Increased Job Demands Research Articles

Health and motivation as mediators of the effects of job demands, job control, job support, and role conflicts at work and home on sickness presenteeism and absenteeism

PurposeThe first objective was to contribute to a better understanding of the contrasting and paradoxical results in studies of work environment factors and sickness presence and sickness absence. A second objective was to examine if, and under what conditions, employees choose to replace sickness absence with sickness presence, i.e., so-called substitution.MethodsThe study utilizes a large body of cross-sectional questionnaire data (n = 130,161) gathered in Sweden from 2002 to 2007 in connection with a comprehensive health promotion initiative. Health and motivation were analyzed as mediators of the effects of five job factors, job control, job support, job demand, role conflict and “work to family conflict” on sickness presence and absence.ResultsThe results concerning job demands indicate substitution in that increased job demands are associated with increased presenteeism and reduced absenteeism. The direct effect of higher job support was increased absenteeism, but via the health and motivation paths, the total effect of more social support was health-promoting and associated with a reduction in sickness absence and sickness presence. High job control emerged as the most pronounced health-promoting factor, reducing sickness presenteeism as well as absenteeism. More role conflicts and work-to-family conflicts were directly and indirectly associated with decreased health and increased absenteeism as well as presenteeism. earlier research.ConclusionThe mediation analyzes shed light on some of the paradoxes in research on sickness presenteeism and sickness absenteeism, especially regarding job demands and job support. The substitution effect is important for workplace policy and occupational health practice.

Health behaviours and psychosocial working conditions as predictors of disability pension due to different diagnoses: a population-based study

BackgroundTo investigate whether the clustering of different health behaviours (i.e. physical activity, tobacco use and alcohol consumption) influences the associations between psychosocial working conditions and disability pension due to different diagnoses.MethodsA population-based sample of 24,987 Swedish twins born before 1958 were followed from national registers for disability pension until 2013. Baseline survey data in 1998–2003 were used to assess health behaviours and psychosocial Job Exposure Matrix for job control, job demands and social support. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI).ResultsDuring follow-up, 1252 disability pensions due to musculoskeletal disorders (5%), 601 due to mental diagnoses (2%) and 1162 due to other diagnoses (5%) occurred. In the models controlling for covariates, each one-unit increase in job demands was associated with higher (HR 1.16, 95%CI 1.01–1.33) and in job control with lower (HR 0.87, 95%CI 0.80–0.94) risk of disability pension due to musculoskeletal disorders among those with unhealthy behaviours. Among those with healthy behaviours, one-unit increase of social support was associated with a higher risk of disability pension due to mental and due to other diagnoses (HRs 1.29–1.30, 95%CI 1.04–1.63).ConclusionsJob control and job demands were associated with the risk of disability pension due to musculoskeletal disorders only among those with unhealthy behaviours. Social support was a risk factor for disability pension due to mental or other diagnoses among those with healthy behaviours. Workplaces and occupational health care should acknowledge these simultaneous circumstances in order to prevent disability pension.

Psychosocial working conditions, pain, mental disorders, and disability pension

We aimed to investigate associations between psychosocial working conditions and disability pension (DP), and the role of co-existing pain or common mental disorders (CMDs). Survey data collected 1998–2003 on 25,135 Swedish twins born 1935–1958 were linked with national DP register data until 2013. Psychosocial working conditions, pain and CMDs were analyzed by Cox proportional hazards regression models (hazard ratios with 95% confidence intervals). One unit increase in job demands or control was associated with a higher risk for DP due to musculoskeletal disorders. One unit decrease in job demands predicted lower risk of DP due to mental diagnoses. Co-existing pain or CMD played no role for associations of job demands with DP, but pain influenced the associations with DP due to mental diagnoses. To conclude, psychosocial working conditions play different roles for DP depending on the diagnoses.

Trends in Work Conditions and Associations with Workers' Health in Recent 15 Years: The Role of Job Automation Probability.

