Keeping nurses working: development and psychometric testing of the Nurse-Work Instability Scale (Nurse-WIS)

Aim. This paper reports a study to develop and test the psychometric properties of the Nurse-Work Instability Scale (Nurse-WIS). Background. Work Instability describes the extent of any mismatch among functional (in)capacity, work demands and its potential impact on efficiency/productivity at work. Recruitment, retention and migration of nurses are global issues influenced by many factors. It is well documented that musculoskeletal pain and subsequent disability account for a high proportion of sickness absence and premature retirement in the nursing workforce. The challenge to clinicians is to identify such problems early so that appropriate interventions can be targeted to facilitate job retention. Method. Analyses of 48 qualitative interview transcripts conducted with nursing staff during 2003 were used to generate potential items for the Nurse-WIS. Analysis of the psychometric properties of the scale derived from these items was undertaken by using the Rasch model and data generated in postal surveys in 2004. The scale was validated against a gold standard of expert vocational assessment by occupational health physiotherapists/ergonomists. Findings. The resulting self-administered questionnaire consisting of 30 items not only measures the risk of job loss relating to musculoskeletal symptoms, but also captures relevant psychosocial issues. The scaling properties of this questionnaire meet the rigorous psychometric requirements of the Rasch model. Conclusions. The Nurse-WIS is a psychometrically sound method for the early identification of nursing staff experiencing difficulties at work. It offers the prospect of positive proactive management to prevent or minimize sickness absence and potentially prevent loss of nursing staff from the workforce through long-term sickness absence and early retirement.