Read the article attach and aswer the following 1. From the description in the Methods section, how were the participants chosen

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International Journal of Nursing Studies 57 (2016) 60–69

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ccupational factors associated with obesity and leisure-time hysical activity among nurses: A cross sectional study

al Lae Chin a, Soohyun Nam b, Soo-Jeong Lee a,*

niversity of California San Francisco, School of Nursing, San Francisco, CA, USA

ale University, School of Nursing, Orange, CT, USA

hat is already known about the topic?

The increasing prevalence of obesity is a major public health problem in the U.S. and worldwide.

* The vast majority of U.S. adults does not engage in regular physical activity.

* Research shows adverse working conditions contribute to obesity and physical inactivity.

What this paper adds

* Nurses are faced with the high prevalence of over- weight/obesity and their leisure-time physical activities are far from optimal.

R T I C L E I N F O

icle history:

ceived 19 July 2015

ceived in revised form 25 January 2016

cepted 27 January 2016

ywords:

dy mass index

rses

esity

cupational characteristics

ysical activity

A B S T R A C T

Background and objective: Adverse working conditions contribute to obesity and physical

inactivity. The purpose of this study was to examine the associations of occupational

factors with obesity and leisure-time physical activity among nurses.

Methods: This study used cross-sectional data of 394 nurses (mean age 48 years, 91%

females, 61% white) randomly selected from the California Board of Registered Nursing list.

Data on demographic and employment characteristics, musculoskeletal symptom

comorbidity, physical and psychosocial occupational factors, body mass index (BMI), and

physical activity were collected using postal and on-line surveys from January to July in 2013.

Results: Of the participants, 31% were overweight and 18% were obese; 41% engaged in

regular aerobic physical activity (�150 min/week) and 57% performed regular muscle- strengthening activity (�2 days/week). In multivariable logistic regression models, overweight/obesity (BMI � 25 kg/m2) was significantly more common among nurse managers/supervisors (OR = 2.54, 95% CI: 1.16–5.59) and nurses who worked full-time

(OR = 2.18, 95% CI: 1.29–3.70) or worked �40 h per week (OR = 2.53, 95% CI: 1.58–4.05). Regular aerobic physical activity was significantly associated with high job demand

(OR = 1.63, 95% CI: 1.06–2.51). Nurses with passive jobs (low job demand combined with

low job control) were significantly less likely to perform aerobic physical activity

(OR = 0.49, 95% CI: 0.26–0.93). Regular muscle-strengthening physical activity was

significantly less common among nurses working on non-day shifts (OR = 0.55, 95% CI:

0.34–0.89). Physical workload was not associated with obesity and physical activity.

Conclusions: Our study findings suggest that occupational factors significantly contribute

to obesity and physical inactivity among nurses. Occupational characteristics in the work

environment should be considered in designing effective workplace health promotion

programs targeting physical activity and obesity among nurses.

� 2016 Elsevier Ltd. All rights reserved.

Corresponding author at: Department of Community Health Systems,

ool of Nursing University of California, San Francisco, 2 Koret Way,

ite N505, San Francisco, CA 94143-0608, USA. Tel.: +1 415 476 3221;

: +1 415 476 6042.

E-mail address: [email protected] (S.-J. Lee).

Contents lists available at ScienceDirect

International Journal of Nursing Studies

journal homepage: www.elsevier.com/ijns

p://dx.doi.org/10.1016/j.ijnurstu.2016.01.009

20-7489/� 2016 Elsevier Ltd. All rights reserved.

*

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D.L. Chin et al. / International Journal of Nursing Studies 57 (2016) 60–69 61

Overweight/obesity and leisure-time physical inactivity among nurses were associated with occupational factors, such as job title, full-time work, long work hours, shift work, and high job demand.

