Work Ability of Slovak and Czech Nurses in the Context of Age Management Measures

INTRODUCTION

In recent years, interest in the concept of work ability in nursing has been increasing, especially in international studies. However, when searching for relevant literature we found a very limited number of Slovak and Czech studies addressing the measurement of nurses’ work ability. For this reason, in this paper we focus on the concept of work ability in the context of age-management measures, based on the so-called House of Work Ability, on the work ability of nurses in the Slovak Republic, and on comparing work-ability measurement results among Slovak and Czech nurses.

Work ability denotes the extent to which an employee is physically and mentally capable of handling the psychological and physical demands of his or her work, given health. According to Professor Imarinen, who is considered the “father” of age management, supporting work ability is a key factor in extending productive working life (Kol. et al., 2015).

Work ability is based on a balance between individual resources and job demands and is determined by individual factors: health status, lifestyle, physical and mental job demands, and organizational conditions (Husaříková et al., 2021). Snopek (2023) defines work ability as a certain current and near-future well-being of an employee and at the same time as how capable the employee will be to perform work in relation to job demands and their physical and psychological resources. The author also clarifies that work ability is not only a physical or psychological ability to perform tasks, but includes a broad range of factors affecting work performance, satisfaction, and overall long-term ability to work. Work ability is the balance between characteristics and demands of work and the employee’s health, capacities, competencies, values, attitudes, and motivation. A high level of work ability occurs when there is alignment between job characteristics and individual resources (Slovak Association of Age Management, 2026). The work ability model is a complex, evidence-based, systematic framework supporting a longer employee career. Supporting work ability enables employees to maintain health and functional capacity. Maintaining balance between job demands and employee resources is essential for preserving work ability. Over a working life, employee performance changes and job demands also change (Jašová, 2024).

Work ability is defined as an employee’s ability to perform work considering job demands and physical and psychological conditions. It is a tool for identifying employees at risk of imbalance between health, capabilities, and job demands (Kol. et al., 2021). The concept of work ability represents a comprehensive approach to health, employment, lifelong learning, and also to supporting the alignment of work, personal, and family life across aspects that influence and shape an employee on the labor market (also outside it) and that are simultaneously a source of potential, but in some cases a limitation or boundary.

The concept of work ability, developed in Finland in 1980, is used in many countries worldwide, but is used very little in organizations in Slovakia and the Czech Republic. The areas where this concept is applied are primarily research, education, and counseling. In working life, the ability to work is the most important capital of a person. Work ability means the degree of competence and the stability of the balance between personal aspects of health, capacity, and personal values on one side, and job demands and working conditions on the other side. Work ability indicates a person’s potential to cope with job demands at a given time. Development of individual functional capacity must be considered in relation to those demands. Employee and his or her duties/requirements may change over time, and if necessary, they must be redesigned to be appropriate to age, aging, and health of the employee (Kol. et al., 2021).

Work ability is defined as the balance between work and individual resources. When work and individual resources complement each other, work ability is stable (excellent/good); if there is no balance between job demands and individual ability to cope with those demands, work ability is only average or even low (Kol. et al., 2022). Work ability is the basis of work quality and retention (not only) of older employees. It concerns health, competencies, values, and working conditions (including management/leadership). Maintaining work ability means finding balance between job demands and personal resources throughout a person’s working life. Work ability is highly important both for employees and employers. According to Prof. Ilmarinen, work ability means “how good the employee is today, in the near future, and how they carry out their work from the perspective of job demands and health and psychological capacities”. This definition stems from the so-called “Work Ability Concept,” according to which work ability is the result of the interaction between employee and work. Work ability can also be described as the balance between an employee’s capacities and job demands. The newly conceptualized holistic model of work ability therefore does not focus only on employee health as the key source of work ability, but also includes other personal resources, including competencies, motivation, values, and attitudes that intersect with the work environment and workplace conditions and with other influences that affect work life on a daily basis. If demands and individual human resources are in balance, work ability is stable (at excellent or good level). If balance between job demands and individual capacities to handle them does not exist, then a person’s work ability reaches an average or low level. Work ability can be measured and expressed numerically with the Work Ability Index (WAI). Work ability thus describes the person’s potential to cope with job demands at a given time (Kol. et al., 2022).

