Workaholism among stricto sensu graduate nursing professors in Brazil*

Objective: to identify the prevalence and factors associated with workaholism among stricto sensu graduate nursing professors. Method: a cross-sectional study with 333 professors of master’s/doctorate degrees from 47 Brazilian public universities. Participants answered a characterization questionnaire and the Dutch Work Addiction Scale, which were analyzed descriptively and by multiple logistic regression. Results: the prevalence of workaholism was 10.5%. The factors associated with the dimensions of workaholism were: having a marital relationship, being dissatisfied with work and sleep, indicating low ability to concentrate and few leisure opportunities, belonging to Graduate Programs with grades 3, 4 and 5, receiving a research productivity grant, considering the influence of work on life as negative, showing difficulty in combining work with personal life, to present work-related anxiety, feel pressure for scientific publishing, elaborate more than 11 articles simultaneously, give more than 21 opinions in the last year, work an extra 11 hours a week in addition to the work schedule and dedicate less than 10 hours a week to graduate school. Conclusion: there is an indication of workaholism in the investigated professors, and the associated factors were related to working conditions and requirements. Universities must adhere to management models that include occupational health promotion.


Introduction
Studies have reported workaholism as one of the causes of workers' mental and physical illness (1)(2)(3) . It is estimated that 10% of North Americans are workaholic (4) , this condition being more prevalent among workers who perform activities at the managerial level and specific sectors, such as health professionals and teachers (5) .
Among nurses, a study carried out in Norway showed that this phenomenon is strongly associated with work characteristics rather than individual (6) .
The workaholic was, for a long time, considered as proactive and, therefore, a person's quality, mainly in the industrial and business sector, which aims at high publishing as a result of the work process (7) . However, the term workaholism originates from the junction of the prefix "work" with the suffix "aholism", to describe the addiction to work, characterized by compulsive and excessive work (8) , which is performed excessively and irrationally, as that even aware of the excess, the worker does not take control of the burden (9) .
In the contemporary world, it is clear that the organizational culture of the institutions is not far from this reality, including in universities, as it is observed in the dynamics of the teacher's work, more specifically, in the Graduate Programs (Programas de Pós-graduação, PPG), some potential determinants for the development of workaholism.
In this sense, to promote technical and scientific progress, professors of the Graduate Nursing Programs , which can lead the professor to work compulsively and excessively, dedicating substantial time and effort and giving up other activities such as leisure, family and friends, in addition to experiencing an environment of high competitiveness and high demand for publishing (11) .
These elements increase the number of hours dedicated to work, in addition to the contract with the institution, which is fostered by information and communication technologies, making the worker not to detach from work, even outside away from it, leading to illness (7) .
Despite the above, few studies have identified the prevalence and factors associated with workaholism among individuals inserted in the work process of the different fields of activity in the public or private sector (1)(2)(3) , especially among nursing professors from PPGEnf. Studies that fill this gap are essential to support management actions and public policies about the risks to workers' health since workaholism is a pathological condition that implies a decrease in professional performance, presenteeism (12) , techno-stress (7) , burnout (13) , deterioration of interpersonal relationships, mainly social and family relationships (2) , increased cardiovascular risk (14) and karoshi, the sudden death from overwork (15) . Therefore, the aim of this study was to identify the prevalence and factors associated with workaholism among stricto sensu graduate nursing professors.

Method
Cross-sectional study conducted with PPGEnf professors from 47 public universities in the five regions of Brazil. These are programs recommended and recognized by CAPES, with grades 3 to 7, linked to Area 20 -Nursing, which offer master's and/or academic doctoral courses.
The study population consisted of 919 permanent teachers accredited to the PPGEnf under study, according to data extracted from the Sucupira Platform in May 2018.
Teachers with a degree in nursing and affiliated with the program for at least one year were included. Those who were on work leave were excluded. All professors were invited, and 368 answered the questionnaire, of which 333 met the study's eligibility criteria and made up the sample of this investigation. The multiple models were elaborated by the stepwise forward method, in which the independent variables were added individually according to the pre-determined order (decreasing values of significance). In the model, the statistically significant variables remained (p<0.05), according to the Wald test. All analyzes were adjusted for the variables gender, age, years of teaching at the masters and/or doctorate level, as pointed in the literature (2,17) , and senior professor and number of PPG affiliation, because we consider potential confounders of

Results
The sample of this study was composed of 333   As demonstrated, professors with a stable marital relationship, who stated high-demand for scientific publishing, those who reported issuing more than 21 opinions in the last 12 months and those who reported having more than 11 articles in progress in the time of collection presented significantly increased chances of overwork. On the other hand, there were significantly reduced chances of high overwork, professors who spent less than 10 hours a week to regular graduate work, those who were satisfied with their work in graduate school, with a great ability of concentration, with many opportunities leisure and satisfied with sleep.

