Mid Sweden University

Background: Problem drinking and illicit drug use among healthcare workers (i.e., physicians and nurses) may impair their attention and cognitive functioning, thereby increasing the risk of medical errors and diminishing the quality of patient care. Objective: To investigate the association between healthcare workers' problem drinking and illicit drug use with subsequent self-rated quality of care provided. Design: A two-wave longitudinal observational study. Methods: Panel data were drawn from the Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS), collected in 2022 (baseline) and 2023 (follow-up), encompassing a sample of 3280 healthcare workers. Questionnaires included problem drinking, illicit drug use (cannabis and stimulants), and self-rated quality of care they provide to patients. Logistic regression models analysed relationships between the study variables. Results: At baseline, the prevalence of problem drinking was 3.8 %, and illicit drug use was 1.3 %. Both problem drinking (OR = 1.93, 95 % CI = 1.28–3.02) and illicit drug use (OR = 2.07, 95 % CI = 1.00–4.29) were significantly associated with lower self-rated quality of care provided at follow-up, after adjustment for confounding variables. Conclusions: This novel longitudinal study shows that healthcare workers reporting substance use at baseline were about twice as likely to report providing poor quality of care one year later. These findings are of clinical relevance and highlight the need for targeted preventive measures and interventions to safeguard the health and well-being of healthcare workers while maintaining quality standards in patient care. 

Background: A growing body of literature shows moral distress is increasingly prevalent across healthcare professions, including primary care medicine (Čartolovni et al., 2021; Dean et al., 2019, 2024; Molinaro et al., 2023; Rabin et al., 2023; Talbot & Dean, 2018). Our research uses qualitative methods to develop a grounded theoretical understanding of how primary care doctors experience and cope with moral distress in their daily work.

Method: The data for our theorisation come from a cross-national research project that initially focused on meaningful and meaningless work among primary care doctors in three countries: New Zealand (NZ), the United States (US), and Sweden. We conducted semi-structured interviews with a total of 68 doctors (NZ=26; US=24; Sweden=18). Interviews lasted an average of one hour and were digitally recorded and transcribed. We have thus far thematically analysed interview data from all doctors in the US and NZ, following the template approach of King (2012); we will have finished analysing Swedish data by the time of next year’s conference. Preliminary results, therefore, are based on NZ and US data and may be updated based on themes in Swedish data.

Results: We found that moral distress was a common experience among primary care doctors in both NZ (known as general practitioners or GPs) and in the US (known as family physicians). Most commonly, moral distress was triggered by doctors’ powerlessness to overcome cost-related hurdles to patient care. Our initial analysis suggests doctors cope with moral distress through what we call “moral boundary management approaches,” whereby they (re)position their personal moral responsibilities in relation to their roles in the healthcare system. We identified three main approaches, as summarised. Moral self-differentiation: Doctors view themselves as moral actors in an immoral system and “prove” this by going above and beyond for patients. Our data suggest this often becomes unsustainable over long periods, leading to burnout. Moral dissociation: Doctors “morally zone out” when they cannot provide appropriate care due to cost constraints beyond their control, blaming the system rather than themselves. We found this strategy often develops over the course of longer careers, and due to the perceived futility of moral-self differentiation. Clinical moral dissociation combined with non-clinical moral self-investment:  Doctors “morally dissociate” from their clinical roles (when unable to provide appropriate care) but simultaneously pursue moral imperatives in non-clinical roles as systemic change agents. We found that this approach was most common among doctors with established careers and a relatively high degree of control over their time, due to the absence of financial pressures.

Conclusion: Our research offers valuable insights into how doctors cope with moral distress at an individual level. However, it also emphasises that individual-level coping strategies are inherently related to a systemic context—for example, some doctors combine clinical moral dissociation with non-clinical work to address underlying issues. As such, our work demonstrates the importance of combining individual and systemic initiatives to address moral distress.

Background

Illegitimate tasks are assignments that workers perceive as unreasonable or unnecessary. Unreasonable tasks conflict with workers’ understanding of their role and job expectations, while unnecessary tasks feel pointless because they lack a clear rationale (Semmer et al., 2019). Prior research links illegitimate tasks to negative emotions and work attitudes, counterproductive work behaviour, reduced health and wellbeing, and strained interpersonal relationships (Ding & Kuvaas, 2023). Despite existing research on the negative consequences of illegitimate tasks, little is known about how such tasks become intertwined with the construction, maintenance, or erosion of professional identity in high-autonomy occupations such as medicine (Slay & Smith, 2011). In this study, we ask: How do illegitimate tasks interact with professional identity, and what are the consequences of these interactions?