Job automation and associated psychosocial hazards are emerging workplace challenges. This study examined the trends in work conditions and associations with workers’ health over time in jobs with different automation probabilities. We utilized data from six waves of national questionnaire surveys of randomly selected 95,762 employees between 2001 and 2016. The Job Content Questionnaire, the Copenhagen Burnout Inventory, and the Self-Rated Health Scale were applied, and working time was self-reported. Automation probability was derived for 38 occupations and then categorized into three groups. Trends in work conditions and the associations between automation probability, work conditions and health were examined. We observed a 7% decrease in high automation probability jobs, an overall increase in job demands for and prevalence of shift work, and a decrease in job control. Workers with high automation probability jobs had low job demands, low job control and high job insecurity. Low automation probability was associated with burnout in logistic regression models. The odds ratio of job insecurity, long working hours, and shift work relating to health was higher in the later years of the surveys. In conclusion, there has been a decrease in high automation probability jobs. Workers employed in jobs with different levels of automation probability encountered different work condition challenges.

Three Types of Turnover and Team Performance: Three Distinctive Psychological Mechanisms

This research reveals three distinctive mechanisms through which different forms of turnover have impacts on team performance. In addition to the distinction between voluntary and involuntary turnover, the authors argue that the effects of involuntary turnover can be better understood by further classifying it into performance- driven involuntary turnover and misconduct-driven involuntary turnover. Supportive of the authors’ hypotheses, the analyses of multi-source (team members, department head, archive records) and multi-wave (three waves) longitudinal data from 481 sales employees in 139 sales teams in a Korean company show that the three forms of turnover affect team performance through different mechanisms. Voluntary turnover has a negative effect on team performance via increased job demands and decreased team potency. Involuntary performance turnover has a positive effect on team performance via decreased job demands and increased team potency, whereas involuntary misconduct turnover has a positive effect via increased justice climate. The authors present implications for research and practice of their theory and empirical findings.

Empathy and job resources buffer the effect of higher job demands on increased salivary alpha amylase awakening responses in direct-care workers

The job demands-resources (JD-R) model has rarely been used in conjunction with physiological indicators of stress and ill-health. This study explored the associations between the JD-R model and physiological indicators of the stress response, while considering potential moderators of this relationship. Across 2 timepoints (summer-winter) direct-care workers completed questionnaires assessing job demands, job resources, empathy and self-efficacy, and provided morning saliva samples to assess physiological indices of stress and ill-health. Changes in job resources and empathy were positively correlated with changes in the cortisol awakening response (CAR). Further, changes in both job resources and empathy independently buffered the impact of higher job demands on increased salivary alpha amylase awakening response (sAA-AR) concentrations. These findings suggest that despite increased job demands, the sAA-AR decreased for direct-care workers that had perceived high job resources or who reported higher empathy. Potentially, job resources and empathy may act as a protective factor against the development of poor health associated with workplace stress.

Specific components of a complex depression care program can affect staff outcomes differently: post-hoc analyses of a stepped-wedge cluster-randomized trial in nursing homes.

The Act in case of Depression program showed effects on the quality of life and depression in nursing home (NH) residents. We aimed to explore the effects of this complex multidisciplinary program on job satisfaction, job demands, and autonomy in nursing home staff. Four data points from a stepped-wedge cluster-randomized trial on patient outcomes were used for secondary analyses on staff outcomes. Sixteen dementia special care and 17 somatic care units in Dutch NHs.Participants were 717 (90.1%) care staff or trainees, 34 (4.3%) paramedical staff, and 45 (5.7%) other staff members.Intervention describes procedures for nursing staff, activity therapists, psychologists, and physicians. It contains evidence-based pathways for depression assessment, treatment, and monitoring treatment results. Mixed models for intention-to-treat analyses showed no significant changes in job demands, job satisfaction, or autonomy. Models corrected for the ratio of unit residents who received, when indicated, a specific program component revealed reduced job demands and improved job satisfaction and autonomy when treatment procedures were used. A better use of assessment procedures was associated with increased job demands, while conducting monitoring procedures was associated with increased job demands and decreased autonomy. Components of complex care programs may affect the staff outcomes in opposite directions and, taken together, produce a zero-sum or a statistically insignificant effect. While implementing treatment protocols affecting patients directly can also improve job outcomes such as satisfaction and autonomy and decrease job demands, it is possible that other procedures of complex programs may have unfavorable effects on job outcomes. It is important to account for specific components of complex interventions when evaluating intervention effects.

