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Journal of Research in Nursing logoLink to Journal of Research in Nursing
. 2021 Sep 24;26(7):602–615. doi: 10.1177/17449871211041679

Nursing workplace and its relation to occupational health outcomes and physical activity

Nagah Abd El-Fattah Mohamed Aly 1,✉, Safaa M El-Shanawany 2, Maha Ghanem 2
PMCID: PMC9163756  PMID: 35669144

Abstract

Background

Working in hospitals entails several risks to nurses. A better nursing workplace can help in improving physical activity and reducing adverse occupational health outcomes among nurses.

Aim

This study aimed to investigate the relationships of the nursing workplace with occupational health outcomes and physical activity.

Methods

A cross-sectional correlation study was conducted with 623 nurses. Data were collected through report self-administered questionnaires that included employment and occupational conditions, hospital workplace environment, and adverse occupational health outcomes as well as physical activity pattern.

Results

The current study showed that the nursing workplace environment and conditions had a negative effect on occupational health outcomes and physical activity among nurses in the study units. Nurses in this study reported a high prevalence of low back pain (82.7%), burnout (78.3%), and occupational injuries (70.5%). They also reported insufficient physical activities (90.6%). High prevalence of burnout and low back pain were associated with low levels of physical activities among nurses.

Conclusion

A fair working environment and conditions have been implicated as a causative factor of negative occupational health outcomes and limitations of physical activity among nurses. Adverse occupational health outcomes also affect the nurses engaging in physical activity.

Keywords: hospital units, nurses, occupational health, physical activity, workplace

Introduction

In terms of health and safety, hospitals like all complex employment settings or industries have the usual variety of routine employee hazards along with special risks unique for hospital workplace environments (Shi et al., 2020). The nursing staff is the largest sector of employees in a hospital setting. Nurses are potentially exposed to different occupational health hazards such as biological, chemical, ergonomic, and psychological hazards (Stone et al., 2007). The National Institute for Occupational Safety in the United States placed the nursing job in the top 40 occupations with the highest prevalence of occupational illness and diseases (Dressner and Kissinger, 2018). According to the Work and Health of Nurses in Canada, over 24,000 nurses (9%) were absent each week in 2016 because of occupational illness or injury. The annual cost of such absenteeism continues to increase and was estimated to be $989 million in 2016 (Reed et al., 2018).

Understanding the workplace context is the most important step in building a safer healthcare system (Clarke, 2007). Workplaces have been shown to play an important role in employees’ physical activity levels and occupational health and safety (Reed et al.,2018; Stone et al., 2007). Dissatisfaction with certain nursing workplaces may lead to occupational illnesses such as cardiovascular diseases (e.g., hypertension), diabetes, high cholesterol levels, osteoarthritis, osteoporosis, and certain types of cancer. Occupational injuries may also occur, commonly sharp and needle stick injuries (Clarke, 2007; Shi et al., 2020). Insufficient physical activity may lead to low back pain and burnout (Abou El-Soud et al., 2014; Kermit et al., 2015; Mohamed, 2012).

Nursing workplace conditions consist of a web of physical, mental, social, organisational (occupational and employment) and technological factors that interact in a complex way leading to individual effects as well as an interactive chain of work effects. Therefore, organizational and safety climate, as well as workplace support environment for physical activity should be established in the nursing workplace (Plotnikoff et al., 2005; Prodaniuk et al., 2004; Reed et al., 2018).

Organizational safety climate is defined as the work environment perceived by workers, or its “personality” as recognised by employees. It has also been described as the “feel” of the workplace (Gurkova et al., 2020; Wagner et al., 2019). Organizational and safety climate can be assessed through multiple indicators including management practices, professional-practice environment, manageable workload positive schedule climate, safety measures, minimal conflict, and good communication (Choi et al., 2004; Robyn et al., 2000).

