Work Ability and Associated Factors Among Nurses in a Teaching Hospital: A Cross-Sectional Study

Paola Ferri; Angela Contri; Loretta Casolari; Alberto  Modenese; Sergio Rovesti; Elena Righi; Lucia Rampino; Domenico Cannizzaro; Annalisa Bargellini

doi:10.23749/mdl.2026.18637

Autori

Paola Ferri Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. https://orcid.org/0000-0001-7761-7226
Angela Contri Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. https://orcid.org/0000-0002-6057-6816
Loretta Casolari Health Surveillance and Workers Health promotion Service, University Hospital of Modena. https://orcid.org/0000-0001-6360-7449
Alberto Modenese Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. https://orcid.org/0000-0002-0850-5615
Sergio Rovesti Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. https://orcid.org/0000-0002-1499-3897
Elena Righi Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. https://orcid.org/0000-0002-3469-7446
Lucia Rampino University Hospital of Modena
Domenico Cannizzaro Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia https://orcid.org/0009-0001-6675-2788
Annalisa Bargellini Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. https://orcid.org/0000-0002-7562-1472

Parole chiave:

Work Ability, Nurses, Work environment, Work-life balance, Job Satisfaction, Shift works, Occupational Health, Musculoskeletal Disorders, Healthcare Workforce Retention, Work Ability Index

Abstract

Background: Preserving nurses’ work ability (WA) is essential for healthcare sustainability, especially given the current global workforce crisis and an ageing population. This study aims to assess the prevalence of inadequate WA among hospital nurses and to identify the personal, domestic, and organisational predictors that influence it, focusing on modifiable factors to inform targeted retention strategies.

Methods: A cross-sectional study was conducted at an Italian university hospital (August–October 2022). Data from 182 nurses were collected during mandatory health surveillance visits using the Work Ability Index (WAI), alongside assessments of socio-demographic, occupational, and extra-work responsibilities (caregiving/education). Multivariable binary logistic regression was performed to identify independent predictors of WA, adjusting for confounders such as BMI and lifestyle factors. Results: Inadequate WA was reported by 44.5% of participants (mean age 45.8±11.1 years). A significant health burden was observed, with 41.8% suffering from musculoskeletal disorders. The regression model (χ²₍₉₎=31.026; p<0.001) revealed that the likelihood of adequate WA decreased significantly with advancing age (OR=0.93 per year; p<0.001) and high extra-work burdens (OR=0.97 per hour; p=0.041). Conversely, satisfaction with working conditions emerged as the primary modifiable protective factor, significantly increasing the likelihood of adequate WA (OR=2.41; p=0.010). No significant associations were found for sex, BMI, or smoking status. Conclusions: Nearly half of the nursing workforce exhibits vulnerable work ability. Findings suggest a detrimental 'double duty' effect where domestic responsibilities and age intersect. Organisational interventions should prioritise work-life balance and improved work climates to mitigate the impact of demographic shifts and preserve workforce sustainability.

Biografie autore

Paola Ferri, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.

Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy

Angela Contri, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.

Angela Contri, PhD, is a Research Fellow at the Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy.

Loretta Casolari, Health Surveillance and Workers Health promotion Service, University Hospital of Modena.

Health Surveillance and Workers Health promotion Service, University Hospital of Modena, 41125 Modena, Italy

Alberto Modenese, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.

PhD,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;

Sergio Rovesti, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.

MD, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy

Elena Righi, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.

Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;

Domenico Cannizzaro, Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia

Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy

Annalisa Bargellini, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia.

Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;

Riferimenti bibliografici

1. Rypicz Ł, Witczak I, Rosińczuk J, Karniej P, Kołcz A. Factors affecting work ability index among polish nurses working in hospitals - A prospective observational survey. J Nurs Manag. 2021;29(3):468-476. Doi: 10.1111/jonm.13192

2. World Health Organization. Global strategic directions for nursing and midwifery 2021-2025. Accessed 16 December 2024, https://www.who.int/publications/i/item/9789240033863

3. Scheffler RM, Arnold DR. Projecting shortages and surpluses of doctors and nurses in the OECD: what looms ahead. Health Econ Policy Law. 2019;14(2):274-290. Doi: 10.1017/s174413311700055x

4. OECD/European Union. Health at a Glance: Europe 2022. State of Health in the EU Cycle. [Last Accessed 16 December 2024], https://doi.org/10.1787/507433b0-en

5. Federazione Nazionale Ordini Professioni Infermieristiche. Carenza infermieristica: la buona Università può fare la differenza. Accessed 16 December 2024, https://www.fnopi.it/wp-content/uploads/2024/07/4-luglio-2024-Incontro-FNOPI-CRUI-carenza-infermieristica-la-buona-Universita-puo-fare-la-differenza.pdf

6. McHugh MD, Aiken LH, Sloane DM, Windsor C, Douglas C, Yates P. Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. Lancet. 2021;397(10288):1905-1913. Doi: 10.1016/s0140-6736(21)00768-6

7. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama. 2002;288(16):1987-93. Doi: 10.1001/jama.288.16.1987

8. Aiken LH, Sermeus W, McKee M, et al. Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries. BMJ Open. 2024;14(2):e079931. Doi: 10.1136/bmjopen-2023-079931

9. Bagheri Hosseinabadi M, Khanjani N, Etemadinezhad S, Samaei SE, Raadabadi M, Mostafaee M. The associations of workload, individual and organisational factors on nurses' occupational injuries. J Clin Nurs. 2019;28(5-6):902-911. Doi: 10.1111/jocn.14699

10. Sasso L, Bagnasco A, Zanini M, et al. The general results of the RN4CAST survey in Italy. J Adv Nurs. 2017;73(9):2028-2030. Doi: 10.1111/jan.13066

11. Wang K, Zeng X, Li J, Guo Y, Wang Z. The prevalence and risk factors of work-related musculoskeletal disorders among nurses in China: A systematic review and meta-analysis. Int J Nurs Stud. 2024;157:104826. Doi: 10.1016/j.ijnurstu.2024.104826

12. Rosa D, Terzoni S, Dellafiore F, Destrebecq A. Systematic review of shift work and nurses' health. Occup Med (Lond). 2019;69(4):237-243. Doi: 10.1093/occmed/kqz063

13. Ilmarinen J. Work ability – A comprehensive concept for occupational health research and prevention. Scand J Work Environ Health. 2009;35(1):1-5. Doi: 10.5271/sjweh.1304

14. Ilmarinen J. The work ability index (WAI). Occupational Medicine. 2007;57 Doi: 10.1093/occmed/kqm008

15. Tuomi K, Työterveyslaitos. Work ability index. 2nd rev. ed. Occupational health care, 19. Finnish Institute of Occupational Health; 1998.

16. Tuomi K, Huuhtanen P, Nykyri E, Ilmarinen J. Promotion of work ability, the quality of work and retirement. Occup Med (Lond). 2001;51(5):318-24. Doi: 10.1093/occmed/51.5.318

17. von Bonsdorff MB, Seitsamo J, Ilmarinen J, Nygård CH, von Bonsdorff ME, Rantanen T. Work ability in midlife as a predictor of mortality and disability in later life: a 28-year prospective follow-up study. Cmaj. 2011;183(4):E235-42. Doi: 10.1503/cmaj.100713

18. La Torre G, Grima D, Romano F, Polimeni A. Perceived work ability and work-family conflict in healthcare workers: An observational study in a teaching hospital in Italy. J Occup Health. 2021;63(1):e12271. Doi: 10.1002/1348-9585.12271

19. Garzaro G, Clari M, Ciocan C, et al. Physical Health and Work Ability among Healthcare Workers. A Cross-Sectional Study. Nurs Rep. 2022;12(2):259-269. Doi: 10.3390/nursrep12020026

20. Romero-Sánchez JM, Porcel-Gálvez AM, Paloma-Castro O, et al. Worldwide prevalence of inadequate work ability among hospital nursing personnel: A systematic review and meta-analysis. J Nurs Scholarsh. 2022;54(4):513-528. Doi: 10.1111/jnu.12749

21. Loyd LA, Stamler LL, Culross B. Early career nurses and moral distress: An integrative review. Nurse Educ Pract. 2023;73:103844. Doi: 10.1016/j.nepr.2023.103844

22. Ronchese F, Ricci F, Peccolo G, et al. Relation of the work ability index to fitness for work in healthcare and public employees in a region of Northeastern Italy. Int Arch Occup Environ Health. 2023;96(8):1203-1210.Doi: 10.1007/s00420-023-02001-7

23. Casolari L, Curzi Y, Mastroberardino M, et al. Factors associated with work ability among employees of an Italian university hospital. BMC Health Serv Res. 2024;24(1):30. Doi: 10.1186/s12913-023-10465-z

24. D'Ettorre G, Pellicani V, Caroli A, Greco M. Shift work sleep disorder and job stress in shift nurses: implications for preventive interventions. Med Lav. 2020;111(3):195-202. Doi: 10.23749/mdl.v111i3.9197

25. Kafle S, Paudel S, Thapaliya A, Acharya R. Workplace violence against nurses: a narrative review. J Clin Transl Res. 2022;8(5):421.