. Introduction

The increasing prevalence of obesity is a major public ealth problem in the United States (U.S.) and worldwide legal et al., 2012; Ogden and Carroll, 2010; World Health rganization, 2004). According to a recent study using 011–2012 National Health and Nutrition Examination urvey data, two out of three adults in the U.S. are verweight or obese (Ogden et al., 2014). Obesity is linked

type 2 diabetes, mental health, and cardiovascular isease morbidity and mortality, which result in substan- al health care costs (National Heart Lung and Blood stitute, 2003; U.S. Department of Health and Human

ervices (USDHHS), 2001; Wang et al., 2008). The cause of besity is multifactorial, including unhealthy eating, sleep eprivation, psychological, genetic, environmental, and ehavioral factors (Institute of Medicine, 2006; USDHHS, 001). Physical activity is one of the major factors targeted

obesity prevention and management and also produces arious health benefits. Engaging in physical activity ffsets the adverse health effects of overweight or obesity, educing the risk of cardiovascular disease (Centers for isease Control and Prevention [CDC], 2011; Li et al., 2006; ofi et al., 2008; Thompson et al., 2003), and the protective ffects of physical activity hold true even after controlling r body mass index (BMI) (Kriska et al., 1993; Wareham

t al., 2000). However, the vast majority of U.S. adults do ot engage in regular physical activity, and only 21% meet ecommended levels for both aerobic and muscle- trengthening physical activity (CDC, 2013a).

Research suggests that occupational factors contribute obesity and physical inactivity. Adverse working

onditions such as long work hours, high job demands, nd exposure to hostile work environments are signifi- antly associated with obesity (Han et al., 2011; Jaaske- inen et al., 2015; Luckhaupt et al., 2014). Individuals with ighly stressful jobs require more recovery time and are ss likely to engage in physical activity (Fransson et al., 012; Lallukka et al., 2008a,b; McVicar, 2003; Sveinsdottir nd Gunnarsdottir, 2008). Furthermore, studies demon- trated that obesity is associated with high absenteeism nd low workplace productivity, which lead to rising costs

businesses and society (Goetzel et al., 2010; Thompson, 007; Zapka et al., 2009).

In a recent study, health care employment was ignificantly associated with increased prevalence of besity (Luckhaupt et al., 2014). Nurses are the largest ealth care occupation group, and the prevalence of verweight/obesity among U.S. nurses ranges from 30% to 5% depending on geographical area, race and ethnicity, and ork settings (Han et al., 2011; Miller et al., 2008; Tucker

t al., 2010; Zapka et al., 2009). Nursing jobs involve shift ork and long work hours and are often reported as highly

tressful from physically and psychologically demanding atient care (McVicar, 2003; Sveinsdottir and Gunnarsdot- r, 2008). Also, work-related musculoskeletal injuries and

pain are common among nurses due to patient handling (Lee et al., 2013). Such factors may be associated with reduced leisure-time physical activity, which, in turn, contributes to overweight/obesity among nurses (Atkinson et al., 2008; Keller, 2009; Lallukka et al., 2008a,b; Zhao et al., 2012).

Previous studies of obesity among nurses have often focused on the relationship between shift work and irregular meal or disrupted sleep patterns (Field et al., 2007; Geiger-Brown et al., 2011). There is limited research on the effect of occupational factors other than shift work on obesity among nurses. Also, little is known about leisure-time physical activity among nurses and associated occupational risk factors. The purpose of this study was to describe the prevalence of overweight/obesity and leisure- time physical activity among nurses and to examine the relationships of occupational factors with obesity and physical activity.

2. Methods

2.1. Study design and participants

This study analyzed cross-sectional survey data of 394 California registered nurses. The survey data were collected through mail and internet from January to July in 2013. The study initially invited 2000 nurses randomly selected from a list of actively licensed nurses by the California Board of Registered Nursing by sending mail surveys. Respondents were given an alternative response option of on-line completion following log-on information provided in the study information letter. A total of 526 nurses responded, and 394 nurses were eligible for the analysis in the present study. Excluded were 102 retired or not working, 14 currently on disability leave, and 11 employed less than one year. Additionally, three subjects with more than 50% missing data, and two subjects with missing data on both BMI and physical activity were excluded.