Healthy workplace support environment has a critical emphasis on the working climate in which employees interact. It is essential for promoting physical activity behaviour and increasing its levels among employees. Workplace support environment for physical activity has been focused on the following: (a) individual employee characteristics including age, gender, skills, knowledge, and confidence; (b) social level including culture, social relationships, and peer and supervisor relationships factors; (c) organisational level involving leadership and workplace characteristics that would promote physical activity; (d) community level indicating how the workplace interacts with other organisations, community-based resources, or government bodies that may foster physical activity behaviour of employees; (e) policy level including the workplace’s policies that may enhance or hinder employees' physical activity behaviour; and (f) physical environment level including workplace infrastructure as buildings, workplace grounds, and surrounding areas related to physical activity behaviour of employees (Plotnikoff et al., 2005; Prodaniuk et al., 2004; Reed et al., 2018).

Although the risk of work-related occupational hazards for nurses and physical activity has been studied previously (Clarke et al., 2002; Kermit et al., 2015; Lela and Frantz, 2012; Sokunbi and Tersoo-Ivase, 2015), there have been few studies examining the influence of the nursing workplace (such as work environments and working conditions) on occupational health outcomes and physical activity among nurses (Reed et al., 2018; Prodaniuk et al., 2004). To our knowledge in Egypt, few studies examined the relationships between the nursing workplace and the prevalence of low back pain as occupational health outcomes (Abou El-Soud et al. 2014; Mohamed 2012). For that reason, the objectives of this study were to examine the relationships of nurse workplace environments and conditions with occupational health outcomes and levels of physical activity and exercises among nurses.

Methods

Study setting and design setting

A cross-sectional correlation study was conducted in hospital units within the Main Alexandria University Hospital.

Sample size

Nurses who had at least one year of experience were included in the study sample. Nurses with spinal pathological conditions were excluded. The self-administered questionnaires were distributed to 856 nurses after obtaining informed consent, where the researchers interviewed nurses to explain the study, answer questions, and clarify self-administered questionnaire items. About 750 of the 856 administered questionnaires were returned. Only 623 out of 856 successfully completed the questionnaires. The response rate was 72.8%, as 47 administered questionnaires were incomplete and 80 administered questionnaires contained excluded criteria. Thereby, 127 administered questionnaires were excluded from the study analysis. Nurses needed about 45 min to fill the questionnaires.

Data collection

Using self-reported administered questionnaires to collect data, the validity and reliability of the study questionnaires were tested on the following:

I. Face and content validity and inter-rater reliability

The study questionnaires were developed based on literature reviews (Abou El-Soud, et al., 2014; Choi et al., 2004; Clarke, 2007; Clarke et al., 2002; Craig et al., 2003; International Physical Activity Research Committee (IPARC), 2005; Kuorinka et al., 1987; Maslach and Jackson, 1981; Mohamed, 2012; Plotnikoff, et al., 2005; Robyn et al., 2000; World Health Organization (WHO), 2011). The questionnaires were evaluated by five expert panels with experience and knowledge in the field of hospital risk management. Kendall’s Coefficients of inter-rater reliability were 0.80 for organizational and safety climate; 0.85 for workplace support environment; 0.76 for physical activity scale. Kappa Coefficients of inter-rater reliability were 0.87 for occupational health outcomes and 0.72 for nurse working conditions. Self-administered questionnaires were translated into Arabic and translated back into English. The experts evaluated the Arabic version of the administered questionnaire. The questionnaires included four parts which are the following:

  1. Self-reported nurse workplace environment questionnaires:

    1. Nursing workplace environment questionnaire included the following: (1) Organizational and safety climate scale: The scale was developed by Robyn et al., (2000) and Choi et al., (2004). It consisted of five Likert scales (1 = strongly disagree up to 5 = strongly agree) and was used to identify a healthy nursing work environment; and (2) workplace support environment for physical activity scale: the scale was developed by Plotnikoff et al., (2005). It was used to measure nurses' perceptions of the workplace support environment. It included 5-point Likert scale (1 = not all considered up to 5 = completely considered).

    2. Nursing workplace conditions included the following: (1) employment conditions: containing hospital workplace (critical care and wards); type of shift (rotated and fixed); shift time (day, long, and night shifts); average working hours (36 hours/week and >36 hours/week); and years of clinical experience; (2) occupational-related physical risk conditions: The questionnaires consisted of 12 close-ended questions related to occupational-related physical risk in the nursing workplace as twisting, bending forward, lifting and transferring patients, and pushing–pulling heavy objects (Abou El-Soud, et al., 2014; Mohamed, 2012). The nurses were asked to choose between yes or no answers.