The most widely used work ability model is the House of Work Ability (Fig. 1).

Work ability is depicted as a scheme of four interconnected levels affecting personal and working life. The first level concerns health and all its components. The second level is our professional competence, which we must continually develop to meet job demands. The third level represents internal aspects of the person, including values, attitudes, and motivation. Through the “balcony,” outside environment may exert influence. The fourth level relates to working conditions, workplace environment, and management. The staircase suggests interconnection among the levels, i.e., aspects of work ability (Slovak Association of Age Management, 2026).

Fig. 1 House of Work Ability (Slovak Association of Age Management, 2026).

Work ability is one of the defining concepts of age management. Modern understanding of managing and supporting work ability is connected to identifying ways to detect its decline or deterioration before a significant drop occurs, or even before its complete loss, i.e., identifying ways to prevent sickness absence and early exit from working life.

Age management is an approach to human resource management that considers employee age, as well as employee abilities and potential. It takes into account life stages at the workplace and recognizes changing resources (e.g., health, competencies, values, attitudes, motivation). It is based on the idea that organizations should recognize changes in employee resources (work ability) over the lifespan and support employees in different age and career stages while achieving organizational goals (Hulková, 2025; Slovak Association of Age Management, 2026). Snopek (2023) sees age management in healthcare as a key concept for optimizing health and caring for individuals in different age groups. According to Popovičová and Lacka (2025), age management is a strategic approach focused on maintaining work ability, supporting health, and developing effective intergenerational cooperation. It considers the age diversity of the workforce and seeks to manage the potential of all generations in the workplace effectively. The concept is based on principles of fairness, sustainability, and active employee engagement across all life stages. Given current demographic trends, age management is becoming an essential tool for preserving work ability, health, and activity of employees of all age categories. It focuses on balancing work and personal life, adapting to technological changes, and developing competencies across generations. Implementing age management in healthcare is a long-term process requiring a systematic approach, open communication, and organizational support (Popovičová, Lacko, 2025). Age management is a comprehensive approach to addressing demographic changes in the workplace and supporting age diversity, taking employee age structure into account (Snopek, Bejtkovský, 2023).

The topic of age management in the Slovak Republic has been promoted since 2016 by the Slovak Association of Age Management, registered association (hereafter “SAAM”). The founder and long-term director of the association until 2026 was PaedDr. Ilona Hegerová, who significantly contributed to raising awareness of age management. Since May this year, Tatiana Trebatická was elected by the SAAM Executive Board as director and statutory representative of the association. The association’s activity involves bringing together experts from various fields and organizations interested in age management; implementation of scientific projects focused on age management in cooperation with Slovak, Czech, and foreign universities, research centers, public administration, and employers; professional publishing activity. SAAM submits proposals and cooperates with state bodies when preparing legislative measures addressing negative consequences of demographic changes, develops human-resource project plans, implements education and counseling in age management, organizes conferences, seminars, workshops, engages in international activities, and promotes the latest knowledge on age management from abroad (Hulková, 2025; Slovak Association of Age Management, 2026).

OBJECTIVE

1. To determine the work ability index in a sample of Slovak nurses using the Work Ability Index™1.0 questionnaire.
2. To assess the relationship between work ability score and nurses’ age.
3. To assess the relationship between current work ability of nurses and their own two-year occupational performance prognosis.
4. To compare work ability measurement results among Slovak and Czech nurses using available literature.

MATERIAL AND METHODOLOGY

The mixed-methods study had an explanatory sequential design. In 2024 we conducted an observational cross-sectional study among 371 nurses. The primary tool for collecting data on nurses’ work ability was the WAI™1.0 questionnaire (Work Ability Index Questionnaire), an internationally standardized and validated tool for measuring work ability. The results provide a prediction of future health status of the employee. The questionnaire provides information about current work ability of employees in relation to age and health status. The resulting index ranges from 7 to 49 points; the higher the score, the more stable the work ability (Table 1).

Table 1 Work Ability Index interpretation

Source: (Hulková, 2025; Slovak Association of Age Management, 2026).

By self-assessment using the WAI™1.0 questionnaire, an employee evaluates the ability to cope with work tasks in the current situation according to his or her physical and mental state (Snopek, 2023). The WAI™1.0 questionnaire has seven items (Table 2)

Table 2 Items of the WAI™1.0 questionnaire

Source: (Hulková, 2025; Slovak Association of Age Management, 2026).

