Pain and long-term absences among Canadian nurses with MSIs

In brief

  • Two important factors associated with how long Canadian female nurses stay off of work due to musculoskeletal injuries (MSIs) are the level of pain and the extent to which pain interferes with job duties.
  • The latter factor — the extent to which pain interferes with work — is more strongly associated with prolonged work absence.
  • Other factors exert an indirect impact on the length of time off work through these pain-related factors. That is, workplace factors such as the physical demands of the job and the level of worker control in relation to the strain of the job, as well as individual factors such as depression, have a direct impact only on pain severity and pain interference, which in turn have an impact on length of absence.

Why was this study done?

Work-related MSIs are the most common cause of work absence among health-care workers. However, little is known about how pain interacts with other workplace factors to prolong time off work. In a previous study of Canadian nurses off work for all types of disabilities, key factors strongly linked to long absences included depression, pain severity, respect and support at work. In this study, researchers focused only on nurses with MSIs to determine whether pain plays a bigger role than the other factors in prolonging time off work.

How was the study done?

Researchers drew on the National Survey of the Work and Health of Nurses, a survey conducted in 2005 with about 23,000 respondents from across all the provinces and territories, and across all areas of the profession. After selecting participants who were female nurses who had missed at least one day of work in the previous year due to an MSI, researchers ended up with a sample of 941 nurses.

Based on previous studies of work absence and MSIs, the researchers hypothesized that individual health and workplace factors would have an indirect impact on how long nurses stayed off of work by affecting both the severity of pain and the extent to which pain interfered with job duties.

What did the researchers find?

The researchers found that the severity of the pain and the extent to which pain interfered with job duties had the largest impact on how long the injured nurses stayed off work. The effect of these two factors was three times as large as the next biggest factor, which was the physical demands of the job.

Of all the individual and workplace factors looked at, only age had a direct impact. The impact of the other factors—arthritis, depression, job strain and control, physical demands and union status—were all indirect. That means these factors had a direct impact only on the severity and work interference of pain, which then exerted an impact on the duration of the absences.

Researchers also looked at several other factors but found no association with duration of work absence. The individual worker factors included: marital status, household income and employment status. The workplace factors looked at but found to have an insignificant association were: facility type, availability of lifting equipment, organizational culture, respect at work, and worker experience of abuse or assault at work.

What are the implications of the findings?

Addressing pain should be a part of any intervention aimed at helping nurses return to work following MSIs. Programs that help nurses cope with or manage their pain may be beneficial. Also, workplace interventions that focus on reducing physical demands and giving nurses more control over their jobs may also have positive effects by reducing the level and impact of pain. Special attention should also be given to workers with depression to address both the physical and mental aspects of pain.

What are some strengths and weaknesses of the study?

One of the strengths of this study is its large sample size. However, due to the focus of the dataset, certain important factors could not be assessed, including information about the injury and return-to-work programs, as well as certain psychological variables such as fear of pain, fear of movement, etc.

Publication Information

Title: 

Pain-related work interference is a key factor in a worker/workplace model of work absence duration due to musculoskeletal conditions in Canadian nurses

Author(s): 

Murray E, Franche R-L, Ibrahim S, Smith P, Carnide N, Côté P, Gibson J, Guzman J, Koehoorn M, Mustard C

Journal: 

Journal of Occupational Rehabilitation, 2013; vol. 23, no. 4: pp. 585-596; doi 10.1007/s10926-012-9408-7