This appeared to be an important concept. Peters et al. (2011) found indications that the extent to which the work schedule fits with nurses’ private life moderated the relationships between work schedule demands and both emotional exhaustion and health complaints. The extent to which their work schedule fits with private life is not only related to objective characteristics, such as duration of work and flexitime, but also to positive and negative consequences (Krausz et al., 2000, Nabe-Nielsen et al., 2010). A large study among European nurses, the Nurses’ Early Exit Study (NEXT study), indicated that it was not the work schedule itself, but rather the discrepancies between individuals’ wishes and the schedule, that affected turnover intention (Hasselhorn et al., 2005) and highlighted the positive aspects of the work schedule in relation to the private life.

Burnout is a unique type of stress syndrome that includes emotional exhaustion, depersonalization (or cynicism), and diminished personal accomplishment (De Rijk et al., 1998, Schaufeli and Van Dierendonck, 2000). Work engagement is a positive, work-related state of fulfilment that is characterized by vigour, dedication, and absorption (Schaufeli and Bakker, 2004). According to Bakker et al. (2008), it can be seen as the opposite of burnout. Emotional exhaustion, the main dimension of burnout (Goodman and Boss, 2002, Tourigny et al., 2013, Wright and Cropanzano, 1998) and vigour are opposite ends of the energy dimension of work engagement, while cynicism and dedication are opposite ends of an underlying attitudinal dimension (Demerouti et al., 2010). The inclusion of work engagement reflects the growing interest in the benefits of work and not just in its negative effects.

It is widely assumed that shiftwork contributes to stress reactions and negative health effects in a comparable way to other occupational stressors and processes (Harma, 2006, Olsson et al., 1990, Totterdell, 2005). A considerable number of theories about work-related stressors and health have been developed in the past. In these models, causes and outcomes are more or less conceptually integrated and ordered into a causal pattern of relationships. A well-known example is the Job Demand-Control model (Karasek and Theorell, 1990). The most innovative aspect of this model was that psychological strains were considered a consequence of the interaction effects of job demands and job control. More recent developed models emphasize, merely build upon the COR theory, not only the effect of demands but also of resources on health effects, e.g. the Job Demand-Resources model (JD-R). According to this JD-R model, each occupation has its own specific risk factors associated with job-related stress and can be applied to various occupational settings, irrespective of the particular demands and resources involved (Demerouti and Bakker, 2011). Elaborating on this JD-R model, we stated the following research model for studying the moderation effects of personal and job resources (Demerouti et al., 2001, Hobfoll et al., 2003, Schaufeli and Taris, 2014). Resources are assumed to buffer the impact of job demands on job strain, including burnout. The interaction of job demands and resources affects engagement and burnout (Bakker and Demerouti, 2007, Schaufeli and Taris, 2014). Hobfoll et al. (2003) propose that resources are particularly used when demands are high.

The present study aims to identify and understand the role of these resources in order to develop or provide input for interventions to enhance nurses’ work engagement and to prevent burnout.

In line with the theoretical and empirical findings above, the following hypotheses were formulated (and incorporated in the research model, see Fig. 1).

Hypothesis 1

Work schedule demands predict higher emotional exhaustion.

Hypothesis 2a

Personal resources predict greater work engagement.

Hypothesis 2b

Job resources predict greater work engagement.

Hypothesis 3a

Personal resources buffer the relationship between work schedule demands and emotional exhaustion.

Hypothesis 3b

Job resources buffer the relationship between work schedule demands and emotional exhaustion.

Hypothesis 4a

Personal resources particularly predict work engagement under conditions of high work schedule demands.

Hypothesis 4b

Job resources particularly predict work engagement under conditions of high work schedule demands.