Paper questionnaires were personally distributed by the author of the research to nurses in selected health facilities in the Slovak Republic. Participation in measurement was voluntary and anonymous. After completion, each nurse returned the questionnaire at the agreed location. Questionnaires were then collected, WAI index values were calculated according to methodology, and data were statistically analyzed. Calculations were performed using statistical software InStat®, version 3.02, 32-bit, GraphPad Software, Inc., USA; Statistica 12®, 64-bit, StatSoft/TIBCO Software, USA; and XLStat for Windows 2024, Lumivero, USA. The relationship between observed parameters was tested using appropriate methods: non-parametric Kruskal-Wallis test; median test; Kendall tau; Spearman coefficient; ANOVA. After obtaining quantitative data, a qualitative phase followed. According to Grešš Halász et al. (2025), explanatory sequential design emphasizes the collection and analysis of quantitative data, often on a large participant sample, thereby obtaining statistically relevant information on occurrence, prevalence, or relationships between observed variables. Qualitative analysis complements context and meaning of quantitative results.

The author of the article is the only certified Work Ability Index 1.0 Junior expert in Slovakia, No. CZ2024/7, and is therefore authorized to use the WAI™1.0 tool and work with the data set. The author is also a member of the Executive Board of the Slovak Association of Age Management. All respondents completed the questionnaire anonymously and provided written consent for processing personal data and sensitive personal data under Act of the Slovak Republic No. 18/2018 Z.z. on the protection of personal data and related amendments for research and statistical purposes. For the implementation of work ability measurements in selected healthcare facilities, prior approval was obtained from the Deputy for Nursing.

Demographic data for respondents are summarized in Table 3.

Table 3 Demographic data of respondents

RESULTS

The sample of nurses (n=371) reached an average work ability index (WAI) of 37.87 points with a standard deviation of 6.097; this WAI score is evaluated as good work ability. This resulting WAI value can also be interpreted as borderline between average and good index, as the difference is only 1.87 points between index values. The difference is greater between the resulting index (37.87 points) and the lower limit of excellent work ability (44 points); it is as high as 6.13 points. It may be concluded that the resulting score reflects the physical and psychological demands of the nursing profession, which are reflected in nurses’ health status and subsequently in their average/good work ability. Findings suggest that the older the nurse, the lower the WAI score. The lowest WAI score of 15 points was recorded for a 59-year-old nurse who had worked for 40 years. She rated her current work ability with 1 point on a 0 to 10 scale (highest rating). Nurses aged 21–30 had the highest mean WAI score (39,68; SD=4,80), median 40. Table 4 presents evaluation of nurses’ work ability.

Table 4 WAI index values

Legend: n – number of respondents, x̄ – arithmetic mean, sd – standard deviation, xm – median, min. – minimum value, max. – maximum value, mod(x) – mode, Q1–Q3 quartiles, s² – variance

Evaluation of WAI Item 1 The mean score of current work ability compared to the past (x̄ = 8) indicates a subjectively positive perception of their work potential. As many as 100 nurses (27%) reported the highest score of ten points. 19,67% rated their current work ability as nine points and 20,21% of nurses as eight points. Evaluation of WAI Item 2 75% of nurses in our sample consider nursing work to be both psychologically and physically demanding. Evaluation of WAI Item 3 Results of our study showed that musculoskeletal disorders were the most common health problem among nurses (38,3%). Nurses were treated on average for two doctor-confirmed diseases. 25% of nurses reported that they were not being treated for any disease. Most diagnosed conditions (ten) were reported by a nurse born in 1965; and nine diagnoses were reported by two nurses born in 1970 and 1971. A notable finding concerned self-perception in the category of mental diseases: as many as 18,32% of nurses in our sample subjectively believed they suffer from mental problems. Evaluation of WAI Item 4 The results indicated that nurses can perform their work with some difficulties, or sometimes need to change working pace or style. 39,35% of nurses reported they can perform current work without obstacles. Evaluation of WAI Item 5 The average number of days absent from work due to illness in our nurse sample during the last year was up to 9 days. As many as 55% of nurses were not in sick leave during the observed period. Evaluation of WAI Item 6 72,2% of nurses (n = 268) reported that based on their health status, they will continue to practice nursing in two years. We considered this result a positive finding. Evaluation of WAI Item 7 Results for nurses’ mental health in our sample had average values. 29,65% of nurses rarely feel relaxed when performing everyday activities; 50,67% of nurses feel a lack of energy and vitality, and 42,31% are not optimistic about the future.

