Musculoskeletal symptoms, stress, and burnout contribute to nurse attrition. This study builds on previous research about physical strain in nurses by exploring the relationship between musculoskeletal symptoms and two occupational psychological factors: job-related stress and burnout.
Methods:
This cross-sectional, observational study utilized an online survey to assess musculoskeletal symptoms (Nordic Musculoskeletal Questionnaire), job-related stress (Job Content Questionnaire), and burnout (Oldenburg Burnout Inventory). The survey also included questions about sociodemographics, work information, COVID-19-related stress level, and likelihood of leaving current position. A logistic regression model assessed musculoskeletal symptoms for associations with Job Content Questionnaire and Oldenburg Burnout Inventory scores while controlling for personal and work-related factors.
Findings:
Fifty-three percent of nurses in the sample (N = 173) indicated limited functional activity due to musculoskeletal symptoms. High overall burnout approached a significant association with limited function (OR = 1.13, 95% CI [0.995, 1.28], p = .06). The odds of having limited function were 15.32 times higher (OR = 15.32, 95% CI [3.10, 75.82], p = .01) in nurses who were very likely to leave their job in the next year.
Conclusions/Applications to Practice:
Limited function due to musculoskeletal symptoms was significantly associated with nurse attrition and approached a significant association with high burnout. Nurse attrition is costly to healthcare organizations and compromises patient safety. Future interventions aimed at musculoskeletal health and attrition in nurses should reduce job-related stress and burnout, in addition to reducing physical strain.
AmbersonT.GravesJ. M.SearsJ. M. (2024). Overview of occupational injuries among registered nurses in Washington State, 2007 to 2019. Workplace Health & Safety, 72(5), 187–195.
2.
BaeS.-H. (2022). Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review. International Nursing Review, 69(3), 392–404.
3.
BarrosC.BaylinaP. (2024). Disclosing strain: How psychosocial risk factors influence work-related musculoskeletal disorders in healthcare workers preceding and during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 21(5), Article 564.
4.
BordignonM.MonteiroM. I. (2019). Predictors of nursing workers’ intention to leave the work unit, health institution and profession. Revista Latino-Americana de Enfermagem, 27, Article e3219.
5.
Borrell-CarrióF.SuchmanA. L.EpsteinR. M. (2004). The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine, 2(6), 576–582.
CallisonM. C.NussbaumM. A. (2012). Identification of physically demanding patient-handling tasks in an acute care hospital. International Journal of Industrial Ergonomics, 42(3), 261–267.
9.
ChangE. M.HancockK. M.JohnsonA.DalyJ.JacksonD. (2005). Role stress in nurses: Review of related factors and strategies for moving forward. Nursing & Health Sciences, 7(1), 57–65.
10.
ChowdhuryR.ShahD.PayalA. R. (2017). Healthy worker effect phenomenon: Revisited with emphasis on statistical methods - A review. Indian Journal of Occupational and Environmental Medicine, 21(1), 2–8.
11.
ChowdhuryU.DasT.MazumderS.GangopadhyayS. (2023). Work-related musculoskeletal disorders and mental health among nursing personnel in the context of COVID-19 pandemic in west Bengal, India. International Journal of Occupational Safety and Health, 13(2), 234–244.
12.
CrawfordJ. O. (2007). The Nordic musculoskeletal questionnaire. Occupational Medicine, 57(4), 300–301.
13.
DavisK. G.KotowskiS. E. (2015). Prevalence of musculoskeletal disorders for nurses in hospitals, long-term care facilities, and home health care: A comprehensive review. Human Factors, 57(5), 754–792.
14.
DemeroutiE.BakkerA. B.NachreinerF.SchaufeliW. B. (2001). The job demands-resources model of burnout. The Journal of Applied Psychology, 86(3), 499–512.
15.
DemeroutiE.BakkerA. B.VardakouI.KantasA. (2003). The convergent validity of two burnout instruments: A multitrait-multimethod analysis. European Journal of Psychological Assessment, 19(1), 12–23.
16.
de OliveiraD. R.GriepR. H.PortelaL. F.RotenbergL. (2017). Intention to leave profession, psychosocial environment and self-rated health among registered nurses from large hospitals in Brazil: A cross-sectional study. BMC Health Services Research, 17(1), Article 21.
17.
DickinsonC. E.CampionK.FosterA. F.NewmanS. J.O’RourkeA. M.ThomasP. G. (1992). Questionnaire development: An examination of the Nordic Musculoskeletal questionnaire. Applied Ergonomics, 23(3), 197–201.
18.
DimitriouC.AlegakisA.KarageorgiouI.MantadakiA. E.SymvoulakisE. K. (2023). Stress and prevalence of musculoskeletal disorders among the nursing personnel of a tertiary hospital unit in Greece: A cross-sectional study. Current Health Sciences Journal, 49(1), 45–53.
19.
Erdoğan KurtaranN.KurtaranM.Şarli GündüzS.ÖztürkL. (2022). Healthcare workers’ musculoskeletal disorders, sleep quality, stress, and fatigue during the COVID-19 pandemic. Pamukkale Medical Journal, 15(2), 11.
20.
FochsenG.JosephsonM.HagbergM.ToomingasA.LagerströmM. (2006). Predictors of leaving nursing care: A longitudinal study among Swedish nursing personnel. Occupational and Environmental Medicine, 63(3), 198–201.
21.
FoxJ.MonetteG. (1992). Generalized collinearity diagnostics. Journal of the American Statistical Association, 87(417), 178–183.
22.
