Hospital Patient Care Workers Research Articles

Adding injury to insult: Unfair treatment at work and occupational injury among hospital patient-care workers.

Hospital patient-care workers have high occupational injury rates. While physical hazards within hospital work environments are established determinants of injury, social exposures may also contribute. This study examined how reports of unfair treatment at work, a dimension of work-related experiences of discrimination, were associated with injury among hospital-based patient-care workers. We used data from the Boston Hospital Workers Health Study, a longitudinal cohort of nurses and nursing assistants at two Boston-area hospitals. In 2018, we conducted a worker survey asking about three types of unfair treatment at work and occupational injuries during the past year. We used mixed-effects logistic regression models to evaluate associations between specific types, total load, and high-frequency exposure of unfair treatment with injury, adjusting for age, gender, race and ethnicity, job title, and unit type. Among 1001 respondents, 21% reported being humiliated in front of others at work, 28% reported being watched more closely than other workers, and 47% reported having to work twice as hard as others for the same treatment. For each type of unfair treatment, we observed a monotonic relationship with occupational injury wherein increasing frequency of exposure was associated with increased odds of injury. We also observed monotonic relationships between total load and high-frequency exposure to unfair treatment and odds of injury. Work-related unfair treatment is associated with injury among hospital workers. Programs and policies that focus on preventing unfair treatment may lessen injury burden in hospital workers.

Job satisfaction and the psychosocial work environment: Does the relationship vary by hospital patient care workers’ age?

Increasing job satisfaction of healthcare workers is important for workers themselves, their employers, and their patients. This study draws on a sample of 1,409 patient care workers across two hospitals in the United States to explore the moderating effect of age in associations between job satisfaction and individual-workplace psychosocial exposures. Psychosocial work factors analyzed include job flexibility, job demands, decision latitude, break practices, and meal breaks. Contrary to mainstream management discourse, our findings suggest that most situational determinants of job satisfaction may not vary significantly by age. Findings can be used to inform occupational social work practice and future directions for managing employee behavioral health.

Mental Health Expenditures: Association With Workplace Incivility and Bullying Among Hospital Patient Care Workers.

Bullied workers have poor self-reported mental health; monetary costs of bullying exposure are unknown. We tested associations between bullying and health plan claims for mental health diagnoses. We used data from 793 hospital workers who answered questions about bullying in a survey and subscribed to the group health plan. We used two-part models to test associations between types of incivility/bullying and mental health expenditures. Workers experiencing incivility or bullying had greater odds of any mental health claims. Among claimants, unexposed workers spent $792, those experiencing one type of incivility or bullying spent $1557 (P for difference from unexposed = 0.016), those experiencing two types spent $928 (P = 0.503), and those experiencing three types spent $1446 (P = 0.040). Workplace incivility and bullying may carry monetary costs to employers, which could be controlled through work environment modification.

The relationship between organizational policies and practices and work limitations among hospital patient care workers.

We examined relationships between organizational policies and practices (OPPs) (safety practices, ergonomic practices, and people-oriented culture) and work limitations in a sample of hospital workers. We used the 6-item Work Limitations Questionnaire (WLQ) to assess workers' perceptions of health-related work limitations. Self-reported OPPs and the WLQ were collected from workers in Boston, Massachusetts (n = 1277). We conducted random-intercept multi-level logistic regression models for each OPP using stepwise selection of covariates. As the unit-average ergonomic practice score increased by one, the odds of a worker reporting work limitations decreased by approximately 39% (P-value = 0.018), adjusted for job title, age, and body mass index. A similar relationship existed for people-oriented culture (P-value = 0.038). The association between safety practices and work limitations was similar, but not statistically significant. This study demonstrated the importance of workplace OPPs. OPPs that promote positive and supportive environments and that foster improvements in ergonomics may help reduce work limitations.

