Kirsikka Selander

Background: An extensive health and social services reform was implemented in Finland at the beginning of 2023. Aims: To describe the working conditions and well-being of persons preparing extensive organizational changes, to compare their results to the reference group, to analyse whether unreasonable workload impacted work recovery, psychosocial distress, work ability and work performance, and to analyse whether the changes in work recovery, psychosocial distress and work ability were associated with a change in work performance. Methods: Data were collected by four surveys from reform preparers in 2022 in open cohort settings. Descriptive statistics were used to report the preparers’ situation and in relation to the reference group at the endpoint. Further, covariance and linear regression analyses were performed to study the associations between start and endpoint data (N = 340). Results: While putting in significant effort, decreasing proportions of preparers experienced leader support, participatory safety and opportunities for innovation. Many preparers had unreasonable workload, a significant proportion working long hours and doing preparation work alongside their main responsibilities. Their situation was notably worse on various work-related indicators compared to the reference group. Unreasonable workload and adverse changes in working conditions decreased the well-being of many preparers, impacting their work performance. Conclusions: When preparing for extensive organizational changes, the focus should be on leading preparers’ collaboration and work processes. Leadership should support innovation, foster a positive team climate, ensure participatory safety and provide a reasonable workload to support well-being. Good working conditions are important as they promote better well-being, work ability and performance.

The purpose of this paper is to investigate the experiences of engaging leadership and work recovery among preparers of a major health-care and social services reform in Finland in 2022; to investigate whether engaging leadership was associated with work recovery; and to investigate whether engaging leadership alleviated the harmful effect of job demands on work recovery. Altogether 258 reform preparers participated in four job well-being surveys. Means and paired t-test were used to measure engaging leadership and work recovery during the study period. Hierarchical multiple linear regression analysis was used to analyze associations between engaging leadership, job demands and recovery from work. Experiences of engaging leadership and recovery from work decreased during the study period. A change in engaging leadership had a small positive association with work recovery at endpoint. A change in job demands had a stronger association with work recovery at endpoint. Engaging leadership did not alleviate the association between job demands and recovery from work. This study expands previous work recovery literature by demonstrating that engaging leadership style can improve work recovery during health and social care reforms. However, engaging leadership style alone is insufficient to alleviate job demands, and therefore more effective management of job demands is needed. Practically, the findings can be used to plan and lead future reforms.

We analyzed the association of job autonomy, mental demands, and organizational support on work engagement and the moderating role of organizational support between mental demands and work engagement. We also examined differences in these factors among onsite, hybrid, and remote workers during the COVID-19 pandemic using data from the Finnish MEADOW survey.Results showed that the remote workers had highest job autonomy, but no other significant differences were found. Job autonomy was positively associated with work engagement, while mental demands had a negative association with it. Organizational support had the strongest positive association with work engagement, and it was able to moderate the negative association betweenmental demands and work engagement. We conclude that the remote work cannot be classified as good or bad; rather, the question is more on how work is organized and managed. The new environment where remote work is increasingly done, however, presents several challenges for managers and supervisors.

Background: Ethically challenging situations are one of the many stressors that strain eldercare employees. Aim: The study aimed to examine (1) the mean levels of ethically challenging situations among eldercare employees in different Finnish eldercare service types and (2) the associations between organizational constraints and poor work-unit collaboration with ethically challenging situations. Research design: Cross-sectional survey in 2020 including 4,347 Finnish eldercare employees (response rate 67%). These employees provide care and support to older adults, such as assist with daily activities and manage medical needs. Employees were classified into four categories based on the eldercare service type: home care ( n = 1,683), service housing ( n = 1,649), outpatient and ward care ( n = 650), and guidance and activity services ( n = 365). The data was analyzed with variance analysis, t-tests, and linear regression analysis. Ethical considerations: The study was approved by the ethical board of the Finnish Institute of Occupational Health. Respondents’ provided informed consent for participation. Findings: Analyses showed that the level of ethically challenging situations was highest in service housing, among nurses, and among practical nurses. Organizational constraints—job strain and organizational injustice—had the strongest positive association with ethically challenging situations. Poor work-unit collaboration, instead, had a minor positive association with ethically challenging situations. Conclusions: Organizational constraints, especially job strain and organizational injustice, are important to identify to alleviate ethically challenging situations among eldercare workers.

Aim: To analyse whether the harmful effect of job demands on recovery can be alleviated by healthy lifestyle, psychological recovery experiences and job resources. We also describe their prevalence among employees in different types of eldercare service and in the health and social services sector in general.Design: Cross‐sectional study.Methods: The data were collected using a self‐report survey in 2020 in the health and social services sector organizations (n = 4478). Employees were classified as the following service types: general health and social services (N = 3225), home care (N = 452), service housing (N = 550) and outpatient and ward care (N = 202). The data were analysed using percentages, cross‐tabulations and logistic regression analysis.Results: Poor recovery, high job demands, low appreciation and low autonomy in terms of worktime and breaks were more prevalent in eldercare. Employers could alleviate the risk of high job demands by offering job resources—appreciation, autonomy in terms of worktimes and breaks—and motivating employees to maintain healthy lifestyle habits and use recovery experiences such as relaxation.Conclusion: The study emphasizes the importance of appreciation in the health and social services sector context. Even with moderate levels of appreciation employers can protect employees from poor recovery from work in the demanding health and social services work environment.Impact: Eldercare employees face continuous and accumulating work strain at the same time as the sector struggles against a labour shortage. One way to prevent the harmful consequences of strain is to enhance recovery from work.Employers could alleviate the risk of high job demands and poor recovery by showing appreciation and giving employees more autonomy in terms of work time and breaks during the workday. This could also motivate employees to keep up healthy lifestyle habits and use their recovery experiences. Results are important especially in the daily management of HSS work.What Does this Paper Contribute to the wider Global Clinical Community?: Managers in the health and social services sector and eldercare can use these findings to promote recovery from work.Reporting Method: STROBE checklist.Patient or Public Contribution: No patient or public contribution.