Methods

We draw on data from a cross‑national research project originally designed to examine meaningful and meaningless work among primary care doctors in New Zealand (NZ), the United States (US), and Sweden. We conducted semi‑structured interviews with 68 doctors (NZ = 26; US = 24; Sweden = 18). We have completed preliminary analyses of the NZ and US datasets using template analysis (King et al., 2018). By July 2026, (SASE Annual Conference), we will have conducted comparative data analysis across all three national contexts allowing us to refine and consolidate our emerging conceptual model.

Preliminary Results

We found that doctors typically interpreted unreasonable and/or unnecessary tasks through a professional‑identity lens that operated along two distinct paths.

Path 1: Identity affirmation: 

In Path 1, doctors framed certain illegitimate tasks as unreasonable relative to role expectations, yet necessary to uphold patient care. For example, they described conducting consultations, regardless of patient or condition complexity within compressed appointment slots as unreasonable. However, when such tasks were simultaneously seen as necessary for delivering quality care, they became identity-affirming. Consequently, doctors were more likely to complete unreasonable tasks without explicit resistance. This acceptance encouraged them to treat coping with workload pressures as central to their professional identity. We argue that this dynamic can create a self-reinforcing loop in which professional pride and commitment become organisationally exploited, normalising overwork and self-sacrifice.

Path 2: Identity disaffirmation

In Path 2, doctors construed illegitimate tasks as both unreasonable and unnecessary. For example, they viewed onerous non‑clinical documentation as beyond their professional remit and pointless due to system redundancies and inefficiencies. Such tasks were experienced as identity‑disaffirming, and doctors typically resisted them. For instance, one doctor described collaborating with colleagues to change an electronic “carbon copy” system that had previously forced her to review results from “pointless” tests ordered for her patients. When resistance succeeded, it preserved doctors’ identities and functioned as a form of collective boundary work, that protects professional status and autonomy. However, when resistance was unsuccessful or futile—often due to power asymmetries—it undermined professional identity and contributed to deprofessionalisation.   

Conclusion

We argue that normalisation and codification of illegitimate tasks not only undermines professional identity but also reconfigures the boundaries of professional autonomy, with implications for organisational governance and the sustainability of primary care work.  

Background: Recruiting and retaining nurses remains a persistent challenge globally, with workforce shortages affecting healthcare quality and sustainability. While previous research often focuses on structural factors such as pay and workload, there is limited understanding of how future professionals—nursing students—perceive and construct workplace attractiveness during their clinical training. Clinical placements serve as a formative arena where students not only acquire professional skills but also form impressions of what constitutes an appealing and sustainable workplace. This study explores how nursing students make sense of workplace attractiveness through their lived experiences in clinical practice.

Method: A qualitative, reflexive, and inductive thematic analysis was conducted, grounded in a constructionist epistemology. Thirteen semi-structured interviews were held with final-year nursing students from four Swedish universities between February and May 2025. Three interviews were individual, and four were group interviews with two to three participants each. The discussions centred on students’ experiences of workplace attractiveness, professional identity, and future career considerations. Interviews were recorded, transcribed verbatim, and analysed iteratively according to Braun and Clarke’s approach, with continuous reflexive discussions among the research team to ensure analytical depth and transparency.

Results: Clinical placements shaped how students envisioned their professional futures, making them key sites for constructing perceptions of workplace attractiveness. The overarching theme, Looking Ahead, encapsulated workplace attractiveness as a dynamic socialisation process evolving through four interrelated themes. Becoming captured by the significance of supervision, feedback, and being treated as a “future colleague”. Belonging reflected the importance of inclusive team relationships, collegial support, and emotional safety. Balancing concerns and reconciling professional demands with personal life, emphasising manageable workloads, recovery time, and flexible scheduling. Beyond referred to aspirations for professional growth, continued learning, and long-term development opportunities. Together, these themes illustrated workplace attractiveness as relational and temporal—shaped in the intersection between students’ immediate experiences and their imagined futures as professionals.

