Psychosocial and organizational factors affecting occupational well-being in Polish telemedicine nurses: a cross-sectional pilot study

Introduction

According to the World Health Organization (WHO), telemedicine is defined as “The delivery of health care services, where distance is a critical factor, by all healthcare professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health care workers, with the aim of advancing the health of individuals and communities” [1].
Although the concept of telemedicine dates back to the 1950s [2], its substantial evolution and widespread adoption can be largely attributed to the COVID-19 pandemic, which fundamentally reshaped healthcare delivery across all medical professions [3]. Among healthcare workers, nurses experienced one of the most significant shifts, being required to rapidly transition from hands-on, in-person care to remote consultations [4].
Today, nurses play an increasingly central role in telemedicine. They provide care via video consultations, telephone communication, and remote monitoring tools, such as digital stethoscopes, thermometers, and glucometers. Their scope of practice encompasses patient education, clinical management, and counselling, delivered across various modalities, including fully remote platforms, hybrid models, and traditional settings that integrate telehealth technologies [5-7].
In telemedicine settings, nurses perform a broad range of professional activities, including conducting telephone and video consultations, providing patient education, and carrying out symptom assessment and triage. Their responsibilities also involve the remote monitoring of patients with chronic conditions through digital health technologies, systematic documentation of clinical information, and coordination of patient care. Depending on the organizational model and scope of practice, nurses may additionally offer health counseling, conduct follow-up after medical interventions, and collaborate closely with physicians and other healthcare professionals as part of an interdisciplinary care team [4].
Nursing is widely recognized as a high-stress profession, often characterized by emotional demands, physical strain, and challenging work environments. Occupational stress and burnout remain persistent issues, with serious implications for staff well-being and patient outcomes [9, 10].
While telemedicine introduces new organizational and psychosocial dynamics into nursing practice, it also presents potential opportunities to alleviate some of the traditional stressors associated with the profession. Greater flexibility, reduced physical burden, and the potential for more balanced workloads may support nurses in maintaining occupational well-being. Importantly, remote care delivery may not only serve as a new mode of practice, but also act as a buffer against burnout, by reshaping stress exposure, recovery processes, and the overall experience of professional identity. However, despite the growing relevance of telemedicine, previous studies have largely focused on technical implementation and patient outcomes, with limited attention to how this shift affects healthcare workers. Nurses, in particular, remain underrepresented in this discourse, with most studies concentrating on physicians or healthcare staff in general, often overlooking the unique psychosocial stressors and organizational challenges nurses face in remote care settings. Moreover, evidence from Central and Eastern Europe, including Poland, remains limited. Given the lack of existing tools and limited evidence from Central and Eastern Europe, this study was intentionally designed as a pilot investigation aimed at generating preliminary insights and assessing the feasibility of a newly developed questionnaire.
This pilot study aimed to obtain preliminary insights into the psychosocial and organizational factors associated with occupational well-being among nurses working in telemedicine in Poland and to evaluate the initial performance and feasibility of the newly developed questionnaire.