FranssonE. I.NybergS. T.HeikkiläK.AlfredssonL.BacquerD. D.BattyG. D.BonenfantS.CasiniA.ClaysE.GoldbergM.KittelF.KoskenvuoM.KnutssonA.LeineweberC.Magnusson HansonL. L.NordinM.Singh-ManouxA.SuominenS.VahteraJ.. . . KivimäkiM. (2012). Comparison of alternative versions of the job demand-control scales in 17 European cohort studies: The IPD-Work consortium. BMC Public Health, 12(1), Article 62.
23.
GalanisP.VrakaI.FragkouD.BilaliA.KaitelidouD. (2021). Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Advanced Nursing, 77(8), 3286–3302.
24.
GargA.OwenB. D.CarlsonB. (1992). An ergonomic evaluation of nursing assistants’ job in a nursing home. Ergonomics, 35(9), 979–995.
25.
HaasS.SwanB. A.JessieA. T. (2020). The impact of the Coronavirus pandemic on the global nursing workforce. Nursing Economics, 38(5), 231–237.
26.
HamptonS. (2005). The appropriate use of equipment for moving and handling patients. International Journal of Therapy and Rehabilitation, 12(9), 416–420.
27.
HappellB.DwyerT.Reid-SearlK.BurkeK. J.CaperchioneC. M.GaskinC. J. (2013). Nurses and stress: Recognizing causes and seeking solutions. Journal of Nursing Management, 21(4), 638–647.
28.
HosmerD. W.LemeshowS. (1980). Goodness of fit tests for the multiple logistic regression model. Communications in Statistics: Theory and Methods, 9(10), 1043–1069.
HsiehF. Y.BlockD. A.LarsenM. D. (1998). A simple method of sample size calculation for linear and logistic regression. Statistics in Medicine, 17(14), 1623–1634.
JonesD. M.EagertonG. (2020). Reducing preventable injuries through the safe patient handling and mobility program bundle. International Journal of Safe Patient Handling & Mobility, 10(4), 134–139.
33.
KarasekR.BrissonC.KawakamiN.HoutmanI.AmickB. (1998). The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology, 3(4), 322–355.
34.
KuorinkaI.JonssonB.KilbomA.VinterbergH.Biering-SørensenF.AnderssonG.JørgensenK. (1987). Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics, 18(3), 233–237.
35.
LaiJ.MaS.WangY.CaiZ.HuJ.WeiN.WuJ.DuH.ChenT.LiR.TanH.KangL.YaoL.HuangM.WangH.WangG.LiuZ.HuS. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open, 3(3), Article e203976.
LiangH. Y.TsengT. Y.DaiH. D.ChuangJ. Y.YuS. (2023). The relationships among overcommitment, effort-reward imbalance, safety climate, emotional labour and quality of working life for hospital nurses: A structural equation modeling. BMC Nursing, 22(1), Article 204.
38.
MaizuraH.MasilamaniR.ArisT. (2009). Reliability (internal consistency) of the job content questionnaire on job stress among office workers of a multinational company in Kuala Lumpur. Asia-Pacific Journal of Public Health, 21(2), 216–222.
39.
MartinB.Kaminski-OzturkN.O’HaraC.SmileyR. (2023). Examining the impact of the COVID-19 pandemic on burnout and stress among U.S. nurses. Journal of Nursing Regulation, 14(1), 4–12.
40.
MaslachC. (2015). Burnout, psychology of. In WrightJ. D. (Ed.), International encyclopedia of the social & behavioral sciences (2nd ed., pp. 929–932). Elsevier.
41.
MasłońA.KamińskaM.KvåleA. (2024). Workload, general perceived stress, body function, musculoskeletal pain, and their mutual relationships in nurses - a pilot study. International Journal of Occupational Medicine and Environmental Health, 37(3), 257–270.
42.
MuratM.KöseS.SavaşerS. (2021). Determination of stress, depression and burnout levels of front-line nurses during the COVID-19 pandemic. International Journal of Mental Health Nursing, 30(2), 533–543.
43.
NelsonA.FragalaG.MenzelN. (2003). Myths and facts about back injuries in nursing: The incidence rate of back injuries among nurses is more than double that among construction workers, perhaps because misperceptions persist about causes and solutions. The first in a two-part series. AJN The American Journal of Nursing, 103(2), 32–40.
NIOSH. (2020). Fundamentals of Total Worker Health® approaches: Essential elements for advancing worker safety, health, and well-being. https://doi.org/10.26616/NIOSHPUB2017112
OhlssonK.AttewellR. G.JohnssonB.AhlmA.SkerfvingS. (1994). An assessment of neck and upper extremity disorders by questionnaire and clinical examination. Ergonomics, 37(5), 891–897.
PalmerK.SmithG.KellingrayS.CooperC. (1999). Repeatability and validity of an upper limb and neck discomfort questionnaire: The utility of the standardized Nordic questionnaire. Occupational Medicine, 49(3), 171–175.
51.
PompeiiL. A.LipscombH. J.SchoenfischA. L.DementJ. M. (2009). Musculoskeletal injuries resulting from patient handling tasks among hospital workers. American Journal of Industrial Medicine, 52(7), 571–578.
52.
SiegristJ. (1996). Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology, 1(1), 27–41.
53.
TullarJ. M.BrewerS.AmickB. C.3rdIrvinE.MahoodQ.PompeiiL. A.WangA.Van EerdD.GimenoD.EvanoffB. (2010). Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector. Journal of Occupational Rehabilitation, 20(2), 199–219.
54.
VieiraL. M. S. M. D. A.MininelV. A.SatoT. D. O. (2023). Sleep quality as a mediator of burnout, stress and multisite musculoskeletal pain in healthcare workers: A longitudinal study. Healthcare (Basel, Switzerland), 11(18), Article 2476.
55.
WatersT. R. (2007). When is it safe to manually lift a patient?The American Journal of Nursing, 107(8), 53–58; quiz 59.