2.2. Measures

2.2.1. Outcomes

2.2.1.1. Overweight/obesity. Overweight and obesity were determined by using BMI, which is calculated by weight in kilograms divided by height in meters squared (kg/m2). BMI was categorized as underweight (<18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (�30 kg/m2) (CDC, 2012). We divided the categories into two groups as follows: underweight/ normal (<25 kg/m2) and overweight/obese (�25 kg/m2).

2.2.1.2. Leisure-time physical activity. Leisure-time aerobic physical activity and muscle-strengthening physical activ- ity were measured by questions from the Behavioral Risk Factor Surveillance System (CDC, 2013b).

Aerobic physical activity was measured by the following two questions: ‘‘During the past month, other than your regular job, how many times per week did you take part in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?’’

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D.L. Chin et al. / International Journal of Nursing Studies 57 (2016) 60–6962

ose who reported at least one time were then asked hen you took part in this activity, for how many minutes

d you usually keep at it?’’ Using the two questions, the tal number of minutes per week of aerobic physical tivity was calculated by multiplying the frequency of ysical activity per week by the number of minutes spent physical activity. Based on the 2008 Physical Activity idelines for Americans (USDHHS, 2008), regular aerobic ysical activity was defined as engaging in at least 150 min r week of aerobic physical activity. Muscle-strengthening physical activity was measured by

king, ‘‘During the past month, other than your regular b, how many times per week or per month did you do ysical activities or exercises to strengthen your mus- s?’’ Regular activity was defined as performing muscle- engthening physical activity 2 or more days a week SDHHS, 2008).

.2. Sociodemographics

Sociodemographics included age, gender, race/ethnici- , and education.

.3. Musculoskeletal pain

Musculoskeletal pain was assessed by asking whether ey had pain, aching, stiffness, burning, numbness, or gling in the low back, neck, shoulders, and hands/wrists

the past 12 months (Lee et al., 2013). Pictograms were ovided for each body region on the questionnaire.

.4. Occupational factors

Workplace and employment factors included type of orkplace (e.g., hospital), work setting (e.g., rural), job title .g., staff nurse), work status (e.g., full-time), work shift .g., day), hours worked per shift, and hours worked per eek.

Physical workload was assessed by the Physical Work- ad Index Questionnaire (PWIQ) (Hollmann et al., 1999), hich includes 19 items assessing the average frequency

specific body postures (trunk, arms, and legs) and ndling weights (lifting, pushing, pulling, or carrying of

ads) during ordinary daily work. All responses were nstructed using a 5-point Likert-type scale ranging from never) to 5 (very often). The physical workload index was lculated by summing weighted item scores (Hollmann

al., 1999). Psychosocial work factors were assessed using the Job

ntent Questionnaire (Karasek et al., 1998). Job stress estions included five items assessing job demand (e.g., nflicting job demands, excessive amount of work); three ms assessing decision authority (e.g., little freedom to cide); and six items assessing skill discretion (e.g., a high el of skill, opportunity to develop special abilities). All

sponses were constructed using a 4-point Likert scale nging from 1 (strongly disagree) to 4 (strongly agree). Job ntrol was created as the sum of decision authority and ill discretion subscales. Job demand and job control were chotomized at the median. The two variables were mbined and classified into four categories: (a) high-strain bs (high job demand and low job control); (b) active jobs igh job demand and high job control); (c) low-strain

jobs (low job demand and low job control). Job satisfaction was measured by a single question, ‘‘How satisfied are you with your job?’’ on a 4-point Likert-type scale (1 = not at all satisfied to 4 = very satisfied).

