- Email: [email protected]
Promotion of work ability among French health care workers—value of the work ability index
International Congress Series 1280 (2005) 73 – 78
www.ics-elsevier.com
Promotion of work ability among French health care workers—value of the work ability index M. Estryn-Behara,T, G. Kreutzb, O. Le Nezeta, L. Mouchotb, D. Camerinoc, R.K. Sallesd, E. Ben-Brika, J.P. Meyerb, J.F. Caillarda, H.M. Hasselhorne the NEXT study group a
Service central de me´decine du travail de lTAP-HP, Hotel-Dieu, Paris, France b INRS, Vandoeuvre, France c Department of Occupational Health, University of Milan, Italy d Universite´ Federale de Santa Catarina, Brasil e Department of Occupational Medicine, University of Wuppertal, Germany
Abstract. The French HCWs who have been studied belong to the French sample of European NEXT Study. This sample consists of 55 public and private institutions in five regions. WAI has been calculated on 4306 subjects out of 5376 because of missing data. More than a third have a moderate or a poor index (29.4% and 5.2%, respectively). Half (50.6%) of the sample have a good index and only 14.9%, an excellent one. The WAI decreases with age: 19.4% of the bless than 30Q, 14.6% of the 30–44 years old and 12.3% of the 45 + have an excellent WAI. But, the rate of decrease depends definitely on job demands and especially on physical load. The multivariate analysis showed that in France as well as in the other countries, work demand, uncertainty about treatments, low support from colleagues, and dissatisfaction with psychological support had high odds ratios for a low WAI. Dissatisfaction with physical working conditions and the necessity to maintain uncomfortable postures were the second group of factors with a strong influence on a low WAI. The absence of time for sports or leisure remained strongly linked with a low WAI after an adjustment to the other risk factors. The WAI enables the workplace physician to summarize data which the hospital can use to further its thinking about how to manage jobs and skills. D 2005 Published by Elsevier B.V. Keywords: Nursing; Ageing; Work ability; Prevention; Physical load; Team support
T Corresponding author. Tel.: +33 1 42 34 88 17; fax: +33 1 42 34 85 20. E-mail address: [email protected] (M. Estryn-Behar). 0531-5131/ D 2005 Published by Elsevier B.V. doi:10.1016/j.ics.2005.02.058
74
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
1. Introduction Use of the Work Ability Index (WAI) in Finland evaluated the success of the FIN-AGE program, based on decreasing the painfulness of jobs while increasing the physical fitness of salaried staff [1]. In France as well, demographic trends have made it necessary to rethink the employability of older personnel [2]. In France, post-retirement life expectancy with or without disabilities varies considerably with the strain of the job performed. The cost to the French health care system of such disability was previously underestimated. Yet the ESTEV study has clearly revealed the existence of powerful factors of risk in certain occupations [3]. The application of the WAI to the major NEXT sampling of French hospital health care workers enables us to test the relevance of the WAI to France. It also enables us to pinpoint the best ways of improving the WAI [4]. 2. Subjects and methods The French NEXT survey respondents appear to differ little in age and occupation from the national statistical breakdown [5]. The French NEXT sample group comprises 469 ancillary staff, 1543 nursing auxiliaries, 2368 state-registered nurses, 289 specialized nurses, 336 managerial-staff members, and 306 other (midwives, psychologists. . .). The sample group numbers 1050 health care workers (HCWs) under thirty, 2526 between 30 and 44 years old, and 1735 who are 45 years of age or older. The total NEXT sample was collected in 10 countries in autumn 2002. The selection should, so far as possible, reflect the national distribution of HCWs working in the different types of institutions and cover different regions in each country. [6]. The Work Ability Index (WAI) [7] is divided into four ratings: 7–27 is poor; 28–36, moderate; 37–43, good; and 44–49, excellent. For the data analysis, we employed SPSS 12.0 software. Pearson’s v 2 test was used (with p b .05) to determine whether differences among the four categories of WAI were significant. We were able to compute the WAI of 4306 French health care workers out of 5376. We lacked data for the remainder. Binomial logistic regression was used in order to assess the impact of a set of predictors on a low WAI index. We tested all predictor variables as one unit to assess their predictive ability. At the same time, we controlled the effects of the other predictors in our model. We tested our model on the eight countries where the entire set of variables was collected. The total European panel used for this analysis numbered 24,712 HCWs. We then conducted the analysis on each country to see if the French situation differs or if major predictors could be found in most countries. In our model, we used validated scales: social support, burnout, and uncertainty about the treatment [6]. 3. Results 3.1. The WAI, social and demographic characteristics We observed that more than a quarter of this representative sampling of French HCWs show a moderate WAI (in 23.5% of cases) or poor WAI (4.1%). Slightly under half (40.5%) have a good WAI, and only 11.9% tallied an excellent score. The WAI diminishes with age: 19.4% of the under-thirties sampled have an excellent WAI, as against 14.6% of the 30–44 age group and 12.3% of the over 45. The more skilled the occupation, the higher the WAI. However, the content of the work, from the standpoint of physical painfulness and the resulting strain, varies with the category of occupation (see below). Of
