Link between work-family conflict and musculoskeletal pain among nurses

Nurses and other hospital workers, especially those who work long hours or the night shift, often report trying to juggle the demands of the job and family obligations. A study out today by The George Washington University School of Public Health and Health Services (SPHHS) suggests that the higher the work-family conflict the greater the risk that health care workers will suffer from neck and other types of musculoskeletal pain.

"Work-family conflict can be distracting and stressful for hospital employees," says lead author of the study Seung-Sup Kim, a postdoctoral scientist and professorial lecturer in environmental and occupational health at SPHHS. "Hospitals that adopt policies to reduce the juggling act might gain a host of benefits including a more productive workforce, one that is not slowed down by chronic aches and pains," Kim said.

The study fits into a growing body of evidence showing that conflict between increased workloads or long hours can spill over into domestic life and adversely affect workers on the front lines of patient care. Other research suggests that work-home conflict can put workers at risk of depression, substance abuse and even heart disease. But could the stress of trying to care for multiple sick patients on a hospital ward and manage the domestic front actually lead to physical pain?

Kim and principal investigator, Glorian Sorensen, PhD, Professor of Society, Human Development and Health at Harvard School of Public Health and other researchers decided to try to find out by conducting a survey among 2,000 hospital workers who provided direct patient care in two large Boston hospitals. Nearly 80 percent of the workers took the survey and the team ended up including a total of 1,199 patient care workers in the current analysis. The team assessed work-family conflict with five questions. They asked workers if they agreed with statements like: "The amount of time my job takes up makes it difficult to fulfill family or personal responsibilities" and "My job produces strain that makes it difficult to fulfill my family or personal responsibilities."

In addition, the researchers used a questionnaire to assess how much the participants in the study experienced musculoskeletal pain during the previous three months. And they also took note of factors that might affect the outcome of the study, such as the amount of on-the-job lifting or pulling-which could strain muscles and lead to pain.

The researchers discovered that nurses and other employees who reported high conflict between their job duties and obligations at home had about a 2 times greater chance of suffering from neck or shoulder pain in the last three months. And workers with the highest work-life imbalance had nearly a 3 times greater risk of reporting arm pain during that period.

All told, the researchers found that workers who reported lots of conflict had more than a 2 times greater chance of experiencing any kind of musculoskeletal pain. At the same time, the research found no lasting link between this kind of ongoing conflict and lower back pain, which might be caused when hospital workers lift heavy patients on a regular basis, Kim said.

Hospital workers, and especially nurses, often pull double shifts or work the night shift, and in some cases are handling heavy volumes of very sick patients. The conflict between on-the-job duties and home responsibilities-such as taking calls about a forgetful parent who has wandered off-can, as this study suggests, lead to chronic bodily pain-and possibly other health problems.

The consequences of that unhealthy cycle are serious and affect not just hospitals but society at large, Kim says. He says that the work-home conflict might exacerbate shortages of key health professionals caused when burned-out nurses or other health professionals retire early or leave the field because of the stress. Workers distracted by issues at home or by ongoing muscular pain might be more likely to call in sick or if they do show up for work might provide less than attentive care, he speculates.

The study, authored by Kim and his colleagues, will be published in the online version of the American Journal of Industrial Medicine September 27. Kim says that the findings must be confirmed by additional research in order to prove a cause-and-effect relationship between work-family conflict and the aches and pains reported by workers in this study.

Even at this stage, the findings should push administrators to take a hard look at working conditions in hospitals. "Hospital employees who don't have to juggle extreme work hours and family obligations might be happier and more productive on the job," Kim said. "And that's a win-win situation that will benefit not just hospitals but also workers, patients-and family members."