Work week duration, work-family balance and difficulties encountered by female and male physicians: results from the French SESMAT study.

OBJECTIVE: France encounters difficulties attracting physicians to work in hospitals. Organisation at work and at home may be at the heart of the problem for female as well as for male physicians. PARTICIPANTS: A comprehensive questionnaire was filled out online by a representative sample of 1924 French hospital physicians. METHODS: We conducted gender bivariate and multivariate analysis of the risk factors for burnout and intent to leave the profession(ITL). RESULTS: ITL was declared by 17.4% of physicians. According to 41.3% of female physicians (FP), their profession was an obstacle to having children (versus 19.3% for male physicians (MP)). Major factors linked with burnout were Effort/Reward imbalance (FP adjOR = 5.09, MP adjOR = 5.93), Work-family conflicts (FP adjOR = 2.97, MP adjOR = 3.04), and Low quality of teamwork (FP adjOR = 1.82, MP adjOR = 2.68). Major factors linked with ITL were Low quality of teamwork (FP adjOR = 4.49, MP adjOR = 3.03), Patient-related burnout (FP adjOR = 2.10, MP adjOR = 2.35) and General burnout (FP adjOR = 1.85, MP adjOR = 1.45). CONCLUSIONS: Excessive job demands are linked with burnout and with work-family conflicts, conducting to difficulties in organising one's life in order to have and raise children. Potential solutions include facilitating teamwork in order to reduce departure, which increase workload on those who stay increasing their work family conflict.

[Burnout in French doctors: a comparative study among anaesthesiologists and other specialists in French hospitals (SESMAT study)]. / Enquête comparative sur le syndrome d'épuisement professionnel chez les anesthésistes réanimateurs et les autres praticiens des hôpitaux publics en France (enquête SESMAT).

OBJECTIVE: Burnout is one of the main chronic health problems with negative consequences on health care givers but also on quality of care. The main goal of Physician Health Survey was to study the frequency of burnout among salaried physicians and pharmacists and to compare anesthesiologists and intensivists (AI) with other practitioners (OP). The secondary end points were to analyze risk factors of burnout in each group. MATERIAL AND METHODS: An anonymous, self-administered questionnaire was diffused via a specific website. Burnout was measured using the Copenhagen Burnout Inventory (CBI). Several different factors were examined: work/family conflict, salary satisfaction, quality of teamwork, interpersonal relationships, workplace influence, workload and perceived health. The role of each factor was calculated by multivariate logistic regression and comparisons were made between AI and OP. RESULTS: Among the 3196 responses, CBI revealed an elevated score of burnout in 38.4% in AI and in 42.4% in OP. In each group, a great gap was displayed between the CBI results and the self-assessment of burnout (15%). Among AI, risk factors of burnout were high quantitative demand (ORadj=3.40; CI(95) 1,34-8,63), Work/family conflict (ORadj=; 3.12 CI(95) 1.60-6.08), low quality of teamwork (ORadj=1.99; CI(95)1.14-3.47) and tense Relation within team (ORadj=1.92; CI(95) 1.25-2.95). All these factors are observed also among OP. Female gender, young age and dissatisfaction with pay have significant influence but different in the two groups. Claims of recurrent harassment by superiors is a risk factor for burnout only for the AP (adj.OR=1.83; CI(95) 1.04-3.22). DISCUSSION: Burnout affected near one about two salaried physicians and pharmacists in France. AI were not more concerned by burnout than OP but all of whom have difficulty identifying their own levels of psychological stress and burnout. Decreasing the level of different risk factors i.e. by improving the quality of teamwork should lead to reduce burnout frequency.

Emergency physicians accumulate more stress factors than other physicians-results from the French SESMAT study.

INTRODUCTION: France is facing a shortage of available physicians due to a greying population and the lack of a proportional increase in the formation of doctors. Emergency physicians are the medical system's first line of defence. METHODS: The authors prepared a comprehensive questionnaire using established scales measuring various aspects of working conditions, satisfaction and health of salaried physicians and pharmacists. It was made available online, and the two major associations of emergency physicians promoted its use. 3196 physicians filled out the questionnaire. Among them were 538 emergency physicians. To avoid bias, 1924 physicians were randomly selected from the total database to match the demographic characteristics of France's physician population: 42.5% women, 57.5% men, 8.2% < 35 years old, 33.8% 35-44 years old, 34.5% 45-54 years old and 23.6% ≥ 55 years old. The distribution of physicians in the 23 administrative regions and by speciality was also precisely taken into account. This representative sample was used to compare subgroups of physicians by speciality. RESULTS: The outcomes indicate that the intent to leave the profession (ITL) was quite prevalent across French physicians and even more so among emergency physicians (17.4% and 21.4% respectively), and burnout was highly prevalent (42.4% and 51.5%, respectively). Among the representative sample and among emergency physicians, work-family conflict (OR=4.47 and OR=6.14, respectively) and quality of teamwork (OR=2.21 and OR=5.44, respectively) were associated with burnout in a multivariate analysis, and these risk factors were more prevalent among emergency physicians than other types. A serious lack of quality of teamwork appears to be associated with a higher risk of ITL (OR=3.92 among the physicians in the representative sample and OR=4.35 among emergency physicians), and burnout doubled the risk of ITL in multivariate analysis. CONCLUSIONS: In order to prevent the premature departure of French doctors, it is important to improve work-family balance, working processes through collaboration, multidisciplinary teamwork and to develop team training approaches and ward design to facilitate teamwork.

