This study significantly contributes to our understanding of the well-being and work experiences of care workers, offering valuable and timely insights. Across the three-year observation period, certain trends became apparent. Notably, the psychosocial health and perceived calling of care workers remained relatively stable over time, indicating a resilient aspect of their well-being. Concurrently, a positive development was observed as perceived precarious employment (PE) among care workers decreased between 2020 and 2023. Although the decrease was very small, it is a promising sign in an often challenging and precarious field. Additionally, there was a modest increase in work well-being, showcasing a potentially improving work environment or coping mechanisms. These dynamics align with the evolving landscape of care work, which is undergoing significant transformations. The study underscores the need to recognize and address the distinctive challenges faced by care workers, particularly emphasizing the disparities between younger and older care workers. Younger workers perceive their psychosocial health and work well-being slightly lower and experience a 20% higher perception of PE compared to their older counterparts. This underlines the importance of age as a factor in understanding how individuals perceive their well-being and employment circumstances, which can have significant implications for designing targeted interventions and support systems to enhance the well-being of younger workers in the care sector.

The perceived PE levels displayed a decline during the three-year follow-up, indicating a favourable trend towards enhanced employment quality. This observation likely mirrors the challenging employment conditions brought about by the COVID-19 pandemic in 2020 (Purkayastha et al. 2021). Subsequently, as the pandemic abated, there was an observable improvement in employment circumstances. During the pandemic’s peak, the health and social care sectors implemented measures such as holiday cancellations and employee reassignments without prior consultation (Marceau et al. 2022), potentially diminishing care workers’ autonomy and rights, while amplifying feelings of uncertainty and inequity. However, it is notable that younger workers consistently reported elevated levels of PE, aligning with prior research findings (Vives et al. 2010; Bodin et al. 2020; Matilla-Santander et al. 2022).

The dimension consistently associated with the highest levels of perceived PE is inadequate compensation. This issue is particularly pronounced in Finland, where the average salary of nurses falls below the national average (Eurostat 2022). For example, in Estonia, despite significantly lower health expenditure compared to Finland, nurses receive salaries slightly above the average. On the contrary, in countries like Belgium, nurses enjoy salaries 1.6 times higher than the average. Intriguingly, nurses have conveyed that dissatisfaction with salary levels is not the primary cause for discontent or attrition within the industry. Instead, they emphasize that decent working conditions hold greater importance (Ring and Kaarakainen 2023). To enhance working conditions, a bottom-up planning approach and active involvement of staff are recommended, as care workers possess valuable insights to effectively address workflow-related challenges.

The three-year follow-up did not reveal a shift in the perceived psychosocial health of care workers, even considering the period encompassing the COVID-19 pandemic. Notably, numerous studies have underscored the detrimental impact of the COVID-19 pandemic on the health of care workers (Matilla-Santander et al. 2021; Llop-Gironés et al. 2021). Consequently, one might have anticipated a decline in psychosocial health. However, the stability of the measure can be elucidated by the fundamental assumptions of the measurement instrument employed. The instrument was grounded in a salutogenic approach, emphasizing positive health, with a pivotal focus on a sense of coherence (Bringsén et al. 2009; Hult and Välimäki 2023). According to the salutogenic theory, a sense of coherence is fortified when an individual perceives their life as meaningful, comprehensible, and manageable (Antonovsky 1996). Despite some studies indicating that interventions could augment a sense of coherence, particularly among working-aged individuals facing depression (Wagman et al. 2023), it is generally viewed as a relatively stable personal state of mind. The diminished psychosocial health and work well-being among younger workers likely underscore the dissatisfaction prevalent among them. Achieving a sense of meaningfulness in the sector proves challenging, given that the workload and demands may surpass the comprehension and control of care workers. The outcomes further illuminate that young nurses experience significantly higher levels of burnout than their older counterparts (Shapiro et al. 2022). Overall, young workers are especially susceptible to the adverse consequences of PE on their health and well-being (Creed et al. 2020).

