Broken psychological contracts in health and social care during COVID-19 among nursing professionals.
Authors: Kaarakainen Minna , Ring Marjo 
Published: January 2024

In this study we are interested about the reasons why nurses leave their occupation as a nurse and what is the role of the COVID-19 pandemic behind this decision. Our focus is in registered and auxiliary nurses working in all fields of health and social care. The research, which this abstract is based, investigates why nursing professionals are leaving their occupation and how the health care as working environment should be developed in order to secure enough enthusiastic professionals to the field. Theoretical background leans on the concept of psychological contract which we using to describe the relationship between employer and employee referring to an individual´s beliefs about the terms and conditions of a mutual exchange agreement.

Psychological contract exchange is based on the perceptions of employee and employer rather than what is explicitly agreed and written down. The studies of the psychological contract have emphasized to breach of the contract meaning the situation where another contract party has failed to fulfill the expectations and obligations of the other party. Psychological contract breach cause dissatisfaction towards to work, impairs commitment to the organization and affects to the employee´s mental well-being and retention to work. In this study we examine situation where the psychological contracts breach has already led to leave work in health and social care. Explicit research question is: Why nurses leave their nursing position and how the COVID-19 has influenced to this decision?

Our data consists of 36 stories wrote by registered and auxiliary nurses telling why they have left their nursing position and it was collected in Autumn 2021 via textual data collection tool “Penna” which is maintaining by Finnish Social Science Data Archive (FSD). Written request was intentionally very open and gave respondents freedom to describe their thoughts why they have left the nursing position. Altogether there were 310 stories but in here, we decided to concentrate to stories (n=36) where the COVID-19 was mentioned to be the final reason to leave the field.  Based on preliminary findings, it seems that psychological contract was breached many ways during the COVID-19. For example, nurses were strongly disappointed how the work was organized during the crisis (leadership issues, working environment). They felt that their self-determination was broken especially considering the vaccination policy.  In these stories, the writers emphasize the workload and lack of appreciation.

This study highlighted that there were critical perspectives towards health and social care working conditions that the COVID-19 made even worse. This means that the was negativity and feeling of unappreciation and the COVID-19 somehow enabled to final decision. This is appearing as increase in workload and nurses were not able to have their normal and entitled vacations.  Based on preliminary findings, it seems that psychological contract breached.

Study indicates that we need to recognize the factors that are breaching the psychological contracts in order to develop and plan health and social care as well as nursing profession. This should be considered in all levels: individual, leadership and management as we