Relationship between nurses’ work ability score and age

Nurses were divided into age categories: category 1 (21–30 years); category 2 (31–40 years); category 3 (41–50 years); category 4 (51–60 years); category 6 (61–70 years); and category 8 (71–80 years). Through bivariate analysis we tested whether a direct relationship (asymmetric) exists between the ordinal variable “age category” (equidistant ordinal scale) and the interval variable WAI. For comparison of group means, the non-parametric Kruskal-Wallis test, median test, and ordered correlation with Kendall’s tau and Spearman coefficient were used. In addition, summary statistics were used: ETA, Kendall’s tau-c; inferential statistics: F-test (one-way ANOVA), significance test for coefficient tau-c (Table 5).

Table 5 Statistical analysis of the relationship between work ability value and nurses’ age

The correlation coefficient has a negative sign (-0,193), meaning the relationship is inverse. ETA=0,225 (the coefficient ranges from 0 to 1), and direction, linearity, and symmetry cannot be determined from it. It is suitable for determining size of the relationship. A value of 0,225 is described as low to moderate. Kendall’s tau-c = -0,138 (the coefficient ranges from -1 to 1), determining both direction and magnitude. Spearman correlation coefficient = -0,180. Since there is a difference between these two coefficients, it can be assumed that the relationship is not entirely linear; therefore, ETA=0,225 is the most suitable value for assessment. Like the Kruskal-Wallis test, ANOVA analysis also confirmed a statistically significant difference between average WAI score and age of nurses. Pairwise comparisons were performed using the Post Hoc Scheffé test. A statistically significant difference was found between the group of nurses aged 21–30 and the age group 51–60; Sig.=0,006; the difference is 3,645. We can state that nurses aged 21–30 years on average have a WAI value higher by 3,645 than nurses aged 51–60. The relationship between nurses’ age and resulting work ability score is statistically significant; its magnitude is low to nearly moderate, with a negative direction (-0,193). This can be interpreted as: the older the nurse, the lower the WAI score. The strength of this influence is statistically significant, with low to almost moderate strength (0,225).

Relationship between nurses’ current work ability and their own two-year prognostic performance in the profession

To assess effect size between variables, both symmetric and asymmetric coefficients were used. The symmetric coefficient Kendall’s tau-c assesses mutual association of variables. Its value was 0,166 and is statistically significant, low to moderate.

The asymmetric Somers’ d coefficient assesses direct dependence. The effect of current work ability on the two-year prognosis was quantified by 0,136 (low to moderate), and the reverse effect by 0,261 (moderate) (Table 6).

Table 6 Statistical analysis of the relationship between current work ability of nurses and their own two-year prognosis of professional performance

From ANOVA analysis it is clear that there is a statistically significant difference in work prognosis in two years among 10 categories characterizing current work ability of nurses (Sig. = 0,000). In examining the direct effect of WAI score on prognosis in two years, ETA=0,561 was used, indicating a substantial to very strong effect size of WAI score on expression of their own work ability estimate in two years. The symmetric Kendall’s tau C=0,406 indicates a moderate to substantial degree of association between the two-year work prognosis and the obtained WAI score.

DISCUSSION

The concept of work ability takes into account the balance between individual and job factors and is operationalized through the Work Ability Index questionnaire. The work ability index is widely used in international occupational health studies. WAI describes how the employee perceives own work ability by evaluating mental and physical demands of work and one’s health status.

We designed this study to expand knowledge on nurses’ work ability in the context of implementing age-management measures. The findings indicated that nurses in our sample achieved a good level of work ability (37.87 points; median 36; range 15–49 points). Because our aim was to compare work ability measurements between Slovak and Czech nurses, we have only four studies available, with an average WAI index value of 37 points, which may also be considered a borderline value between average and good index (Table no. 7). We do not compare these results with those from our study published in 2024 (Hulková, V. Age management in nursing as a tool for optimizing workforce use in an age-diversified workplace team. Zdravotnícke štúdie. 2025; XVII(1): 33–40.).