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
75
sisters in charge over 45, 14.7%—despite their age—have an excellent WAI and 53.5% have a good one, whereas only 15.9% of nurse’s aids under thirty have an excellent WAI and only 52.4% a good WAI. Twenty-four percent (24%) of managers between 30 and 44 years of age show an excellent WAI rating. More than age, occupational constraints, whether they relate to posture or heavy lifting, account for a poor WAI. Women in the botherQ category with an excellent WAI rating (21.1%) surpass that of male ancillary staff (17.4%). Women’s average WAI (21.1%) is nearly equal to men’s (21.3%). 3.2. The WAI and physical working conditions The perception of one’s physical workload significantly influences the WAI. Only 6.5% of HCWs highly dissatisfied with their physical working conditions score in the bexcellentQ bracket , as opposed to 38.6% of those declaring themselves bvery satisfiedQ. Only 7.6% of nurse’s aids compelled to maintain an uncomfortable posture more than ten times daily score bexcellentQ, as compared to 19.3% of those who must adopt an uncomfortable posture no more than once a day ( p b .001). 3.3. The WAI and satisfaction with psychological conditions and the pace of work The WAI is highly linked to the indicator of satisfaction with the psychological support received at work. Thirty-three percent (33%) of the bvery satisfiedQ show an excellent WAI as well as 22.3% of the bsatisfiedQ, in contrast to 8% and 12.2%, respectively, of those who claim to be very dissatisfied or merely dissatisfied ( p b .001). Merely 8.8% of HCWs who experience difficulty keeping pace with a workload which they describe as invariably uneven have an excellent WAI, as against 27.4% of those who almost never fall behind ( p b .001). The WAI is excellent in 10.1% of HCWs who maintain that they never have enough time to complete their work. But fully 28% of those given sufficient time have an excellent WAI ( p b .001). This disparity is even more marked in nurse’s aids and ancillary staff. Only 11.1% of nurse’s aids forever rushing to finish their work have an excellent WAI, whereas 35.6% of those virtually never short of time post a rating of excellent. HCWs, who describe themselves as constantly lacking time to speak with patients post a score of bexcellentQ on the WAI three times less often (9.3%) than those who say that they nearly always have sufficient time (27.5 %). 3.4. The support of co-workers or supervisors as factors in the WAI The support and advice of their colleagues may partly compensate for the difficulties encountered by HCWS. Of those who state that they receive such support boftenQ or bvery oftenQ, 16.3% show an excellent WAI rating, in contrast to the 11% who say that they brarelyQ or bneverQ receive such support. Of the HCWs who testify that their colleagues, 16.7% are willing to help them boftenQ or bunhesitatinglyQ produce an excellent WAI, as against 7.9% of those who maintain that their co-workers are bnot at allQ or brarelyQ willing to lend them a hand. A nurse’s impression that his or her work is valued by co-workers is testimony to the team’s supportiveness. Of HCWs who assert that their colleagues, 17.5% are bgreatlyQ or bemphaticallyQ aware of the value of their work and its outcome post an excellent WAI, as compared to 7.8% who hold their co-workers to be bnot at allQ or bbarelyQ conscious of their efforts. The support of supervisors also may play a role in the solution of possible problems encountered by HCWs. Of them who claim to receive such support boftenQ or bvery frequentlyQ, 18.4% show an excellent WAI, as against the 13%
76
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