26. Magnavita N, Meraglia I. Poor Work Ability Is Associated with Workplace Violence in Nurses: A Two-Wave Panel Data Analysis. Int J Environ Res Public Health. 2024;21(9):1118. Doi: 10.3390/ijerph21091118

27. Magnavita N, Meraglia I, Viti G, Borghese L. The Work Ability Index (WAI) in the Healthcare Sector: A Cross-Sectional/Retrospective Assessment of the Questionnaire. Int J Environ Res Public Health. 2024;21(3):349. Doi: 10.3390/ijerph21030349

28. World Health Organization. State of the world's nursing 2025: investing in education, jobs, leadership and service delivery. 2025. https://www.who.int/publications/i/item/9789240110236/

29. Phillips CS, Dupree G, Kwak J, Thomas Hebdon MC. A Qualitative Study Exploring the Experience of Double-Duty Nurse Caregivers. West J Nurs Res. Sep 2025;47(9):836-843. Doi: 10.1177/01939459251348135

30. Clendon J, Walker L. Nurses as family caregivers – barriers and enablers facing nurses caring for children, parents or both. J Nurs Manag. 2017;25(2):93-101. Doi: 10.1111/jonm.12445

31. Rony MKK, Alrazeeni DM, Akter F, et al. The role of artificial intelligence in enhancing nurses’ work-life balance. Journal of Medicine, Surgery, and Public Health. 2024;3:100135. Doi: 10.1016/j.glmedi.2024.100135

32. Sermeus W, Aiken LH, Van den Heede K, et al. Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology. BMC Nurs. 2011;10:6. Doi: 10.1186/1472-6955-10-6

33. Aiken LH, Sloane DM, Bruyneel L, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014;383(9931):1824-30. Doi: 10.1016/s0140-6736(13)62631-8

34. Demerouti E. The Job Demands-Resources Model: State of the Art. J Manag Psychol. 2007;22:309-328. Doi: 10.1108/02683940710733115

35. Chowdhury R, Shah D, Payal AR. Healthy Worker Effect Phenomenon: Revisited with Emphasis on Statistical Methods – A Review. Indian J Occup Environ Med. 2017;21(1):2-8. Doi: 10.4103/ijoem.IJOEM_53_16

36. Zhang H, Wang J, Zhang S, et al. Relationship between night shift and sleep problems, risk of metabolic abnormalities of nurses: a 2 years follow-up retrospective analysis in the National Nurse Health Study (NNHS). Int Arch Occup Environ Health. 2023;96(10):1361-1371. Doi: 10.1007/s00420-023-02014-2

37. Di Muzio M, Dionisi S, Di Simone E, et al. Can nurses’ shift work jeopardize the patient safety? A systematic review. Eur Rev Med Pharmacol Sci. 2019;23(10):4507-4519. Doi: 10.26355/eurrev_201905_17963

38. Bell T, Sprajcer M, Flenady T, Sahay A. Fatigue in nurses and medication administration errors: A scoping review. J Clin Nurs. 2023;32(17-18):5445-5460. Doi: 10.1111/jocn.16620

39. Ferri P, Guadi M, Marcheselli L, Balduzzi S, Magnani D, Di Lorenzo R. The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts. Risk Manag Healthc Policy. 2016;9:203-211. Doi: 10.2147/rmhp.S115326

40. Nelson A, Baptiste AS. Evidence-based practices for safe patient handling and movement. Online J Issues Nurs. 2004;9(3):4.

41. Stimpfel AW, Arabadjian M, Liang E, Sheikhzadeh A, Weiner SS, Dickson VV. Organization of Work Factors Associated with Work Ability among Aging Nurses. West J Nurs Res. 2020;42(6):397-404. Doi: 10.1177/0193945919866218

42. Krishnanmoorthy G, Rampal S, Karuthan SR, Baharudin F, Krishna R. Effectiveness of Participatory Ergonomic Interventions on Work-Related Musculoskeletal Disorders, Sick Absenteeism, and Work Performance Among Nurses: Systematic Review. JMIR Hum Factors. 2025;12:e68522. Doi: 10.2196/68522

43. Ferreira AG, Lopes MRC, Borba A, Marques APO, Alves FAP, Lima BCC. Factors associated with absenteeism in elderly nursing workers. Rev Gaucha Enferm. 2022;43:e20210063. Doi: 10.1590/1983-1447.2022.20210063.en

44. Burmeister EA, Kalisch BJ, Xie B, et al. Determinants of nurse absenteeism and intent to leave: An international study. J Nurs Manag. 2019;27(1):143-153. Doi: 10.1111/jonm.12659

45. Aiken LH, Simonetti M, Sloane DM, et al. Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study. Lancet Glob Health. 2021;9(8):e1145-e1153. doi:10.1016/s2214-109x(21)00209-6

46. Dulko D, Kohal BJ. How Do We Reduce Burnout In Nursing? Nurs Clin North Am. 2022;57(1):101-114. Doi: 10.1016/j.cnur.2021.11.007

47. Bahlman-van Ooijen W, Malfait S, Huisman-de Waal G, Hafsteinsdóttir TB. Nurses’ motivations to leave the nursing profession: A qualitative meta-aggregation. J Adv Nurs. 2023;79(12):4455-4471. Doi: 10.1111/jan.15696

48. El-Helaly M. Artificial Intelligence and Occupational Health and Safety, Benefits and Drawbacks. Med Lav. 2024;115(2):e2024014. Doi: 10.23749/mdl.v115i2.15835