Shift Work and Quality of Personal, Professional, and Family Life among Health Care Workers in a Rehabilitation Center in Greece.

CONTEXT: Adverse work schedules and conditions may affect the physical, mental, and social wellbeing of workers, impairing quality of life and causing conflict between family and work roles. AIMS: To compare quality of life, professional quality of life (ProQOL), and work/family conflict (WFC) between shift workers and nonshift workers and explore possible associations with demographic characteristics. SETTINGS AND
DESIGN: : A cross-sectional study was conducted in a rehabilitation center in Central Greece, recording demographic, occupational, and family characteristics.
MATERIALS AND METHODS: Participants answered the World Health Organization-5 Well-Being Index, the ProQOL questionnaire [compassion satisfaction (CS), and the burnout (BO) and secondary traumatic stress scales], and the WFC scale. STATISTICAL ANALYSIS USED: IBM Statistical Package for the Social Sciences version 19.0 for Windows.
RESULTS: Ninety-one employees (68.7% shift workers) participated, with mean age 33.5. Females reported higher compassion/satisfaction level (P = 0.031). Nursing profession was associated with higher levels of BO (P = 0.021), impact of work to family life (P = 0.008), and impact of family to work (FtW), and WFC (P = 0.008). Parenthood increased the impact of FtW (P = 0.008) and predispose to WFC (P = 0.023). In general, wellbeing was significantly correlated with CS (r = 0.368, P < 0.01), BO (r = -0.538, P < 0.01), and levels of WFC (P = 0.003). Work and family roles conflict was statistically significantly correlated with levels of BO (r = 0.497, P < 0.01), and CS (r = -0.288, P < 0.01).
CONCLUSIONS: The interaction between general, professional, and family quality of life can guide interventions in the workplace in order to improve workers' quality of life and promote workers' health.

INTRODUCTION

Shift work refers to a pattern involving rotation through different fixed periods of work across a week or month and is common in health care settings.[1] Although it is an excellent way to improve service, it may lead to the occurrence of circadian rhythm disruption, job strain, and stress among employees.[2] According to the literature, shift workers are at higher risk for adverse health effects, reduced quality of life, and negative impact in social and family life.[34] The negative impact on shift workers' quality of life is attributed to the increase of anxiety and irritability, the reduction of professional and general satisfaction, the lower ability to manage domestic responsibilities, to develop relationships and participate in family and social activities,[567] and refers to physical, social, and mental function, and usually includes subjective evaluations of both positive and negative aspects of life.[8] Working in shifts impairs quality of life via chronic fatigue, sleepiness, and somatic symptoms and also by hindering requirements of daily social life,[456] although there are studies that provide no evidence of a significant association between shift work and quality of life.[9]

Professional quality of life (ProQOL) is the quality one feels in relation to their work as a helper.[10] ProQOL incorporates two aspects: Compassion satisfaction (CS) which is described as “the pleasure deriving from being able to do your work” and Compassion fatigue (CF) which is “the negative aspect of helping those who experience traumatic stress and suffering” and concerns things such as exhaustion, frustration, anger and depression typical of burnout (BO), and secondary traumatic stress.[10] As conceptualized by Stamm,[10] a sustainable ProQOL is achieved by maintaining a healthy balance between the positive and negative aspects of caring.

ProQOL is associated with stress levels at work and BO in health care workers.[111213] Few studies have explored the relationship between shift work and BO in health care workers, and have reported conflicting results. In some, shift work was associated with a higher level of BO,[141516] while in a study conducted in intensive care physicians, shift work seemed to be a protective factor as it offered breaks in the usual staffing regime, whereby physicians required to take night calls could do so from home and return to the hospital only if necessary.[17] A study conducted to investigate the ProQOL reported that nurses in Greece are at high risk for BO and low CS, but not related to the working hours.[18]

WFC is the interaction between work and family life and refers to the extent to which functioning in one domain negatively impacted the other.[19] There are two directional components of WFC that have different antecedents and consequences and can be conceptualized as separate but related constructs: FtW and WtF conflict.[20212223] Shift workers are at higher risk for WFC because shift work involves working and living patterns that diverge from community rhythms of social, recreational, and domestic activity.[242526]

Aim of the study was to assess and compare quality of professional life, wellbeing, and work/family life conflict among shift workers and day workers in a health care setting.