Is it worth it? Linking perceived high-performance work systems and emotional exhaustion: The mediating role of job demands and job resources

The present study utilizes the job demands–resources model and examines the effects of employees’ perceptions of high-performance work systems (HPWS) on emotional exhaustion. For the needs of this study, structural equation modeling (SEM) was used on a sample of 343 frontline employees in a Greek manufacturing company. The findings do not support the critical arguments regarding HPWS, which suggest that these systems lead to work intensification and emotional exhaustion through increased job demands. In contrast, HPWS was positively related to job resources, although no support was found for a direct and negative relationship with emotional exhaustion. Last but not least, this study calculates HPWS as both a system and bundles of practices and provides useful insights regarding the differences between the two different measurement methods. Finally, theoretical and managerial implications are drawn for improving our understanding of how HPWS influences job demands and resources and employees’ emotional exhaustion.

Exploring possible trade‐offs between organisational performance and employee well‐being: The role of teamwork practices

AbstractThere is growing evidence linking teamwork practices to performance outcomes. However, critics have raised concerns that such outcomes are achieved at the expense of increased job demands and stress among workers. Using large data from a representative sample of British workplaces (N = 4,311 workers in 664 workplaces), this study explores the pattern of relationships between teamwork practices, organisational performance, and employee well‐being. The study draws on a mutual gains model linking teamwork practices to organisational performance via affective commitment, and a conflicting outcomes model associated with high job demands and job‐related anxiety. The study also examines an interactive outcomes model that integrates the mutual gains and conflicting outcomes models. The study reports evidence that the performance gains of teamwork practices may actually come at the cost of increased job demands and job‐related anxiety. Nevertheless, these adverse outcomes tend to weaken at higher levels of affective commitment.

Development of job demands, decision authority and social support in industries with different gender composition \u2013 Sweden, 1991\u20132013

BackgroundThis study aims to explore the development of job demands, decision authority and social support within and between industries with different gender composition in Sweden between 1991 and 2013.MethodsCross-sectional data from 12 waves of the Swedish Work Environment Surveys (1991 to 2013), comprising in total 109,698 respondents, were used. Industries were classified in 7 categories according to its gender composition and main activity, comprising two female-dominated, three gender-mixed and two male-dominated industries. Proportions of workers reporting high job demands, low decision authority and poor social support between 1991 and 2013 were calculated. Logistic regression analyses were performed to estimate variation across time, using 1991 as the reference category, and between industries, using knowledge intensive services as the reference category. Estimates for high job demands, low decision authority and poor social support were presented as average marginal effects (AMEs).ResultsThe probabilities of reporting low decision authority were higher in education and health and social care during the whole study period, for both genders, compared with the reference category of knowledge intensive services. The probability of having high job demands were higher for men and women in education, and women in health and social care, compared with the reference category. Men in the male dominated industries had increased job demands over time, compared to the beginning of the study period (1991). The probability of reporting poor social support was higher in the later than in the earliest time period for women in the female-dominated industry health and social care as well as in the gender-mixed labour intensive services industry.ConclusionsThere has been a negative development of job demands and decision authority in the female-dominated industries education and health and social care in Sweden, whereas social support has developed more negatively for women in health and social care and in labour intensive services.

Mindful Emotion Regulation, Savouring and Proactive Behaviour: The Role of Supervisor Justice

The global financial crisis and recession‐prompted budget cuts represent significant challenges to public sector organisations, limiting their ability to make changes to job design and increasing job demands. In such environments, primary interventions targeted at changing the job or the work are not always viable. In this research, we examine the effectiveness of a mindful emotion regulation (MER) intervention versus a “control” savouring nature (SN) intervention in terms of facilitating the investment of work engagement into proactive behaviours. We also examine how the job resource of supervisor justice impacts these relationships. We collected data from an Irish public sector organisation using a cluster randomised controlled trial design. The final sample comprised 108 participants (MER = 74; SN = 34). Results highlight the valuable role that job resources play as boundary conditions of psychological‐based interventions since the success of MER and SN depended on the participants’ perceptions of supervisor justice. When supervisor justice was high, a restorative SN exercise was effective in promoting proactive behaviours. When supervisor justice was low, a more complex cognitive and emotional exercise in the form of MER was required. We explain these results and consider their implications for future research.

