Original Article

Low back pain among nurses in Slovenian

hospitals: cross-sectional study
c1 RN, BSc, MSc, PhD, K. Pesjak2
B. Skela-Savi BSc (Social Sciences), PhD &
c-Touzery3 BSc (Social Sciences), PhD
S. Hvali
1 Associate Professor, Dean, 2 Researcher, 3 Assistant Professor, Vice-Dean, Fakulteta za zdravstvo Angele Boskin/Angela
Boskin Faculty of Health Care, Jesenice, Slovenia

SKELA-SAVIC  B., PESJAK K., HVALIC-TOUZERY

 S. (2017) Low back pain among nurses in
Slovenian hospitals: cross-sectional study. International Nursing Review 64, 544–551

Aim: The study investigated the prevalence and factors predicting low back pain among nurses in Slovenian
hospitals.
Background: The risk factors for low back pain are physical and psychosocial. Implementation of
interventions for reducing low back pain calls for management support, accessible equipment, education,
knowledge and risk assessment.
Introduction: Low back pain prevalence and incidence among healthcare workers is very high compared to
the general population and is a strong risk factor for long-term sickness absence.
Methods: A cross-sectional study design was utilized. We used validated instruments: Nordic
Musculoskeletal Disorder Questionnaire, Stanford Presenteeism Scale and Perceived Stress Scale. The sample
included 1744 nursing employees from 16 Slovenian hospitals, ranging from practical nurses, registered
nurses, nurses with a bachelor’s degree and those with a master’s degree.
Findings: Results revealed a prevalence of low back pain among 85.9% of respondents. Relevant risk factors
included female gender, age, length of employment, years in current position, shift work and the number of
nurses per shift. In the regression model, factors predicting low back pain included presenteeism with a
negative effect on work, presenteeism and maintaining work productivity, inability to control daily life,
number of nurses per shift and respondents’ age.
Conclusions: Future activities should be oriented towards eliminating or reducing risks for low back pain
incidents and towards different strategies, guidelines and actions which empower individuals and provide
knowledge to manage and prevent low back pain.
Implications for management and health policy: Slovenian healthcare system planning needs a national
strategy to successfully promote LBP preventive and controlling strategies. Management can plan preventive
and curative measures to reduce low back pain prevalence among nursing personnel. Management should
also implement policies reflecting research findings.

Keywords: Low Back Pain, Musculoskeletal Disorders, Nurses, Presenteeism, Slovenia, Stress

Correspondence address: Dr Katja Pesjak, Fakulteta za zdravstvo Angele Boskin/Angela Boskin Faculty of Health Care, Spodnji Plavz 3, 4270 Jesenice, Slovenia;
Tel: 00386-4-5869-364; Fax: 0038645869369; E-mail: kpesjak@fzab.si.

Funding
The research was financed by the Health Insurance Institute of Slovenia (Project No. 0142-3/2014-DI/477) in the period 2015–2016.
Conflict of interest
The authors report no conflict of interests.

