Healthcare and Social Assistance

Participating core and specialty programs: Center for Motor Vehicle Safety, National Center for Productive Aging and Work, Prevention through Design, Surveillance and Translation Research.

Employers, workers, professional and labor organizations, medical educators and accrediting bodies use NIOSH information to improve occupational safety and health through work design in the healthcare and social assistance sector.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker Population* Research Type
A Depression, Anxiety, Cognitive impairment, Suicide Fatigue and stress due to suboptimal work organization Healthcare workers, veterinary medicine/animal care (VM/AC) workers; vulnerable workers InterventionTranslation
B Depression, Anxiety, Cognitive impairment, Suicide Improved surveillance on work practices, work factors (e.g., psychosocial and safety climate), and health outcomes Healthcare and VM/AC workers Surveillance research
C Fatal and non-fatal injuries Fatigue, stress, work organization as risk factors for motor vehicle crashes during commutes and shifts Residents, interns, and home healthcare workers; others with long hours / irregular schedules InterventionTranslation
D Depression, Anxiety, Cognitive impairment, Suicide Stressful social, interpersonal, and situational aspects of work environment (esp. bullying, violence, interpersonal interactions, dealing with traumatic situations such as those involving death and dying, injury, illness, anger, grief, loss) Healthcare and social assistance workers who directly interact with patients/families, VM/AC workers, small businesses Intervention
E Infectious diseases, Blood borne pathogen infection Safety culture/safety climate/safety leadership Mid-to-small healthcare settings, nursing aides, home healthcare workers, management, VM/AC, other settings where poor adherence to safe practice has been documented InterventionTranslation
F Depression, Anxiety, Cognitive impairment Non-standard work arrangements Healthcare workers Intervention


* See definitions of worker populations

Activity Goal 7.2.1 (Intervention Research): Conduct intervention studies to develop and assess the effectiveness of work design and well-being interventions to reduce injuries and illness among healthcare workers.

Activity Goal 7.2.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective work design and well-being interventions among healthcare workers.

Activity Goal 7.2.3 (Surveillance Research): Conduct surveillance research to better track work practices, work factors (psychosocial and safety climate), and health and safety outcomes among healthcare workers, including those in contingent work arrangements and VM/AC workers.


Work in healthcare (human and animal) and social assistance is often associated with high levels of stress resulting in multiple adverse health and safety outcomes and burnout. The American Nurses Association surveyed 4,614 nurses in 2011 and found that 74% had concerns about the effects of stress and overwork, 24% cited the risk of a fatigue-related crash after a shift as one of their top 3 safety and health concerns, and 53% worked some mandatory or unplanned overtime each month [ANA 2011]. In one survey of veterinary personnel, 35% consider their job dangerous, 34% reported adverse effects from workplace stress, and 42% of veterinarians experienced or witnessed workplace abuse [Fowler 2016]. Veterinarians are estimated to be at higher risk for suicide, compared with the suicide risk for the general population [Bartram and Baldwin 2010; Platt B 2012]. Suboptimal work organization issues have been associated with increased exposure to blood and body fluids and increased risk of needlestick injuries among healthcare workers [Clarke 2007; Hessels 2016]. Temporary, contract, as-needed (pro re nata or PRN), on-call and other non-standard job arrangements are common in healthcare. These work arrangements have been associated with adverse psychological outcomes and performance [Ferrie 2008; Martens 1999; Virtanen 2005].


The relationship between suboptimal organization of work and resulting work-related fatigue and stress with depression, anxiety, cognitive impairment, suicide and other related health and safety outcomes among workers in the healthcare and social assistance sector is not fully understood. Research to better characterize how these organizational factors impact health, and interventions to address these organizational factors, is necessary. This may include surveillance on work practices, work factors (psychosocial and safety climate), and health outcomes among healthcare workers. Innovative surveillance approaches are especially needed for certain groups such as those in non-standard work arrangements. Work organization interventions from other healthcare settings such as hospitals and clinics could be translated to workers in nursing homes, homes, veterinary/animal care environments and non-standard work arrangements.

American Nurses Association [2011]. Health & safety survey report. American Nurses Association,

Bartram DJ, Baldwin DS [2010]. Veterinary surgeons and suicide: a structured review of possible influences on increased risk. Vet Rec 166:388–397.

Clarke SP [2007]. Hospital work environments, nurse characteristics, and sharps injuries. Am J Infect Control 35:302-309.

Ferrie JE, Westerlund H, Virtanen M, Vahtera J, Kivimäki M [2008]. Flexible labor markets and employee health. SJWEH Suppl 6:98–110.

Fowler HN, Holzbauer SM, Smith KE, Scheftel JM [2016]. Survey of occupational hazards in Minnesota veterinary practices in 2012. JAVMA 248:207-218.

Hessels AJ, Larson EL [2016]. Relationship between patient safety climate and standard precaution adherence: a systematic review of the literature. J Hosp Infect 92(4):349-62.

Martens MJ, Nijhuis FN, Van Boxtel MJ, Knottnerus JA [1999]. Flexible work schedules and mental and physical health. A study of a working population with non-traditional working hours. J Organiz Behav 20: 35–46.

Platt B, Hawton K, Simkin S, Mellanby RJ [2012]. Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review. Soc Psychiatry Psychiatr Epidemiol 47:223–240.

Virtanen M, Kivimäki M, Joensuu M, Virtanen P, Elovainio M, Vahtera J [2005]. Temporary employment and health: a review. Int J Epidemiol 34(3):610-22.

Page last reviewed: April 24, 2018