2.3. Data analysis

Data were analyzed using SPSS version 20 (SPSS, Chicago, IL). Descriptive statistics were used to summarize the study variables. Values for continuous variables were presented as means and standard deviations, and categorical variables were summarized by frequencies and percentages. Preva- lence rates of overweight/obesity and aerobic physical activity and muscle-strengthening physical activity were described by sociodemographics, musculoskeletal symp- tom comorbidity, and occupational factors. Bivariate analysis was conducted to examine differences in over- weight/obesity, aerobic physical activity, and muscle- strengthening physical activity by study variables, using chi-square tests. Multivariable logistic regression analysis was conducted to examine the relationships of occupational factors with overweight/obesity, aerobic physical activity, and muscle-strengthening physical activity. Sociodemo- graphics and musculoskeletal pain were adjusted in the multivariable logistic regression analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A value of p < .05 was considered to be significant.

3. Results

3.1. Participant characteristics

Table 1 summarizes the characteristics of the study participants. Participants were predominantly middle- aged (mean 48.4 years), women (90.6%), non-Hispanic white (61.2%), and 65.5% had bachelor’s degrees or higher education. The majority of the participants (81.2%) experienced musculoskeletal pain in the past 12 months, most commonly in the lower back (61.8%). The majority of participants were employed in hospital settings (67.5%) as staff nurses (52.2%), working full-time (73.3%) on day shifts (69.4%). About 43% of the participants worked more than 12 h per shift (mean 10 h), and 46.5% worked more than 40 h per week (mean 37.6 h). About half of the participants (44.9%) were very satisfied with their job.

3.2. Overweight/obesity and regular physical activity:

prevalence and bivariate analysis

Of the participants, 31.1% were overweight and 17.6% were obese. For physical activity, 41.3% engaged in regular aerobic physical activity and 56.6% performed muscle- strengthening activity 2 or more days a week (see Table 1). Significant associations were found between BMI and physical activity: the proportion of obese nurses was significantly higher among nurses who did not participate in regular aerobic physical activity (23.7% vs. 9.5%, p = .004) and in regular muscle-strengthening activity (23.6% vs. 13.4%, p = .040), compared to nurses performing regular

ysical activity (see Table 2).

bs (low job demand and high job control); and (d) passive ph

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D.L. Chin et al. / International Journal of Nursing Studies 57 (2016) 60–69 63

Table 3 presents the prevalence of obesity and regular physical activity by sociodemographics, musculoskeletal symptom comorbidity, and occupational factors. Nurses who were older, men, non-Hispanic white, and had a diploma or associate degree were significantly more likely to be overweight or obese (p < .05). No sociodemographic factors were significantly associated with regular physical activity, but the proportion of regular muscle-strengthen- ing physical activity tended to decrease with increased age (p = .084). Nurses reporting musculoskeletal symptoms tended to have a higher prevalence of overweight/obese and lower prevalence of regular aerobic physical activity compared to those without any musculoskeletal symp- toms, but the findings were not statistically significant (p > .05).

The prevalence of overweight/obesity was significantly higher among nurses who worked full-time compared to part-time or per-diem nurses (52.1% vs. 37.8%, p = .015) and among nurses who worked �40 h per week compared to those who worked <40 h per week (58.9% vs. 39.9%, p < .001). The prevalence of regular aerobic physical activity was significantly higher among nurses who perceived high job demand (47.4% vs. 36.5%, p = .003) while nurses in the passive job category had the lowest prevalence of regular aerobic physical activity (29.3%, p = .033). Nurses with low physical workload tended to

able 1

haracteristics of the study participants (N = 394).a

Characteristics Mean � SD (range) or n (%)

Age (years) 48.4 � 12.1 (23–81)

Gender

Men 37 (9.4)

Women 356 (90.6)

Race/ethnicity

Hispanic 28 (7.1)

White, Non-Hispanic 241 (61.2)

Asian or Pacific Islander 89 (22.6)

Otherb 36 (9.1)

Education

Diploma or associate 135 (34.4)