who assert that they are bneverQ or bhardly everQ supported by their supervisors. Of HCWs who assert that their supervisors are conscious of the worth of their work and its outcome, 18.7% have an excellent WAI, as opposed to 9.7% of those who maintain that their supervisors are not at all or slightly aware of the value of their efforts. 3.5. The WAI and the fitness lifestyle The percentage of HCWs with an excellent WAI greatly increases when they work out at least several times weekly. Twelve percent of those engaging in athletic activity once a month or less have an excellent WAI, versus 20.5% of more active HCWs. Only 10.6% of nurse’s aids who never train show an excellent WAI, as opposed to 19.7% of those who work out at least a few times every week ( p b .001). About eleven percent (11.1%) of the totally unathletic state-registered nurses show an excellent WAI, in contrast to 18.3% of stateregistered nurses who play a sport a minimum of once a week. We have observed that obese HCWs (those with a body–mass index of z 30) show a poor WAI overall. Only 9.7% of the obese HCWs in the sample group as a whole have an excellent WAI as opposed to 15.9% of those not overweight. Thirty-three percent (33%) of French male and female HCWs still call themselves smokers. In this youthful group, only 11% of those who smoke more than fifteen cigarettes daily have an excellent WAI, as against 14.8% of non-smokers ( p b .001). Poor WAI is clearly linked with intent to leave the profession 38.4% for poor and 23.6% average WAI as opposed to 10.4% for good and 8.7% for excellent WAI. 3.6. Multivariate analysis for low WAI by country The factors of risk which are significant on the total panel are found among the 3274 French HCWs for whom we were able to apply the multiple logistic regression (Table 1). In France, the category of occupation is linked to certain difficult working and living conditions; nurse’s aids and less qualified workers clearly show a poorer WAI than sisters in charge (OR = 1.52; p b .001). State-registered nurses are in a more delicate situation than managerial-staff members (OR = 1.28; p b .001). In France, the factors of the workload and the team’s supportiveness remain especially important. The French and Slovak HCWs who state that they are boftenQ overburdened with work show a poorer WAI than those who bneverQ or brarelyQ complain about that (respectively, OR = 1.70 and OR = 1.92; p b .01). Those who express great doubts about the treatment show a poorer WAI in France, Finland, Belgium and Italy (respectively, OR = 1.31, 1.31, 1.40 and 1.48; p b .01). The HCWs who report low support from their colleagues show a poorer WAI in all countries (OR = 1.31 in France, OR = 1.48 in the Netherlands; p b .01). Dissatisfaction with psychological support plays a very important part in France, Germany and Belgium (respectively, OR = 1.45, 1.33 and 1.44; p b .01). The second most important factors accounting for a poor WAI among French HCWs are those linked with physical working conditions. In all countries, HCWs have a poor WAI much more often when they are dissatisfied with their physical working conditions (OR = 1.86 in France and OR = 2.24 in Germany; p b .001). In all countries except Slovakia, the necessity to maintain an uncomfortable posture is a factor which shows a gradient with an increase in the odds ratios when the frequency of daily uncomfortable postures also increases (OR = 1.43 in France and 1.95 in Belgium; p b .01 for postures maintained more than 10 times day). Again, the practice of sports and/or leisure activities
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
77
Table 1 Multivariate analysis for low WAI by country Total Number with high or medium WAI score Number with low WAI score Factors associated with low WAI score Gender (Male) Female Age 30–44 years old (b30 years old) 45 years+ Sport and hobbies /month (/week) Never Occup. Spec. N Level Reg. N (Sister ch) Nurse aids Satisfied work prospect (Yes) No Satisfied use of competence No (Yes) Social support Medium Superior (High) Low Social support Colleag. (High) Low Satisfied psychol support (Yes) No Incertitud concern treatment High (Low) Satisfied quality of care (Yes) No Work unevenly Seldom Distribut Sometimes Piles up Often (Never) Always Satisfied Physical wo. Cond No (Yes) Uncomfortable 2–5/day Postures 6–10/day (0–1/day) N 10/day
BE
DE
FIN
FR
IT
POL
SLK
18,158 2844 6554 422 aj OR 22,032 1.40 ns 14,066 1.65***
NL
2409 688 aj OR 1.35 ns 1.79***
1762 968 aj OR 1.30* 1.43***
2362 666 aj OR 0.97 ns 1.78**
2174 1100 aj OR 1.52** 1.36**
2172 662 aj OR 1.70*** 1.00 ns
1514 1078 aj OR 2.72 ns 1.54***
1560 510 aj OR 0.70 ns 1.36*
5514 6666 8874 3708 14,921 2082 10,419 8094
2.84*** 1.23 ns 1.62*** 1 1.11 ns 1.25 ns 1.41* 0.98 ns
2.32*** 1.29* 1.35* 1.21 ns 1.12 ns 2.04*** 1.73*** 1.11 ns
2.81** 1.21 ns 1.83*** 1.15 ns 1.45** 1.79** 1.47*** 1.27*
4.05*** 1.66*** 1.73*** 0.65*** 0.67** 1.54 ns 1.70*** 1.16 ns
2.46*** 1.28* 1.65*** 0.83 ns 1.34* 1.52** 1.67*** 1.44***
1.97*** 1.68*** 1.84*** 2.30*** 1.47 ns
4.06*** 2.39*** 0.97 ns 1.22 ns 1.70*** 1.15 ns 1.56 ns 1.15 ns 1.40* 0.95 ns 3.23*** 1.56*** 1.28* 1.24 ns 1.16 ns 1.14 ns 1.23 ns
10,818 5568 6710 12,809 9436
0.86 ns 0.65** 1.48** 1.44** 1.27 ns
0.98 ns 1.04 ns 1.27* 1.10 ns 1.40***
1.24* 1.49** 1.24* 1.33** 1.12 ns
1.02 ns 1.29 ns 1.43*** 1.18 ns 1.31**
1.13 ns 1.16 ns 1.33** 1.45*** 1.31**
1.29* 1.37* 1.36** 1.09 ns 1.48***
0.93 ns 0.82 ns 1.22* 0.87 ns 1.17 ns
1.02 ns 1.16 ns 1.44** 1.01 ns 1.23 ns
10,786 4935 10,345 6824 1329 11,380
1.01 ns 0.67 ns 0.96 ns 1.34 ns 1.02 ns 1.83***
1.42*** 1.32 ns 1.37 ns 1.79 ns 2.02 ns 2.14***
1.26* 1.37 ns 1.43 ns 1.31 ns 1.65 ns 2.24***
0.97 ns 0.41 ns 0.63 ns 0.68 ns 0.79 ns 1.63***
1.05 ns 1.20 ns 1.25 ns 1.70** 1.60 ns 1.86***
1.07 ns 0.68 ns 0.79 ns 0.98 ns 1.12 ns 1.52***