The percentage evaluation of work ability indices in our sample was similar to the studies mentioned above: 5,92% of nurses had low index (7–27 points); 29,91% had average index (28–36 points); 47,70% achieved good index (37–43 points), and 16,44% had excellent index (44–49 points). The lowest work ability value in our sample (15 points) was of a 59-year-old respondent who had worked as a nurse for 40 years with completed secondary professional education.

Table 7 Comparison of work ability measurement results among Slovak and Czech nurses

Within the comparison of results from the four studies, we focus on selected WAI™1.0 questionnaire items: current work ability of respondents; diagnosed diseases; and prognosis of professional performance in two years.

Table 8 Comparison of results of selected WAI™1.0 questionnaire items

Resulting values of current work ability in the cited studies (Table 8) were consistent with our findings. The average score of nurses’ current work ability in our sample was 8 points (on a scale from 0=unable to work to 10=highest work ability). Similar conclusions were reached in evaluating the item related to diseases. Our study found that musculoskeletal disorders were the most common health problem among nurses (38,3%). Nurses were treated for an average of two doctor-confirmed diseases.

A positive finding from the studies is that nurses expressed interest in staying in the nursing profession for two more years.

Based on the obtained work ability measurement data, an employee, employer, and even the state can ensure appropriate measures (evidence-based policy).

An effective tool for identifying and evaluating work ability is WAI, which has become a platform for work ability assessment in many countries worldwide. In the Slovak Republic, no large-scale work ability measurement was carried out in the past; however, at present, within the national project “Measurement of Work Ability in the Sectors of the National Economy in the Slovak Republic,” planned for 2025–2029, WAI assessment will be conducted among 15 600 respondents, of whom 6 000 will be aged 50 years and above, in 1 000 selected organizations. WAI measurement will begin in summer 2026 and end in May 2027. Data processing will last two years. After processing, each respondent will receive an individual analysis of the WAI questionnaire concerning their work ability, and each of the 1 000 employers involved will receive a comprehensive report. The research will be carried out across 24 sectors, and the Ministry of Labour, Social Affairs and Family of the Slovak Republic has also proposed the 25th sector—informal caregivers, i.e., persons caring for sick relatives for a certain number of hours daily. Project results will then be incorporated into legislative proposals (Slovak Association of Age Management, 2026).

In the Czech Republic, the project “Assessment of Work Ability of Employees in the Czech Republic” began in 2021 and had two phases. The goal of the first phase was, using WAI and other source data, to identify which sectors of the Czech economy appear at risk from a work ability perspective. In addition to health and social care sectors, processing industry, transport, and warehousing were selected. For comparison purposes, we focus on health sector data. In this sector, 1496 WAI measurements were performed. The results confirmed that work ability declines with age. The largest age group were women aged 41–50 (30%) (Husaříková et al., 2022).

Snopek (2023) views age management in healthcare as a key concept for optimizing health and caring for individuals in different age groups. We agree with the author, as due to an aging workforce in nursing, managers need to begin engaging in developing strategies to secure employability. One such approach is implementation of specific age-management elements in nursing. Start by measuring nurses’ work ability, continue by adapting the working environment to the needs and limitations of older nurses, and use additional measures to support work ability, including health promotion and healthy lifestyle support, preventive measures, healthy nutrition and physical activity, assistance with new technologies, education, mentoring, intergenerational learning, workplace wellbeing, employee satisfaction measurement, work-life balance, retirement readiness programs, supervision, team activities, communication, coaching, active employee participation, recognition of work, analyses such as WAI 2.0, workplace ergonomics, work organization, leadership style, feedback, and process changes (Kol. et al., 2021). Age management measures should ensure that every employee has the opportunity to use his or her potential and is not disadvantaged because of age (Kol. et al., 2015).

Employees contribute to their work ability through health and functional capacities, knowledge and skills, attitudes, and motivation. In particular, changes in employee attitudes are related to future planning, lifelong learning, and their approach to their own health and aging. It is now necessary to account for long careers and focus more on maintaining work ability into older age. Employment influences work ability through organizational work factors, especially leadership and management of workload and work environment factors, including social aspects (Kol. et al., 2022). The Work Ability Index provides employees and employers with information that should be taken into account when developing tools to improve work efficiency, at both individual and organizational levels. Low work ability increases risk of long-term sick leave, early retirement, inability to perform work, and has negative effects on work efficiency and job satisfaction.

