The purpose of the study is to investigate the psychological and physical well-being of healthcare professionals working at an orthopedic surgical hospital. In particular, we want to assess the presence and spread of a new work phenomenon called "quiet quitting," a phenomenon that has spread significantly in recent years in many work contexts.

STUDY SETTING The study will be conducted within the hospital services of the Istituto Ortopedico Rizzoli (IOR). The central site in Bologna, the Rizzoli-Sicilia Department, and the Departments of Orthopaedics and Traumatology and Physical and Rehabilitation Medicine of the Rizzoli-Argenta site will be involved.

VARIABLES

To describe the sample of enrolled healthcare workers and to identify potential risk factors related to quiet quitting, the following variables will be collected in categorical form to ensure anonymity:

Age, classified into three categories: 18-30 years, 30-50 years, and >50 years

Sex

Educational level, classified into three categories: high school diploma, bachelor's degree, and postgraduate education

Profession (nurses, physiotherapists, technical area professionals, healthcare assistants)

Years of work experience (<5 years; 5-20 years; >20 years)

Years of employment at the enrolling hospital (<1 year; 1-5 years; >5 years)

Presence of minor children in the household (yes/no)

Presence of elderly parents in the family environment (yes/no)

Work activity involving night shifts (yes/no)

Work activity on public holidays (yes/no)

On-call duty (yes/no)

Holding a functional/managerial role (yes/no)

Area of work activity (inpatient wards; outpatient services; critical care units/services; technical services)

Correspondence between expectations and job assignment/work activity

In describing their work context, participants will also be asked to express their perceptions regarding the role of training, autonomy and staff recognition, career development opportunities, outcome monitoring, and communication. Each item will be rated on a 1-5 Likert scale, where 0 indicates a minimally relevant aspect and 5 a highly relevant aspect.

ENROLLMENT TIMELINE The estimated total duration of the study is 2 years from approval by the Ethics Committee. The enrollment period for the first data collection is planned from June 2025 to December 2025. The second data collection will be conducted during 2026.

SAMPLE SIZE AND STATISTICAL ANALYSIS A quality improvement project conducted at the Istituto Ortopedico Rizzoli on a sample of 76 nurses reported a quiet quitter prevalence of 46.6%. Assuming a 95% confidence level and a confidence interval width of 10%, the estimated sample size is at least 382 healthcare workers.

Collected data will be reported as mean and standard deviation or median and percentiles for continuous variables, according to their distribution, and as absolute and percentage frequencies for dichotomous/categorical variables. The group defined as "quiet quitters" will include workers reporting a score greater than 2.06 on the Quiet Quitting Scale. Variables will be described for the overall enrolled population and compared between quiet quitters and non-quiet quitters.

Identification of risk factors associated with the quiet quitter condition will be performed using univariate analyses, applying the chi-square test for dichotomous variables and Student's t-test or the Mann-Whitney test for continuous variables. Variables with a statistical significance level <0.157 in the univariate analysis will be included in the multivariable logistic regression model. Data from the first phase will be compared with those from the second year of data collection to assess trends in the overall phenomenon of disengagement.

ENROLLMENT PROCEDURE Informed consent and data collection will be carried out using the REDCap platform, which will be configured to ensure participant anonymity. The same procedure will be applied at both data collection time points (baseline administration and follow-up). On both occasions, feedback on the study results will be provided to all healthcare workers through staff meetings and the dissemination of summary tables and graphs. Participants may withdraw at any time before completing the questionnaires by simply not completing them.

DATA COLLECTION Study participants will be enrolled on a voluntary and anonymous basis. Data will be collected through an anonymous survey, completed electronically using the REDCap platform. A draft version of the questionnaire and the assessment scales to be used are attached to the documentation (see CRF). All workers will receive a dedicated participation link and will be able to complete the survey, which has an estimated duration of approximately 15 minutes, during working hours. Upon completion of data collection, data will be exported to an Excel file and stored in an electronic database for statistical analysis.

Inclusion Criteria:

• All workers in the healthcare sector, such as nurses, physical therapists, technical professionals, and social
• Healthcare workers employed by the services and departments of the facilities involved.
• Workers who express their willingness to participate in the study

Exclusion Criteria:

• Workers employed on temporary contracts or on contracts with third parties other than the hospital involved
• Workers who are absent from work for more than 3 months during the survey period, such as workers on maternity leave, long-term sick leave, or accident leave.

The study will be conducted within the hospital services of the Istituto Ortopedico Rizzoli (IOR). The central site in Bologna, the Rizzoli-Sicilia Department, and the Departments of Orthopaedics and Traumatology and Physical and Rehabilitation Medicine of the Rizzoli-Argenta site will be involved.

data will be made available upon reasonable request to the Principal Investigator.