© 2017 International Council of Nurses 544

Low back pain among nurses in Slovenian hospitals
Introduction
Low back pain (LBP) is defined as pain or discomfort,
including radiating pain, which occurs specifically between
the twelfth rib and the inferior gluteal folds (Woolf et al.
2012). The prevalence and incidence of LBP among healthcare
workers are unusually high in comparison with the general
population, and, consequently, LBP is a strong risk factor for
long-term sickness absence (Andersen 2012; Andersen et al.
2014; Holtermann et al. 2013; Wang et al. 2015).
Background
Musculoskeletal disorders (MSDs) with LBP are most com-
monly reported by nurses – they are at a greater risk of MSDs
compared to other healthcare professionals and the general
population (Abedini et al. 2013; Attar 2014; Wang et al.
2015). Indeed, MSDs could be termed ‘an epidemic in nurs-
ing’ (Nutty 2014). For this reason, LBP tends to be addressed
through different health and safety procedures, strategies and
interventions in hospitals where safe patient handling has
been introduced over the last decades in many countries
(Andersen et al. 2014; Briggs et al. 2015; Lee et al. 2015; Lid-
gren et al. 2014; Powell-Cope et al. 2014). The European
Union (EU) outlines the basic principles of LBP prevention
and treatment in Council Directive 90/269/EEC.
The fact that LBP has most frequently been reported
among nurses is well documented (Golabadi et al. 2013;
Rahimi et al. 2015; Yassi & Lockhart 2013). The development
of occupational LBP is associated with physical and psychoso-
cial risk factors (Yilmaz & Dedeli 2012). Previous research
evidence suggests that nursing personnel remained at work
despite suffering from LBP on a significant number of
working days (d’Errico et al. 2013; Martinez & Ferreira 2012;
Skerjanc & Dodic Fikfak 2015). Different nursing activities
posed a greater risk of LBP and were more likely to cause
back disorders irrespective of nursing technique, personal
characteristics and other factors unrelated to work (Yassi &
Lockhart 2013). Sezgin & Esin (2014) found several risk fac-
tors for MSDs and LBP, including excessive workload, irregu-
lar working hours, risky body movements, poor income
satisfaction, frequency of exercise, general health perception
and educational level. Moreover, age and length of employ-
ment were significantly associated with the severity of pain
and disability brought on by LBP (Lin et al. 2012; Rahimi
et al. 2015; Sezgin & Esin 2014). In more demanding jobs,
the prevalence of LBP was higher compared to less demand-
ing jobs (Gandhi et al. 2014; Ghilan et al. 2013). Psychosocial
factors at work (e.g. work demands, decision latitude and
stress symptoms) have also been identified as determinants of
© 2017 International Council of Nurses
545
LBP development among nurses (Gandhi et al. 2014; Ghilan
et al. 2013; Yilmaz & Dedeli 2012). Psychosocial job strains
and demands have been linked with stress and as such result
in a higher prevalence of LBP. An important correlation
between LBP and presenteeism among nurses has also been
confirmed. The majority of nurses report that health prob-
lems affect their work productivity and that pain is impor-
tantly correlated with presenteeism (Letvak et al. 2012). Work
quality is importantly influenced by presenteeism: a study
reported that workers adjust their activities and work to the
level of pain (Campo & Darragh 2012). What is more, nurse
presenteeism in hospitals is raising healthcare costs (Letvak
et al. 2012; Taghinejad et al. 2015).
Nurses’ work productivity, patient safety and healthcare
costs importantly depend on workers’ health. Therefore,
interventions directed at reducing injuries in health care have
several requirements, including management and policy sup-
port, accessible equipment, education and knowledge, and
risk assessment (Nørregaard Rasmussen et al. 2013;
Schoenfisch et al. 2013).
Aim
The appearance of LBP and its consequences among nurses is
becoming an international challenge. Our study aimed to
establish the prevalence of LBP among nursing employees in
Slovenian hospitals and to recognize the factors predicting
LBP risk.
Method
Study design and respondents
A cross-sectional quantitative study design was used with
descriptive, correlational and exploratory logistic regression
methods.
All Slovenian hospitals were invited to participate in the
study, of which 16 (59.3%) confirmed participation. The total
number of nursing personnel in participating hospitals was
2777, including practical nurses (PNs), registered nurses
(RNs), nurses with a bachelor’s degree (BSN) and nurses with
a master’s degree (MSN); all were administered question-
naires. PNs represent 60% of the nursing workforce in Slove-
nian hospitals. A total of 1744 (62.23%) completed
questionnaires were returned. In terms of gender, 1534 (88%)
of the respondents were female and 203 (11.6%) were male.
The mean age of respondents was 40.8 years (SD = 10.27),
and the average length of employment in nursing in their
current position was 14.36 years (SD = 11.32). In terms of