The impact of social support upon intention to leave among female nurses in Europe: secondary analysis of data from the NEXT survey.

OBJECTIVES: This study examined the importance of one's social work environment in the light of prevention of premature leave from the nursing profession. A research model with social support (from direct supervisor and close colleagues) as predictor and intention to leave as the dependent variable has been tested, while controlling for job satisfaction and age. Moreover, we have studied the impact of nurses' age upon the prevalence of social support from both parties. PARTICIPANTS: Data were obtained from 17,524 registered female nurses working in hospitals throughout Europe (Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, and Slovakia). RESULTS: Our findings indicated that a lack of job satisfaction is an important risk factor in the light of nurses' turnover as for most countries the intention to leave cannot be buffered by social support from one's close colleagues. However, in general, social support from one's direct superior appeared to contribute negatively to the intention to leave the profession, over and above job satisfaction and age. As regards age effects, in line with our expectation, we have found a significant negative relationship between age and social support from close colleagues, while the hypothesis regarding the relationship between age and supervisory support could not be confirmed. CONCLUSIONS: Given its importance in the light of preventing premature leave, we advocate not to neglect the possible positive effects of social support from important key figures like nurses' direct supervisor and close colleagues. It is necessary for health care institutions to carefully pay attention to finding opportunities to obtain more social support for all staff members. In Section 5, limitations and practical implications of this study are dealt with.

[Factors linked to premature leaving of the nursing profession. Confirmation of the impact one year later. Longitudinal analyses of nurses. PRESST/NEXT study]. / Les facteurs liés à l'abandon prématuré de la profession soignante. Confirmation de leur impact à un an d'intervalle. Analyse longitudinale des soignants de l'enquête. PRESST/NEXT

BACKGROUND: The organization of French medical institutions is changing, and the nursing personnel can encounter difficulties of adaption to these changes. The results of 2 questionnaires of the PRESST/NEXT study relative to working conditions (respectively, the questionnaires "Q0" and "Q12"), sent in a year interval to a sample of nurses were compared. METHODS: Three samples were made up: a sample of 5376 nurses having answered the initial questionnaire (Q0); a sample of 2627 nurses having answered the questionnaire sent one year after (Q12), and working in the same establishment; a group of 208 nurses having answered the questionnaire "Qex", specific to nurses who left their establishment. RESULTS: Among nurses who answered the "Qex", approximately 1/5 of nurses chose to leave the profession definitively or temporarily before the retirement age; of these, almost 13% began a new work not in the healthcare sector. Seven factors are significantly related to the intention of leaving the profession: Dissatisfaction regarding professional prospects (Q0: OR = 3.1 and Q12: OR = 2.82); Difficulties assuming the family responsabilities (Q0: OR = 1.36 and Q12: OR = 2.10); Mental health disorders for nurses not followed medically (Q0: OR = 1.76 and Q12: OR = 1.47), and for nurses receiving care for this (Q0 : OR = 1.90 and Q12: OR = 1.77); Dissatisfaction concerning the psychological support available at work (Q0: OR = 1.57 and Q12: OR = 1.87); Tiredness (Q0 : OR = 1.40 and Q12: OR = 1.6); Musculo-skeletal disorders diagnosed by doctor (Q0: OR = 1.32 and Q12: OR = 1.61); Dissatisfaction concerning the use of competences (Q0: OR = 1.27 and Q12: OR = 1.97). CONCLUSION: These results raise questions as to the benefits of new management which promotes flexibility in work and schedules, and which reduces the possibilities of support within the nursing teams. This type of management implies uncertainty for nurses as far as the technical aspects of their work are concerned, and a lack of time for the education and follow-up of patients.

Pre-employment screening among health care workers--ethical issues.

Occupational health practitioners deal with the questions of confidentiality, relation between the right to work and the right to health, between individual freedom and the risks other can run. An audit of pre-employment health assessment of health care workers, in the United Kingdom and in France, discussed the efficiency of pre-employment screening. Screening tests and medical examinations should not be used as a pretext to avoid implementing effective preventive measures. The pre-employment examination has mostly to be used for education of the future employees and for collection of baseline data. Appropriate procedures such as developing preventive policies, health promotion, and control of hazards in the work environment are efficient for the promotion of equal employment rights for women, older workers, or people with disabilities.

Work schedules in health care in France: very few changes between 1991 and 1998, according to national data.