  2. International Physical Activity Questionnaire Short Form (IPAQ-SF) was developed by Craig et al., (2003). The questionnaire consisted of seven open-ended questions related to the frequency, duration, and intensity of physical activity and exercises (walking from home to workplace and vice versa and exercising for losing weight mostly at home). It allows estimating time spent per week on different physical activity levels. The total nurses' responses were calculated and recorded in metabolic equivalent-minutes (METs) according to physical activity guidelines (Craig et al., 2003). MET values were 3.3 for walking; four for moderate–intensity activities, and eight for vigorous physical activity (Craig et al., 2003; International Physical Activity Research Committee, 2005). Metabolic equivalent-minute/week was estimated by multiplying the number of nurses' exercise days in a week by the duration of time in minutes and metabolic equivalent. The METs/week were categorised into low, medium, and high levels, according to the standard of IPAQ scoring cutoffs and guidelines (Craig et al., 2003; International Physical Activity Research Committee, 2005). Also, IPAQ scoring was classified into sufficient and insufficient, according to the World Health Organization (WHO) (2011) recommended guidelines of physical activity levels (≥150 min/week of moderate physical activity or 90 min of vigorous physical activity per week).

  3. Occupationally related health outcomes involved the following: (a) low back pain: prevalence and level of low back pain were measured by Standardized Nordic questionnaires and developed by Kuorinka et al., (1987). The nurses were asked to report if they had low back pain in the preceding 12 months and indicate the duration of the most recent episode of back pain. The severity of back pain was categorised as the following: “0 days” indicating “no pain”; “1–7°days” indicating “mild pain”; 8–30°days indicating “moderate”; and more than 30 days indicating “severe pain”; (b) occupational injuries, including sharp/needle stick injuries: prevalence of sharp and needle stick injuries was collected by one question which was developed by Clarke et al., (2002) and Clarke (2007). This question was related to nurses ever having a contaminated needle stick or sharp or cut injury in the last 12 months. Exposure to injuries was assessed by asking the nurses to indicate “yes” or “no”; and (c) Burnout: emotional exhaustion scale of the Maslach Burnout International Physical Activity Research Committee (2005) was used to measure the burnout level among nurses. It contained nine items and was self-scored on a seven-point frequency scale, ranging from 0 (never) to 6 (every day). Cutoff scores of burnout were 27. Emotional exhaustion with scores 27 or above indicated high burnout.

II. Test–retest reliability

The pilot study was carried out on 65 nurses in different inpatient care units. Self-administered questionnaires were tested on the same 65 nurses after 2 weeks. The test–retest correlation coefficients were 0.74 for workplace environments, 0.82 for workplace conditions, 0.86 for occupational health outcomes, and 0.77 for physical activity.

III. Construct validity and internal consistency reliability

63 items of the organizational and safety climate and 42 workplace environment items were subjected to one confirmatory factor analysis. Factor analysis of organizational and safety climate produced 42 items and six subscales. Six subscales were named according to original questionnaires (Robyn, et al., 2000; Choi et al., 2004) as presented in Table 1. Additionally, factor analysis of workplace support environment for physical activities produced 16 items and three components. These components were labelled according to the yield items as shown in and Table 2.

Table 1.

Organizational and safety climate scales.

Subscales Description of subscales
Professional practice 11-items related to professional development, orientation, and opportunities for nurses advancement and involvement in hospital governance (Alpha =0.76)
Management practices 6-items related to the nurse manager practices, including rewards, support, and consult nurses, decision making (Alpha =0.73)
Manageable workload 7-items related to the staffing resources and time (Alpha =0.68)
Positive scheduling climate 3-items related to nursing scheduling processes and outcomes (Alpha =0.89)
Workplace safety measures 12-items related to effective safety measures, including management support, job hindrance, and safety training (Alpha =0.85)
Minimal conflict and good communication 3-items concerning conflict and communication between nurses and their supervisors and physicians (Alpha = 0.90)
Alpha of the scale 0.95
Factor loading 0.64–0.0.92
% of the total variance 79.85
KMO value a 0.84
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aThe Bartlett’s test was significant.