Popovičová and Lacko (2025) focused in their study on analyzing implementation of age management principles in healthcare facilities and assessing their impact on intergenerational collaboration, job satisfaction, and professional development of nurses. The sample included 240 respondents. Study results point to a low level of perceived systematic age-management policy in healthcare facilities in the Slovak Republic. 50% of nurses reported that organizational leadership does not apply age management. Only 33,3% of respondents felt that leadership considers age-related employee needs. The authors emphasize that organizational leadership must understand current and future age composition of the workforce, risks of early exits, and critical occupations. In practice this means succession planning, mapping key competencies, individual development plans, differentiated support, intergenerational collaboration, continuous education, internal transfers, and motivating older employees to remain active. Key steps include formal adoption of age-management policy, clearly defined standards and responsibilities. Regular evaluation of indicators (e.g., Work Ability Index) and transparent communication to employees are also important. If these measures become a visible part of organizational culture, age-management policy moves from a formal topic to a practical tool (Popovičová, Lacko, 2025).

In the context of age management, age diversity is considered a strategic advantage because it enables linking the experience of older nurses with the innovativeness of younger ones. Age diversity represents added value that supports transfer of experience, professional learning, and team stability in nursing. Slovak nursing faces the challenge of turning age management from a theoretical concept into a practical strategic human-resource management tool. Sustainability of the nursing profession depends on healthcare organizations continuously reflecting on demographic changes and flexibly responding to changing workforce needs. Implementing age-management principles in healthcare is a long-term and dynamic process requiring active involvement not only of organizational leadership, but also nurses themselves. International experience shows that the costs of investments in supporting work ability are outweighed by the benefits. Positive return on investment is based on lower rates of sick leave, lower costs of work disability, and higher employee productivity (Popovičová, Lacko, 2025; Hulková, 2025).

Study limitations

The study has several limitations. Only women participated, as the nursing profession is highly feminized. We conducted a cross-sectional study, which limits generalizability. In the article, we used only Slovak and Czech sources. Despite the limitations, we believe the study provided valuable findings, points to professional specifics related to nurses’ work ability, and the results may serve as inspiration for systematic implementation of the concept of work ability in nursing in the Slovak Republic. By conducting this study and publishing the results, we contributed to expanding knowledge of age management in nursing. The author continues to conduct research on measuring nurses’ work ability in an international context.

Implications for nursing management

Nurses who participated in work ability measurement showed good to average work ability, which is also related to aging of this professional group. For the healthcare system this is a significant challenge, as the largest group of nurses was aged 41 to 60 years. Nursing management professionals should focus on improving and maintaining good/average work ability of nurses. Based on the results of this study, it is possible to develop programs to create or improve a healthy working environment that will help prevent occupational illnesses, increase nurse productivity, and reduce work burden. Recommendations arising from WAI measurement results can be divided into system-level recommendations, recommendations by levels of the work ability house, and sector-unspecific and profession-specific recommendations. Good international practices and consultations with experts active in age management should be used where desirable. In holistic management, integrate preventive measures: flexible work time with ergonomic workplace design; task rotation with continuous education; employers should regularly reassess physical and psychological work requirements, implement mentoring and peer-to-peer programs that transfer skills and expertise between older, experienced nurses and younger or newly hired nurses.

CONCLUSION

Work ability of nurses is one of the central focuses of nursing research in international terms, and results are used in human-resource management proposals in nursing. This study highlights the importance of supporting and increasing work ability in the nursing profession. Findings also empirically confirm the physical and psychological demands of the nursing profession, which manifest in nurses’ deteriorated health status. The findings also significantly contribute to understanding the importance of age management and the need for regular assessment and measurement of nurses’ work ability. Since work ability is based on balance between employee resources and work demands, which change over the life course, maintaining optimal work ability is a task throughout the entire working life.

Author: doc. PhDr. Viera Hulková, PhD., MPH Department of Nursing, Faculty of Health, University of Constantine the Philosopher in Trnava ORCID 0000-0003-2631-1803

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