MATERIALS AND METHODS

The study was conducted in the autumn of 2015 in the city of Larissa in Central Greece. Study population consisted of employees of a rehabilitation center with patients with neurological and movement disorders. The employer was informed on the delivery of the study protocol. Workers were informed by presenting the protocol and the questionnaire and were invited to participate in the study. Subsequently, the questionnaire was distributed to all workers and they were asked to complete it anonymously. Each replied questionnaire was placed in a special opaque-sealed envelope to which only the investigator had access. Participants were physicians, nurses, physiotherapists, trainers, speech therapists, ergotherapists, psychologists, technicians, and administration clerks. All of them answered anonymously the following questionnaires:

Questionnaire on demographics (age, gender, educational level, marital status, existence and number of children, occupational history and exposures, such as work position, working time, shift work duration, daily habits, and addictions, such as smoking, alcohol, and caffeine use, and physical activity)

WHO-5 Well-Being Index:[27] A 5-item questionnaire where participants define wellbeing by providing the proper answer regarding their feelings the past 2 weeks. Each answer ranges between 0 (=never) and 5 (=all the time), therefore total score ranges between 0 and 25

ProQOL scale:[10] A 30-item questionnaire where participants are asked to evaluate how often they experienced a certain condition in the last 30 days. Possible answers range between 1 (never) and 5 (very often). It includes three different scales: CS, BO, and CF

The WFC scale:[28] A 10-item questionnaire assessing the effect of work on family life (5 items) and the effect of family on work life (5 items). Participants are asked to assess their level of agreement with every item on a 1 (totally disagree) to 7 (totally agree) scale.

With the use of the abovementioned questionnaires, the following variables were evaluated as follows:

Quality of life (with the use of WHO-5 Well-being Index): In order to depict better results, this score was multiplied by 4, so as to express it as a percentage of the highest value (100)

CS scale: For assessment of the CS scale, answers of questions 3, 6, 12, 16, 18, 20, 22, 24, 27, and 30 were summed and the values were transformed into t-scores so that mean value was equal to 50 and standard deviation equal to 10 (10). Higher CS values respond to higher levels of satisfaction the employee receives by offering

BO scale: For assessment of the BO scale, the same procedure was repeated (summing of questions 1, 4, 8, 10, 15, 17, 19, 21, 26, and 29, after reversing the values of questions 1, 4, 15, 17, and 29). Likewise, values were transformed into t-scores so that mean value was equal to 50 and standard deviation equal to 10 (10). Higher BO values respond to higher levels of BO experienced by the employee

Work to family (WtF) conflict scale: Evaluates the magnitude of influence of work on family life. Values are derived by summing the answers of questions 1, 2, 3, 4, and 5 of WFC scale. Values range between 7 and 35, with 7 representing lower levels of effect of work on family life and 35 representing higher possible levels of work on family life

Family to work (FtW) conflict scale: Evaluates the magnitude of influence of family life on work. Values are derived by summing the answers of questions 6, 7, 8, 9, and 10 of WtF conflict scale. Values range between 7 and 35, with 7 representing lower levels of effect of work on family life and 35 representing higher possible levels of family on work life

WFC scale: Evaluates the total magnitude between work life and family life conflicts Values derive by adding those of WtF and FtW scales and range between 10 and 70, with 10 referring to the lower possible level of conflict and 70 the higher possible level.

Ethical issues

Workers' participation was voluntary. Both the company and the participants have been informed and have consented to participate in the study. All the sensitive personal data of the participants remained only with the knowledge of the principal investigator of the study.

Statistical analysis

Continuous variables are presented as mean (±standard deviation), while categorical variables are presented as numbers (percentages). The Kolmogorov-Smirnov test (P > 0.05 for all variables) was used to test the normality assumption. Cronbach's alpha was used to assess questionnaires' reliability with values >0.7 indicating acceptable reliability. Multivariate linear regression analyses was used to control potential confounding variables. We estimated adjusted coefficients beta with 95% confidence intervals and Pvalues. Statistical significance was set at <0.05. IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) was used for data analysis.

RESULTS

A total of 91 health care workers in a rehabilitation center in Greece consented to the study The majority of participants were women (n = 71, 78%). Mean age was 33.5 ± 8.8 years, with no difference between males and females. Regarding their educational background, this varied from basic (9-year) education (1 participant) to Ph.D. level (3 participants). Demographic characteristics are summarized in Table 1.