Material and methods

In this study, we applied a cross-sectional, descriptive design and gathered data using an anonymous online questionnaire. The research aimed to examine psychosocial and organizational factors that influence occupational well-being among nurses engaged in telemedicine in Poland. As this was a pilot study with an exploratory aim, no formal sample size calculation was performed. A convenience sample of 81 participants was deemed sufficient to explore preliminary patterns and assess the feasibility of the research tool. Nurses could take part if they were registered and currently working in Poland as a nurse, had at least one month of experience with remote home-based telemedicine services, were 18 years or older, and gave their informed consent. Additionally, telemedicine had to account for at least 25% of their overall working time. Participants who reported telemedicine use below 25% of their working time were excluded from the final analysis. Taking part in the study was entirely voluntary, and all responses were collected anonymously.
Importantly, all participants had prior experience working in traditional, in-person clinical settings, even if they currently practiced remotely.
To address the absence of a tool specific to nurses working in telemedicine, we constructed a new questionnaire based on existing research and expert input. The questionnaire was developed based on a review of key literature related to telemedicine, digital health, and the well-being of nurses. To develop the questionnaire, we adopted items from validated instruments and worked closely with telemedicine nurses to make sure it was relevant and grounded in day-to-day practice. Our own experience working in telemedicine nursing also played a role in shaping the questionnaire, ensuring that it was both understandable and applicable in everyday practice. The questionnaire combined original items with elements adapted from established scales, including the Job Satisfaction Survey (JSS) by Spector, the Minnesota Satisfaction Questionnaire (MSQ), the Maslach Burnout Inventory (MBI), the Work–Life Balance Scale, the Nursing Stress Scale, and components of the Technology Acceptance Model (TAM). Table 1 presents selected items alongside their theoretical or empirical justification. We made additional adjustments to ensure the questionnaire aligned with the Polish healthcare system and the practical realities of nurses working in telemedicine.
The final version consisted of 31 items grouped into six thematic areas: demographic and professional information, experience and competence in telemedicine, job satisfaction in telemedicine, stress and fatigue, positive and negative work-related factors, and future plans and perceptions. The majority of items used a five-point Likert scale (ranging from 1 – strongly disagree to 5 – strongly agree), with a mix of closed-ended and semi-open questions to allow for additional insights where appropriate.
We developed and administered the questionnaire entirely in Polish, the native language of our target group, making sure that all items, instructions, and response options were clearly worded and culturally appropriate to ensure ease of understanding. For the purposes of this manuscript, selected sample items were translated into English to illustrate the content of the tool. The full version of the questionnaire is provided as Supplementary Material (Appendix A).
Before launching the main part of the study, we ran a small pretest of the questionnaire with a group of 10 nurses who had experience in telemedicine. We used the pretest phase to verify whether the wording was intuitive and whether the time needed to complete the survey was acceptable. Based on nurses’ feedback, we made a few minor wording changes to improve the flow and precision of the items. The data collected during this pilot phase were used only to refine the tool and were not included in the final analysis.
To assess the reliability of the questionnaire, we calculated internal consistency for each of the subscales. The results were promising. For the job satisfaction section, Cronbach’s a was 0.75, which indicates solid reliability. The stress and fatigue subscale performed even better, with an alpha of 0.84 – suggesting very good internal consistency.
Because the questionnaire was multidimensional by design, we evaluated each part separately rather than calculating a single overall score. While the results are encouraging, further testing on larger and more diverse samples is needed to confirm the scale’s structure and psychometric properties.
The survey was disseminated via nationwide professional nursing networks and online platforms commonly used by nurses in Poland, including mailing lists and social media groups. These channels potentially reach several thousand nursing professionals; however, due to the open nature of distribution, the exact number of individuals who received or viewed the invitation could not be determined. Participants were informed about the study’s aims, procedures, and ethical safeguards at the beginning of the survey and were asked to confirm their informed consent. Data collection was conducted anonymously between late April and mid-June 2025. Ethical considerations were fully respected, including voluntary participation, the right to withdraw at any time, and the absence of any personal data collection. The study was approved by the Ethics Committee of the University of the National Education Commission in Krakow (approval no. DNa.0046.1.9.2025) and was conducted in accordance with the ethical standards set forth in the Declaration of Helsinki.
We used descriptive statistics to summarize the sociodemographic characteristics of the sample and to identify general patterns in the data. To explore the relationships between selected psychosocial and organizational variables, we conducted Spearman’s rank correlation analyses and multiple linear regression models. Quantitative variables measured on Likert scales were treated as continuous for the purposes of correlation and regression analysis. No categorical grouping of variables was applied. Statistical significance was set at p-values < 0.05. All analyses were performed in Python 3.10 using the pandas, statsmodels, scipy, and matplotlib libraries. There were no missing data in the analyzed dataset.
As this was a pilot study, all analyses were exploratory in nature and aimed at identifying initial patterns rather than providing definitive conclusions. The regression and correlation models were used solely to examine whether the newly constructed questionnaire was capable of capturing theoretically meaningful relationships, not to generate population-level inferences. Internal consistency was calculated only for the two subscales that contained a sufficient number of items and met the basic assumptions for reliability testing. The remaining subscales were not assessed due to their formative or descriptive nature and will be refined and re-evaluated in the next stage of scale development.