Conclusion: Workplace attractiveness in healthcare should be understood as a lived, relational, and evolving process rather than a fixed organisational attribute. It is actively produced in everyday interactions through experiences of recognition, inclusion, and growth. For healthcare organisations, this implies that improving workplace attractiveness requires more than structural interventions; it demands relational and symbolic engagement. Supportive supervision, inclusive social climates, and opportunities for professional development are key to fostering belonging and identity formation. By viewing attractiveness as an ongoing practice of inclusion and learning, organisations can better retain early-career nurses and sustain both workforce stability and the quality of patient care.

(1) Background - Research on the influence of funding structures and regulatory models in health care is predominantly informed by quantitative studies conducted in the United States (US). This raises concerns about transferability of findings to contexts with differently configured health systems. For example, in Sweden and New Zealand (NZ), health care is organized under universal coverage, whereas in the US it is primarily insurance-based. This contrast warrants a crossnational, qualitative comparative exploration of how structural factors influence meaningful and meaningless work for health care providers in different contexts. Hence, we pose the following research question: How do systemic factors (i.e., funding, governance, regulation, institutional logics) in Swedish, NZ, and US health care systems differentially shape family physicians' experiences of meaningful and meaningless work?  

(2) Methods - We conducted semi‑structured interviews with 68 physicians (Sweden = 18; NZ = 26; US = 24). We have completed preliminary analyses of the NZ and US datasets using template analysis. By September 2026, (Scandinavian Symposium of Work and Organizational Psychology), we will have conducted comparative data analysis across all three national contexts allowing us to refine and consolidate our emerging conceptual model.  

(3) Results - Family physicians in NZ and the US viewed available practice models as system‑level drivers of meaningful work. In NZ, co‑payment and capitation, especially Very Low Cost Access support that lowers patient fees were critical for equity‑oriented physicians’ sense of meaningful work. In the US, Direct Primary Care offered an alternative to fee‑for‑service, reducing organizational pressure, time‑based metrics, and prescriptive professional‑presentation standards, thereby strengthening meaning. Across both contexts, physicians linked meaninglessness work to instrumental, market‑oriented logics and the “McDonaldization” of medicine through standardization via efficiency, calculability, predictability, and control. Administrative expansion, whether profit‑seeking or resource‑rationing, has eroded physician autonomy in care delivery.  

(4) Conclusion - By examining family physicians across contrasting health systems, we show how system‑level factors shape meaningful and meaningless work. The findings inform workforce well‑being and retention and contribute to interdisciplinary debates on studying meaningful work in future‑of‑work research. 

Background: Older adults receiving psychiatric care are at greater risk of adverse events (AEs) than younger patients. This reflects broader vulnerabilities, including marginalization, complex health needs, and frequent transitions between care settings. It is therefore necessary to investigate AE risk in this population and to validate a previous version of the Global Trigger Tool – Psychiatry (GTT-P), originally developed for the general psychiatric population, for use with older psychiatric patients. Objective: To apply the Norwegian version of GTT-P in psychiatric care for older adults, to identify the prevalence of AEs in this subpopulation. Methods: A retrospective cohort study was conducted by reviewing medical records of 184 patients aged 65+ admitted to a psychiatric hospital between 2022 and 2023. All patients who did not opt out were included. Results: AEs were identified in 10.9% of patients. Triggers related to compulsory treatment and medication significantly increased AE risk. No AEs occurred without associated triggers. Of the AEs identified, 63% were considered avoidable. Conclusions: This study demonstrates the utility of GTT-P in detecting AEs in older psychiatric patients. Specific clinical triggers were significantly associated with AEs. Preventive strategies and improved care coordination are essential to reduce avoidable harm and enhance patient safety in psychiatric care. 