Bachelor 180 (45.9)

Master or doctoral 77 (19.6)

Comorbidity: musculoskeletal

symptoms

Low back pain 241 (61.8)

Neck pain 191 (49.0)

Shoulder pain 164 (42.2)

Hand/wrist pain 163 (42.1)

Musculoskeletal pain

(any region)

319 (81.2)

Body mass index (kg/m2) 25.7 � 4.8 (16.0–41.6) Underweight (<18.5) 5 (1.3)

Normal (18.5–24.9) 193 (50.0)

Overweight (25–29.9) 120 (31.1)

Obese (�30) 68 (17.6)

Aerobic physical activity

(minutes a week)

148.9 � 128.2 (0–900)

No activity 37 (9.5)

<150 min a week 192 (49.2)

150–300 min a week 109 (28.0)

�300 min a week 52 (13.3)

Muscle strengthening

physical activity

None 126 (32.7)

1 day a week 41 (10.6)

�2 days a week 218 (56.6)

Type of workplace

Hospital 266 (67.5)

Ambulatory

/outpatient clinic

52 (13.2)

Long term care/home health

agency/hospice

29 (7.4)

Other 47 (11.9)

Type of work setting

Rural 50 (14.0)

Suburban 125 (34.9)

Urban 183 (51.1)

Job title

Staff nurse 205 (52.2)

Charge nurse 40 (10.2)

Nurse manager/supervisor 40 (10.2)

Other 108 (27.5)

Work status

Full-time 272 (73.3)

Part-time/per-diem 99 (26.7)

Work hours per shift 10.0 � 2.2 (0–15) <8 h 17 (4.7)

8–11 h 191 (52.5)

�12 h 156 (42.9)

Work hours per week 37.6 � 11.7 (0–85)

Table1 (Continued )

Characteristics Mean � SD (range) or n (%)

<40 h 197 (53.5)

�40 h 171 (46.5)

Shift

Day 258 (69.4)

Evening 23 (6.2)

Night 76 (20.4)

Rotating 15 (4.0)

Physical workload index 35.0 � 13.3 (14.0–70.2)

Job demand 34.1 � 6.4 (18–48)

Job control 70.0 � 10.0 (42–94)

Job strainc

Low strain (low demand

and high control)

113 (29.0)

Passive job (low demand

and low control)

101(25.9)

Active job (high demand

and high control)

90 (23.1)

High strain (high demand

and low control)

86 (22.1)

Job satisfaction

Not at all or not

too satisfied

36 (9.2)

Somewhat satisfied 179 (45.9)

Very satisfied 175 (44.9)

a Sample sizes for variables may not add up the total due to missing

data. b Other: African-American, American Indian or Alaskan Native, and

Other. c Low vs. high of psychological demand and job control were

dichotomized at median.

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D.L. Chin et al. / International Journal of Nursing Studies 57 (2016) 60–6964

ve a higher prevalence of overweight/obesity and lower evalence of regular physical activity, but the findings ere not statistically significant (p > .05).

. Associations of occupational factors with obesity and

gular physical activity

Table 4 presents the associations of occupational factors ith overweight/obesity and regular physical activity. All nificant variables in bivariate analysis maintained nificant associations in multivariable analysis, control- g for age, gender, race/ethnicity, education, and

usculoskeletal pain. Additionally, job title and work ift showed significant associations with overweight/ esity or regular muscle-strengthening physical activity

multivariable analysis. Compared to staff nurses, anagers/supervisors were significantly more likely to

overweight or obese (OR = 2.54, 95% CI: 1.16–5.59). orking full-time (OR = 2.18, 95% CI: 1.29–3.70) and orking �40 h per week (OR = 2.53, 95% CI: 1.58–4.05) ere associated with 2–3 fold odds of being overweight or ese, compared to working part-time/per-diem and 0 h per week, respectively. The odds of regular aerobic ysical activity were 1.6 times greater among nurses

