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Objective: This study aimed to test longitudinal associations linking the work-unit-level psychosocial and organizational work environment and biomechanical constraints to workers' shoulder pain in the French multi-centre cohort ORSOSA study of registered nurses (RN) and nursing assistants (NA). Methods: We analyzed 1896 female RN and NA, who were free of shoulder pain in 2006 and in the same position and work unit in 2008. Incident shoulder pain (SP) was defined as self-reported pain that persists for =4 days and/or increases during a lateral movement of the arm away from the midline of the body (abduction). Both crosssectional and longitudinal models were built to test if work-unit-level features or their influences on both work tasks and individual perception of the work environment directly influence the risk of developing incident SP. Results: RN in work units with understaffing issues or poor relationships reported higher levels of biomechanical constraints in movements and postures and a lower level of perceived job security and stability. NA who experienced such issues reported higher levels of biomechanical constraints in indirect patient-handling activities only. The exposure to these latter factors was associated with higher two-year incident SP among workers. Conclusion: This study shows that the work-unit-level organizational characteristics may impact workers' musculoskeletal disorders by conditioning both work-task-related biomechanical exposures and individual perception of the working environment. In healthcare settings, primary prevention programs to reduce MSD would benefit from a focus on work unit level exposures. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Our questioning focuses on the role played by the gendered division of labour and by the collective organisation of work in strategies deployed by workers in order to reconcile professional and private lives. How does work organisation facilitate schedule management so as to fit in with workers' domestic lives by offering the possibility of work activity accommodations? Method: A comparison of two stress management studies allowed us to examine the strategies used to manage professional and private schedules. One study focused on nurses in a female environment and one study looked at police officers or a male environment recently incorporating women into the work group. Results: In the hospital sector, management resorts to curtailing leave in order to overcome staff shortages and ensure the quality of health care; however, the female environment facilitates collective regulation to adapt work schedules. These management imposed organisational constraints are especially difficult for female staff due to their roles in the domestic sphere. It is more difficult for women to adapt work schedules in the predominantly male police officer environment. Police ask supervisors for timetable changes more frequently following the introduction of women to the group. Conclusion: The strategies to reconcile professional and private lives depend on division of labour and collective regulation. [ABSTRACT FROM AUTHOR]

Objective: Like most Western countries, France is faced with rapid changes in how social welfare and care regimes are being organized. Home care for the elderly has been closely affected by such trends. This study will analyse the consequences of such developments on work schedules and working conditions of female home care workers. Methods: We carried out 55 biographical interviews with experienced female home care workers employed by six associations as well as 13 interviews with representatives of those associations. Results: The findings reveal an increase in time pressure linked to a reduction in care time per care recipient as well as the fragmentation of care work. These conditions negatively affect the provision of quality care as well as care workers' physical and mental well-being and blur the distinction between workers' professional and home lives. Conclusions: The negative impacts observed call for a change in perspective in relation to how home care work for fragile, elderly people is organized. Our research bears out the necessity of drawing on the experience of the most highly-qualified care workers and entrusting them with the autonomy needed to manage the care time allotted to each care recipient. [ABSTRACT FROM AUTHOR]

Objective: This paper presents research on the early retirement of kindergarten teachers in France. We sought to understand the reasons for this in a context which the government is putting in place measures to lengthen people's working lives. Methods: In order to examine the difficulties teachers experience at the end of their working lives, we conducted interviews focusing on job constraints, health problems, and the impact work has on the private sphere, with reference to the task system model put forward by Curie (2002). Participants: Eight females in their fifties were interviewed. Results: Despite their experience acquired over the years, the more teachers age, the greater the human cost of their job. Health problems increase, work-related fatigue worsens and they need more time to recover. The teachers are also more affected by work-related constraints. From this perspective, the menopause seems to aggravate work-related fatigue. The teachers' feeling of personal effectiveness declines with age, causing them to worry about the last few years of their working lives. This forces teachers to make more and more adjustments to both their jobs and their private lives and sometimes makes them cut their working hours and in extreme cases take early retirement. Conclusions: The close links between the role of a female teacher and a mother contribute to premature exhaustion phenomena. Several areas for change are proposed. [ABSTRACT FROM AUTHOR]