Background: Extubation of patients undergoing general anaesthesia is a shared concern among registered nurse anaesthetists and anaesthesiologists. Although it has been described as complex and unpredictable, knowledge of this critical moment remains limited. Clinical judgment is consistently applied when making crucial decisions regarding patient care. This study aimed to investigate how RNAs and ANs expressed clinical judgment during extubation through noticing, interpreting, responding, and reflecting. Methods: A qualitative reflexive thematic analysis was conducted, using interviews with registered nurse anaesthetists and anaesthesiologists from university and regional hospitals in Sweden. Triangulation was used to explore the perspectives of registered nurse anaesthetists (n = 20) and anaesthesiologists (n = 17) at extubations. Two datasets, one from focus group interviews with registered nurse anaesthetists and one from individual interviews with anaesthesiologists, were used to triangulate data. Results: Extubation was described as a dynamic process of clinical judgment, where anaesthesia professionals continuously integrated clinical cues, experience, and situational awareness to ensure patient safety. Multisensory patient-related and situational cues were attended to and integrated to form an initial understanding of the patient’s condition. These cues were interpreted through prior experience and pattern recognition, while responses were shaped by context and often guided by embodied intuition. Reflection both in action and on action supported ongoing adjustment and the development of clinical judgment over time. Conclusions: During extubation, registered nurse anaesthetists and anaesthesiologists exercised clinical judgment by putting the pieces together, continuously integrating clinical cues, experience, and situational awareness. This process involved multisensory noticing, experience-based interpretation, context-dependent responding often guided by embodied intuition, and ongoing reflection to ensure patient safety. These findings highlight the importance of supporting clinical judgment through experience-based learning, reflective practice, and work environments that enable focused attention during extubation.

Background: Research suggests a comorbidity between illicit drug use and mental health conditions. However, it remains unclear whether illicit drug use serves as a risk factor for, or a consequence of, mental health conditions in healthcare workers (HCWs). This study aimed to 1) examine the prevalence of illicit drug use among HCWs in Sweden and 2) investigate the bidirectional relationship between illicit drug use and mental health conditions(i.e., depression and burnout). Methods: Data from the 2022 and 2023 Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS) were used. The data included 3280 HCWs (50.3 % physicians and 49.7 % nurses). Questionnaires assessed illicit drug use frequency, burnout complaints (BAT-12), and depression (SCL-CD6). Cross-lagged panel models (CLPMs) were used to examine the reciprocal relationships over the two studied time-points between illicit drug use and mental health conditions. Results: The prevalence of illicit drug use in 2022 was 1.3 %, which increased slightly to 1.6 % one and a half years later, in 2023. Using two-wave panel data, results revealed a bidirectional effect between illicit drug use and burnout. However, while depression was associated with subsequent illicit drug use, the reversed association was not observed. Conclusions: These findings suggest that illicit drug use plays different roles in relation to burnout and depression among healthcare workers. This highlights the importance of integrated treatment strategies and preventive measures that address both illicit drug use and mental health conditions—especially burnout—simultaneously. 

Background: In line with the Job Demand-Resources (JD-R) model, physicians with high work engagement tend to cope more effectively with demanding work situations. However, the potential negative aspects of work engagement in relation to the JD-R model and among physicians have not been explored. This study aims to investigate if 1) a curvilinear association exists between work engagement and burnout, and 2) if work engagement moderates the relationship between job demands (quantitative demands, and effort-reward imbalance) and subsequent burnout complaints.

Method: This longitudinal observational panel cohort comprises approximately 1649 physicians who responded at two time points (T1: 2022; T2: 2023 and T3: 2025) to the Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS). The Burnout Assessment Tool (BAT-12) was used to assess burnout complaints. Furthermore, quantitative demands and work engagement were measured using validated items from the Copenhagen Psychosocial Questionnaire III (COPSOQ III), and effort-reward imbalance was assessed using the Effort-Reward Imbalance Questionnaire by Siegrist. First, both linear and quadratic terms of work engagement will be included to test for curvilinear associations with subsequent burnout. Moderation analyses will further test whether work engagement buffers or amplifies the longitudinal effects of job demands on burnout, controlling for baseline burnout and relevant covariates. Lagged modelling will be employed, using predictors at each wave to forecast burnout at the subsequent wave, ensuring temporal precedence.

Results: Preliminary results among primary care physicians using two time points show a statistically significant U-shaped association (B=-0.071, p=0.011) between work engagement and follow-up burnout complaints after adjusting for confounders. Work engagement acted as a moderator, amplifying the negative effects of illegitimate work tasks (B = 0.101, p-value = 0.006) and effort-reward imbalance (B = 0.126, p-value = 0.007), respectively, on burnout complaints at follow-up. In time for the conference, updated results with all physicians will be ready.

Conclusion: Our study demonstrates that work engagement may have a protective impact on the demands-burnout relationship to a certain extent, after which it may instead amplify this adverse link. This finding underscores the need for a contextual consideration of the proposed positive elements of the established J-DR model.