Table 2.

Workplace support environment for physical activity scales.

Subscales Description of subscales
Organization and management level 10-items related to physical activity policies, procedures, program, infrastructure, and resources (Alpha =0.74)
Nurses’ leadership level 3-items related to management support and promoting physical activity (Alpha =0.65)
Nurses’ individual level 3-items related to encouraging and supporting nurses to participate in physical activity (Alpha =0.95)
Alpha of the scale 0.86
Factor loading 0.51–0.81
% of the total variance 70.9
KMO value a 0.76
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aThe Bartlett’s test was significant.

Ethical considerations

Official approvals were obtained from the Faculty of Medicine administration to carry out the study in inpatient care units. All data were anonymously and confidentially handled through a coding system.

Statistical analysis

Data were analysed using Statistical Package for the Social Sciences edition 18. Statistical analysis included the following: (a) descriptive statistics; (b) logistic and linear regression; (c) Pearson correlation examined test–retest reliability. Kappa and Kendall’s Coefficients assessed the inter-rater reliability test while Cronbach’s alpha coefficient examined the internal consistency reliability, and (d) factor analysis was tested by Principal Component Analysis with Varimax rotation. The scoring system of dependent and independent data was described as follows:

Percentage/score Fair (mild/low) Moderate High
The average percentage of occupational-related physical risk conditions ≤5 (≤45%) 6 to 9 (50–75%) 10 to 12 (80–100%)
Mean scores of the nursing workplace environment <3 3–3.5 ˃ 3.5. High mean score indicated a high and positive workplace environment
Percentage of time spent on physical activity <600 min per week 600 min–1499°minutes per week ≥1500 minutes per week
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Results

Nurses' perceived workplace environment and conditions

The nurses fairly rated organizational and safety climate (2.55) and its six components. Also, they fairly reported workplace support environment for physical activity in their work (1.14) and its three components (Figure 2).

Figure 2.

Figure 2.

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Levels of occupational risk in the workplace from the nurses' perspective.

Nurses reported that inappropriate employment and occupational conditions were found in their workplace (Table 3).

Table 3.

Nursing workplace conditions in inpatient care units.

Nurse workplace conditions (n=623)
Employment conditions Frequency
No. (%)		 Occupational conditions (yes/No) Frequency
No. (%)
Hospital workplace
Wards
Critical care and toxicology units		 342 (54.9)
281 (45.1)		 No usage of body mechanics 406 (65.2)
Duration of employment (years)
<10
10–20
≥20		 165 (26.5)
213 (34.2)
245 (39.3)		 Lifting patients 576 (92.5)
Working hours per week — Standing for a prolonged time 551 (88.4)
36 hours 226 (36.3) Sitting for a prolonged time 127 (19.4)
36 hours 397 (63.7) Walking for a long-distance 545 (87.5)
Type of shift — Pushing–pulling heavy objects 558 (89.6)
Rotated shift 428 (68.7) Doing work that requires bending forward 518 (83.1)
Fixed shift 195 (31.3) Frequent doing occupied beds 482 (77.3)
Shift scheduled — Twisting the body during patient care 475 (76.5)
Night 293 (47.0) Transferring patients 456 (73.2)
Day shift 190 (30.5) Rushing in emergency conditions 561 (90.1)
Long shift 140 (22.5) Frequent carrying patient care equipment 500 (80.3)
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Physical activity patterns, levels of occupational risk, occupational health outcomes, and workplace predisposing factors

The level of physical risk in occupational conditions was highest in all inpatient care units (70.6%). A high level of occupational risk was recorded in critical care and toxicology care units (76.9%) compared to inpatient wards (62.3%) (Figure 1).

Figure 1.

Figure 1.

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Mean scores of nurses' perceived workplace environment.

According to the nurses’ perceptions, the physical activity was graded as being an insufficient level in most of them (90.4%). The majority of nurses in the study units suffered from low back pain (82.7%), burnout (78.3%), and occupational injuries (70.5%) (Table 4 and Figure 3).

Table 4.

Physical activity patterns (n = 623).