Discussion
The prevalence of workaholism was 10.5% among the masters and doctoral professors studied, is lower than that obtained among hospital nurses in Italy (18) .
However, the Italian study used the median as the cutoff point for the investigation, the 75 th percentile was used, which may be a limitation in determining the number and type of people affected by workaholism (2) .
Workaholics work excessively and compulsively, that is, they abdicate moments of leisure or social and family life due to work pace, however, in most cases, they do not achieve the desired performance, because workaholism increases the vulnerability to disability labor, due to the impairment of biopsychosocial health (19)(20) .
The prevalence identified in this study concerning the dimensions of workaholism points that two out of ten professors dedicate an excessive amount of time to work and think persistently and continuously at work, even outside the university. It should also be considered that 7.2% of the professors in the study sample were unable to leave work at the time of retirement, since they returned to activities at PPGEnf as senior professors, even without a financial employment relationship. About this, a study carried out with professors from a Brazilian public university revealed that they return to work due to the desire to continue experiencing the feelings of pleasure that work provides, as well as the contribution they can provide due to the professional experience acquired (21) .
At some point in life, people will need to leave work, because preparation for retirement is essential, as it will contribute to the person's empowerment and experience it to its fullest, without becoming physically or mentally ill (22) .
Regarding work patterns, a representative part of the participants in the investigation were classified as positive workers, as they indicated that they adequately reconcile personal and professional life, with little emotional stress and without giving up leisure time due to work. However, positive workers can develop dependence for work, in the long term, if exposed to unfavorable working conditions, such as excessive functions and activities, high demands and competitiveness and lack of professional valorization (23) .
Still, 9.0% of the teachers in this investigation were hard workers, because they predisposed to work hard, with high efficacy in the performance of their duties, without compromising their social life and 9.6% were classified as compulsive, who are dependent on work for their personal satisfaction, extrapolate the daily workload, take work home and think about work, constantly. Both profiles are indicated by the literature as predictors for workaholism since they emerge from the dimensions of excessive and compulsive work (24) .
Compulsive work, the cognitive dimension of workaholism, reflects persistent thoughts about work and constant concern with issues in the work environment, even outside professional situations (24) . The data in this study showed that high compulsive work was higher among teachers who affiliated to the PPGEnf CAPES Teachers who received a publishing grant had more chances of high compulsive work, which is awarded to researchers, leaders, and paradigms in their areas of knowledge, classifying them in levels, according to their scientific, technological and innovation publishing. In addition to being a way of recognition and appreciation, the granting of the scholarship aims to encourage an increase in qualified publishing (25) . The findings of this study indicated that teachers with this benefit had an addictive relationship with work, which may be an attempt to maintain the status of a reference researcher in their area of expertise.
Professors in this study who worked more than 11 hours a week in addition to the regular work, on nights and weekends also had a greater chance of high compulsive work. Such a result may be related to the need to perform multiple activities in a short time, especially those that need theoretical deepening.
The overload of activities causes the teacher to get used to the intense pace of work, not being able to disconnect from his/her professional duties mentally, feel guilty for resting considering the numerous pending activities or get frustrated, for feeling useful only when working hard (19) . Thus, he/she is unable to manage time properly, as he/she is anxious to develop his/her work www.eerp.usp.br/rlae 6 Rev. Latino-Am. Enfermagem 2020;28:e3326.
activities, even though he/she realizes that the pace and intensity of work are negatively influencing his life and remain to relegate his/her personal and social life, leisure and sleep because he/she believes that work alone brings professional and own satisfaction.
The behavioral dimension of workaholism is overwork and is manifested by hard work, in which the person spends a large amount of time on work activities, working above their economic needs and the demands of the organizations to which they belong (24) . Significantly increased chances of high overwork occurred among professors with a domestic relationship, who feel greater pressure for scientific publishing, those who issued more than 21 opinions in the last 12 months, those who have more than 11 articles in progress, those who dedicate less 10 hours a week to graduate school, those dissatisfied with their work in graduate school, with little ability to concentrate, few leisure opportunities and dissatisfied with sleep.
Regarding the association between a stable marital relationship and overwork, the literature explains only about the unsatisfactory family relationship and bad marriage, that is, the one that is considered as conflictual or that does not bring satisfaction, and can make people work long hours (26) .
Significantly greater chances of high overwork were found among the professors who participated in this research due to pressure for scientific publishing, issuing many opinions annually and having many articles in progress. Publication in scientific issues represents the dissemination of knowledge and has been widely used for teacher evaluations (career advancement, qualification of the program, promotion of research, obtaining scientific initiation and publishing grants, among others). However, preparing articles for specialized and well-qualified journals requires knowledge, investment of time, dedication, focus and discipline, so that they have the quality, relevance and novelty, that is, that contribute to the advancement of knowledge (27)(28) .
Issuing opinion on a scientific article also requires time, considering the responsibility to critically and constructively analyze the originality, the coherence between theoretical, methodological and interpretations, to collaborate with the improvement of the research in question.
It is inferred that excessive work among graduate professors is related to intense mental activity, in an attempt to achieve expectations promptly, given the quantity and complexity of tasks, which occur besides to other activities. This situation can also lead to dissatisfaction with work in graduate school.
The relationship between overwork and dissatisfaction with sleep can derive from nights, late nights, and moments of rest relegated due to work activities, disrupting the sleep-wake cycle, especially in the quality of sleep and lasting (29) . It should be noted that most teaching activities, due to their diversity, are challenging to measure in hours and are not usually included in the weekly workload. However, they become mandatory due to their roles and goals established by the programs.
The study has a limitation because it was carried out with a self-applied questionnaire and, consequently, the possibility of biased responses, considering that the condition of workaholic leads the individual to self-denial, with attempts to fit his condition with an committed worker (30) . However, it has potentialities such as the expressive sample, distributed in all regions of the country, associating the working conditions of nursing professors from PPGEnf to a phenomenon little studied in the area. Workaholism is a problem of a subjective nature and, therefore, can be influenced by personal characteristics and the work process can contribute to its emergence or aggravation, since producing more and more is the motto of the capitalist world. Thus, it is suggested that other studies include the mediating effect of personality to deepen the theme.

Conclusion
The results allow us to conclude that there is a sign of workaholism in the studied sample and it was