Results

The study included 81 nurses practicing telemedicine in Poland, most of whom were women (84.0%). The participants were predominantly between 25 and 54 years old and held a Master’s (65.4%) or Bachelor’s (30.9%) degree in Nursing. Their professional experience ranged widely, with 35.8% having 6-10 years of nursing practice. Experience with telemedicine varied: 38.3% had used it for up to one year, while 61.7% had over one year of experience, including 18.5% with more than five years. In terms of work model, 25.9% of nurses worked exclusively in telemedicine, 22.2% mainly remotely with some in-person duties, and 51.9% primarily in traditional settings, using telemedicine as an additional form of practice or workplace.
The respondents evaluated various psychosocial and organizational aspects of telemedicine work using a 5-point Likert scale. The distribution of responses showed that the majority of participants assessed telemedicine work positively, particularly in terms of job satisfaction, flexibility, and work–life balance. Elements such as the ability to work from home, improved integration of professional and personal life, and the opportunity to assist a greater number of patients were rated most favorably. In contrast, challenges related to emotional strain, such as feelings of isolation, technological stress, and perceived overload, received lower mean scores, indicating lower perceived intensity on average.
Detailed results are presented in Table 2.
Spearman’s correlation analyses revealed several significant relationships between the studied variables (see Table 3). Notably, job satisfaction was strongly associated with both the ability to work from home and improved work–life balance. Indicators of remote work strain, such as technological stress and feelings of isolation, were closely associated with a sense of overload, suggesting that these challenges often co-occur. Additionally, higher levels of technological stress were related to poorer work–life balance, highlighting the potential negative impact of digital demands on employees’ personal well-being.
A multiple regression analysis was conducted to identify key predictors of job satisfaction in the context of remote nursing work. The dependent variable in this model was the participants’ self-reported job satisfaction, measured by agreement with the statement: “Work in telemedicine gives me professional job satisfaction”. Responses were rated on a 5-point Likert scale (1 – strongly disagree, 5 – strongly agree).
The expanded model included six predictors: technical and organizational support, perceived benefit to patients, job stability, reduced fatigue from remote work, feeling overwhelmed with remote work duties, and the ability to combine professional and private life through remote work.
As shown in Table 4, three predictors were statistically significant. Among them, perceived benefit to patients emerged as the strongest predictor, followed by job stability and the ability to maintain work–life balance. Other predictors, including technical support and reduced fatigue, did not reach statistical significance.
Overall, the model was statistically significant and explained approximately 59% of the variance in job satisfaction (R2 = 0.59, p < 0.001).
A multiple regression analysis was conducted to identify predictors of perceived work overload among nurses working remotely.
The dependent variable was the level of work overload, measured by agreement with the statement: “I feel overwhelmed with responsibilities related to remote work”.
The model included three predictors: stress caused by technology use, feelings of isolation during remote work, and the perception that reduced physical strain increases job satisfaction.
As shown in Table 5, all three predictors were statistically significant. Technology-related stress was the strongest predictor, followed by feelings of isolation. Interestingly, perceiving less physical strain as beneficial to job satisfaction was negatively associated with work overload.
The model was statistically significant and explained approximately 62% of the variance in work overload (R2 = 0.62, p < 0.001).

Discussion

This study provides initial evidence that telemedicine may offer valuable benefits for nurses by reducing physical strain and improving work–life balance, while also identifying potential organizational stressors that require attention. As a pilot study, the findings should be interpreted as preliminary and primarily hypothesis-generating. This study investigated the impact of telemedicine on the occupational well-being of nurses in Poland, addressing both organizational and day-to-day psychosocial dimensions. Several important patterns emerged. The analysis showed that job satisfaction and feelings of work overload were both strongly associated with specific factors, including work–life balance, flexibility, physical strain, technostress, and isolation. The regression models explained a substantial part of the variation in these outcomes (R2 ≈ 0.59 for satisfaction, R2 ≈ 0.62 for overload). These preliminary results indicate potential patterns that merit further investigation and suggest that the telemedicine work environment may play a key role in shaping nurses’ overall experience. These factors warrant close attention in future planning and support strategies.
Technostress and feelings of isolation turned out to be key factors behind the sense of overload among respondents. Both showed strong positive associations with perceived work strain (r = 0.68 and r = 0.64), and their influence was confirmed in the regression model (b = 0.39 and b = 0.31). Although previous studies such as those by Tarafdar et al. [17] and Bencsik and Juhász [18] did not focus specifically on telemedicine, their findings regarding the psychological toll of continuous digital tool use and reduced interpersonal interaction closely parallel the patterns observed in this study.
Our results are also consistent with broader findings from studies on telehealth and remote work contexts [19], which identify technological stress and social isolation as significant predictors of perceived overload. The strong correlation between technostress and overload may reflect not only cognitive strain, but also gaps in digital literacy – an issue highlighted in the Technology Acceptance Model (TAM) and supported by research indicating that insufficient training and lack of digital competence can intensify feelings of fatigue and reduce professional well-being [20].
A notable finding from the study is the clear negative correlation between technostress and work–life balance (r = –0.47, p < 0.001). In simple terms, the more stress people experience from digital tools, the harder it becomes to maintain healthy boundaries between their job and personal life. Although this connection has been mentioned before, it is rarely backed by solid numbers. Here, the strength of the relationship stands out and points to the need for practical solutions, such as better user-focused training or more thoughtfully designed digital systems.
This issue may be particularly relevant in Poland, where dual employment and extended working hours among nurses have been reported. Studies on Polish nursing workforce patterns indicate that a substantial proportion of nurses work in more than one workplace, often exceeding standard monthly working hours, primarily for financial reasons [21]. Evidence from Poland and broader European data suggest that long shifts and overtime are associated with fatigue, reduced recovery, and potentially poorer perceived quality and safety of care [22, 23]. Although research directly linking dual employment with technostress in telemedicine nursing is limited, existing findings on technostress in healthcare professionals suggest that cumulative workload combined with continuous digital demands may exacerbate strain and hinder work–life boundary management [24].
Consistent with previous studies, our findings highlight the importance of work–life balance and flexible scheduling in shaping job satisfaction among nurses working remotely. The strong correlation observed between job satisfaction and the ability to work from home (r = 0.71) reinforces the idea that flexibility plays a vital role in supporting staff wellbeing. This study further provides empirical support for the broader hypothesis that remote nursing work offers unique psychosocial and organizational benefits. In particular, improved work–life balance, perceived benefit to patients, and job stability emerged as significant predictors of satisfaction among telemedicine nurses. These results align with prior research indicating that autonomy, flexibility, and perceived control over time are key drivers of occupational satisfaction in healthcare settings [25, 26]. Dousin et al. [27] similarly emphasized these factors in their study on job satisfaction in nursing.
Currently, there are no comprehensive national statistics indicating how many nurses in Poland are formally qualified or trained to work in telemedicine. Telemedicine nursing has not been established as a separate specialization, and training opportunities remain fragmented and largely employer-driven, most often organized internally by healthcare institutions providing remote services. As a result, competencies related to telemedicine are acquired in a non-standardized manner, which makes it difficult to estimate the scale of telemedicine nursing practice at the national level. This situation contrasts with international efforts to systematize telehealth competencies in nursing. For example, Rutledge et al. [28] proposed a structured framework for telehealth education and practice, highlighting key domains such as professional preparation, technological readiness, patient-centered care, and policy awareness. In the absence of comparable national frameworks in Poland, telemedicine-related competencies among nurses may develop unevenly, potentially influencing both perceived technostress and occupational well-being.
It is also worth noting that recent changes in national educational standards, including the introduction of elective courses related to telemedicine and e-health in nursing education, indicate a growing institutional recognition of the importance of digital competencies in healthcare. However, these regulatory changes are relatively recent and primarily address pre-licensure education, meaning that their impact on the current nursing workforce and on everyday telemedicine practice remains limited. Future research should therefore consider how evolving educational frameworks may influence preparedness, exposure to technostress, and professional well-being among nurses working with digital health technologies [29].

