5 recommendations for carers to improve the quality of their working lives

Carers consider that that they do not have enough time to do their job properly,[1] with 50% of all nurses considering this to be the case. In the hospital sector, 80% of all employees claim that they frequently have to interrupt their work to carry out an unforeseen task and always, or at least often, have to hurry in order to finish. Taking all sectors into consideration, this applies 46% of employees.[2].
Is the workload too heavy for the available resources? Or is this a profession that likes to complain? These figures are indicative of the problems affecting the quality of carers’ working lives. How can they put things into perspective and, in particular, what can be done to improve the quality of their working lives? This article takes its inspiration from Gollac’s work and proposes 5 behaviours for carers to adopt to improve their working lives in hospitals.

 

How should we measure the quality of work life?

The first step is to understand the dynamics at work in our institutions. Measuring the indicators of work life quality is a major challenge for public health. They will provide us with information about the decisive factors influencing work life quality. The institution has a number of indicators related to working conditions at its disposal (the arduousness of work, the quality of relationships with colleagues etc.) as well as indicators relating to health and absenteeism or career paths (for example, on-the-job training). The list of indicators should be specific to each situation and should correspond as much as possible to the environment of the institution. Several theoretical models are used – we will choose those of Siegrist[3] and Karasek[4].
The aim of Siegrist’s model is to foresee the psychological distress and health problems which may arise if there is an imbalance between the effort required to do the job and the recognition that is received. The nursing team puts a lot of effort into its work and expects, in return, to be compensated for its efforts (self-esteem, a feeling of self-efficacy etc.). The model stipulates that an absence of reciprocity between effort and reward is likely to produce emotional stress.
The objective of the scale developed by Karasek is to evaluate mental strain at work. The questionnaire enables us to measure tensions (stress) at work in three different areas:
  • Psychological demands;
  • Job decision latitude;
  • Social support at work.
Gollac has defined a number of risk factors:[5]
  • Working hours and intensity
  • Emotional demands
  • Autonomy
  • Social relationships
  • Value conflicts
  • Social and economic uncertainty

Don’t allow your working life to intrude on your private life

Carers often have to spread themselves too thinly. Caring for their patients and managing the administrative side of their work, while responding to urgent requests and remaining available for new admissions, are all part of nurses’ daily routines. If they do not have enough room for manoeuvre or support to confront this situation, or if this complexity is not fully recognised, their health may suffer as a result. The amount of effort put in and the recognition received are no longer in equilibrium. Up to a certain threshold, an increase in the workload can be compensated by changes in strategy or method, but only if the organisation allows it.
As a result, a carer’s self-esteem may be affected when the requirement to work quickly conflicts with the carer’s wish to provide quality care. Studies applying Karasek’s model have demonstrated the overwhelming effect of excessive demands.
The perceived intensity of work also results from a series of factors such as responsibility, and we are aware of the extent to which carers feel responsible for their work. We just have to think about the mistakes and oversights that we carers have inevitably encountered at some stage in our careers.
This feeling only becomes more acute when there is a demand for greater availability. We are required to replace a colleague on the night-shift at a moment’s notice and hand over a tidy and well-ordered department after having provided high-quality care. At the risk of our lives outside work falling apart completely, we do as we are asked because we feel responsible. The adverse effects of extra hours on our work-life balance are well documented in the specialised press (Albertsen et al., 2008). Always being available increases the number of working hours and reduces our flexibility when completing tasks outside work.
Organisational changes or the adoption of new technologies also often result in work being perceived as more intense. This highlights the importance of managing every change in an appropriate manner.
The adverse effects of extra hours on our work-life balance are well documented in the specialised press (Albertsen et al., 2008). Always being available increases the number of working hours and reduces our flexibility when completing tasks outside work.
Organisational changes or the adoption of new technologies also often result in work being perceived as more intense. This highlights the importance of managing every change in an appropriate manner.

Recognising and handling one’s emotions

Helping people is at the heart of our profession – and it is one of its most gratifying aspects. Yet in the collective imagination, nurses selflessly follow their vocation. Often without even realising it, they conform to this popular image. Nurses are in contact with all kinds of suffering and the reality of the human body – yet at the same time, they have to hide their emotions and deal with the fear of failure.
This continuous soliciting of their emotions, rendered ever more acute by the positive image that they wish to convey, represents a real risk for their occupational well-being.

This is down to you – and you alone. Take responsibility for your professional development. Never stop learning!

As a result of their continual presence at patients’ bedsides and their level of education, carers are an indispensable part of the health system. The fact that nurses have little autonomy in medical matters and are regarded as doctors’ assistants is firmly ingrained in the collective subconscious. And yet the indications are that the opposite is true – it is high time that this is realised.
Recent developments relating to advanced practices and the importance accorded to on-the-job training demonstrate this.
The feeling of control that people can have over their work is often dependent on the recognition that they are accorded – an essential aspect of the quality of work life. For this reason, make sure that you identify clearly your added value for the health system and claim it for yourself.
Educate yourself, develop your skills and use them.

Do not be greedy for recognition. Participate in hospital life.

Social relationships between colleagues and your contacts with the institution are key aspects of the quality of your work life. The key watchwords here are integration, justice and recognition.
Participating in different hospital working groups and giving one’s opinion at interdisciplinary meetings are good ways of creating a space for sharing among fellow professionals, which can result in professional recognition.
Even if the balance between effort and reward is not always achieved with patients, this is possible with one’s peers. Work hard to cultivate the relationships with your colleagues.

Define what is ethical for you and remain true to your principles.

It is not possible to talk about ethics without referring to your personal limits. Ethics can be defined as a choice where you will not compromise without giving a justification. In certain situations, carers are confronted with ethical dilemmas. The requirement of providing quality care is not always realistic given the available resources – in this case, we can talk of an impediment to quality.

At the end of the day, what are we able to influence as carers?

We certainly cannot have an influence on financial recognition or on the workload. On the other hand, we are in a position to influence the feeling of control that we have over the care we provide. This requires us to increase the number of interactions that we have with the members of our profession in order to create an environment in which we find recognition. We can have an influence on the organisation of our department and the definition of our priorities. We can work on our own self-esteem and that of our profession. We need carers with strong ethics who want to continue learning in order to provide high-quality care.

[1] Le Lan R, Baubeau D. « Les conditions de travail perçues par les professionnels des établissements de santé ». Études Résult 2004 ; (335).

[2] Loquet J, Ricroch L. « Les conditions de travail dans les établissements de santé ». Dans : Direction de la recherche des études de l’évaluation et des statistiques, éd. Le panorama des établissements de santé, édition 2014. Paris : DRESS; 2014. p. 9-30, https://drees.solidarites-sante.gouv.fr/IMG/pdf/panorama2014.pdf.

[3] Siegrist J., « Adverse health effects of high efforts/low-reward conditions ». Journal of Occupational Health Psychology 1996 ; 1:27-41.

[4] « Job Demands, Job Decision Latitude, and Mental Strain: Implications for Job Redesign ». Robert A. Karasek, Jr. Administrative Science Quarterly. Vol. 24, No. 2 (juin 1979), pp. 285-308

[5] Gollac, M., Bodier, M. (2011). Mesurer les facteurs psychosociaux de risque au travail pour les maîtriser. Rapport du Collège d’expertise sur le suivi des risques psychosociaux au travail, faisant suite à la demande du ministre du Travail, de l’Emploi et de la Santé, avril 2011, disponible en ligne : http://travail-emploi.gouv.fr/IMG/pdf/rapport_SRPST_definitif_rectifie_11_05_10.pdf.

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