porting high job demand (OR = 1.63, 95% CI: 1.06–2.51) d 51% lower among nurses on passive jobs (OR = 0.49, % CI: 0.26–0.93). Compared to day shifts, working on n-day shifts (OR = 0.55, 95% CI: 0.34–0.89) was signifi- ntly associated with 45% lower odds of regular muscle- engthening physical activity. In particular, nurses who

orked on night shifts were significantly less likely to rform regular muscle-strengthening physical activity R = 0.44, 95% CI: 0.25–0.77) and tended to be less likely

perform aerobic physical activity (OR = 0.59, 95% = 0.33–1.05; data not shown in Table 4).

Discussion

Nurses are at high risk of both overweight/obesity and sure-time physical inactivity, which may be associated

ith occupational and work environment factors. To the st of our knowledge, this study is the first study that mprehensively investigated the relationships among cupational factors, obesity and leisure-time physical tivity among nurses. This study found that increased risk

overweight/obesity was associated with being nurse

more than 40 h per week and that physical activity was associated with working on day shifts and experiencing high job demand.

4.1. Overweight/obesity

In our study sample of California registered nurses, about half (48.7%) were overweight or obese; this prevalence is similar to or lower than the reports of previous studies of nurses (Han et al., 2011; Miller et al., 2008; Tucker et al., 2010; Zapka et al., 2009). This finding may be explained from the fact that our study was based in California, which presents a lower obesity prevalence in the U.S. (CDC, 2013c). Therefore, the obesity prevalence reported in the study is likely an underestimate of the prevalence among U.S. nurses.

This study found a significant association between job title and overweight/obesity. Nurse managers/super- visors presented a significantly higher prevalence of overweight/obesity than staff nurses. A possible expla- nation would be that nurse managers/supervisors tend to be more sedentary at work during their shift, while staff nurses, in general, perform more physically active and demanding tasks by delivering direct patient care (Trinkoff et al., 2001, 2003). Indeed, we found that nurse managers/supervisors had a significantly lower physical workload (PWIQ score: 30.1 vs. 38.5 score, p < .001). Previous research suggested that more sedentary work and low physical job demand were associated with increased risk of total and central obesity in workers (Choi et al., 2010b). A multinational study of nurses and midwives in Australia, New Zealand and the United Kingdom reported that those employed in administra- tion and management positions were at increased risk of overweight or obesity due to sedentary work practices (Bogossian et al., 2012). In that respect, this high-risk group of nurses should be targeted specifically for health promotion interventions, enabling positive lifestyle changes.

Another important finding of our study is the impact of work status and work hours as risk factors of obesity. Working full-time and working �40 h per week were associated with increased risk of obesity. Similarly, previous research showed that full-time workers had a significantly higher prevalence of overweight and obesity than workers with part-time or casual working status

ble 2

robic and muscle strengthening physical activity by body mass index among California nurses.

Aerobic physical activity Muscle strengthening physical activity

<150 min/week

(n = 229)

�150 min/week (n = 161)

<2 days/week

(n = 167)

�2 days/week (n = 218)

n (%) n (%) p n (%) n (%) p

ody mass index (kg/m2) .004 .040

Underweight (<18.5) 2 (0.9) 3 (1.9) 3 (1.9) 2 (0.9)

Normal (18.5–24.9) 105 (46.9) 87 (55.1) 70 (43.5) 118 (54.6)

Overweight (25–29.9) 64 (28.6) 53 (33.5) 50 (31.1) 67 (31.0)

Obese (�30) 53 (23.7) 15 (9.5) 38 (23.6) 29 (13.4)

mple sizes for variables may not add up the total due to missing data.

ong nurses and midwives (Bogossian et al., 2012;

anagers/supervisors, working full-time, and working am

Table 3

Prevalence (%) of overweight/obesity and regular physical activity by sociodemographics and occupational factors among California nurses (N = 394).a