Variables Frequency (%) Total (MET-min) week*
Min-maximum Mean ±SD Median
Physical activity pattern
Physical activity level
Low		 493 (79.1) 150.00–594.00 277.81±171.42 264.00
Moderate 91 (14.6) 600.60–1485.00 1004.11±257.64 976.80
High 39 (6.3) 1501.50–2079.00 1743.84±165.67 1722.60
Total physical activity level 623 (100.0) 150.0–2079.00 616.40± 485.58 495.00
Physical activity patterns
Sufficient		 60 (9.6) 1050–2079 1447.02±275.28 1407.45
Insufficient 563 (90.4) 150–976 464.59±300.94 435.60
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*MET-min/week = metabolic equivalent-minute/week.

Figure 3.

Figure 3.

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Prevalence of occupational health outcomes and levels of low back pain.

The workplace environment and conditions were the predisposing factors that directly and indirectly affect the physical activity patterns and occupational health outcomes in study units (Table 5).

Table 5.

Workplace predisposing factors affecting physical activity patterns and occupational health outcomes.

Predisposing factors Occupational health outcomes
Physical activity pattern Odds ratio: OR (95% CL)
Linear regression analysis Occupational diseases Occupational injuries
B Beta R2 Low back pain Burnout Sharps \ needle stick injuries
Occupational health outcomes
Low back pain 0.50 −0.46** 0.000 — — —
Sharps/needle stick injuries 0.68 −0.08 0.110 — — —
Burnout 0.89 0.44** 0.000 — — —
Organizational and safety climate 0.45 0.33** 0.11 0. 41* (0.32,0.51) 0.72* (0.59,0.89) 0.64* (0.52, 0.78)
Workplace support environment 0.21 0.19** 0.09 1.02NS (0.82,1.27) 1.21NS (0.87,1.67) 0.97NS (0.72,1.30)
Employment conditions
Hospital workplace
 Wards 0.23 0.29** 0.08 0.10* (0.07,0.15) 0.13* (0.07,0.26) 0.03* (0.01,0.07)
 Critical units −0.32 −0.60** 0.36 4.72* (3.03,7.38) 2.26* (1.65,3.08) 2.39* (1.06,3.48)
Duration of employment (years)
<10
10–20
≥20 −0.11
Working hours per week
36 hours 0.54 0.62** 0.43 0.21* (0.14,0.33) 0.91* (0.73,1.13) 0.13* (0.07,0.23)
36 hours −0.27 0.65** 0.43 2.17* (1.74,2.70) 1.21* (0.78,1.89) 2.29* (1.96,6.97)
Type of shift
Fixed shift 0.26 0.28** 0.09 0.78* (0.63,0.98) 0.78 (0.65,0.94) 0.03** (0.02,0.06)
Rotated shift −0.13 0.29** 0.08 1.63* (1.04,2.55) 1.32 (1.02,1.71) 1.67** (2.75,4.95)
Shift time
Day shift (morning/evening) 0.05 0.17** 0.03 0.94* (0.84,1.06) 0.82* (0.71,0.94) 0.10* (0.16,0.62)
Long shift 0.51 −0.19** 0.04 3.94* (2.85,6.037) 1.11* (1.87, 1.40) 1.11* (0.93, 1.34)
Night 0.05 −0.21** 0.05 3.98* (2.56,6.19) 1.76* (1.06,2.91) 5.94* (3.94,8.97)
Occupational risk conditions
Low −0.20 −0.23** 0.08 1.51* (1.32,1.80) 1.32* (1.25,1.77) 1.11* (1.06,1.16)
Moderate − 0.29 −0.34** 0.12 2.10* (1.54,4.24) 1.44* (1.59,1.93) 2.53* (1.20,4.08)
High − 0.35 −0.42** 0.14 2.51* (2.68,4.78) 1.83* (1.07,1.94) 2.73* (2.59,7.19)
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Beta is significant (p<0.01), *p-value of Odds Ratio is significant, NS: p-value of Odds Ratio is not Sign.

Discussion

Nowadays, high levels of lost workdays among nurses have been recorded in different healthcare settings due to occupational illness and injuries (Shi et al., 2020). Enhancing nurse workplace conditions will not only improve safe work practices and reduce exposure risk but will also encourage participating in physical activities among nurses (Gurkova et al., 2020). Therefore, the present study tried to shed light on the influence of the nursing workplace on occupational health outcomes and physical activity among nurses in inpatient care units.