Table 1

Demographic characteristics of participants

Most of the participants (n = 44; 51.2%) were nurses, while the rest were working in different positions within the rehabilitation center. The majority (68.7%) reported working in shifts for the last 6.5 ± 5.2 years. Mean work experience was 10 ± 8.3 years (range: 6 months to 35 years). Mean weekly hours of work was 41.3 ± 9.5 (range: 8 to 90 hours)[Table 2].

Table 2

Occupational characteristics

Most of participants were currently smokers (53.8%) with mean daily consume of 12.1 ± 5.8 cigarettes (range: between 2 and 20). Regarding alcohol use only 26.4% answered affirmatively, with consume ranging between 2 glasses/week and 2 glasses/day (mean consume 1.2 ± 0.6 glasses/day). The vast majority (91.2%) reported consuming caffeine containing drinks and beverages (mean daily consume was 1.9 ± 0.9 cup) [Table 3].

Table 3

Lifestyle and habits of participants

Physical exercise was reported by 38 participants (41.8%), with a frequency ranging between 1 and 7 times/week (mean 2.95 ± 1.34 times/week).

Cronbach's alpha was calculated for the seven parameters assessed with the questionnaires [Table 4]. For all of them, Cronbach's alpha was >0.7, indicating an excellent reliability.

Table 4

Cronbach's alpha for the following scales: WHO-5%, CS, BO, WtF, FtW και WFC

Statistical data for WHO-5, CS, BO, STS, WtF, FtW, and WFC scale are presented in Table 5.

Table 5

Statistical data for WHO-5%, CS, BO, WtF, FtW and WFC scale

For comparison of quality of life, Student's t-test analysis of WHO-5 scores was conducted between the two groups. No statistically significant difference was revealed between shift workers (mean score 55.6 ± 21.8) and day workers (mean score 55.6 ± 18.7) (P = 0.993).

For occupational quality of life, specific questions of the ProQOL questionnaire were used, as previously mentioned. No significant difference between groups in CS scale was revealed. For shift workers, this was 49.78 ± 10.6 and for day workers 50.3 ± 9.2 (t = −0.213, P = 0.832).

Likewise, no difference in BO scale was observed between shift workers (49.9 ± 10.7) and day workers (50.1 ± 8.9) (t = −0.072, P = 0.943).

Investigating the impact of work on family life, no difference was observed in work to family scale between shift workers (17.1 ± 7.5) and nonshift workers (17.0 ± 6.1) (t = −0.088, P = 0.930) and in FtW scale between shift (10.3 ± 6.1) and nonshift workers (8.9 ± 4.1) (t = 1.143, P = 0.256). Likewise, no difference was found in WFC scale between shift (27.4 ± 11.5) and nonshift workers (25.9 ± 8.1) (t = 0.666, P = 0.507).

In order to explore the association between ProQOL and WFC, Spearman's rank correlation coefficient was used, showing that high CS and low BO level were associated with low level of WFC regarding the two directions FtW and WtF [Table 6].

Table 6

Correlation between WtF, FtW, WFC and CS, BO scales

The investigation of the impact of ProQOL on workers wellbeing was conducted using Spearman's rank correlation coefficient. According to the results, the lower the CS and higher the BO scale score, the lower is workers' wellbeing (P < 0.01), while the lower the BO scale score, the higher the workers' CS (P < 0.01).

A statistically significant correlation was also found between wellbeing and WFC, namely the increase of WFC scale score with the reduction of life satisfaction (P = 0.003).

Among all investigated parameters of wellbeing and occupational and family life by using Student's t-test analysis, only CF score was correlated to sex. Women (mean = 51.2, SD = 9.4) had higher CF score than men (51.2 ± 9.4 vs. 45.8 ± 11.2, respectively; 45, t = −2.193, P = 0.031).

A statistically significant difference was found between nurses and other health care workers in the rehabilitation center regarding WFC (P = 0.008) and WtF scale (P = 0.008). According to the presence of children in family, the study revealed that workers with children faced statistically significant higher WFC (P = 0.023) and higher FtW scale score (P = 0.008) than workers without children.

Investigating working parameters, the more the working hours per week, the greater the BO (P = 0.010) and the less wellbeing (P = 0.042) experience health care workers.

Marital status, physical exercise, educational level, smoking, and alcohol consumption did not affect the quality of life, CS, and BO scale level.

DISCUSSION

This is the first study conducted in Greece to investigate quality of life in terms of “wellbeing,” professional, and family life in shift and nonshift health care workers in a rehabilitation center.