Overweight/obesity

(BMI � 25 kg/m2) Regular aerobic physical

activity (�150 min/week) Regular muscle

strengthening physical

activity (�2 days/week)

n (%)* p n (%)* p n (%)* p

Total 188 (48.7) 161 (41.3) 218 (56.6)

Age (years) .014 .818 .084

<30 9 (31.0) 12 (41.4) 19 (65.5)

30–39 31 (40.8) 28 (36.4) 50 (64.9)

40–49 34 (48.6) 29 (42.6) 43 (62.3)

50–59 66 (47.8) 62 (44.6) 74 (54.0)

�60 44 (64.7) 28 (39.4) 30 (44.8)

Gender .006 .945 .365

Men 26 (70.3) 15 (41.7) 23 (63.9)

Women 162 (46.4) 145 (41.1) 195 (56.0)

Race/ethnicity .001 .223 .865

Hispanic 15 (53.6) 11 (39.3) 17 (60.7)

White, Non-Hispanic 127 (53.8) 105 (43.8) 135 (57.2)

Asian or Pacific Islander 26 (29.9) 28 (32.2) 45 (52.9)

Otherb 20 (57.1) 17 (48.6) 21 (58.3)

Education .006 .388 .923

Diploma or associate 77 (58.8) 51 (37.8) 75 (56.8)

Bachelor 72 (40.4) 80 (45.2) 101 (57.4)

Master or doctoral 37 (49.3) 30 (39.5) 41 (54.7)

Musculoskeletal symptoms c .299 .090 .471

Yes 156 (49.8) 124 (39.1) 173 (55.6)

No 31 (43.1) 36 (50.0) 44 (60.3)

Type of workplace .880 .438 .669

Hospital 126 (48.1) 101 (38.5) 145 (55.8)

Ambulatory/outpatient clinic 27 (54.0) 23 (44.2) 30 (57.7)

Long term care/home

health agency/hospice

13 (46.4) 14 (48.3) 13 (50.0)

Other 22 (47.8) 23 (48.9) 30 (63.8)

Type of work setting .811 .930 .530

Rural 25 (50.0) 19 (38.8) 29 (60.4)

Suburban 63 (50.8) 52 (41.9) 64 (52.0)

Urban 83 (47.2) 74 (40.9) 103 (57.2)

Job title .106 .265 .281

Staff nurse 89 (44.3) 74 (36.6) 115 (56.9)

Charge nurse 19 (50.0) 18 (45.0) 22 (59.5)

Nurse Manager/supervisor 25 (65.8) 19 (47.5) 16 (42.1)

Other 54 (50.0) 50 (46.7) 64 (59.8)

Work status .015 .210 .293

Full-time 138 (52.1) 104 (38.7) 147 (55.3)

Part-time/Per-diem 37 (37.8) 45 (45.9) 59 (61.5)

Work hours per shift

<12 h 104 (51.5) .135 89 (43.2) .190 115 (56.9) .934

�12 h 67 (43.5) 56 (36.4) 87 (56.5)

Work hours per week <.001 .895 .160

<40 h 77 (39.9) 78 (39.8) 104 (53.3)

�40 h 99 (58.9) 68 (40.5) 100 (60.6)

Shift

Day shift 120 (47.6) .675 108 (42.4) .274 150 (59.5) .108

Non-day shift d 56 (50.0) 41 (36.3) 56 (50.5)

Physical workload index .055 .531 .229

Low 95 (54.6) 70 (39.1) 93 (53.8)

High 79 (44.4) 75 (42.4) 107 (60.1)

Job demand .282 .003 .247

Low 107 (51.2) 77 (36.5) 112 (54.1)

High 79 (45.7) 83 (47.4) 105 (60.0)

Job control .252 .195 .293

Low 84 (45.7) 70 (38.0) 100 (54.1)

D.L. Chin et al. / International Journal of Nursing Studies 57 (2016) 60–69 65

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