educational achievement, respondents ranged from PN
546 B. Skela-Savi
c et al.
(n = 1.006, 57.7%), BSN (n = 631, 36.2%) and RN (n = 49,
2.8%) to MSN (n = 47, 2.7%).
Measures
A structured questionnaire was used, containing five thematic
categories designed to determine LBP prevalence, workplace
presenteeism, workplace stress, organization of institutions
and socio-demographic factors. The questionnaire consisted
of 94 questions, 25 of which were related to demographic and
workplace characteristics.
For establishing the prevalence of LBP, the Nordic Muscu-
loskeletal Disorder Questionnaire (Kuorinka et al. 1987) was
used, containing eight questions on LBP in the form of cate-
gorical variables, with a definition of LBP and a picture of
the body showing the possible positions of LBP.
To obtain a description of work experience in the past
month, the Stanford Presenteeism Scale (SPS-6; Consortium for
Mental Healthcare [COHM] 2009) was used, including six
items for which respondents were asked to indicate their level
of agreement on a five-point scale: three items used a one-
to-five scale, where 1 = strongly disagree, 2 = disagree,
3 = partly disagree, partly agree, 4 = agree and 5 = strongly
agree, and the remaining three items used a five-to-one scale,
where 5 = strongly disagree, 4 = disagree, 3 = partly disagree,
partly agree, 2 = agree and 1 = strongly agree. Result scores
for the Stanford Presenteeism Scale (SPS-6) range between 6
and 30 points. A high SPS-6 score denotes increased presen-
teeism, defined as having ‘a greater ability to concentrate on
and accomplish work despite health problem(s)’. A low score
indicates decreased presenteeism, which means that a person
is physically present at work but may ‘experience decreased
productivity and below-normal work quality’ resulting from
an illness or other constraint (Consortium for Mental Health-
care [COMH] 2009, p. 1). Reliability coefficient a was 0.674
for six items. The instrument yielded two factors (Factor 1
and Factor 2) that, combinedly, explained 66.34%
Table 1 Descriptive results of work experiences in the past month and factor analysis
Items
Because of my low back pain, the stresses of my job were much harder to handle
Despite having low back pain, I was able to finish hard tasks in my work
Low back pain distracted me from taking pleasure in my work
I felt hopeless about finishing certain work tasks, due to my low back pain
At work, I was able to focus on achieving my goals despite low back pain
Despite having low back pain, I felt energetic enough to complete all my work
M, Mean = five-point scale (1-strongly disagree, 5-strongly agree); SD, standard deviation; F1, factor ‘presenteeism with a negative effect on work’; F2,
factor ‘presenteeism and maintaining work productivity’. Extraction method: principal axis factoring. Significance of bold values at 0.05.
© 2017 International Council of Nurses
(KMO = 0.712 and Barlett P < 0.001) of the total variance as
follows: 33.80% was explained by the first factor ‘presenteeism
with a negative effect on work’ (a value 0.852) and 32.54% by
the second factor ‘presenteeism and maintaining work produc-
tivity’ (a value 0.839). Factor analysis results are presented in
Table 1.
The instrument Perceived Stress Scale (PSS 10; Cohen et al.
1983) was used to solicit respondents’ self-assessment of their
feelings and thoughts in the past month. They were asked to
indicate how often they had felt something or thought about
something in a certain way on a five-point scale, from 0 to 4
(0 = never, 1 = almost never, 2 = sometimes, 3 = often,
4 = very often). Reliability coefficient a was 0.858. Scores on
the Perceived Stress Scale (PSS 10) range from 0 to 40, with
higher scores being a sign of higher perceived stress. Scores
from 0 to 7 would be considered a stress level much lower
than average, from 8 to 11 slightly lower than average, from
12 to 15 average, from 16 to 20 slightly higher than average
and 21 and over much higher than average (Cohen et al.
1983). The instrument yielded two factors that, combinedly,
explained 49.71% (KMO = 0.869; Barlett P < 0.001) of the
total variance as follows: 39.57% was explained by the first
and 10.13% by the second factor. Factor analysis results are
presented in Table 2. Factor 3 (inability to control daily life)
a value was 0.862 for six items. Factor 4 (ability to control
daily life) a value was 0.759 for four items.
Data collection and ethical considerations
Survey was conducted in autumn 2015. The study was autho-
rized by the Senate Committee for Science, Research and
Development at the Faculty of Health Care Jesenice (FHCJ)
on 20 October 2015. The decision to participate in the study
was made by the relevant scientific or ethical committee at
each hospital. The purpose of the research was explained in
advance to the respondents. Respondents were informed of
the voluntary nature of participation and that they had the
M SD F1 F2
2.95 1.22 0.732 0.021
3.98 1.04 0.143 0.697
2.94 1.23 0.867 0.020
3.10 1.26 0.837 0.044
3.72 1.07 0.015 0.898
3.49 1.13 0.143 0.811
Low back pain among nurses in Slovenian hospitals 547