As it was demonstrated in the present study, shift work did not affect workers' quality of life. This finding was also demonstrated in previous studies,[929] who reported no association between shift work and the general and mental aspect of quality of life, although other studies report negative impact of shift work on employees' wellbeing.[34,]53031]

Moreover, ProQOL was not significantly different between shift and nonshift workers. This outcome agrees with a study conducted previously in Greece, investigating the ProQOL of nurses, in which the high risk for BO and low CS that was found, was not related to the working hours.[18] In contrast, another study in the same country showed that shift work impairs health care workers job satisfaction.[32] In our opinion, there are other working factors that may affect the ProQOL, such as quality of working environment, relationships with colleagues, working condition, and autonomy, which should be investigated. Furthermore, that the special conditions in a rehabilitation center, i.e., the long stay of patients and relatives and the particular psychology of hospitalized patients due to the limitation of their functionality and the fear of incomplete recovery, have an additional negative impact on employees. An additional special work characteristic is that the main workload in a rehabilitation center is during the day, while nights are less demanding, so that shift work is not a significant factor that affects workers life.

In our study, shift work was not shown to be a potential risk factor for impaired health care workers WFC in both directions. In contrast, studies in other countries such as USA, Croatia, and Poland reported negative effect of shift working program in workers' family life.[672533] Our outcome can be attributed to different culture of each country, namely the intensity of family-ties and bonds to relatives.

ProQOL is related to “wellbeing,” namely the greater CS and the lower BO levels were associated with better quality of life experienced by health care workers. These results agree with the literature, which led to a positive correlation between job satisfaction and quality of life on the vitality and mental health, but mainly affect the psychological parameters.[3334] A correlation was found between quality of life and WFC in both directions. According to our results, the greater professional satisfaction compassion and the lower exhaustion and stress experienced, the lower reacts the work on family life, and vice versa. The result converges with other works, in which satisfaction compassion is negative related to BO, while WFC is related to workplace stress and exhaustion.[6182534]

WFC of higher level is experienced from health care workers with lower sense of “wellbeing” and reduced life satisfaction. According to the literature, WFC has a negative impact on workers life, due to the fact that it is a factor that causes stress, reduces job, and life satisfaction and is related to emotional exhaustion.[223536]

Significant differences according to sex were noted in the ProQOL scales. Women scored higher on the CS scale than men. A possible interpretation could be that women are better at expressing the positive feelings derived from helping others. Other studies also discovered a relationship between ProQOL scores and sex,[1337] but further study is warranted to fully understand sex-based differences as they relate to ProQOL.

Working as a nurse affects ProQOL and work/family interaction. Nurses, compared to the other health professional, had higher score in BO scale and WtF, FtW, and WFC scale. This suggests that nurses experience some stress at work that decrease job satisfaction and affect work/family balance and quality of life, such as workload, nonrecognition of their contribution, lack of educational opportunities, and low economic earnings compared with the offered work.[3338394041] Therefore, efforts to promote organizational interventions and education about BO as well as coping and self-care skills [42] should be emphasized.

WtF balance is affected from the presence of children. According to our study, the presence of children impairs the quality of family life, increasing WFC and family's influence at work, but does not affect statistically significant work impact on family life. This result is consistent with those of the study of Dombrowski (2011), according to which working mothers face many obstacles in their daily activities. Similar results showed study in Poland, in which the impact of work on family life in shift workers with children was attributed to the lack of contact with the family and irregular eating with them.[7] Additionally, it is a fact that parenthood and other family liabilities restrict the time that can be dedicated to work and other activities.[33]

Limitations

Certainly, there are some limitations in our study that may impair the generalization of our findings. We focused on investigating the impact of shift work on “wellbeing” and professional and family quality of life in a sample of employees of a rehabilitation center, with the use of a self-reported questionnaire. Additionally, the ongoing economic crisis in Greece has a significant effect on employees' wellbeing and general health.[43] Despite these limitations, our results highlight the importance of quality of life, professional and family, measurement among rehabilitation center health professional, and identifies areas for future research.

CONCLUSION

Quality of Life measured with two different questionnaires and Work-Family Conflict did not differ between shift workers and day workers in a line of 91 employees of a rehabilitation center in Greece. Differences between sexes were observed though. Additionally, professional quality of life and wellbeing were correlated with higher compassion- satisfaction and lower burnout measurements.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.