0.78* 1.00 ns 1.35 ns 1.49 ns 2.17** 1.60***
1.13 ns 1.58* 2.10*** 1.92** 2.84** 1.48**
1.16 ns 1.10 ns 1.47* 1.37 ns 1.95*** 1.51*
0.87 ns 1.25 ns 1.64**
1.01 ns 1.38* 1.43**
1.07 ns 1.41** 1.18 ns 1.48** 1.69*** 1.54**
9117 1.12 ns 4610 1.52* 4216 1.86**
1.14 ns 1.05 ns 1.24 ns
is a factor which reduces the impact of working conditions for HCWs in all countries except Slovakia (OR = 1.65 in France and 1.84 in Italy; p b .01 for bno sports Q). 4. Discussion The multivariate analysis showed that in France as well as in the other countries taking part in the NEXT study, work demand, uncertainty about treatments, low support from colleagues, and dissatisfaction with psychological support had high odds ratios for a low WAI. Dissatisfaction with physical working conditions and the necessity to maintain uncomfortable postures were the second group of factors with a strong influence on a low WAI. The absence of time for sports or leisure remained also strongly linked with a low WAI. This interaction of adverse working conditions and psychosocial factors on French workers, have been highlighted [8]. Among HCWs, the review conducted by Cassoum [8] proved the efficiency of action on physical work environment on low back pain as opposed to teaching lifting techniques [9], which never showed any efficiency. In a recent study, Costa and Sartori [10] has found that nurses appeared to have lower mean WAI scores than technicians and physicians in all age groups. The outcomes regarding our nursesT sample are alarming. However, experience generates an important increase in cognitive efficiency [11]. Good knowledge of the working environment and of used
78
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
material together with their mastery of procedures allow experienced workers to help their younger colleagues considerably. Our findings about the major role of uncertainty about procedures and material or about what to reply to patient’s questions, which is particularly detrimental for ageing HCWs, are in line with psycho-ergonomic knowledge. This strongly calls into question the new management which promotes flexibility in work stations and in shifts. Indeed, this management reduces team support and increases uncertainty. The lack of time to develop experience in order to compensate difficulties connected with age [12] is worrying, in this sector where errors may be dramatic. Certain work constraints may uncover certain deficiencies as senior employees no longer have sufficient leeway to make the most of their experience, thus making up for their ageing abilities. The WAI enables the workplace physician to summarize data which the hospital can use to further its thinking about how to manage jobs and skills. Acknowledgement The authors would like to thank the European Union within the fifth Framework Programme and by Assistance Publique-Hoˆpitaux de Paris and Institution Notre-dame de Bon Secours for financial support and Daniel Birbaum and Stephane Lambadaris for their help with the translation. References [1] J. Ilmarinen, Ageing Workers in the´ European Union — Status and Promotion of Work Ability, Employability and Employment, Finnish Institute of Occupational Health, Helsinki, 1999. [2] A.F. Molinier, S. Volkoff, La de´mographie du travail pour anticiper le vieillissement, Collection Outils et me´thodes, Editions de l’ANACT, Lyon, 2002, 76 pp. [3] F. Derriennic, A. Touranchet, S. Volkoff, Age, travail, sante´. Etude sur les salarie´s aˆge´s de 37 a` 52 ans, Enqueˆte ESTEV 1990 Collection Questions en sante´ publique, INSERM, 1996, 440 pp. [4] M. Estryn-Behar, Ergonomics and Health Care, Encyclopaedia of Occupational Health and Ssafety, fourth edition, ILO, Geneva, 1997, 13–97.17; 17–97.22; 97.22–97.26.; 97.29– 97.33. [5] Sicart D, Les professions de sante´ au 1er janvier 2001 — Re´pertoire ADELI, Document de travail, se´rie statistiques, 21, DREES, Ministe`re de l’emploi et de la solidarite´, 2001. [6] H.-M. Hasselhorn, P. Tackenberg, B.-H. Mqller, the NEXT-Study group, Working conditions and intent to leave the profession among nursing staff in Europe, Working Life Research Report, vol. 7, National Institute for Working Life, Stockholm, 2003, ISSN 404-790X, 258 pp. [7] K. Tuomi, et al., Promotion of work ability, the quality of work and retirement, Occup. Med. 51 (5) (2001) 318 – 324. [8] B. Cassou, et al., Chronic neck and shoulder pain, age and working conditions: longitudinal results from a large random sample in France, Occup. Environ. Med. 59 (8) (2002) 537 – 544. [9] S. Hignett, Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review, Occup. Environ. Med. 60 (9) (2003) e 6, http://www.occenvmed.com/cgi/content/full/ 60/9/e6. [10] G. Costa, A. Sartori, Aging, working hours and health: some preliminary statistics from the 3rd European Survey on working conditions, The 4th Confe´rence on Ageing and Work, 2002, p. 28, Krakow. [11] J.R. Anderson, Acquisition of cognitive skill, Psychosoc. Rev. 89 (4) (1982) 369 – 406. [12] T.A. Salthouse, Resource reduction interpretations of cognitive ageing, Dev. Rev. 8 (1988) 238 – 272.