Table 2 Stress exposure results with factor analysis

Items M SD F3 F4

In the last month, how often have you been upset because of something that happened unexpectedly? 2.21 0.89 0.741 0.078
In the last month, how often have you felt that you were unable to control the important things in your life? 1.44 0.97 0.631 0.216
In the last month, how often have you felt nervous and ‘stressed’? 2.34 0.97 0.781 0.041
In the last month, how often have you felt confident about your ability to handle your personal problems? 2.62 0.82 0.050 0.732
In the last month, how often have you felt that things were going your way? 2.36 0.80 0.194 0.580
In the last month, how often have you found that you could not cope with all the things that you had to do? 1.84 0.87 0.562 0.108
In the last month, how often have you been able to control irritations in your life? 2.63 0.84 0.064 0.555
In the last month, how often have you felt that you were on top of things? 2.68 0.80 0.120 0.705
In the last month, how often have you been angered because of things that were outside of your control? 1.77 0.90 0.693 0.073
In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? 1.50 0.96 0.757 0.084

M, mean = five-point scale (0-never, 4-very often); SD, standard deviation; F3, factor ‘inability to control daily life’; F4, factor ‘ability to control daily
life’. Extraction method: principal axis factoring. Significance of bold values at 0.05.

right to withdraw from the study at any time. Respondents’
confidentiality was maintained.
Data analysis
We used descriptive analysis, paired t-test, Mann–Whitney U-
test, chi-square test, Pearson’s correlation coefficient, factor
analysis and logistic regression. An exploratory factor analysis
using principal axis factoring was used. Bartlett’s test of
sphericity was performed (P < 0.05) and the Kaiser–Meyer–
Olkin measure was used (KMO > 0.6; Pallant 2010). Data
were analysed using the statistical software SPSS 23. The sig-
nificance level was set at 5%.
Results
Respondents’ work characteristics and prevalence of LBP
A total of 176 respondents (10.1%) held a management posi-
tion. In terms of job satisfaction, 1431 (82.1%) respondents
reported being satisfied with their job, 224 (12.8%) reported
being dissatisfied and 89 (5.1%) did not answer the question.
The mean number of overtime hours per month was 11.49
(SD = 14.01). The actual number of nurses per shift was 3.88
(SD = 2.71), while the number of nurses that should be
working a shift according to recommendations is 5.27
(SD = 3.59). A total of 986 (56.50%) respondents reported
having access to lifting devices and other equipment designed
to limit forceful movements.
Overall, 1498 respondents (85.9%) reported experiencing
LBP and 246 respondents (14.1%) reported no problems.
LBP was more common in females than in males
(v2 = 14.640, P < 0.001). A total of 656 (37.6%) respondents
reported experiencing LBP in the past 7 days. Over the past
12 months, 683 (49.2%) respondents were forced to reduce
their activity at home and at the workplace due to LBP, 904
(66.2%) were forced to reduce their free-time physical
activity due to LBP and 529 (37%) respondents required
healthcare provision.
The results also showed that an increase in age, length of
employment and years in current position raised the risk for
LBP (P < 0.001). Also, dissatisfaction with work (v2 = 4.399,
P = 0.036) and non-existence of nurse-manager provision of
lifting devices and other equipment designed to limit forceful
movements (v2 = 3.686, P = 0.049) further increased LBP
risk. Educational achievement did not significantly correlate
with LBP prevalence. Finally, working a multishift schedule
(Z = 3.342, P < 0.001) and the number of nurses per shift
(Z = 2.217, P = 0.027) proved to be significant determi-
nants of LBP, while other characteristics of nursing work like
overtime hours per month (M = 13.82, SD = 12.23), number
of night shifts per month (M = 3.76, SD = 3.27), number of
patients per workday (M = 17.90, SD = 13.62) did not corre-
late significantly with LBP.
Description of work experiences in the past month
A mean SPS-6 score in our study was 20.16 (SD = 4.27), sug-
gesting that respondents could successfully complete their
work obligations despite having health issues. The level of
presenteeism correlated with expressed work dissatisfaction
(Z = 8.528, P < 0.001), a conviction that nurse managers
failed to provide lifting devices and equipment designed to
limit forceful movements (Z = 4.806, P < 0.001), and a
non-managing position (Z = 2.805, P = 0.005). In addition,
presenteeism correlated with decrease in work activity
(Z = 12.454, P < 0.001), decrease in physical activity

