Shortened Working Hours for Nurses in Elderly Care and Municipal Home Care - Work Environment, Work-life Balance & Well-being

Shortened Working Hours for Registered Nurses in Elderly Care and Municipal Home Care - How is it Linked to Nurse-rated Work Environment, Work-life Balance and Well-being?

Elderly care and municipal home care have and are facing several challenges with an increasing number of elderly people and fewer people of working age. In addition, welfare staff also have more sick days on average than other areas. Stress, mental ill health and intention to leave work are common. Furthermore, there is a national and international shortage of staff and especially a shortage of specialist nurses, e.g., elderly care and primary care. Strengthening the positive aspects will be central and creating good conditions for staff and thus hopefully also better care and welfare. A sustainable working life where the staff thrive, experience learning, meaning, well-being, good structural conditions, work-life balance and want to stay in the long term.

In one of the municipalities in this research project, they will introduce shortened working hours for registered nurses. A shortened working hours (reduced full-time standard by 3.25 hours/week with maintained salary) during a one-year pilot project for nurses in elderly care and municipal home care. Current full-time standard 38.25 hours/week. The municipality has initiated, decided and will implement the changes and the researchers are asked to follow the project.

Nurses from the municipality implementing reduced working hours and nurses from municipalities without changed working hours will be invited to participate in the study. The nurses will answer a questionnaire before and after the changes (6 and 12 months after the first data collection).

The overall aim of the research is to investigate registered nurses' experiences of their work environment, health, well-being and intention to quit/remain, as well as the quality of care, nurse turnover and sick leave. To study the relationship between shortening working hours or not, nurses' assessments of the work environment, intention to quit/remain, health, well-being and quality of care.

The main research questions are:

• What are the relationships over time between working hours reduction or not, sociodemographic factors, nurse-rated work environment, intention to quit/remain, health, well-being and nurse-rated quality of care (follow-up after 12 months)?
• What changes occur over time in nurses' assessments of work environment, intention to quit/remain, health, well-being and quality of care, and are there any differences compared to a comparison group/municipalities?

Study Overview

• Status: Not yet recruiting
• Conditions: Registered Nurses
• Intervention / Treatment: Other: Shortened working hours

Detailed Description

The research project has a prospective design and all nurses (approximately 40) in the municipality where the working hours reduction is implemented will be asked to participate, as well as all nurses in five comparison municipalities (approximately 150).

Data analysis: For the correlation analyses, bivariate correlation analyses and regression analyses (univariate and multiple) or Generalized Estimating Equations (GEE) will be used. GEE to take clustering into account. For the comparative tests, t-test or ANOVA/ANCOVA will be used or equivalent non-parametric tests if the data is not normally distributed.

To study relationships in a multiple linear regression analysis, 50+8*m (people) are required, where m is the number of variables included in the relationship analysis. In this case, investigators expect to use approximately 5-10 explanatory variables, one of which is working time reduction or not, i.e. approximately 90-130 participants. Investigators will invite approximately 190 nurses and expect that some nurses will decline or drop out over time.

• Study Type: Observational
• Enrollment (Estimated): 190

Contacts and Locations

• Study Contact: Name: Maria Engström, Professor, PhD; Phone Number: +4626648215; Email: maria.engstrom@hig.se
• Study Contact Backup: Name: Charlotte Roos, PhD; Email: charlotte.roos@regiongavleborg.se

Study Locations

• Sweden
  • Gävle, Sweden, 80176
    • University of Gävle
    • Contact: Maria Engström, PhD Professor; Phone Number: +4626648215; Email: maria.engstrom@hig.se
    • Principal Investigator: Maria Engström, PhD Professor

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Registered nurses from six municipalities, one of which will introduce shortened working hours for its nurses.

Description

Inclusion Criteria:

• Registered nurses working in elderly care or in municipal home care.

Exclusion Criteria:

• Registered nurses on long-term leave.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Registered nurses working in elderly care and/or municipal home care
Registered nurses in elderly care and/or municipal home care with shortened working hours; In one of the municipalities in this research project, they will introduce shortened working hours for registered nurses. A shortened working hours (reduced full-time standard by 3.25 hours/week with maintained salary) during a one-year pilot project for nurses in elderly care and municipal home care. Current full-time standard 38.25 hours/week. The municipality has initiated, decided and will implement the changes and the researchers are asked to follow the project.	Other: Shortened working hours; In one of the municipalities in this research project, they will introduce shortened working hours for registered nurses. A shortened working hours (reduced full-time standard by 3.25 hours/week with maintained salary) during a one-year pilot project for nurses in elderly care and municipal home care. Current full-time standard 38.25 hours/week. The municipality has initiated, decided and will implement the changes and the researchers are asked to follow the project.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Well-being - Work-life balance - dimension "work interference with personal life"	A scale will be used for nurses' self-rated work-life balance - "the 17-item work/non-work interference and enhancement scale", response options 5-grade 1) not at all to 5) almost always. Four dimensions: work interference with personal life, personal life interference with work, work enhancement of personal-life, and personal life enhancement of work. For this outcome, it is the dimension "work interference with personal life" and higher scores represent imbalance/an undesirable outcome.	Data collection before the changes (pre-), and then 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Well-being - Work-life balance - dimension "work enhancement of personal life"	A scale will be used for nurses' self-rated work-life balance - "the 17-item work/nonwork interference and enhancement scale", response options 5-grade 1) not at all to 5) almost always. Four dimensions: work interference with personal life, personal life interference with work, work enhancement of personal life, and personal life enhancement of work. For this outcome, it is the dimension "work enhancement of personal life" and higher scores represent balance/a desirable outcome.	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Well-being - Thriving	The 10-item Thriving scale will be used to measure thriving, 5-point response alternatives. For total score the mean is calculated and a higher score represent higher thriving.	Data collection before the changes (pre-), and thereafter 12 months after the first data collection (post data collection).
Well-being - Intention to quite/leave the job	One question on intention to leave from the Satisfaction with work questionnaires, 'Have you recently seriously considered quitting your job on the unit because you don't enjoy it?', with response alternatives 1) No, 2) Yes, but I have not done anything and 3) Yes, and I have taken action.	Data collection before the changes (pre-), and thereafter 12 months after the first data collection (post data collection).
Well-being - Intention to remain at this workplace	1 study specific question "Is it your intention to stay at this workplace?" Response options (…) yes (…) no	Data collection before the changes (pre-), and thereafter 12 months after the first data collection (post data collection).
Quality of care - Nurse satisfaction with given care	The Nurse Satisfaction with Given Care Scale will be used. Response alternatives are 7-grade Likert scale (1. Not at all to 7. To a very high extent). For total score, the item scores are averaged, with higher scores representing greater satisfaction.	Data collection before the changes (pre-), and thereafter 12 months after the first data collection (post data collection).
Well-being - Work-life balance - dimension "personal life enhancement of work"	A scale will be used for nurses' self-rated work-life balance - "the 17-item work/nonwork interference and enhancement scale", response options 5-grade 1) not at all to 5) almost always. Four dimensions: work interference with personal life, personal life interference with work, work enhancement of personal life, and personal life enhancement of work. For this outcome, it is the dimension "personal life enhancement of work" and higher scores represent balance/a desirable outcome.	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Well-being - Recovery experience	The Recovery Experience Questionnaire will be used , response options 5-grade Likert-scale, item scores are averaged and higher scores represent a better recovery experience.	Data collection before the changes (pre-), and thereafter 12 months after the first data collection (post data collection).
Well-being - Job satisfaction	The 4-item Brief index of affective job satisfaction will be used, response options 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree. Items are averaged to get the total score and higher scores represent higher job satisfaction	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Well-being - Life satisfaction	1 item from the Life satisfaction questionnaire will be used, 7-grade response alternatives (1. Very low to 7. Very high) and higher scores representing better life satisfaction.	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Health - Stress symptoms	Stress symptoms will be measured using the Psychosomatic health aspects scale, one factor 10 items. Response alternatives are 5-grade [1) very often, 2) Quite often 3) Sometimes 4) Seldom 5) Never]. Scores from the ten items are averaged for factor score, and higher scores represent more stress symptoms.	Data collection before the changes (pre-) and 12 months after the first data collection (post data collection). After 6 months, nurses from the municipality with reduced working hours will answer 1 question about tiredness from the stress scale.
Health - Sleep quality	1 question about sleep quality from the Satisfaction with work questionnaires: "Overall, how do you rate your sleep quality?" 5-grade response alternatives from 1) Very bad to 5) Very god	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Health - Depression symptoms	The Patient health questionnaire-2 will be used that gives a score for depression 0-6, higher score more depressive symptoms, each item rated from 0 "not at all" to 3 "nearly every day".	Data collection before the changes (pre-), and 12 months after the first data collection (post data collection).