Objective: This article is based on an exploratory study in occupational psychology. Participants: The participants were French female bus drivers in 1996. Methods: The qualitative approach of the study, based on interviews with and observation of some 40 drivers, stressed their difficulties in managing two occupations, professional and familial. In fact, the job involves work in shifts that change every week for every driver. Results: The management of family duties, still planned by the majority of the women, requires of them extremely complex strategies of reconciliation. The real dynamics of such reconciliatory work is not ever taken into account in studies undertaken in occupational psychology or in ergonomics. Conclusions: This article is therefore intended to stimulate researchers concerned in particular with women's work to think about a methodological approach pertinent to analyzing the activity of reconciliation. This activity does not consist a simple proximity between professional and familial tasks but demands, rather, a mental and material linking of the two occupations that remains for now only implicit in women's work. Our task is to render it explicit in order to identify it. [ABSTRACT FROM AUTHOR]

Abstract: Few studies have analysed the association between the organisational work environment and depression in hospital workers and we still have little understanding of how processes in the practice environment are related to depressive disorders. However, individual perception of an imbalance between efforts made and expected rewards has been associated with incident depression. The main goal of this study was to test the hypothesis that some organisational constraints at the work-unit level may be related to depressive symptoms in hospital workers, either directly or through individual perceptions of effort–reward imbalance (ERI). In 2006, 3316 female registered nurses and nursing aids working in 190 work units in seven French university hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded in 2006 to valid self-report questionnaires (CES-D, ERI). The organisational work environment was assessed with the self-rated Nursing Work Index – Extended Organisation (NWI-EO) aggregated at the work unit level. Multilevel models were used. We found that poor relations between workers within work units were associated with higher CES-D score, independently of perceived ERI. Low level of communication between workers in the unit was associated with individual perceptions of ERI and indirectly associated with depressive symptoms. Understaffing and non-respect of planned days off and vacations were associated with perceived ERI but these organisational constraints were not associated with depressive symptoms. Our study allowed us to identify and quantify organisational factors that have a direct effect on hospital workers’ depressive symptoms, or an indirect effect through perceived ERI. Better understanding of the effect of organisational factors on health through perceived ERI would provide targets for successful interventions. Organisational approaches may be more effective in improving mental health at work and may also have a longer-lasting impact than individual approaches. [Copyright &y& Elsevier]

The aim of this study was to identify forms of work organization in a French region and to study associations with the occurrence of symptomatic and clinically diagnosed shoulder disorders in workers. Workers were randomly included in this cross-sectional study from 2002 to 2005. Sixteen organizational variables were assessed by a self-administered questionnaire: i.e. shift work, job rotation, repetitiveness of tasks, paced work/automatic rate, work pace dependent on quantified targets, permanent controls or surveillance, colleagues' work and customer demand, and eight variables measuring decision latitude. Five forms of work organization were identified using hierarchical cluster analysis (HCA) of variables and HCA of workers: low decision latitude with pace constraints, medium decision latitude with pace constraints, low decision latitude with low pace constraints, high decision latitude with pace constraints and high decision latitude with low pace constraints. There were significant associations between forms of work organization and symptomatic and clinically-diagnosed shoulder disorders. [ABSTRACT FROM AUTHOR]