© 2017 International Council of Nurses

548 B. Skela-Savi
c et al.

(Z = 9.852, P < 0.001), the need for healthcare provision in Table 3 Factors predicting LBP
past 12 months (Z = 7.381, P < 0.001) and LBP in past
7 days (Z = 4.229, P < 0.001). Characteristics R2 = 0.304 (95% IZ 13.9–
We also analysed both factors obtained with factor analysis 30.4)
(Table 1). Items in the Factor 1 were at the level of partial
agreement and partial disagreement (M = 3.00, SD = 1.09), OR (95% CI) P
indicating indecision of respondents over whether LBP
affected their work or not. Items in the Factor 2 were Increase in the mean level of 0.65 (0.50–0.87) 0.003
presenteeism with a negative
approaching agreement (M = 3.74, SD = 0.94) on being able
effect on work (F1)
to meet work obligations despite having LBP. Factor 1 corre-
Increase in the mean level of 2.57 (2.07–3.20) <0.001
lated with LBP (Z = 8.042, P < 0.001), similarly to the presenteeism and maintaining
Factor 2 (Z = 8.538, P < 0.001). work productivity (F2)
Increase in the mean level of 1.43 (1.04–1.96) 0.027
Exposure to stress the inability to control daily life (F3)
The mean respondents’ score on PPS 10 was 16.89 Decrease in the mean level of the 1.04 (0.76–1.43) 0.811
ability to control daily life (F4)
(SD = 5.81), which indicates a high health concern level. Both
Decreased mean number of nurses 1.11 (1.00–1.22) 0.044
factors obtained with factor analysis were also analysed
per shift
(Table 2). Items for Factor 3 range between answers ‘almost Increase in the mean age (in years) 1.06 (1.03–1.10) <0.001
never’ and ‘sometimes’ (M = 1.85, SD = 0.71), whereas items Dissatisfaction with work 1.39 (0.60–3.21) 0.443
for Factor 4 range between answers ‘sometimes’ and ‘fairly Non-existence of nurse-manager 0.92 (0.55–1.55) 0.765
often’ (M = 2.57, SD = 0.62). Both variables are connected provision of lifting devices and
with the prevalence of LBP as follows: factor ‘inability to con- other equipment
trol daily life’ (Z = 5.409, P < 0.001), and factor ‘ability to Increase in the length of two-shift 1.01 (0.98–1.04) 0.602
and three-shift work schedules
control daily life’ (Z = 2.150, P = 0.032).
(in years)

