Lack of staff and time, repeated administrative tasks: this reality in hospital services is well known. Who pays for it? The caregivers. Consequence: a loss of motivation, increasing fatigue, a team spirit that flap, … These disorders can lead to burn out but also cause musculoskeletal disorders (MSD).
Relationships between medical power and administrative power have also become complicated. “There is a real problem of recognition and health professionals are suffering,” she adds. The series of changes that affected hospital services is not unrelated to the emergence of staff troubles. “Since the 1980s, caregivers have been facing a deterioration of their working conditions, and the rationalization of hospital expenditure has led to a limitation of the growth of the workforce,” says Valérie Carrara, a staff psychologist at the Public Assistance-Hospitals in Paris. Paris (AP-HP). However, they have more and more administrative work, more protocols to respect, and therefore less time to go to bed.
This suffering at work can be manifested physically by the caregiver who will then develop headaches, stomach ache, pathologies leading to burn out. “Burnout is not a definite disease, but rather a process linked to a way of considering the arduousness of the work,” says Marc Loriol, a CNRS researcher specializing in fatigue and stress at work among medical professionals. the health.
There are three main symptoms to define the burn out that takes shape in a vicious circle process. First, emotional exhaustion, then the dehumanization of the relationship with the other and finally the decrease or loss of professional achievement.
To protect themselves, caregivers may dehumanize their relationship with others, sometimes leading to abuse. “Sometimes nurses are afraid to make mistakes because of their tiredness,” says Valérie Carrara. Abuse comes when there are no more words. In the past, service managers organized speech spaces so that caregivers could talk to patients. “They should be put back in place,” she says.
It is when a caregiver fails to find the right medium of commitment to a patient that burnout can occur.
Caregivers then lose interest in their commitment and professional accomplishment. It is when a caregiver fails to find the right medium of commitment to a patient that burnout can occur. “The balance is difficult to find, says Marc Loriol. He is not given once and for all. It depends on the context. Valérie Carrara, however, insists on the importance of the individual aspect of suffering at work. “It depends on each individual, its history, its working conditions,” she says.
In addition to burn-out, the deterioration of working conditions also generates musculoskeletal disorders (MSDs). “Since the 1990s, public authorities have been very interested in prevention to allow good postures, says Marc Loriol. Nevertheless, the number of MSDs is not decreasing “, probably because factors go against them, notably the lack of resources, staffing and therefore cohesion.
Part of the increase in MSDs is related to work intensification, inability to take time, repetitive actions that are more harmful. “To lift the patient, it requires a collaboration at least two, he says. Sometimes there are not enough carers or good cohesion. “
MSDs are a multifactorial disease that is both biomechanical but also related to psychosocial factors. “It is often the combination of the two that leads to the emergence of MSDs,” reports Sandrine Caroly, doctor of ergonomics and teacher-researcher at the University of Grenoble. In addition to the link with the organization of work, with the organizational transformations and intensification of work that increase the pressure of carers, there is also a link with their activity.
“We distinguish the prescribed work from real work,” she says. Teams have procedures to follow, but the task is sometimes far from the activity because they encounter variability at the organizational level.
The team of trainers of CHI Marmande Tonneins (Lot-et-Garonne) shows non-traumatic techniques of mobilization of patients. © DR
“For example, when a person is missing, the caregiver present attempts coping strategies and may, for example, sting without a glove or engaging in conversation with the patient. It is a form of slaughter of work but which allows it to hold the performance objectives. He will then feel a tension, a pressure, which can be at the origin of TMS.
Finally, MSDs can be linked to work groups. “The team does not necessarily share the same values, says Sandrine Caroly. Unlike the collective that brings together professionals sharing ways of working, which gives resources for the individual health of each. Collectively, professionals decide together how to organize work and coordinate. “There is the reality of the suffering of nurses and behind this suffering, the ability of the group to face the difficulty,” concludes Marc Loriol.
Laure Martin Source: Article in Actusoins Magazine
Marion, 27 years old, nurse for five years
“I work in a night service and resuscitation. When you leave school, you do not necessarily see the problems that affect the profession. But I notice that the burnout settles quickly. We nurses have little weight in the medical and paramedical ladder. We are always an executor, rarely making decisions. In addition, we are always facing someone who is not well, it is not easy to detach and we do not necessarily support our colleagues doctors or hierarchy. There is a big turnover in my service because we get tired quickly. I may not be in a burn out phase yet because I still work, but I feel a lot of weariness. I feel like a pawn, I receive little consideration. For some time, I have a herniated disc because of my work. I only had half a day of course on handling while the caregivers have a real module. Now I have to do physiotherapy, but as long as I continue this job, I will not heal. We work in ultra-small, so we do not take the time to do things right. In fact, the patient is not supported optimally. I do not plan to stop my job because I still love what I do. But I’m trying to change hospitals. There are many misconceptions about the craft. That’s not what we think. “
Joëlle *, former manager of a geriatric pole
“My burn out, I was not aware of it. At one point I was exhausted, I came to work with apprehension and stress that never left me. The trigger was the non-sharing of my values to my work. I felt overworked, I had more and more difficulties to perform my tasks in good conditions and in addition, the management did not suit me. I received a lot of contempt and reflections from my hierarchy. By dint of fighting for things that should have flowed naturally, I exhausted myself. Caregivers are despised complements, I can not accept it, it’s a matter of consideration. We are asked to be respectful of patients, but the hierarchy is not with us. One day, I met the occupational doctor in the hallway, she told me that she did not fit me, took me in interview and there I collapsed. A year ago, I was stopped for a year by my doctor. The first six months I was removed from the world. When we are stopped, we are complete in our confinement. I was unable to go out. I was caught in the descent into hell. I went to see a psychiatrist, who continues to follow me. He said the word burn out. Alone I could not have done better and the medication was imposed. I went back to work in September but I changed my job, I’m implementing quality improvement projects. Care and contact with patients I miss. Today, what bothers me is that I do not feel the same anymore. But maybe that’s what it takes. The investment must be measured, the distance must be taken. I am better but I am afraid that it is an artificial well-being because I am still under treatment and I want to do without it. »Anonymous testimony