www.ics-elsevier.com
Promotion of work ability among French health care workers—value of the work ability index M. Estryn-Behara,T, G. Kreutzb, O. Le Nezeta, L. Mouchotb, D. Camerinoc, R.K. Sallesd, E. Ben-Brika, J.P. Meyerb, J.F. Caillarda, H.M. Hasselhorne the NEXT study group a
Service central de me´decine du travail de lTAP-HP, Hotel-Dieu, Paris, France b INRS, Vandoeuvre, France c Department of Occupational Health, University of Milan, Italy d Universite´ Federale de Santa Catarina, Brasil e Department of Occupational Medicine, University of Wuppertal, Germany
Abstract. The French HCWs who have been studied belong to the French sample of European NEXT Study. This sample consists of 55 public and private institutions in five regions. WAI has been calculated on 4306 subjects out of 5376 because of missing data. More than a third have a moderate or a poor index (29.4% and 5.2%, respectively). Half (50.6%) of the sample have a good index and only 14.9%, an excellent one. The WAI decreases with age: 19.4% of the bless than 30Q, 14.6% of the 30–44 years old and 12.3% of the 45 + have an excellent WAI. But, the rate of decrease depends definitely on job demands and especially on physical load. The multivariate analysis showed that in France as well as in the other countries, work demand, uncertainty about treatments, low support from colleagues, and dissatisfaction with psychological support had high odds ratios for a low WAI. Dissatisfaction with physical working conditions and the necessity to maintain uncomfortable postures were the second group of factors with a strong influence on a low WAI. The absence of time for sports or leisure remained strongly linked with a low WAI after an adjustment to the other risk factors. The WAI enables the workplace physician to summarize data which the hospital can use to further its thinking about how to manage jobs and skills. D 2005 Published by Elsevier B.V. Keywords: Nursing; Ageing; Work ability; Prevention; Physical load; Team support
T Corresponding author. Tel.: +33 1 42 34 88 17; fax: +33 1 42 34 85 20. E-mail address: [email protected] (M. Estryn-Behar). 0531-5131/ D 2005 Published by Elsevier B.V. doi:10.1016/j.ics.2005.02.058
74
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
1. Introduction Use of the Work Ability Index (WAI) in Finland evaluated the success of the FIN-AGE program, based on decreasing the painfulness of jobs while increasing the physical fitness of salaried staff [1]. In France as well, demographic trends have made it necessary to rethink the employability of older personnel [2]. In France, post-retirement life expectancy with or without disabilities varies considerably with the strain of the job performed. The cost to the French health care system of such disability was previously underestimated. Yet the ESTEV study has clearly revealed the existence of powerful factors of risk in certain occupations [3]. The application of the WAI to the major NEXT sampling of French hospital health care workers enables us to test the relevance of the WAI to France. It also enables us to pinpoint the best ways of improving the WAI [4]. 2. Subjects and methods The French NEXT survey respondents appear to differ little in age and occupation from the national statistical breakdown [5]. The French NEXT sample group comprises 469 ancillary staff, 1543 nursing auxiliaries, 2368 state-registered nurses, 289 specialized nurses, 336 managerial-staff members, and 306 other (midwives, psychologists. . .). The sample group numbers 1050 health care workers (HCWs) under thirty, 2526 between 30 and 44 years old, and 1735 who are 45 years of age or older. The total NEXT sample was collected in 10 countries in autumn 2002. The selection should, so far as possible, reflect the national distribution of HCWs working in the different types of institutions and cover different regions in each country. [6]. The Work Ability Index (WAI) [7] is divided into four ratings: 7–27 is poor; 28–36, moderate; 37–43, good; and 44–49, excellent. For the data analysis, we employed SPSS 12.0 software. Pearson’s v 2 test was used (with p b .05) to determine whether differences among the four categories of WAI were significant. We were able to compute the WAI of 4306 French health care workers out of 5376. We lacked data for the remainder. Binomial logistic regression was used in order to assess the impact of a set of predictors on a low WAI index. We tested all predictor variables as one unit to assess their predictive ability. At the same time, we controlled the effects of the other predictors in our model. We tested our model on the eight countries where the entire set of variables was collected. The total European panel used for this analysis numbered 24,712 HCWs. We then conducted the analysis on each country to see if the French situation differs or if major predictors could be found in most countries. In our model, we used validated scales: social support, burnout, and uncertainty about the treatment [6]. 3. Results 3.1. The WAI, social and demographic characteristics We observed that more than a quarter of this representative sampling of French HCWs show a moderate WAI (in 23.5% of cases) or poor WAI (4.1%). Slightly under half (40.5%) have a good WAI, and only 11.9% tallied an excellent score. The WAI diminishes with age: 19.4% of the under-thirties sampled have an excellent WAI, as against 14.6% of the 30–44 age group and 12.3% of the over 45. The more skilled the occupation, the higher the WAI. However, the content of the work, from the standpoint of physical painfulness and the resulting strain, varies with the category of occupation (see below). Of
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
75
sisters in charge over 45, 14.7%—despite their age—have an excellent WAI and 53.5% have a good one, whereas only 15.9% of nurse’s aids under thirty have an excellent WAI and only 52.4% a good WAI. Twenty-four percent (24%) of managers between 30 and 44 years of age show an excellent WAI rating. More than age, occupational constraints, whether they relate to posture or heavy lifting, account for a poor WAI. Women in the botherQ category with an excellent WAI rating (21.1%) surpass that of male ancillary staff (17.4%). Women’s average WAI (21.1%) is nearly equal to men’s (21.3%). 3.2. The WAI and physical working conditions The perception of one’s physical workload significantly influences the WAI. Only 6.5% of HCWs highly dissatisfied with their physical working conditions score in the bexcellentQ bracket , as opposed to 38.6% of those declaring themselves bvery satisfiedQ. Only 7.6% of nurse’s aids compelled to maintain an uncomfortable posture more than ten times daily score bexcellentQ, as compared to 19.3% of those who must adopt an uncomfortable posture no more than once a day ( p b .001). 3.3. The WAI and satisfaction with psychological conditions and the pace of work The WAI is highly linked to the indicator of satisfaction with the psychological support received at work. Thirty-three percent (33%) of the bvery satisfiedQ show an excellent WAI as well as 22.3% of the bsatisfiedQ, in contrast to 8% and 12.2%, respectively, of those who claim to be very dissatisfied or merely dissatisfied ( p b .001). Merely 8.8% of HCWs who experience difficulty keeping pace with a workload which they describe as invariably uneven have an excellent WAI, as against 27.4% of those who almost never fall behind ( p b .001). The WAI is excellent in 10.1% of HCWs who maintain that they never have enough time to complete their work. But fully 28% of those given sufficient time have an excellent WAI ( p b .001). This disparity is even more marked in nurse’s aids and ancillary staff. Only 11.1% of nurse’s aids forever rushing to finish their work have an excellent WAI, whereas 35.6% of those virtually never short of time post a rating of excellent. HCWs, who describe themselves as constantly lacking time to speak with patients post a score of bexcellentQ on the WAI three times less often (9.3%) than those who say that they nearly always have sufficient time (27.5 %). 3.4. The support of co-workers or supervisors as factors in the WAI The support and advice of their colleagues may partly compensate for the difficulties encountered by HCWS. Of those who state that they receive such support boftenQ or bvery oftenQ, 16.3% show an excellent WAI rating, in contrast to the 11% who say that they brarelyQ or bneverQ receive such support. Of the HCWs who testify that their colleagues, 16.7% are willing to help them boftenQ or bunhesitatinglyQ produce an excellent WAI, as against 7.9% of those who maintain that their co-workers are bnot at allQ or brarelyQ willing to lend them a hand. A nurse’s impression that his or her work is valued by co-workers is testimony to the team’s supportiveness. Of HCWs who assert that their colleagues, 17.5% are bgreatlyQ or bemphaticallyQ aware of the value of their work and its outcome post an excellent WAI, as compared to 7.8% who hold their co-workers to be bnot at allQ or bbarelyQ conscious of their efforts. The support of supervisors also may play a role in the solution of possible problems encountered by HCWs. Of them who claim to receive such support boftenQ or bvery frequentlyQ, 18.4% show an excellent WAI, as against the 13%
76
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
who assert that they are bneverQ or bhardly everQ supported by their supervisors. Of HCWs who assert that their supervisors are conscious of the worth of their work and its outcome, 18.7% have an excellent WAI, as opposed to 9.7% of those who maintain that their supervisors are not at all or slightly aware of the value of their efforts. 