Objective: The aim of this cross-sectional study was to examine the recovery from work in Finnish home care nurses with objective and subjective recovery measures. Methods: Heart rate and heart rate variability recordings were performed in home care nurses over a period of one work shift and the following night. Following the measurements, the participants (N = 91) answered a questionnaire including questions about their self-rated recovery from work and sleep disturbances. Results: The objectively measured recovery was within the recommended heart rate variability range, yet the self-rated recovery from work was only mediocre. Subjective recovery was not associated with objectively measured recovery. Conclusions: There is a discrepancy between objectively and subjectively measured recovery from work. Therefore, an additional objective method in occupational field studies, along with questionnaires, is recommended to measure physiological recovery.

Work in the health and social sector (HSS) is highly straining and therefore recovery from work needs to be promoted. Less is known on how job resources can be used to alleviate job strain and increase recovery from work. Thus, we analyzed the following: the association between job demands and work recovery; the connections of engaging leadership and psychological safety to recovery from work; and the moderating effects of engaging leadership and psychological safety on the relationship between strain and recovery from work. This cross-sectional study of 18,155 HSS and 4347 eldercare employees in 2020 using linear regression analysis showed that job strain (p < 0.001) and moral distress (p < 0.001) were associated with decreased recovery from work. Engaging leadership (p < 0.001) and psychologically safe work community (p < 0.001) enhanced recovery from work independently. Engaging leadership mitigated the harmful effect of job strain (p < 0.01) and moral distress (p < 0.05), and psychological safety mitigated the effect of job strain (p < 0.001), but not moral distress (p > 0.05). Thus, it is important to reduce job strain so that employees recover from work. Further job resources such as engaging leadership and psychological safety are important in themselves as they support recovery from work and employees’ well-being, but also as they alleviate job demands.

Objective Previous work ability studies have primarily focused on old workers and physical health. This study investigated how poor perceived work ability (PPWA) is associated with work-related factors in different health and social service (HSS) worker age groups. Design Cross-sectional survey in 2020. Setting HSS employees (general HSS and eldercare) in nine Finnish public sector organisations. Participants All employees who were employed in the organisation completed self-reported questionnaires. Of the original sample (N=24 459, response rate 67%), 22 528 gave consent for research use. Primary and secondary outcome measures Participants evaluated their psychosocial work environment and work ability. Lowest decile of work ability was categorised as poor. The association between psychosocial work-related factors and PPWA in different age-groups of HSS workers, adjusting for perceived health, was analysed with logistic regression. Results The proportion of PPWA was highest in shift workers, eldercare employees, practical nurses and registered nurses. Considerable variation between age groups exists in the work-related psychosocial factors associated with PPWA. Among young employees engaging leadership and working time and work task autonomy were statistically significant, whereas in middle-aged and old employees procedural justice and ethical strain were highlighted. The strength of the association with perceived health also differs in age groups (young: OR=3.77, 95% CI 3.30 to 4.30; middle-aged: OR=4.66, 95% CI 4.22 to 5.14; old: OR=6.16, 95% CI 5.20 to 7.18). Conclusions Young employees would benefit from engaging leadership and mentoring, and from more working time and work task autonomy. As employees get older they would benefit more from job modification and from ethical and just organisation culture.

Psychosocial job stressors increase the risk of mental health problems for the workers in health and social services (HSS). Although previous studies suggest that the accumulation of two or more stressors is detrimental to mental health, few studies have examined the synergistic interaction of accumulating job stressors. We examined survey responses from 9855 Finnish HSS workers in a cross-sectional study design from 2021. We conducted an interaction analysis of high job demands, low rewards and low workplace social capital on psychological distress, focusing on the relative excess risk due to interaction (RERI). Additionally, we analysed the interaction of job demands, low rewards and COVID-19 burden (extra workload and emotional load). Our analysis showed that the total RERI for the job stressors on psychological distress was considerable (6.27, 95% CI 3.14, 9.39). The total excess risk was caused by two-way interactions, especially between high demands and low rewards and by the three-way interaction of all stressors. The total RERI for job demands, low reward and COVID-19 burden (3.93, 95% CI 1.15, 6.72), however, was caused entirely by two-way interaction between high demands and low rewards. Mental health interventions tackling high demands, low rewards and low social capital are jointly needed.

The aging of the population in Western countries will increase the use of social and health services in the future. Employees in eldercare are at risk for experiencing moral distress, which is associated with poor work ability. The causes and consequences of moral distress among eldercare workers remain undiscovered. This scoping review investigates the existing studies of causes and consequences of moral distress among eldercare workers. Additionally, it seeks evidence of interventions designed to mitigate moral distress in eldercare workers. Fourteen studies were included in the final review. Most of the included studies were qualitative, aiming to increase understanding of morally challenging situations in eldercare. We also found quantitative studies with cross-sectional designs and small sample sizes. Thus, no reliable evidence of causal effects between moral distress and worker wellbeing in eldercare was found. We found no interventions undertaken to resolve moral distress among eldercare workers, either. More research is needed on the causes and consequences of moral distress and on interventions to mitigate moral distress among eldercare workers. This is of utmost importance to increase the attractiveness of eldercare as a workplace and to improve eldercare workers’ ability to work and sustain long working careers.