The present study pointed out that the majority of nurses achieved low levels of physical activity in the form of daily walking while doing their nursing tasks or walking from their home to the workplace and vice versa. Nurses in this study insufficiently practised physical activity. They were rarely engaged in moderate or vigorous physical activity levels, as 90.6% of nurses were not fulfilling the recommended WHO guidelines of physical activity levels (2011) (≥150 min/week of moderate physical activity or 90 min of vigorous physical activity per week). The majority of nurses (79.1%) in this study were undertaking less than 600 min of low physical activity/week. Similar findings were also reported by several studies conducted in Nigeria (Sokunbi and Tersoo-Ivase, 2015), the UK (Blake et al., 2016), and Taiwan (Lin et al., 2018).

Lack of physical activity was a factor affecting some of the occupational diseases. The present study highlighted the prevalence of low back pain among nurses being 82.7%. It was mild in 18.0% of nurses, moderate in 21.5% of them, while 43.2% of nurses had severe low back pain. Additionally, nurses in the current study experienced high levels of burnout (78.3%) and occupational injuries (70.5%). These findings generally concur with those of several studies conducted in many countries (Elbarazi et al., 2017; Saravanan et al., 2018; Stone et al., 2007; Thon et al., 2016). The present study also proved that a high prevalence of low back pain and burnout among nurses was a predisposing factor of unsatisfactory physical activity. This was similarly reported by Lela and Frantz (2012) study, however, in contrast to Sokunbi and Tersoo-Ivase study (2015) in Africa.

Generally, nurses also showed reduced attention to physical activity when they worked in the unfavourable workplace. Unfavourable nurses' workplace poses a threat to physical activity and nurses' health and safety. The findings of the present study identified nurse workplace environment and conditions as contributing factors leading to negative occupational health outcomes and low physical activity among nurses. The first contributing factor was a fair workplace support environment for physical activity. It was a significant predictor of low physical activity. This could be related to unsupporting hospital management, inadequate facilities and resources, and lack of nurses' awareness of the importance of physical activity. These findings concur with other studies in Canada (Prodaniuk et al., 2004), the UK (Bakhshi et al., 2015), and Taiwan (Lin et al., 2018).

The second contributing factor was the organizational and safety climate, where nurses in the study units fairly rated organizational and safety climate and its factors. This was similarly reported by the study of Stone et al. (2006) who recorded less positive organizational climate factors, but it was in contrast to the study done in the USA (Stone et al., 2007). Moreover, the findings of the current study revealed that organizational and safety climate was a negative predictor of occupational diseases (low back pain and burnout) as well as injuries but a positive predictor of low physical activity levels among nurses. Rating organizational and safety climate as fair in the present study units may be attributed to low professional and management practice, negative schedule climate and safety measures, and minimal communication between healthcare providers in the study units. These findings were generally in line with many other studies carried out from 2004 to 2018 (Dressner and Kissinger, 2018; Lin et al., 2018; Prodaniuk et al., 2004; Reed et al., 2018).

Occupational and employment conditions were the third contributing factor. The present study revealed that inappropriate occupational and employment conditions were significant predictors of occupational diseases and injuries (as low back pain, burnout, and injuries) as well as low physical activity. The nature of nursing work in the study units was characterised by complicated tasks that required working very fast and hard to meet patients’ requirements. Nurses in the study units consumed the majority of their time performing these complicated tasks as care of bedridden patients, changing patients’ position in their beds, helping patients to bath, making occupied beds, lifting and transferring patients as well as carrying, pushing, and pulling heavy load objects and equipment. Additionally, nurses frequently performed nursing care that required bending forward and twisting their bodies, walking for long distances, and standing for a long time. Nurses always performed these physical tasks with improper application of body mechanics techniques. Similar findings were reported by other studies (Abou El-Soud et al., 2014; Bakhshi et al., 2015; Blake et al., 2016; Stone et al., 2007).

