Summary
Background
Healthcare workers often are unsatisfied with their working conditions despite declaring to like their jobs. Psychosocial constraints in the workplace have increased recently due to changes in work organization. These psychosocial constraints are linked to cardiovascular diseases.
Aim
To analyze the relationship between blood pressure levels and organizational occupational risk factors in female hospital workers, using a new questionnaire (the Nursing Work Index-Extended Organization [NWI-EO] questionnaire), which quantifies psychological and organizational work factors.
Methods
The ORSOSA study is a national, multicentre, cohort study conducted in seven voluntary French university hospitals, including 214 work units with a total of 2307 nurses and 1530 nursing assistants.
Results
Systolic and diastolic blood pressure appeared to be significantly associated with age ( P < 0.001) and excess weight ( P < 0.001). The difference between systolic blood pressure in day-shift and night-shift workers was 2.5 mmHg ( P < 0.001). The NWI-EO dimension most strongly correlated with systolic and diastolic blood pressure was poor team relationships ( P < 0.01 for both). For a one-point difference in the NWI-EO stress score, systolic blood pressure was higher by a mean of 0.2 mmHg.
Conclusion
These results suggest that poor relationships within teams are related to high blood pressure among hospital workers. They add to the evidence that working conditions should be considered and investigated further among other risk factors as a pathway to primary prevention of hypertension and cardiovascular diseases.
Résumé
Introduction
Les objectifs de cette étude étaient d’analyser la relation entre pression artérielle (PA) et facteurs de risque lies à l’organisation du travail chez des personnels soignants hospitaliers, en utilisant un questionnaire validé, le NWI-EO, qui décrit les conditions de travail en milieu hospitalier.
Méthodes
L’étude ORSOSA est une étude de cohorte multicentrique nationale conduite dans sept CHU français volontaires, incluant 214 unités fonctionnelles avec un total de 2307 infirmières et 1530 aides-soignantes.
Résultats
Le niveau des PA systolique et diastolique apparaissait significativement associés à l’âge ( p < 0,001), au surpoids ( p < 0,001). L’écart entre le niveau des PA systoliques chez les agents travaillant de jour et ceux travaillant de nuit était de 2,5 mmHg ( p < 0,001). Les mauvaises relations dans l’équipe étaient la dimension du NWI-OH pour laquelle les relations étaient les plus significativement associées à la PA systolique et diastolique ( p < 0,01 pour les deux). Pour une différence d’un point du score de contraintes NWI-OH, la PA systolique était supérieure de 0,2 mmHg en moyenne.
Conclusion
Ces résultats suggèrent que de mauvaises relations dans l’équipe de soin sont liées à des niveaux plus élevés de PA parmi les personnels hospitaliers soignants. Ils confirment que les conditions de travail devraient être considérées et mieux connues parmi les mécanismes qui conduisent à l’hypertension artérielle et être prises en compte dans sa prévention primaire.
Background
Healthcare workers have been shown to be unsatisfied with their working conditions, and many intend to leave their profession despite liking their jobs. While the psychological dimension ineluctably associated with facing the suffering and death of patients has long been measured and must be taken into account, other psychosocial and organizational dimensions must not be neglected. Psychosocial constraints in the workplace have increased during the past two decades due to changes in work organization (hospital restructuring) . These psychosocial constraints are linked to cardiovascular diseases . The INTERHEART study confirmed that unfavorable psychosocial factors (including strain at work) were more prevalent in women than in men in all of the countries included in the study; these factors are associated with a high risk of first myocardial infarction (odds ratio 2.5). A study published by our team showed the association between the incidence of hypertension and the measurement of these kinds of strain at work, particularly among women . It is particularly interesting to study working conditions and cardiovascular health among women, as social inequalities in cardiovascular mortality have recently been shown to be higher among women than among men . The aims of our work were to analyze the relationship between blood pressure (BP) levels and organizational occupational risk factors in female hospital workers, using a new extended version of the Nursing Work Index-Revised questionnaire, the Nursing Work Index-Extended Organization (NWI-EO) questionnaire, which quantifies more psychological and organizational work factors .
Methods
Population
The ORSOSA study has been described in detail elsewhere . Briefly, it is a national, multicentre study conducted in seven voluntary French university hospitals that are part of the CNARCL-CHU network, which develops methods of risk evaluation (Grenoble, Lille, Limoges, Nancy, Toulouse and Strasbourg). Two types of data were collected, evaluating the level of psychosocial and organizational stress as well as the health of staff, at an interval of 2 years (2006 and 2008). In these university hospitals, work units that had at least 20 staff (nurses and nursing assistants) and were not scheduled for closure within 2 years were eligible for the study. These work units were selected at random after stratification for specialty area (medicine, emergency/intensive care, surgery). Ten work units were selected in each specialty area of each university hospital to obtain a total of 210 work units. All nurses and nursing assistants in the selected work units were invited to take part in the survey. Finally, 214 work units took part in the study and 4308 nurses and nursing assistants completed the anonymous questionnaires (inclusion rate 91.4%).
This study is based on the cross-sectional data collected in 2006. In view of the small proportion of men in the hospital environment (10% of the nurses and nursing assistants questioned were men), only the responses of the female nurses and nursing assistants were analyzed.
Data concerning the hospital workers (nurses, nursing assistants) were collected by self-administered questionnaires. Individual information on weight, height and health behaviors was recorded. Characteristics of the work environment as perceived by the workers were assessed with the NWI-EO questionnaire . This French questionnaire measures psychosocial and organizational stress in a healthcare setting, and assesses eight dimensions of stress in the working environment: lack of support from the nurse manager; inadequate staffing; poor communication within the team; frequent interruptions during work; poor team relationships; lack of shared work values; lack of support from the administration; and changes in planned vacations and time off.
The level of stress in each domain was measured by a score ranging from 0 (low stress) to 15 (high stress). One version of the questionnaire was given to the nurses and a slightly modified version was given to the nursing assistants .
The work characteristics of the participants were also recorded: specialty area; type of employment (full or part-time); and work schedule (fixed night shifts, fixed day shifts, rotating shifts).
Body mass index was calculated from the weight and height declared by the workers; excess weight was defined as a body mass index ≥ 25 kg/m 2 . The health behaviors analyzed were sedentary lifestyle (defined as < 1 hour of sporting activity/week), smoking status and alcohol consumption.
Arm BP was measured at work after 5, 6 and 7 minutes of seated rest, using a validated automated device (OMRON M7; OMRON Corp., Kyoto, Japan) . The three readings were averaged to determine BP.
Statistical analysis
Qualitative variables were compared with the chi-square test and quantitative variables with Student’s t test. Pearson’s correlation coefficient and linear regression were used to determine whether organizational stress was associated with BP. A multivariable model was used to adjust for individual variables associated with BP at the 5% threshold in bivariate analysis. Because of the hierarchical nature of the data collected, as the healthcare workers were grouped within work units and within hospitals, mixed regression models were used in the bivariate and multivariable analyses in order to take multistage sampling into account. In this way, the models obtained were adjusted for the hospital and for the work unit, and estimation of standard deviations was corrected by data correlation within groups . The significance of the associations between variables was measured by the P value of the Wald test. Stata v.11 software (StataCorp LP, College Station, TX, USA) was used for all statistical analysis.
Results
The total sample consisted of 3837 hospital workers (2307 nurses and 1530 nursing assistants) ( Table 1 ). Mean age was 35.8 years (standard deviation 9.2) for nurses and 40.7 years (standard deviation 9.4) for nursing assistants. High systolic and diastolic BP, excess weight, smoking and sedentary lifestyle occurred significantly more frequently in nursing assistants than in nurses. The proportions of women working in emergency and intensive care departments and of women working part-time or on fixed day shifts were higher among nurses. Nursing assistants had higher psychosocial and organizational stress scores in six of the eight domains dealt with by the NWI-EO questionnaire ( Table 1 ).
| Characteristics | Nurses ( n = 2307) | Nursing assistants ( n = 1530) | P (χ 2 ) |
|---|---|---|---|
| Health behaviors | |||
| Body mass index (kg/m 2 ) | < 0.001 | ||
| < 25 | 1856 (81.2) | 1073 (70.8) | |
| ≥ 25 | 430 (18.8) | 442 (29.2) | |
| Smoking status | < 0.001 | ||
| Non-smoker | 1712 (74.5) | 1014 (66.5) | |
| Smoker | 585 (25.5) | 510 (33.5) | |
| Alcohol consumption | 0.64 | ||
| 0–1 glass/day | 2268 (98.3) | 1501 (98.1) | |
| ≥ 2 glasses/day | 39 (1.7) | 29 (1.9) | |
| Sporting activities | < 0.001 | ||
| < 1 hour/week | 916 (39.7) | 839 (54.8) | |
| ≥ 1 hour/week | 1391 (60.3) | 691 (45.2) | |
| Work characteristics | |||
| Specialty area | < 0.001 | ||
| Medicine | 711 (30.8) | 590 (38.6) | |
| Emergency/intensive care | 928 (40.2) | 444 (29.0) | |
| Surgery | 668 (29.0) | 496 (32.4) | |
| Type of employment | 0.005 | ||
| Part-time | 585 (25.4) | 327 (21.4) | |
| Full-time | 1716 (74.6) | 1199 (78.6) | |
| Work schedule | < 0.001 | ||
| Fixed day shifts | 885 (38.4) | 980 (64.2) | |
| Rotating shifts | 1327 (57.7) | 481 (31.5) | |
| Fixed night shifts | 90 (3.9) | 65 (4.3) | |
| Age (years) | 35.8 ± 9.2 | 40.7 ± 9.4 | < 0.001 a |
| Blood pressure (mmHg) | |||
| Systolic | 110.9 ± 12.1 | 112.2 ± 13.3 | 0.003 a |
| Diastolic | 74.3 ± 8.9 | 75.2 ± 9.6 | 0.006 a |
| NWI-EO domains | |||
| Lack of support from nurse manager | 6.8 ± 3.4 | 6.5 ± 3.2 | 0.004 b |
| