Forschungs- & Entwicklungsinformationsdienst der Gemeinschaft - CORDIS

France: Premature departure from nursing and 'intention to leave nursing'

In order to represent the diversity of the occupational conditions in the French territory, we selected five different regions to create a partnership for a longitudinal study. These regions are distributed in the north as well as in the south of France. In each area, a sample of the various types of institutions was chosen with the assistance of the governmental agency in charge of hospitalisation (ARH). 55 institutions were selected to provide a sample representing the diversity in proportion to each type of healthcare structure in France. This sample is representative of the repartition between private and public sector, between specialties and representative of the different occupational level of HCWs in France. The national representative sample is made of 5,376 HCWs.

For the total French sample of all occupational levels, the main reasons for dissatisfaction or strong dissatisfaction are: psychological support (expressed by 66.1 % of HCWs versus 50.3 % in Europe), Staff handovers when shifts change (53.7 % vs 37.1%), Physical working conditions ( 52 % vs 44.2%), Opportunities to give patients the care they need (49.5%vs 41.3%), Pay in relation to need for income (44% vs 53%), Work prospects (37.4% vs 40%), The way abilities are used (36.4% vs 31.6%).

Healthcare workers of the European sample (versus France) declared suffering from the following disorders:
- Injury due to an accident 13 % (18%),
- Musculoskeletal disorders 52.8 % (56.2%),
- Mental disorder 18.9 % (25%),
- Skin disorders 27.7% (42.8%).

Over half of HCWs in Poland, Slovakia, Belgium and France declared having had no sick leave in the last 12 months.

Short sick leaves, 5 days or less, are far more frequent in Great Britain, Norway, The Netherlands and Finland. But more than 16 % of HCWs had more than 15 days of sick leave in France, Finland and Germany and less than 8% in Belgium and Norway.

Studies about risk factors where conducted for each of these issues. Risk factors for frequent worries about making mistakes and exposition to violence where also studied. We conclude, that substantial reduction in healthcare errors and violent event will not come until more attention is given to human solutions, such as improving teamwork and communication in healthcare teams.

These multivariate analysis conducted to the conclusion that it is necessary to prevent mental and physical disorders by better working conditions.

To reduce early exit it is necessary to organise better work prospects and to assure better quality of care by team building and team support.

It is important to note that HCWS with serious musculoskeletal disorders cannot find another job. They stay, and have frequent sick leaves.

One year after, frequent ITL is still 13.3 % among the respondent to Q12 (higher among specialised nurses 17.1%).

HCWs who changed their mind, and no longer intended to leave, described better conditions : worry about making mistakes decreased; Care needed to be done less rapidly; less lifting of patients without aid.

HCWs who changed their mind, for ITL described worse conditions: Satisfaction about work prospects; Pride to belong to the institution; Variety of work; Influence on work schedules; Satisfaction with handover shift; Perceived health. Work unevenly distributed so that it piles up was more frequent.

HCWs who exit and answered Qex left at normal retirement age (22.2 %) and premature (13.8 %). The bigest group of those who returned this questionnaire, found new employment within health care or were studying for a higher degree in healthcare (43.3 %). However, 12.8 % started a new job outside care and 7.9 % left for other reasons, mostly child care.

HCWS having exited from their institution considered that contributed strongly to their decision: Low psychological support, Inadequate personnel numbers, Time pressures, Neduced nursing conditions for patient’s care, Inadequate occupational development opportunities.

These longitudinal results confirm the major influence of mental health among HCWs with ITL and the good mental health among HCWs with intent to stay. Those who changed the institution and those who do not work anymore in care do not declare having bad mental health. Most of Qex have recovered good mental health.
These longitudinal results confirm also the negative influence of back pain on ITL. On the other hand, a physician diagnosis of MSD is linked with fewer changes of institution.

A project has been proposed to the Health Ministry to implement targeted measures into 28 out of 61 institutions involved in the NEXT study. Four Regions Councils are also discussing a regional implementation plan and we already have an agreement with Rhône-Alps Region.

Languedoc-Roussillon Region is using these results through the regional social insurance preventive fund.

Assistance Publique-Hôpitaux de Paris included targeted measures resulting from NEXT in its social plan 2005-2009 and its prevention plan.

Reported by

Assistance-Publique Hôpitaux de Paris
1 place du Parvis Notre Dame
75004 Paris
France
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