PE showed a pronounced adverse impact on psychosocial health and work well-being, aligning with prior research that highlighted detrimental effects of PE on various health and work-related outcomes (Julià et al. 2017; Rönnblad et al. 2019; Hult et al. 2022). However, there is a notable paucity of studies focusing on care workers, emphasizing the urgent need for targeted attention to PE within the care sector. These compelling findings underscore the necessity for prompt action and intervention. A collaborative and inclusive dialogue involving representatives from both the employees and employers, as well as key decision-makers, is indispensable to recognize and effectively address the multifaceted concerns arising from PE. Additionally, occupational health physicians and the emerging field of workplace health promotion constitute crucial stakeholders in preventing PE within workplace settings. Enhancing the quality of employment within the care sector has the potential to cultivate commitment among young workers and attract new workers to the sector, contributing to its overall growth and sustainability.

The sense of calling remained stable among the study population during the follow-up period. This consistency is likely attributed to the inherent stability of a sense of calling within a supportive environment (Dalla Rosa et al. 2019), emphasizing the enduring ethical values deeply embedded in care work (Michaelson and Tosti-Kharas 2019). Hence, we posit that the robust value system of care workers remains resilient amidst the challenges their vocation poses. Additionally, these findings support the growing body of evidence regarding calling as a significant source of well-being and meaningfulness in contemporary care work (Kallio et al. 2022; Hult et al. 2023; McKenna et al. 2023). The intriguing interplay between calling and PE merits attention, although it remains a scarcely explored area (Hult et al. 2021). This study offers fresh insights into these critical determinants of work life within the care sector, where both phenomena appear to hold substantial significance. It provokes contemplations of what care work would entail without a sense of calling to sustain individuals through precarious working conditions. Moreover, a valuable discussion regarding potential improvements in working conditions if the foundation of care professions were not based on a sense of calling, would be worthwhile.

In the discourse surrounding employment quality, which categorises jobs from highly precarious to high-quality employment standards (Van Aerden et al. 2013), care work presents a paradox, embodying elements from both extremes. While efforts are ongoing to standardise PE’s definition, measurement, and reporting in public health research, we advocate for customising measurement instruments to specific contexts and professions (Vanroelen et al. 2021), particularly within the care sector work. Moreover, it has been asserted that the expansion of care work represents a significant factor contributing to job polarisation, leading to an escalation of PE (Dwyer 2013). The rising affluence and the increasing participation of highly educated women in the workforce have precipitated outsourcing services traditionally carried out within households, such as childcare and elderly care. This service demand has given rise to a sizable segment of low-skilled and low-wage care work, i.e., PE.

Several limitations should be acknowledged in this study. While the applied instruments are widely used and validated, some participants might have had difficulty comprehending the questions, potentially introducing bias into the results. Additionally, there could be a bias towards more active participation from care workers who perceive good health, well-being, and fair employment conditions. The initial response rate of 9% raises concerns about the representativeness of the sample. To assess potential bias, we conducted an analysis comparing the background characteristics of the first and last respondents, assuming the latter might resemble the non-respondents (Rönmark et al. 2009). However, no significant differences were observed between these groups. Furthermore, the study sample predominantly comprised workers over 40 years old (79%), indicating an underrepresentation of young care workers, constituting only 21% of the sample. This underrepresentation of young care workers may limit the generalizability of the findings to this demographic.

Moreover, during the second data collection round in 2022, rigorous collective bargaining between the representatives of nursing staff, involving two trade unions and public sector employers, started. Consequently, by the close of 2022, nearly 1,000 nurses had formally requested the removal of their professional rights from the supervisory authority (Cubelo 2023). It can be viewed that these negotiations were ultimately resolved in the nurses’ favour at the beginning of 2023, coinciding with the third data collection round. Therefore, nurses can anticipate a wage increase in the upcoming years. Knowing how these circumstances may have influenced workers’ responses to our survey during the research period is paramount.

A major strength of this study lies in its longitudinal design, allowing for the exploration of changes in psychosocial health, work well-being, PE, and calling among care workers during the challenging period of the COVID-19 pandemic. This research makes a valuable and unique contribution by extending the scope of PE research within the care sector and delving into its interrelation with calling, a traditionally intrinsic aspect of the care profession. This broader perspective offers fresh insights into the complexities of employment dynamics in the care sector, especially during a time of global crisis.