Burnout among school teachers: quantitative and qualitative results from a follow-up study in southern Sweden

BackgroundTeachers are at high risk of stress-related disorders. This longitudinal study aimed to (a) identify which occupational, sociodemographic and life-style factors and self-efficacy at baseline that were of importance for burnout, (b) explore associations between changes in the studied factors versus changes in burnout, and (c) by interviews increase the understanding of perceived job demands among teachers.MethodsA cohort of 310 Swedish teachers in school-years 4–9 responded to a questionnaire of occupational, sociodemographic and life-style factors, self-efficacy and burnout, at baseline and at follow-up (mean 30 months later). A combined measure with four levels of burnout was crafted, based on exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey). Quantitative data were analysed with multiple ordinal regression, and qualitative data were analysed with content analysis of interview responses from a subgroup of the teachers (n = 81).ResultsThe occurrence of high burnout (level 2 and 3 combined) were similar at baseline and follow-up (14% vs. 15%). However, many teachers fluctuated between the levels of burnout (28% increased and 24% decreased). Burnout at baseline was of importance for change of work or being off duty at follow up. In the multi-exposure model, low self-efficacy [OR 0.42; CI 0.26–0.68] and high job demands [OR 1.97; CI 1.02–3.8] were the strongest explanatory variables. Low self-efficacy remained as the strongest explanatory factor after adjustment for burnout at baseline. Increased job demands during follow-up was associated with an increased level of burnout [OR 3.41; CI 1.73–6.69], whereas increased decision latitude was associated with a decreased level of burnout [OR 0.51; CI 0.30–0.87]. Two major categories of demands emerged in the qualitative analysis; i.e. too high workload and a sense of inadequacy.ConclusionsA substantial proportion of teachers showed signs of burnout at both occasions. Low self-efficacy and high job demands was of importance for burnout, and changes in burnout was further associated with changes in decision latitude. The results points to the need of actions on individual, organizational and a societal levels.

Job satisfaction and guideline adherence among physicians: Moderating effects of perceived autonomy support and job control

Value-based purchasing of physician services aims to incentivize greater adherence to clinical practice guidelines. By increasing job demands, new reimbursement models could adversely affect job satisfaction and, indirectly, clinical performance. Studies of satisfaction-performance associations among healthcare practitioners have yielded inconsistent findings. We investigated whether physicians' perceptions of autonomy support and job control significantly moderate the relationship between practice satisfaction and guideline adherence in a pay-for-performance context. We performed secondary analysis of a study dataset created by merging prospective information on clinical services provided by Rochester (NY)-based primary physicians (N = 156) during the years 2001–2004 with census data on specific characteristics of their ambulatory-care populations, claims-sourced information on attributes of their primary care practices, and survey data on their work-related attitudes. Greater job satisfaction had a significant multivariate association with lower adherence (β = −0.139; p=<.0001) among physicians that perceived low autonomy support from the market-dominant payer organization. For physicians experiencing high autonomy support, a positive satisfaction-adherence association existed (β = 0.105; p=<.0001). Low job control was a negative moderator (β = −0.103; p=<.0001), and high control a positive moderator (β = 0.071; p=<.0001), of the influence of job satisfaction on guideline adherence. Given the limitations of this study, such as the cross-sectional survey data and potential for unmeasured confounding variables, the validity of our findings should be tested by future research. We conclude that payers attempting to over-direct partner physicians can demotivate the satisfied physicians from achieving top-level guideline adherence, thereby squandering opportunities for intrinsic satisfaction to improve guideline adherence. To optimize the potential for job satisfaction to motivate greater guideline adherence, it may be important for payers to be perceptibly more supportive of physicians’ autonomy and sense of job control.

Working from home: characteristics and outcomes of telework

PurposeThe purpose of this paper is to investigate the relationships between theoretically grounded telework factors and various individual and organizational outcomes of telework (overall satisfaction with telework, perceived advantages of telework, career opportunities and self-reported productivity).Design/methodology/approachBased on a literature review, ten telework factors that may affect individual and organizational telework outcomes were identified and empirically tested using the survey data of 128 teleworkers exercising different telework intensity and representing various sectors of the economy.FindingsThe bundle of theoretically selected variables explained a significant part of the variance of telework outcomes. Reduced communication with co-workers, supervisor’s trust and support, suitability of the working place at home were found to be the most important telework factors impacting different telework outcomes. Higher self-reported productivity was related to reduced time in communicating with co-workers, a suitable working place at home and the possibility to take care of family members when teleworking.Practical implicationsThis study provides insights about the management of telework in organizations by highlighting the factors that promote the satisfaction, productivity and perceived career opportunities of teleworkers.Originality/valueThis paper challenges the results of previous research on the factors related with telework and its outcomes. Based on the job demands-resources theory, the authors identified the factors that serve as resources in generating positive telework outcomes, and the factors increasing job demands and reducing satisfaction with telework.