Factors predicting LBP

Logistic regression analysis was conducted (Table 3). Explana-
tory variables included in the model were those correlating
significantly with the presence of LBP among respondents.
We found that LBP could be explained in 30.4% (R2 = 0.304,
Model v2 = 160.037, df = 8, P < 0.001). Risk of LBP
increased by Factor 1 (P = 0.003) and Factor 2 (P < 0.001),
whereas a lower level of Factor 1 reduced the risk for LBP. In
addition, predictors of LBP also included Factor 3
(P = 0.027), number of nurses per shift (P = 0.044) and
respondents’ age (P < 0.001). Other variables connected to
demographic characteristics and work environment, which
correlated with LBP at the univariate level, did not have sta-
tistical significance in the regression model.
Discussion
This study was the first representative research conducted on
the issue of LBP among nursing personnel in Slovenian hospi-
tals. We found that 86% of nursing professionals experienced
LBP. In previous studies (Barzideh et al. 2014; Stricevic et al.
2012), authors established slightly lower, but still high preva-
lence of LBP among nursing staff, ranging from 71.1% to 79%.
Our research revealed that risk for LBP was higher in
females compared to males, and positively correlated with
R2, Nagelkerke R-squared; OR, Odds ratio; CI, confidence interval; P, P-
value. Significance of bold values at 0.05.
respondents’ age, length of employment and years in the cur-
rent position, which corroborates previous research findings
(Attar 2014; Lin et al. 2012; Rahimi et al. 2015; Sezgin & Esin
2014). In terms of work environment characteristics, LBP
prevalence significantly correlates with not having access to
lifting devices, dissatisfaction with work, duration of two-shift
and three-shift work schedules and the actual number of
nurses working a shift compared to the number of nurses that
should be working a shift according to recommendations.
Our results revealed that work satisfaction and workplace
stress correlated significantly with the prevalence of LBP, a
fact which has also been established by other authors
(Ghilan et al. 2013; Golabadi et al. 2013). Both the inability
and ability to control daily lives correlated with the
occurrence of LBP.
Moreover, our study results show that presenteeism level
was in the top third of the scale and correlated with most of
the variables related to nursing work and the consequences
of LBP. The level of presenteeism significantly correlated
with respondents’ age, LBP experienced in the past 7 days,