3.5. The WAI and the fitness lifestyle The percentage of HCWs with an excellent WAI greatly increases when they work out at least several times weekly. Twelve percent of those engaging in athletic activity once a month or less have an excellent WAI, versus 20.5% of more active HCWs. Only 10.6% of nurse’s aids who never train show an excellent WAI, as opposed to 19.7% of those who work out at least a few times every week ( p b .001). About eleven percent (11.1%) of the totally unathletic state-registered nurses show an excellent WAI, in contrast to 18.3% of stateregistered nurses who play a sport a minimum of once a week. We have observed that obese HCWs (those with a body–mass index of z 30) show a poor WAI overall. Only 9.7% of the obese HCWs in the sample group as a whole have an excellent WAI as opposed to 15.9% of those not overweight. Thirty-three percent (33%) of French male and female HCWs still call themselves smokers. In this youthful group, only 11% of those who smoke more than fifteen cigarettes daily have an excellent WAI, as against 14.8% of non-smokers ( p b .001). Poor WAI is clearly linked with intent to leave the profession 38.4% for poor and 23.6% average WAI as opposed to 10.4% for good and 8.7% for excellent WAI. 3.6. Multivariate analysis for low WAI by country The factors of risk which are significant on the total panel are found among the 3274 French HCWs for whom we were able to apply the multiple logistic regression (Table 1). In France, the category of occupation is linked to certain difficult working and living conditions; nurse’s aids and less qualified workers clearly show a poorer WAI than sisters in charge (OR = 1.52; p b .001). State-registered nurses are in a more delicate situation than managerial-staff members (OR = 1.28; p b .001). In France, the factors of the workload and the team’s supportiveness remain especially important. The French and Slovak HCWs who state that they are boftenQ overburdened with work show a poorer WAI than those who bneverQ or brarelyQ complain about that (respectively, OR = 1.70 and OR = 1.92; p b .01). Those who express great doubts about the treatment show a poorer WAI in France, Finland, Belgium and Italy (respectively, OR = 1.31, 1.31, 1.40 and 1.48; p b .01). The HCWs who report low support from their colleagues show a poorer WAI in all countries (OR = 1.31 in France, OR = 1.48 in the Netherlands; p b .01). Dissatisfaction with psychological support plays a very important part in France, Germany and Belgium (respectively, OR = 1.45, 1.33 and 1.44; p b .01). The second most important factors accounting for a poor WAI among French HCWs are those linked with physical working conditions. In all countries, HCWs have a poor WAI much more often when they are dissatisfied with their physical working conditions (OR = 1.86 in France and OR = 2.24 in Germany; p b .001). In all countries except Slovakia, the necessity to maintain an uncomfortable posture is a factor which shows a gradient with an increase in the odds ratios when the frequency of daily uncomfortable postures also increases (OR = 1.43 in France and 1.95 in Belgium; p b .01 for postures maintained more than 10 times day). Again, the practice of sports and/or leisure activities
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
77
Table 1 Multivariate analysis for low WAI by country Total Number with high or medium WAI score Number with low WAI score Factors associated with low WAI score Gender (Male) Female Age 30–44 years old (b30 years old) 45 years+ Sport and hobbies /month (/week) Never Occup. Spec. N Level Reg. N (Sister ch) Nurse aids Satisfied work prospect (Yes) No Satisfied use of competence No (Yes) Social support Medium Superior (High) Low Social support Colleag. (High) Low Satisfied psychol support (Yes) No Incertitud concern treatment High (Low) Satisfied quality of care (Yes) No Work unevenly Seldom Distribut Sometimes Piles up Often (Never) Always Satisfied Physical wo. Cond No (Yes) Uncomfortable 2–5/day Postures 6–10/day (0–1/day) N 10/day
BE
DE
FIN
FR
IT
POL
SLK
18,158 2844 6554 422 aj OR 22,032 1.40 ns 14,066 1.65***
NL
2409 688 aj OR 1.35 ns 1.79***
1762 968 aj OR 1.30* 1.43***
2362 666 aj OR 0.97 ns 1.78**
2174 1100 aj OR 1.52** 1.36**
2172 662 aj OR 1.70*** 1.00 ns
1514 1078 aj OR 2.72 ns 1.54***
1560 510 aj OR 0.70 ns 1.36*
5514 6666 8874 3708 14,921 2082 10,419 8094
2.84*** 1.23 ns 1.62*** 1 1.11 ns 1.25 ns 1.41* 0.98 ns
2.32*** 1.29* 1.35* 1.21 ns 1.12 ns 2.04*** 1.73*** 1.11 ns
2.81** 1.21 ns 1.83*** 1.15 ns 1.45** 1.79** 1.47*** 1.27*
4.05*** 1.66*** 1.73*** 0.65*** 0.67** 1.54 ns 1.70*** 1.16 ns
2.46*** 1.28* 1.65*** 0.83 ns 1.34* 1.52** 1.67*** 1.44***
1.97*** 1.68*** 1.84*** 2.30*** 1.47 ns
4.06*** 2.39*** 0.97 ns 1.22 ns 1.70*** 1.15 ns 1.56 ns 1.15 ns 1.40* 0.95 ns 3.23*** 1.56*** 1.28* 1.24 ns 1.16 ns 1.14 ns 1.23 ns
10,818 5568 6710 12,809 9436
0.86 ns 0.65** 1.48** 1.44** 1.27 ns
0.98 ns 1.04 ns 1.27* 1.10 ns 1.40***
1.24* 1.49** 1.24* 1.33** 1.12 ns
1.02 ns 1.29 ns 1.43*** 1.18 ns 1.31**
1.13 ns 1.16 ns 1.33** 1.45*** 1.31**
1.29* 1.37* 1.36** 1.09 ns 1.48***
0.93 ns 0.82 ns 1.22* 0.87 ns 1.17 ns
1.02 ns 1.16 ns 1.44** 1.01 ns 1.23 ns
10,786 4935 10,345 6824 1329 11,380
1.01 ns 0.67 ns 0.96 ns 1.34 ns 1.02 ns 1.83***
1.42*** 1.32 ns 1.37 ns 1.79 ns 2.02 ns 2.14***
1.26* 1.37 ns 1.43 ns 1.31 ns 1.65 ns 2.24***
0.97 ns 0.41 ns 0.63 ns 0.68 ns 0.79 ns 1.63***
1.05 ns 1.20 ns 1.25 ns 1.70** 1.60 ns 1.86***
1.07 ns 0.68 ns 0.79 ns 0.98 ns 1.12 ns 1.52***
0.78* 1.00 ns 1.35 ns 1.49 ns 2.17** 1.60***