Do personal resources matter beyond job demands and job resources? Main and interaction effects on health-related outcomes among women working within the welfare sector

Overall, health-related correlates of job demands and job resources are well-known. However, in today's working life, personal resources are considered to be of increasing importance. Beyond general mental ability, knowledge regarding personal resources remains limited. This is particularly so among women working in the welfare sector, a sector mainly employing women and with the work typically involving clients. This study investigated the importance of job demands, job resources, and personal resources for health-related outcomes, as well as the mitigating effects of resources, among women working within the Swedish welfare sector. Self-reports from 372 women employed within the welfare sector were analyzed using hierarchical multiple regression. Overall, increasing job demands were associated with poorer health outcomes while increasing job resources and personal resources were associated with better health. Additionally, lower control aggravated the effects of quantitative job demands on health outcomes while lower feedback mitigated the effect of qualitative demands. However, personal resources had no moderating effect. Job resources seem more pertinent to health than personal resources, at least among women working within the welfare sector in Sweden.

How Work Intensification Relates to Organization-Level Safety Performance: The Mediating Roles of Safety Climate, Safety Motivation, and Safety Knowledge.

Recent changes in the world of work have led to increased job demands with subsequent effects on occupational safety. Although work intensification has been linked to detrimental safety behavior and more accidents, there is so far no sufficient explanation for this relationship. This paper investigates the mediating roles of safety climate, safety motivation, and safety knowledge in the relationships of work intensification with components of safety performance at an organizational level. Safety engineers and managers from 122 Austrian high-accident companies participated in a cross-sectional survey. In line with our hypotheses, work intensification negatively related to both components of safety performance: safety compliance and safety participation. The results of a serial multiple mediation analysis further revealed safety climate and safety motivation to be serial mediators of the relationship between work intensification and safety performance. Unexpectedly, safety knowledge and safety climate only serially mediated the relationship between work intensification and safety compliance, but not the relationship between work intensification and safety participation. This study provides evidence for the detrimental effect of work intensification on safety performance across organizations. Additionally, this study offers an explanation as to how work intensification affects safety performance, enabling practitioners to protect their occupational safety procedures and policies from work intensification.

Job Demands, Burnout, and Teamwork in Healthcare Professionals Working in a General Hospital that Was Analysed At Two Points in Time

AIM:The purpose of the paper was to assess job demands, burnout, and teamwork in healthcare professionals (HPs) working in a general hospital that was analysed at two points in time with a time lag of three years.METHODS:Time 1 respondents (N = 325) were HPs who participated during the first wave of data collection (2011). Time 2 respondents (N = 197) were HPs from the same hospital who responded at Time 2 (2014). Job demands, burnout, and teamwork were measured with Hospital Experience Scale, Maslach Burnout Inventory, and Hospital Survey on Patient Safety Culture, respectively.RESULTS:Significantly higher scores of emotional exhaustion (21.03 vs. 15.37, t = 5.1, p < 0.001), depersonalization (4.48 vs. 2.75, t = 3.8, p < 0.001), as well as organizational (2.51 vs. 2.34, t = 2.38, p = 0.017), emotional (2.46 vs. 2.25, t = 3.68, p < 0.001), and cognitive (2.82 vs. 2.64, t = 2.68, p = 0.008) job demands were found at Time 2. Teamwork levels were similar at both points in time (Time 1 = 3.84 vs. Time 2 = 3.84, t = 0.043, p = 0.97).CONCLUSION:Actual longitudinal study revealed significantly higher mean values of emotional exhaustion and depersonalization in 2014 that could be explained by significantly increased job demands between analysed points in time.

Job demands, resources, and stress among staff in after school programs: Neighborhood characteristics influence associations in the job demands-resources model

After school programs have shown to be important for the safety and health of children. Although research has shown the influence of job stress on the performance of staff in after school programs, little is known about the sources of stress in this workforce and the extent to which neighborhood factors influence job-related stress for after school staff in urban environments. The current study sought to examine the job demands-resources model and the association of neighborhood characteristics with this model. The sample consisted of 94 park-based after school staff recruited from 30 separate parks in a large Midwestern city. Measures of job demands, job resources, and job stress were used in conjunction with the Child Opportunity Index, a measure of neighborhood opportunity. Increased job demands predicted increased job stress. Additionally, hierarchical linear modeling demonstrated that socio-economic opportunity and health opportunity influenced the association between job demands and job stress. Health opportunity influenced the association between job resources and job stress. Findings suggest that specific neighborhood characteristics may partially explain the associations between job demands, job resources, and job stress. As such, staff require adequate resources to meet job demands, within specific neighborhood contexts, to improve and sustain quality services.

