Conference Agenda

Early work life
Wednesday, 05/Jun/2019:
4:00pm - 5:30pm

Session Chair: Ute Bültmann
Session Chair: Louise Lindholdt
Location: Room 99


Educational Differences in Duration of Working Life and Loss of Paid Employment: Working Life Expectancy in the Netherlands

Suzan Robroek, Daan Nieboer, Alex Burdorf

Erasmus Medical Center Rotterdam, the Netherlands

Objectives: This study aims to provide insight into educational differences in duration of working life by working life expectancy (WLE) and working years lost (WYL) through disability benefits and other non-employment states in the Netherlands.

Methods: Monthly information on employment status of the Dutch population (N=4,999,947) between 16 and 66 year from 2001 to 2015 was used to estimate working life courses. Across educational groups monthly transitions between paid employment and non-employment states were calculated. Using a multistate model (R-package mstate) the WLE and WYL due to disability benefits and other non-employment states were estimated, stratified by educational groups.

Results: Despite starting in paid employment earlier, low educated men and low educated women had a 4.17 (men) and 9.50 (women) years lower WLE at age 16 than high educated men and women. Among low educated men 3.59 working years were lost due to disability benefit compared to 0.78 among high educated men. Low educated women lost 3.47 working years due to disability benefit compared to 1.38 among high educated women.

Conclusions:The working life course perspective showed large educational differences in WLE. A considerable amount of the lost working time is health-related due to disability benefits. In comparison to high educated workers, those with a low educational level lose a substantial part of their working life due to disability benefit, unemployment, and no income. The metrics of WLE and WYL provide useful insights into the life-course perspective of working careers.

Sound Performers Canada: Impact of a Blended Learning Course for Occupational Resilience and Health Literacy in Pre-Professional Musicians

Christine Guptill1, Peter Visentin2, Suzanne Wijsman3, Bronwen Ackermann4, Mary Roduta-Roberts1, Teri Slade1

1University of Alberta, Canada; 2University of Lethbridge, Canada; 3University of Western Australia; 4University of Sydney, Australia

Multiple studies have determined that more than 80% of professional musicians will encounter health conditions related to their occupation that negatively affects their abilities to work. The existing literature also suggests these conditions to be prevalent among post-secondary music students. Furthermore, the literature acknowledges a stigmatizing, “don’t ask, don’t tell” occupational environment. This unique learning and working context requires a tailored solution for enhancing occupational resilience - the ability to engage in a valued occupation while positively adapting to stress or adversity. We hypothesize that providing education for tertiary music students will enhance occupational resilience and health literacy, and may impact the development of health conditions in pre-professional musicians.


1. Improve occupational resilience and health literacy in pre-professional musicians;
2. Evaluate the utility of an online educational curriculum from Australia in the Canadian tertiary education context;
3. Assess the impact on student learning and behaviours when this online resource is
integrated into a blended learning classroom context;
4. Develop a questionnaire from existing reliable, validated tools, to evaluate the impact of these two delivery methods in achieving identified educational and behavioural outcomes.

Our international team of collaborators have designed a multi-centre cohort study to evaluate the impact of the online curriculum, Sound Performers, on its own and as part of a blended learning (online and face-to-face) credit course. Measures include a purpose-built questionnaire tool, including reliable, validated measures as well as questions addressing health behaviours that employ the Readiness Ruler to assess readiness to change. Assessment will also include coursework, such as quiz results and reflective journaling, and qualitative focus group interviews with participants at all three sites. Results of this first trial, conducted in Canada at three tertiary institutions, will be shared with attendees.

Effective Interventions For Physical Health Complaints In Nursing Students And Novice Nurses: A Systematic Review

Jos Kox1,2, Ellen Bakker1,4, Sita Bierma-Zeinstra2,3, Jos Runhaar2, Harald Miedema1, Pepijn Roelofs1,5

1Center of Expertise, Innovations in Care, Rotterdam University of Applied Sciences, Netherlands, The; 2Department of General Practice, Erasmus MC University Medical Center Rotterdam, Netherlands, The; 3Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Netherlands, The; 4Department of Public and Occupational Health, Public Health research institute, Amsterdam UMC, VU Amsterdam, Netherlands, The; 5Faculty of Medical Sciences, University Medical Center Groningen, Netherlands, The

Background: The nursing profession is associated with heavy workload and high physical working demands, resulting in increased turnover of nurses. Nursing students and novice nurses are frequently faced with demanding workloads putting them at risk of developing physical health problems, such as musculoskeletal symptoms. An overview of interventions available in this population is lacking. This review aimed to identify interventions studying the treatment and/or prevention of physical health problems in nursing students and/or novice nurses and the effect of these interventions.

Methods: A systematic search of the literature was conducted up to December 2017. Primary outcome of interest was education/work dropout. Secondary outcomes were: musculoskeletal symptoms. Two authors independently screened and selected studies. Three authors assessed risk of bias.

