Servicio de Información Comunitario sobre Investigación y Desarrollo - CORDIS

Effort-Reward Imbalance (ERI) as valuable indicator for healthy and satisfying nursing

One of the two worldwide most discussed stress models is the effort-reward imbalance (ERI) model by Siegrist (Siegrist J. Adverse health effects of high effort – low reward conditions at work. J Occup Health Psychol 1996;1:27–43).

This model maintains that lack of reciprocity between efforts spent and rewards received (i.e. high ‘cost’ / low ‘gain’ conditions) in a core social role, the work role, defines a state of emotional distress in those who are particularly prone to autonomic arousal and neuroendocrine response and related adverse health outcomes.

High efforts and insufficient reward are topics high on the agenda within the nursing profession. Here, effort often includes high emotional, physical and quantitative demands and reward comprises aspects such as
- Pay (financial reward),
- Recognition and respect within a hierarchical system and public image (esteem reward) and
- Possibilities for development, career opportunities and job security (status control reward).

Many of these aspects are closely related to the ongoing adjustments, which have been taking place since the early 80s to the health care sector turning it into an economic environment focused on management efficiency. Besides the ‘effort’ component (assessing work demands), the items cover the three ‘reward’ components as indicated above.

In NEXT the instrument was used to investigate:
- The degree of perceived effort and reward in the participating countries and in different health care settings,

- The impact that effort-reward imbalance has on the nurses with respect to
-- Physical health
-- Psychological health
-- Behaviour intention (“intention to leave the nursing profession”- ITL).

In the analysis we have considered data from 24,328 nurses from seven countries.

- Perceived distress in nursing is not a consequence of increased intensity of demanding work but also of a lack of reward.
- In nurses effort-reward imbalance is associated with an increased risk of poor physical and psychological health.
- Substantial differences exist with respect to effort-reward imbalance (ERI) among nurses in Europe. There are four countries with extremely high ERI: Poland, Slovakia, Germany and Italy.
- High effort-reward imbalance among the nursing profession may reflect the national economic transition (Poland and Slovakia) or transition in the health care system (e.g. Germany and Italy). In all instances it should be regarded as a warning signal.
- The findings emphasise the need for esteem reward and status control reward in nursing, not only of financial reward.
- Nurses with high ERI more often want to leave their profession.
- Institutions with low ERI benefit from higher commitment to their institution and to the profession.

Dissemination and use potential:
- NEXT shows that the ERI model can be used as a valuable indicator in health care: In international benchmarking it identifies nursing professions in a crisis. In national benchmarking it identifies risk groups. The model has shown the potential to identify health care institutions as “models of good practice”.

- The ERI instrument is a self-administered work stress assessment tool, which can be useful in work place health promotion. The instrument supports the implementation of specific intervention activities to reduce the burden of distress among nurses mostly concerned. Appropriate measures include human resources’ development as well as organisational restructuring based on needs of staff and the population served.

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University of Wuppertal
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