Is being a leader a mixed blessing? A dual‐pathway model linking leadership role occupancy to well‐being

SummaryRecent leadership research has drawn greater attention to how the well‐being of leaders influences leadership behaviors, follower performance and well‐being, and overall leadership effectiveness. Yet little attention has been paid to the relationship between occupying leadership positions and job incumbents' well‐being. This research addresses this question by developing and testing a dual‐pathway model. Our model proposes that incumbency in leadership positions is positively related to high levels of both job demands and job control, whereas job demands and job control have offsetting effects on well‐being. Results based on a longitudinal sample revealed that employees who transitioned from nonleadership positions to leadership roles showed trajectories of increasing job demands and job control, whereas such trends were weaker among those who remained in nonleadership positions. Findings from three additional samples generally demonstrated that leadership role occupancy was indirectly related to various indices of psychological and physiological well‐being through job demands and job control. Because the signs of the indirect effects through job demands and job control differed in expected ways, the overall relationship between leadership role occupancy and the well‐being outcomes was generally small and nonsignificant. We discuss research and practical implications of our framework and findings for organizations, employees, and leaders.

Nurse Manager Perceptions of Work Overload and Strategies to Address It

The role of the nurse in the hospital setting has evolved to meet the ever-increasing acuity and complexity of patients. Likewise, the role of the nurse manager has expanded to meet the needs of the staff and patients on the nursing units, and is considered by some to be the most demanding role in health care. 1 Johansson G Sandahl C Hasson D Role stress among first-line nurse managers and registered nurses: a comparative study. J Nurs Manag. 2011; 21: 449-458 Crossref PubMed Scopus (36) Google Scholar In addition to responsibility for the financial outcomes of the unit, nurse managers are also accountable for the experience of the patient, which includes both clinical and satisfaction outcomes, as well as for providing a safe, engaging, positive work environment for the staff in the area. Nurse managers are also expected to foster relationships with leaders of the various interdisciplinary teams throughout the hospital, as well as to promote physician engagement and partnership with nursing. Expanded role responsibilities along with broader spans of control contribute to increased job demands as well as work stress. 2 Wong CA Spence Laschinger HK The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study. Int J Nurs Stud. 2015; 52: 1824-1833 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Additionally, nurse managers often do not have adequate authority to make decisions affecting the operations in their areas, which can undermine their authority, leading to dissatisfaction with the work. 2 Wong CA Spence Laschinger HK The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study. Int J Nurs Stud. 2015; 52: 1824-1833 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar The increased stress and workload can lead to disengagement, burnout, and ultimately, to nurse manager turnover. The role of the nurse in the hospital setting has evolved to meet the ever-increasing acuity and complexity of patients. Likewise, the role of the nurse manager has expanded to meet the needs of the staff and patients on the nursing units, and is considered by some to be the most demanding role in health care. 1 Johansson G Sandahl C Hasson D Role stress among first-line nurse managers and registered nurses: a comparative study. J Nurs Manag. 2011; 21: 449-458 Crossref PubMed Scopus (36) Google Scholar In addition to responsibility for the financial outcomes of the unit, nurse managers are also accountable for the experience of the patient, which includes both clinical and satisfaction outcomes, as well as for providing a safe, engaging, positive work environment for the staff in the area. Nurse managers are also expected to foster relationships with leaders of the various interdisciplinary teams throughout the hospital, as well as to promote physician engagement and partnership with nursing. Expanded role responsibilities along with broader spans of control contribute to increased job demands as well as work stress. 2 Wong CA Spence Laschinger HK The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study. Int J Nurs Stud. 2015; 52: 1824-1833 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Additionally, nurse managers often do not have adequate authority to make decisions affecting the operations in their areas, which can undermine their authority, leading to dissatisfaction with the work. 2 Wong CA Spence Laschinger HK The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study. Int J Nurs Stud. 2015; 52: 1824-1833 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar The increased stress and workload can lead to disengagement, burnout, and ultimately, to nurse manager turnover.