© 2017 International Council of Nurses

Low back pain among nurses in Slovenian hospitals
physical activity, the need for healthcare provision and some
work-related factors. Similar conclusions have also been
reached by other researchers (Campo & Darragh 2012; Sker-
janc & Dodic Fikfak 2015). Theoretical construct of presen-
teeism yielded the factors ‘presenteeism with a negative
impact on work’ and ‘presenteeism and maintaining work
productivity’. Laranjeira (2013) came to similar conclusions
among registered nurses in two Portuguese hospitals. In our
study, ‘presenteeism and maintaining work productivity’ was
more prevalent. There are many reasons for this, perhaps the
most important one being the perceived level of pain and a
cultural predisposition to declare the inability to work. Con-
trary to other research findings (Campo & Darragh 2012;
Letvak et al. 2012), our study did not show that LBP hin-
dered nurses from doing their work. Even so, a significant
correlation was established between both presenteeism factors
and LBP. It is a fact that nurses who come to work despite
experiencing LBP have a greater risk of suffering events
which worsen their condition. These findings are consistent
with other evidence (d’Errico et al. 2013; Letvak et al. 2012;
Martinez & Ferreira 2012).
Regression analysis was conducted for all factors which cor-
related with LBP. This yielded five factors predicting LBP
with high explanatory power, as they explained LBP in 30%.
The factors which significantly predicted the occurrence of
LBP were as follows: presenteeism with a negative effect on
work, presenteeism and maintaining work productivity, the
inability to control daily life, the number of nurses per shift
and respondents’ age. Regression analysis results confirm the
findings of Yilmaz & Dedeli (2012) that the development of
occupational LBP is triggered by both effective physical fac-
tors and psychosocial factors.
International perspectives for prevention of LBP
According to these data and other research evidence (Campo
& Darragh 2012; Letvak et al. 2012; Taghinejad et al. 2015;
Yilmaz & Dedeli 2012), managing LBP is a good way to raise
nurses’ work productivity, improve patient safety, reduce
healthcare costs and provide knowledge and skills on LBP to
nurses. Safe patient handling policies and programmes have
been introduced in the last decades in many developed coun-
tries (Andersen et al. 2014; Briggs et al. 2015; Lee et al. 2015;
Lidgren et al. 2014; Powell-Cope et al. 2014; Speerin et al.
2014). Measures such as a no-lift policy, safe equipment,
training, patient handling protocols and co-workers demon-
strating safe practices have yielded the best results (Lee et al.
2015; Powell-Cope et al. 2014; Theis & Finkelstein 2014).
Briggs et al. (2015) investigated Australian models of care
(MoC) for musculoskeletal health which demonstrate how to
© 2017 International Council of Nurses
549
meet requirements within an existing system, reporting: ‘As
such, MoCs serve as a vehicle to drive evidence into policy and
practice at a jurisdictional level’ (Briggs et al. 2015, p. 2).
Moreover, the Council Directive 90/269/EEC suggests that
employers should take measures to protect workers against the
risk involved in the manual handling of heavy loads. Several
best practice examples in LBP prevention and management
have thus been identified (Lidgren et al. 2014; Nørregaard Ras-
mussen et al. 2013; Speerin et al. 2014), and can prove extre-
mely useful for countries such as Slovenia where even the
application level still lacks the necessary approaches.
According to international approaches for LBP prevention
and management, and according to EU recommendations
(Andersen et al. 2014; Briggs et al. 2015; Council Directive
90/269/EEC; Lee et al. 2015; Lidgren et al. 2014; Powell-Cope
et al. 2014; Speerin et al. 2014), Slovenian healthcare system
planning needs a national strategy to successfully promote
LBP preventive and controlling strategies. Measures should be
oriented towards eliminating or reducing risks for LBP inci-
dents and towards different strategies, guidelines and actions
which empower individuals and provide knowledge (Council
Directive 90/269/EEC).
Limitations
Our study has some limitations. The reliability for SPS-6 for
six statements should be higher. We expected more LBP to be
reported by PNs because they are possibly more exposed due
to their involvement in basic nursing care. We also expected
more overtime hours per month. The sample is not balanced
with respect to respondents’ educational achievement; how-
ever, it corresponds to the education levels of Slovenian hos-
pital employees. The entire population of nurses from 16
Slovenian hospitals was included in the study, with all
employees having the chance to participate. It is possible that
the respondents were overly positive or negative towards
questions, so caution should be used when findings are gener-
alized. Surveys using self-report techniques can be inaccurate,
and a cross-sectional design has its limitations in identifying
possible factors predicting LBP. The factors predicting LBP
obtained in our study have to be verified with an experimen-
tal design to validate their predictive power of LBP. Finally, it
should be remembered that experiencing LBP varies from
person to person.
Conclusion and implications for management and
health policy
The study reveals important findings and provides opportuni-
ties for improving nursing management and health policy. A
high prevalence of LBP among nurses in Slovenian hospitals
550 B. Skela-Savi
c et al.
was found, and five factors predicting LBP were identified.
Adhering to recommended staffing standards per shift and
appropriate planning of nursing workloads are directly related
to one of the five key factors predicting LBP. Human resource
strategies for nursing personnel must be aimed at preventing
presenteeism, stress and managing poor health in the work-
place. One of the first measures to be implemented by nursing
management should be the rotation of positions according to
the difficulty of working conditions and employees’ age/num-
ber of years in current position. Next, prevalence of LBP indi-
cates that nurses lack the knowledge to manage and prevent
LBP. Study results also revealed that nurse respondents often
came to work when they should have been on sick leave.
Nursing managers should be aware that the inability to
manage LBP and associated factors takes a toll on the quality
and safety of provided services. Importantly, our study results
send a clear message to all healthcare decision-makers who are
primarily responsible for creating working conditions ensuring
healthy, safe nursing jobs. In order to achieve that, it is essen-
tial to implement international staffing recommendations and
create safe working conditions in healthcare institutions.
Acknowledgements
This study presents, in part, the results of a broader non-
profit applicative project entitled ‘Workplace health promo-
tion: preventing and managing low back pain among nursing
personnel’. The project received funding from the Health
Insurance Institute of Slovenia based on a public call for co-
financing workplace health promotion projects in 2015 and
2016. The members of project group were as follows: Brigita
Skela Savic (leader), Simona Hvalic Touzery, Katja Pesjak,
Sedina Kalender Smajlovic, Vesna Cuk, Sandra Arh, Polona
Vidmar Beravs, Marta Smodis. Authors thank nurses involved
in the research.
Study design: BSS, SHT, KP
Data collection: SHT, KP
Data analysis: BSS
Study supervision: BSS
Manuscript writing: BSS, SHT, KP
Critical revisions for important intellectual content: BSS, SHT
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