Preventive care utilization: Association with individual- and workgroup-level policy and practice perceptions

Preventive medical care may reduce downstream medical costs and reduce population burden of disease. However, although social, demographic, and geographic determinants of preventive care have been studied, there is little information about how the workplace affects preventive care utilization. This study examines how four types of organizational policies and practices (OPPs) are associated with individual workers' preventive care utilization. We used data collected in 2012 from 838 hospital patient care workers, grouped in 84 patient care units at two hospitals in Boston. Via survey, we assessed individuals' perceptions of four types of OPPs on their work units. We linked the survey data to a database containing detailed information on medical expenditures. Using multilevel models, we tested whether individual-level perceptions, workgroup-average perceptions, and their combination were associated with individual workers' preventive care utilization (measured by number of preventive care encounters over a two-year period). Adjusting for worker characteristics, higher individual-level perceptions of workplace flexibility were associated with greater preventive care utilization. Higher average unit-level perceptions of people-oriented culture, ergonomic practices, and flexibility were associated with greater preventive care utilization. Overall, we find that workplace policies and practices supporting flexibility, ergonomics, and people-oriented culture are associated with positive preventive care-seeking behavior among workers, with some policies and practices operating at the individual level and some at the group level. Improving the work environment could impact employers' health-related expenditures and improve workers' health-related quality of life.

Obscured by administrative data? Racial disparities in occupational injury.

Objectives Underreporting of occupational injuries is well documented, but underreporting patterns may vary by worker characteristics, obscuring disparities. We tested for racial and ethnic differences in injury reporting patterns by comparing injuries reported via research survey and administrative injury database in the same group of healthcare workers in the US. Methods We used data from a cohort of 1568 hospital patient-care workers who were asked via survey whether they had been injured at work during the year prior (self-reported injury; N=244). Using the hospital's injury database, we determined whether the same workers had reported injuries to the hospital's occupational health service during that year (administratively reported injury; N=126). We compared data sources to test for racial and ethnic differences in injury reporting practices. Results In logistic regression models adjusted for demographic and occupational characteristics, black workers' odds of injury as measured by self-report data were 1.91 [95% confidence interval (95% CI) 1.04-3.49] compared with white workers. The same black workers' odds of injury as measured by administrative data were 1.22 (95% CI 0.54-2.77) compared with white workers. Conclusions The undercount of occupational injuries in administrative versus self-report data may be greater among black compared to white workers, leading to underestimates of racial disparities in workplace injury.

Worker assessments of organizational practices and psychosocial work environment are associated with musculoskeletal injuries in hospital patient care workers.

Hospital patient care (PC) workers have high rates of workplace injuries, particularly musculoskeletal injuries. Despite a wide spectrum of documented health hazards, little is known about the association between psychosocial factors at work and OSHA-recordable musculoskeletal injuries. PC-workers (n = 1,572, 79%) completed surveys assessing a number of organizational, psychosocial and psychological variables. Associations between the survey responses and injury records were tested using bivariate and multivariate analyses. A 5% of the PC-workers had at least one OSHA-recordable musculoskeletal injury over the year, and the injuries were significantly associated with: organizational factors (lower people-oriented culture), psychosocial factors (lower supervisor support), and structural factors (job title: being a patient care assistant). The results show support for a multifactorial understanding of musculoskeletal injuries in hospital PC-workers. An increased focus on the various dimensions associated with injury reports, particularly the organizational and psychosocial factors, could contribute to more efficient interventions and programs.

Association between perceived inadequate staffing and musculoskeletal pain among hospital patient care workers

To examine association between perceived inadequate staffing and musculoskeletal pain and to evaluate the role of work-related psychosocial and physical work factors in the association among hospital patient care workers. A cross-sectional study was conducted among 1,572 patient care workers in two academic hospitals. Perceived inadequate staffing was measured using the "staffing adequacy subscale" of Nursing Work Index, which is a continuous scale that averages estimates of staffing adequacy by workers in the same units. Musculoskeletal pain (i.e., neck/shoulder, arm, low back, lower extremity, any musculoskeletal pain, and the number of area in pain) in the past 3 months was assessed using a self-reported Nordic questionnaire. Multilevel logistic regression was applied to examine associations between perceived inadequate staffing and musculoskeletal pain, considering clustering among the workers in the same units. We found significant associations of perceived inadequate staffing with back pain (OR 1.50, 95 % CI 1.06, 2.14) and the number of body area in pain (OR 1.42, 95 % CI 1.01, 2.00) after adjusting for confounders including work characteristics (job title, having a second job or not, day shift or not, and worked hours per week). When we additionally adjusted for physical work factors (i.e., use of a lifting device, and the amount of the time for each of five physical activities on the job), only the association between perceived inadequate staffing and back pain remained significant (OR 1.50, 95 % CI 1.03, 2.19), whereas none of the associations was significant for all of musculoskeletal pains including back pain (OR 0.96, 95 % CI 0.66, 1.41) when we additionally adjusted for work-related psychosocial factors (i.e., job demands, job control, supervisor support, and co-worker support) instead of physical work factors. Perceived inadequate staffing may be associated with higher prevalence of back pain, and work-related psychosocial factor may play an important role in the potential pathway linking staffing level to back pain among hospital workers.