Objectives: This longitudinal study aimed to test the hypothesis that organizational work factors (OWFs) may be related to depressive symptoms through an increased effort-reward imbalance (ERI) ratio among registered nurses (RNs) and nursing assistants working in hospitals. Methods: We studied 2117 female RNs and nursing assistants who stayed in the same work unit and position during the follow-up from the ORSOSA (ORganisation des SOins-SAnté) longitudinal study. The work characteristics and workers' health were assessed in 2006 and 2008. Results: We confirmed our hypothesis of both direct and mediated effects of OWFs on workers' health. We showed that issues about patient-related information exchanges increased RNs' depressive disorders by increasing first a perceived ERI. Conclusions: Our results advocate integrating both the work organizational level and the individual level into preventive actions to improve workers' mental health. [ABSTRACT FROM AUTHOR]

Abstract: Background: Quality of care, job satisfaction and the health of registered nurses (RNs) are associated with their exposure to psychosocial and organisational work factors (POWFs). Objectives: To develop and validate an extended version of the Revised Nursing Work Index (NWI-R), the NWI-EO (Extended Organisation) tool specifically designed for occupational physicians and those involved in prevention programmes in healthcare institutions to assess the perception of POWFs, and then to determine priorities for preventive action to improve work organisation at the hospital staff level. Methods: The tool was validated in the ORSOSA study, a multicentre French cohort of RNs and NAs (n =4085) recruited in 214 work units of 7 French university hospitals. A total of 34 items (19 candidate items developed by a focus group and 15 items from the NWI-R) were analysed using principal component analysis (PCA) based on a randomised split-half of the data. In addition, construct validity, test–retest reliability, internal consistency and concurrent validity were assessed. Results: Response rate was 91%. Twenty-two items were selected (9 of the 15 NWI-R items and 13 of the 19 candidate items) by PCA, resulting in an 8-factor solution that explained 53% of the common variance. The stability of the factorial structure of this 22-item NWI-EO questionnaire was confirmed by PCA on the other half-sample as well as by PCA on subgroups (age, gender, occupational group, specialty area, hospital). Reliability, assessed by internal consistency and test–retest, was satisfactory. Concurrent validity with two external measurements of organisational characteristics of work units was also observed. Conclusion: The NWI-EO was found to have good psychometric properties. Several POWFs accessible to prevention programmes can be evaluated with this tool: poor communication in the work unit, lack of support from senior nurses, inadequate staffing to perform duties, poor relationships between workers, frequency of interruptions during tasks, low level of shared values within the team with regard to work, lack of support from the administration, and changes in planned vacations and time off. We believe the NWI-EO is a useful tool for assessing POWFs among RNs and NAs in order to determine priorities for preventive action to improve work organisation at the unit level. [Copyright &y& Elsevier]

The health of hospital workers, nurses and nurse-aids constitutes a public health challenge for three reasons: maintenance of personnel at work in a context in which many express their desire to quit their jobs, protection of their health, and maintenance of quality of care. ORSOSA (ORganisation des SOins et SAnté des soignants) is a multidisciplinary interventional population health research programme designed to improve quality of life in the workplace of healthcare workers. This programme is designed to develop a tool to diagnose psychosocial and organisational work factors (POWFs) and mechanical constraints (MC), and then to implement this method in primary prevention interventions. ORSOSA consists of two steps: research (ORSOSA 1) and intervention (ORSOSA 2). In ORSOSA 1, a prospective cohort of healthcare workers was developed to construct and validate the diagnostic tool of work-related constraints at the work unit level. ORSOSA 2 consists of using the tool to implement both a collective and consensual dynamic based on collective restitution of the strengths and weaknesses of the work unit in order to propose recommendations for better quality of life at work. ORSOSA is now deployed in 4 teaching hospitals (Lille, Bordeaux, Grenoble and Strasbourg), each with 5 peripheral hospitals. Evaluation and follow-up of the programme is ongoing.

Through a national cohort of more than 4000 nurses and nursing assistants in 14 university hospital centres, a study has developed a tool to assess the health of nursing staff within nursing units. This tool enables the general health condition of caregivers, as well as their working conditions, to be gauged. On this basis, preventative measures in terms of work organisation can be drawn up.