Strengths

This study provides valuable insights into the psychosocial and organizational aspects of telemedicine work among nurses – a topic that is still not widely explored, especially in the Polish context. Using a structured questionnaire, we focused on key areas such as job satisfaction, work–life balance, technological stress, and perceived work overload. Including nurses with different levels of experience in both nursing and telemedicine helped to capture a broad and realistic picture of their working conditions.

Limitations and future directions

Although we pretested the questionnaire to ensure the clarity and relevance of the items, it was not subjected to full psychometric validation such as factor analysis or test–retest reliability. Future work should include such procedures to confirm the scale’s structure and stability over time. Therefore, the findings should be treated as exploratory and interpreted with caution. The sample size was relatively small (N = 81), which limits the generalizability of the results and reduces the ability to detect more subtle effects. In addition, due to the use of open, nationwide recruitment channels and convenience sampling, it was not possible to estimate the response rate or population coverage. Moreover, since all data were self-reported, response bias cannot be ruled out. Future research should involve larger, more diverse samples and consider longitudinal designs to better capture changes over time. The sample was predominantly female (84%), which reflects the gender distribution within the Polish nursing workforce but limits the examination of potential gender-related differences. Future studies should explore whether technostress, perceived isolation, or work–life balance varies by gender, especially given evidence suggesting that female healthcare professionals may experience distinct digital and emotional burdens. As a pilot study, the design was not intended to provide statistical power for confirmatory analyses. Consequently, the correlation and regression models used here should be viewed solely as exploratory tools for identifying potential trends and informing the design of more robust future studies.

Conclusions

This pilot study provides an early look at the psychosocial and organizational factors that may shape the well-being of nurses working in telemedicine in Poland. Although the findings are preliminary, they point to several areas that appear promising. Nurses who felt that their work benefited patients, offered stability, and allowed for better work–life balance tended to report higher job satisfaction, suggesting that these aspects of remote care may support professional well-being.
At the same time, technostress and a sense of professional isolation were associated with feelings of overload. These early patterns highlight the importance of addressing human and relational factors when implementing digital health solutions, and they suggest that practical support – such as training, technical assistance, or structured opportunities for teamwork – may play an important role in shaping the experience of telemedicine work.
Given the small sample size and the early stage of questionnaire development, the results should be viewed as exploratory. Still, the study offers a useful starting point for building a better understanding of telemedicine from the perspective of nurses. As digital care continues to grow, future research will be essential to explore these relationships in more depth and to ensure that telemedicine supports not only patient care, but also the well-being and long-term engagement of the nursing workforce.

Disclosures

This research received no external funding.
The study was approved by the Bioethics Committee of the University of the National
Education Commission in Krakow (Approval No. DNa.0046.1.9.2025).
The authors declare no conflict of interest.
Appendix A is available on the journal’s website.

References