Health - Anxiety symptoms	The Generalized anxiety disorder scale -2 will be used that gives a score for anxiety 0-6, higher score more anxiety symptoms, each item rated from 0 "not at all" to 3 "nearly every day".	Data collection before the changes (pre-), and 12 months after the first data collection (post data collection).
Health - Burnout	The factor burnout from the Copenhagen psychosocial questionnaire III will be used, four items that are averaged, response alternatives on a 5-point scale from 1. All the time to 5. Not at all. Higher scores representing a better outcome.	Data collection before the changes (pre-), and 12 months after the first data collection (post data collection).
Work environment - Work situation	1 item from the Life satisfaction questionnaire will be used, 7-grade response alternatives from 1. Very unhappy to 7. Very happy and higher scores representing a better work situation "How do you like your work situation?"	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Work environment - Structural conditions/empowerment	To measure structural conditions/empowerment the 19-item Condition of work effectiveness scale-II will be used. The total score for the scale range from 6 to 30, higher scores representing better structural conditions. Response alternatives for each item are 5-grade (1. None to 5. A lot).	Data collection before the changes (pre-), and thereafter 12 months after the first data collection (post data collection).
Work environment - Quantitative demands	The factor quantitative demands from the Copenhagen psychosocial questionnaire III will be used, three items that are averaged, response alternatives on a 5-point scale from 1. Always to 5. Never/Almost never. Higher scores mean a better outcome.	Data collection before the changes (pre-), and 12 months after the first data collection (post data collection).
Work environment - Emotional demands	The factor emotional demands from the Copenhagen psychosocial questionnaire III will be used, three items that are averaged with response alternatives on a 5-point scale from 1. Always to 5. Never/Almost never. Higher scores mean a better outcome.	Data collection before the changes (pre-), and 12 months after the first data collection (post data collection).
Work environment - Work pace	The factor work pace from the Copenhagen psychosocial questionnaire III will be used, two items that are averaged, response alternatives on a 5-point scale from 1. Always to 5. Never/Almost never. Higher scores mean a better outcome.	Data collection before the changes (pre-), and 12 months after the first data collection (post data collection).
Work environment - Social support from colleagues	The factor social support from colleagues from the Copenhagen psychosocial questionnaire III will be used, two items that are averaged, response alternatives on a 5-point scale from 1. Always to 5. Never/Almost never. Higher scores mean a worse outcome.	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Work environment - Social community at work	The factor social community at work from the Copenhagen psychosocial questionnaire III will be used, three items that are averaged, response alternatives on a 5-point scale from 1. Always to 5. Never/Almost never. Higher scores mean a worse outcome.	Data collection before the changes (pre-) and 12 months after the first data collection (post data collection).
Work environment - Commitment to the organization	The factor commitment to the organization from the Copenhagen Psychosocial Questionnaire III will be used, three items that are averaged, response alternatives on a 5-point scale. Higher scores mean a worse outcome.	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Well-being - Stress, work-life balance and recovery	An index of three study specific items with 7-grade response options from 1) not true at all to 7) completely true, higher scores representing less stress, better balance and recovery	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Quality of care - Productivity and efficient work	An index of 2 study-specific items with 7-grade response options from 1) not true at all to 7) completely true, higher scores better productivity	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Health - sick days	In the survey, a question about the number of sick days - open-ended response option where the number of sick days is stated.	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Well-being - Work-life balance - dimension "personal life interference with work"	A scale will be used for nurses' self-rated work-life balance - "the 17-item work/nonwork interference and enhancement scale", response options 5-grade 1) not at all to 5) almost always. Four dimensions: work interference with personal life, personal life interference with work, work enhancement of personal life, and personal life enhancement of work. For this outcome, it is the dimension "personal life interference with work" and higher scores represent imbalance/an undesirable outcome.	Data collection before the changes (pre-), and thereafter 6 and 12 months after the first data collection (post data collection). For the 6-months data collection only nurses in the group with shortened working hours, at 12 months all nurses.
Work environment - Influence/impact in work	Two questions about the possibility of influence/impact in work from the Satisfaction with work questionnaires, 5-grade reseponse options for each item, scores are averaged and higher scores represent more influence/impact	Data collection before the changes (pre-) and 12 months after the first data collection (post data collection).

Collaborators and Investigators

• Sponsor: University of Gavle
• Investigators: Principal Investigator: Maria Engström, PhD Professor, University of Gävle

Study record dates

Study Major Dates

• Study Start (Estimated): April 25, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): June 30, 2027

Study Registration Dates

• First Submitted: April 2, 2026
• First Submitted That Met QC Criteria: April 2, 2026
• First Posted (Actual): April 9, 2026

Study Record Updates

• Last Update Posted (Actual): April 28, 2026
• Last Update Submitted That Met QC Criteria: April 22, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Home Care; Work Life Balance; Shortened Working Hours; Elderly Care
• Other Study ID Numbers: HIG-FORSK 2026/81

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The data set with individual data are not available to share due to general data protection regulations (GDPR), and in line with the ethics application.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No