Results: After screening 7,111 titles and abstracts, eleven studies were included. Seven studies evaluated interventions for moving/handling training. Four evaluated other interventions. No studies focused on novice nurses. All studies reported on physical complaints, but none evaluated dropout. Overall, risk of bias was high and clinical heterogeneity prohibited pooling of data. Intervention effects on physical complaints were small and inconsistent. Comparison of five relatively similar studies on additive moving/handling training for back pain in the curriculum revealed that three studies showed a positive intervention effect. However, the other two either showed no effect or favoured the standard curriculum.

Conclusion: This review summarizes interventions promoting the physical health of nursing students and novice nurses. Evidence for the effectiveness of interventions in the nursing curricula for the treatment and/or prevention of physical complaints is scarce and where available conflicting. No studies focussed on our primary outcome education/work dropout. Further high quality research is required to align methods and outcome measures. We recommend research on drop-out due to physical health problems.

Preventing Drop-out of Nursing Students and New Graduates: First Findings from a Bottom-up Approach.

Pepijn D.D.M. Roelofs1,5, Jos H.A.M. Kox1,2, Ellen J.M. Bakker1,3, Jos Runhaar2, Cécile R.L. Boot3, Sita M.A. Bierma-Zeinstra2, Anneke L. Francke3,4, Allard J. van der Beek3, Harald S. Miedema1

1Center of Expertise, Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; 2Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; 3Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, The Netherlands; 4Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 5Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands


With a growing shortage of nursing professionals, preventing drop-out of nursing students and nurse graduates is of foremost importance. Potential causes of drop-out include the demanding physical and mental workload. Unfortunately, interventions to prevent or deal with these strains do not sufficiently seem to find their way into education, and it is unclear who should be targeted with secondary preventive measures. Therefore, the SPRiNG project, Studying Professional Resilience in Nursing students and Graduates, was launched.


A cohort of 731 students from the Bachelor of Nursing program at the Rotterdam University of Applied Sciences, is being followed from their third-year internship up to one and a half year after graduation, using questionnaires and register data. Aims of the cohort study are to: determine prevalence and incidence rates of dropout, identify protective/ risk factors, early indicators of dropout, and it’s interactions. Furthermore, qualitative studies were enrolled to unravel pathways of drop-out; two systematic reviews have been conducted to search for (preventive) interventions; expert meetings were held to designate feasible interventions; and currently the feasibility of adopting possible interventions into the curriculum is explored in six student projects. For two feasible interventions, pilot RCTs are planned.


The first 226 enrolled students reported a physical and mental workload leading to health problems during their internship: e.g., 74% encountered regular/continuous physical complaints such as back pain, 39% experienced distress, and 72% had to deal with aggression. Results from the reviews and qualitative studies provided input for the expert meetings, in which 12 interventions were advised varying from physical fitness consults to Nonviolent Communication training.


SPRiNG is an example of integrating research and education. Scientific and practical findings emerging from this project can be used for teaching healthy working behaviours and deploy targeted interventions before students are lost for the profession.

Interventions Improving Mental Health Of Student and Novice Nurses To Prevent Drop-out: A Systematic Review

Ellen Bakker1,2, Jos Kox1,4, Cécile Boot2, Anneke Francke3, Allard van der Beek2, Pepijn Roelofs1,5

1Research Centre of Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; 2Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 3Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 4Erasmus Medical Center, Department of General Practice, Rotterdam, The Netherlands; 5University Medical Center Groningen, Department of Health Sciences, Community and Occupational medicine, Groningen, The Netherlands

Background: Currently, nursing staff shortages are growing in Western countries, while drop-out among student and novice nurses is high. Mental health problems are a potential cause of drop-out, and occur frequently. Several studies report high prevalences of depression, anxiety and distress. In order to prevent attrition due to reduced mental health, it seems important to teach students to take the lead in their own work-related health. However, an overview of interventions is lacking. This review aimed to provide a systematic overview of interventions aiming at improving mental health in order to prevent drop-out from nursing education/work and an overview of the effectiveness of these interventions.

Methods: Up to 2018 various relevant scientific databases were searched. Two researchers identified studies. Interventions aiming at improving mental health with a quantitative research design were eligible for inclusion. Methodological quality was appraised.

Results: From 7,378 records, 19 studies were included. Only one was an RCT; other studies used a repeated measure, a quasi-experimental or a mixed methods design. The content of interventions varied from multi-component approaches, such as stress management programs, to single-component interventions, such as relaxation interventions. Most of the interventions for student nurses focused primarily on improving mental health. The majority of interventions for novice nurses were multicomponent retention programs that included limited interventions for mental health improvement. Since only five studies showed a significant effect on attrition/retention/sick leave, and an overall high risk of bias, there is limited evidence that these programs are effective. Heterogeneity prohibited pooling of data.

Conclusion: A broad range of interventions aiming at improving mental health in order to prevent drop-out from nursing education/work are available, but the evidence for the effectiveness of these interventions is limited. There is a need for high-quality studies and it is recommended to align methods and measures used in this field.