It was evident from the present study that there were significant predictive relationships between physical activity levels and occupational diseases and injuries as well as employment conditions (as hospital workplace, rotating long night shift work, extra work hours, and years of experience). Concerning the nature of the hospital workplace, nurses working in critical and toxicology care units had a higher prevalence of low back pain, burnout, and occupational injuries and achieved lower levels of physical activity than those working in inpatient wards. These findings were not surprising because of the workload and occupational risks in these units. Patients were more ill and dependent requiring complex care. Heavy duties were responsible for the increased musculoskeletal strain, psychological distress, and occupational injuries. Thereby, these were the main factors leading to limited physical activity of nurses. Two studies also indicated that nurses working in an intensive care unit were at a higher risk of developing occupational diseases and illness with low physical activity (Han et al., 2016; Stone et al., 2007).

Concerning working schedules and hours, a significant relation was recorded with a high prevalence of low back pain, burnout, and occupational injuries as well as limited physical activity in this study. Nurses who worked day fixed time shift (evening and night) and 36 h per week had fewer complaints and were more engaged in physical activity compared to nurses working longer, rotated, and night shifts. This might be related to the fact that nurses working long and night shifts had heavier nursing duties and more stressful patient care with a rotating shift schedule. Thus, this could pose strain and stress to body muscles and increase stressful conditions leading to higher incidence of sharp and needle stick injuries (Saravanan et al., 2018). These results of the present study were in accordance with those of some studies in different countries (Asghari et al., 2016; Horwitz and McCall, 2004; Vorvick, et al., 2012), but different from those reported by Tinubu et al. (2010).

Regarding years of clinical experience, they were predictors of limited physical activity and occupational diseases and injuries in the current study. Physical activity level was decreased among nurses having a work experience of more than 20 years, followed by those between 10–19 years of experience. These findings were similar to one study in the UK (Blake et al., 2016). On the other hand, the risk of occupational injuries was more among nurses with clinical experience less than 10 years. This might be related to the fact that experienced nurses had a high level of knowledge and awareness about injury prevention and how to avoid unsafe practice as well as they had more infection control awareness compared to less experienced nurses. The present study was confirmed by other studies in Egypt and India (Amini et al., 2015; Thon et al., 2016).

The study also found that experienced nurses suffered less back pain and burnout compared to inexperienced nurses. These findings were also incongruent with studies in Taiwan (Lin et al, 2012) and Lower Egypt (Elbarazi et al. 2017). Moreover, this study was confirmed by several studies conducted in many countries such as Japan, Sweden, and Arabic countries (Elbarazi et al., 2017; Fochsen et al., 2006; Smith et al., 2006).

Conclusion

The present study highlighted that a fair working environment and conditions were coupled with negative occupational health outcomes (high prevalence of low back pain, burnout, and occupational injuries) as well as an insufficient physical activity among nurses. Positive occupational health outcomes were responsible for stimulating physical activity among nurses. Physical activity was an important factor in preventing and managing occupational diseases such as low back pain and burnout.

Key Points And Implications For Nursing Pratice

  • • Creating safety measures and supportive workplace climates for protecting nurses against work hazards.

  • • Continuously updating nursing facilities and patient equipment for easier handling and transportation of patients.

  • • Establishing safety training programmes related to health hazards, safety measures, and universal precautions.

  • • Detecting, evaluating, preventing, and treating occupational hazards, diseases, and injuries among nursing personnel.

  • • Providing supportive policies, educational programs, resources, and infrastructure for implementing physical activity.

  • • Establishing the role of nursing leader in implementing physical activity as an essential part of nurses’ practice.

Acknowledgments

The authors are thankful to all the participants who helped us in this study.

Author Biographies

Nagah Abd El-Fattah Mohamed Aly: is an Assistant Professor in Nursing Administration, at Matrouh University, Egypt.

Safaa M. El-Shanawany is Professor in Forensic Medicine and Clinical Toxicology at Alexandria University, Egypt.

Maha Ghanem is Professor in Forensic Medicine and Clinical Toxicology at Alexandria University, Egypt.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study is self-funded by the authors.

Ethics: Official approvals were obtained from the Faculty of Medicine administration to carry out the study in inpatient care unit (Dean of the Faculty of Medicine/Jan 2019).

ORCID iD

Nagah Abd El-Fattah Mohamed Aly https://orcid.org/0000-0003-4442-4633

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