Association between work–family conflict and musculoskeletal pain among hospital patient care workers

A growing body of evidence suggests that work-family conflict is an important risk factor for workers' health and well-being. The goal of this study is to examine association between work-family conflict and musculoskeletal pain among hospital patient care workers. We analyzed a cross-sectional survey of 1,119 hospital patient care workers in 105 units in two urban, academic hospitals. Work-family conflict was measured by 5-item Work-Family Conflict Scale questionnaire. Multilevel logistic regression was applied to examine associations between work-family conflict and self-reported musculoskeletal pain in the past 3 months, adjusting for covariates including work-related psychosocial factors and physical work factors. In fully adjusted models, high work-family conflict was strongly associated with neck or shoulder pain (OR: 2.34, 95% CI: 1.64-3.34), arm pain (OR: 2.79, 95% CI: 1.64-4.75), lower extremity pain (OR: 2.20, 95% CI: 1.54-3.15) and any musculoskeletal pain (OR: 2.45, 95% CI: 1.56-3.85), and a number of body areas in pain (OR: 2.47, 95% CI: 1.82-3.36) in the past 3 months. The association with low back pain was attenuated and became non-significant after adjusting for covariates. Given the consistent associations between work-family conflict and self-reported musculoskeletal pains, the results suggest that work-family conflict could be an important domain for health promotion and workplace policy development among hospital patient care workers.

Relationship of Sleep Deficiency to Perceived Pain and Functional Limitations in Hospital Patient Care Workers

Health care workers are at high risk of developing musculoskeletal symptoms and pain. This study tested the hypothesis that sleep deficiency is associated with pain, functional limitations, and physical limitations that interfere with work. Hospital patient care workers completed a survey (79% response rate) including measures of health, sociodemographic, and workplace factors. Associations of sleep deficiency with pain, work interference due to this pain, and functional limitations were determined. Of 1572 respondents (90% women; mean age, 41 years), 57% reported sleep deficiency, 73% pain in last 3 months, 33% work interference, and 18% functional limitation. Sleep deficiency was associated with higher rates of pain, work interference, and functional limitation controlling for socioeconomic, individual, and workplace characteristics. Sleep deficiency is significantly associated with pain, functional limitation, and workplace interference, suggesting modifiable outcomes for workplace health and safety interventions.

Musculoskeletal Pain and Psychological Distress in Hospital Patient Care Workers

The aim of the study was to assess the association of psychological distress and musculoskeletal pain, how it is related to pain interference with work and multiple pain areas, and potential differences between the different pain areas in hospital patient care workers. Data were collected from a cross-sectional survey of patient care workers (n = 1,572) from two large hospitals. Patient care workers with musculoskeletal pain reported significantly more psychological distress than those without pain. Psychological distress was significantly related to pain interference with work, even after adjusting for pain and demographics (OR = 1.05; CI = 1.01-1.09). The association was strongest for those with both upper- and lower body pain (OR = 1.12; CI = 1.06-1.18). Psychological distress was also independently associated with multiple pain areas. Psychological distress was found to be higher in workers with musculoskeletal pain, and highest among workers with both upper and lower body pain. Distress was further significantly associated with pain interference with work as well as number of pain areas. The findings may be followed up with a longitudinal design to better determine the direction of the associations, and to investigate if psychological distress increases the risk of work disability and injuries.

The Role of the Work Context in Multiple Wellness Outcomes for Hospital Patient Care Workers

To examine the relationships among low back pain (LBP), inadequate physical activity, and sleep deficiency among patient care workers, and of these outcomes to work context. A cross-sectional survey of patient care workers (N = 1572, response rate = 79%). A total of 53% reported LBP, 46%, inadequate physical activity, and 59%, sleep deficiency. Inadequate physical activity and sleep deficiency were associated (P = 0.02), but LBP was not significantly related to either. Increased risk of LBP was significantly related to job demands, harassment at work, decreased supervisor support, and job title. Inadequate physical activity was significantly associated with low decision latitude. Sleep deficiency was significantly related to low supervisor support, harassment at work, low ergonomic practices, people-oriented culture, and job title. These findings point to shared pathways in the work environment that jointly influence multiple health and well-being outcomes.