1.13 ns 1.58* 2.10*** 1.92** 2.84** 1.48**
1.16 ns 1.10 ns 1.47* 1.37 ns 1.95*** 1.51*
0.87 ns 1.25 ns 1.64**
1.01 ns 1.38* 1.43**
1.07 ns 1.41** 1.18 ns 1.48** 1.69*** 1.54**
9117 1.12 ns 4610 1.52* 4216 1.86**
1.14 ns 1.05 ns 1.24 ns
is a factor which reduces the impact of working conditions for HCWs in all countries except Slovakia (OR = 1.65 in France and 1.84 in Italy; p b .01 for bno sports Q). 4. Discussion The multivariate analysis showed that in France as well as in the other countries taking part in the NEXT study, work demand, uncertainty about treatments, low support from colleagues, and dissatisfaction with psychological support had high odds ratios for a low WAI. Dissatisfaction with physical working conditions and the necessity to maintain uncomfortable postures were the second group of factors with a strong influence on a low WAI. The absence of time for sports or leisure remained also strongly linked with a low WAI. This interaction of adverse working conditions and psychosocial factors on French workers, have been highlighted [8]. Among HCWs, the review conducted by Cassoum [8] proved the efficiency of action on physical work environment on low back pain as opposed to teaching lifting techniques [9], which never showed any efficiency. In a recent study, Costa and Sartori [10] has found that nurses appeared to have lower mean WAI scores than technicians and physicians in all age groups. The outcomes regarding our nursesT sample are alarming. However, experience generates an important increase in cognitive efficiency [11]. Good knowledge of the working environment and of used
78
M. Estryn-Behar et al. / International Congress Series 1280 (2005) 73–78
material together with their mastery of procedures allow experienced workers to help their younger colleagues considerably. Our findings about the major role of uncertainty about procedures and material or about what to reply to patient’s questions, which is particularly detrimental for ageing HCWs, are in line with psycho-ergonomic knowledge. This strongly calls into question the new management which promotes flexibility in work stations and in shifts. Indeed, this management reduces team support and increases uncertainty. The lack of time to develop experience in order to compensate difficulties connected with age [12] is worrying, in this sector where errors may be dramatic. Certain work constraints may uncover certain deficiencies as senior employees no longer have sufficient leeway to make the most of their experience, thus making up for their ageing abilities. The WAI enables the workplace physician to summarize data which the hospital can use to further its thinking about how to manage jobs and skills. Acknowledgement The authors would like to thank the European Union within the fifth Framework Programme and by Assistance Publique-Hoˆpitaux de Paris and Institution Notre-dame de Bon Secours for financial support and Daniel Birbaum and Stephane Lambadaris for their help with the translation. References [1] J. Ilmarinen, Ageing Workers in the´ European Union — Status and Promotion of Work Ability, Employability and Employment, Finnish Institute of Occupational Health, Helsinki, 1999. [2] A.F. Molinier, S. Volkoff, La de´mographie du travail pour anticiper le vieillissement, Collection Outils et me´thodes, Editions de l’ANACT, Lyon, 2002, 76 pp. [3] F. Derriennic, A. Touranchet, S. Volkoff, Age, travail, sante´. Etude sur les salarie´s aˆge´s de 37 a` 52 ans, Enqueˆte ESTEV 1990 Collection Questions en sante´ publique, INSERM, 1996, 440 pp. [4] M. Estryn-Behar, Ergonomics and Health Care, Encyclopaedia of Occupational Health and Ssafety, fourth edition, ILO, Geneva, 1997, 13–97.17; 17–97.22; 97.22–97.26.; 97.29– 97.33. [5] Sicart D, Les professions de sante´ au 1er janvier 2001 — Re´pertoire ADELI, Document de travail, se´rie statistiques, 21, DREES, Ministe`re de l’emploi et de la solidarite´, 2001. [6] H.-M. Hasselhorn, P. Tackenberg, B.-H. Mqller, the NEXT-Study group, Working conditions and intent to leave the profession among nursing staff in Europe, Working Life Research Report, vol. 7, National Institute for Working Life, Stockholm, 2003, ISSN 404-790X, 258 pp. [7] K. Tuomi, et al., Promotion of work ability, the quality of work and retirement, Occup. Med. 51 (5) (2001) 318 – 324. [8] B. Cassou, et al., Chronic neck and shoulder pain, age and working conditions: longitudinal results from a large random sample in France, Occup. Environ. Med. 59 (8) (2002) 537 – 544. [9] S. Hignett, Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review, Occup. Environ. Med. 60 (9) (2003) e 6, http://www.occenvmed.com/cgi/content/full/ 60/9/e6. [10] G. Costa, A. Sartori, Aging, working hours and health: some preliminary statistics from the 3rd European Survey on working conditions, The 4th Confe´rence on Ageing and Work, 2002, p. 28, Krakow. [11] J.R. Anderson, Acquisition of cognitive skill, Psychosoc. Rev. 89 (4) (1982) 369 – 406. [12] T.A. Salthouse, Resource reduction interpretations of cognitive ageing, Dev. Rev. 8 (1988) 238 – 272.