It is important to know whether working time schemes offer, following the adoption of the 1990 ILO Night Work Convention, a better use of the actual knowledge in moderating the adverse effects of shiftwork for both sexes. The last two national studies on a representative sample, about working conditions in France (1991, 1998), show an increase of night work among female nursing staff. Long hours of work are becoming more common for nurses. The percentage of women health care workers not working the same number of days every week increased, with work weeks of 7 days or more. Few positive aspects exist such as a reduction in the proportion of those having to work 17 Sundays or more and a reduction of shifts beginning before 7 a.m. for female nurses. New negotiations, starting in 2001, should be an opportunity for improvements.

[Occupational health and ergonomics. IV. Case of hospital professionals]. / Ergonomia y salud en el trabajo (y IV). El caso de las profesionales hospitalarias.

The last of a series presented by Dr. Estryn Behar which analyzes the influences architecture and working conditions may have on the health and quality of life of health care professionals. Concepts such as ergonomics, flexibility, architectural participation, etc., are shown to be essential to achieve a better environment for these workers.

Work in operating rooms and pregnancy outcome among nurses.

The aim of this study was to analyse the relationship between work in an operating room and pregnancy outcome, as described by the rates of spontaneous abortion and of birth defects. The population comprised the female nurses of 17 hospitals in Paris, interviewed in 1987-1989. An exposed group included all operating room nurses, and a control group was composed of female nurses in other departments matched by hospital, age and duration of service. Each woman described all prior pregnancies. In total, 776 pregnancies were described by 418 nurses who were first pregnant in 1970 or thereafter; ectopic pregnancies, those terminated by voluntary induced abortion and those leading to multiple births were excluded. The rate of spontaneous abortion was significantly higher for pregnancies during which women worked in an operating room than for the other pregnancies. Birth defects were not significantly related to work in an operating room during pregnancy. These results are in agreement with others showing a significant relationship between occupational exposure to operating rooms and spontaneous abortion, although identification of the responsible factor remains difficult. They suggest that effective ventilating systems should be installed in all operating rooms and that special preventive measures must be taken for women of childbearing age.

Ectopic pregnancy and occupational exposure to antineoplastic drugs.

The incidence of ectopic pregnancy has risen substantially during the past two decades, but the aetiology of a third of cases remains unknown. We have used data from a survey of nurses in Paris, France, to examine the relation between ectopic pregnancy and various occupational exposures. We studied two groups of women--operating-theatre staff and nurses from other departments. The women were asked about outcomes of all pregnancies and occupational exposure to anaesthetic gases, formol, ionising radiation, and antineoplastic drugs during the first trimester of pregnancy. Of 734 pregnancies reported, 15 (2%) had been ectopic. In chi-square analysis, there were significant associations (p < 0.02) between ectopic pregnancy and exposure to antineoplastic drugs, the woman's age, and the number of previous pregnancies. Other occupational exposures and working in an operating theatre did not show significant associations. In logistic regression analysis with adjustment for gravidity, the odds ratio (by the exact method) for ectopic pregnancy associated with occupational exposure to antineoplastic drugs was 10.0 (95% CI 2.1-56.2). Because we had only small numbers of ectopic pregnancies, the odds ratios we estimated have wide confidence intervals. Our findings should be confirmed by a larger study specifically designed to investigate the relation between antineoplastic exposure and ectopic pregnancy.

[Working conditions of operating room personnel. Different symptoms observed and pregnancy outcome]. / Conditions de travail des personnels des blocs opératoires. Symptômes divers observés et issue des grossesses.

Neuropsychological symptoms and tiredness were reported more frequently by workers in less often scavenged theatres than by controls. The rate of spontaneous abortions was higher among pregnancies for which women were working in operating theatres.

Neuropsychological symptoms and occupational exposure to anaesthetics.

OBJECTIVE: To analyse the relation between symptoms regularly reported by hospital personnel and exposure to anaesthetics. SETTING: Personnel of 18 hospitals in Paris from 1987 to 1989. DESIGN: An exposed group that included all operating theatre members except for doctors, and which was divided into three subgroups depending on the degree of exposure--exposure was measured by the frequency of the use of the scavenging system--and a control group that included other hospital personnel matched by hospital, sex, occupation, age, and duration of service. SUBJECTS: 557 exposed workers and 566 unexposed workers. MAIN OUTCOME MEASURES: The groups were compared according to the crude rates of regular symptoms. Adjusted odds ratios were calculated to estimate the risks associated with exposure to anaesthetic gas. Liver transaminase activities (alanine aminotransferase, aspartate aminotransferase (s-ASAT, and gamma-glutamyl transpeptidase) were measured and compared between groups of exposure. RESULTS: After controlling for working conditions and matching factors, neuropsychological symptoms and tiredness were reported more by workers in less often scavenged theatres than by controls. No difference was found between workers of the well scavenged theatres and controls. Among the exposed workers, the members of paediatric surgical staffs reported a higher rate of neurological complaints (tingling, numbness, cramps) and tiredness than the members of the other surgical staffs. They had a high value of s-ASAT more frequently than the other exposed workers. CONCLUSION: These results strengthen the hypothesis of a causal relation between exposure to anaesthetics and neuropsychological symptoms, and show a dose-response effect. They suggest that the use of ventilating systems in operating rooms is an effective means of prevention.