title: Hospital organizational factors influence work-family conflict in registered nurses: Multilevel modeling of a nation-wide cross-sectional survey in Sweden.
abstract: BACKGROUND
  The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence.
  
  
  OBJECTIVE
  This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict.
  
  
  METHODS
  A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments.
  
  
  RESULTS
  We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work-family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part.
  
  
  CONCLUSIONS
  These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling.
authors.affiliation: Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden; Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Medical Management Center, 171 77 Stockholm, Sweden. Electronic address: constanze.leineweber@stressforskning.su.se.
authors.forename: C
authors.initials: C
authors.lastname: Leineweber
authors.affiliation: Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden.
authors.forename: H S
authors.initials: HS
authors.lastname: Chungkham
authors.affiliation: Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Westerlund
authors.affiliation: Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Medical Management Center, 171 77 Stockholm, Sweden; Stockholms Sjukhem Foundation, Research and Development Unit, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Tishelman
authors.affiliation: Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Medical Management Center, 171 77 Stockholm, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Lindqvist
mesh_terms: D000328:Adult; D000368:Aged; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D003625:Data Collection; D005190:Family; D005260:Female; D006739:Hospital Administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D013548:Sweden; D016526:Workload; D055815:Young Adult
keywords: Family; Multilevel analysis; Nurses; Workload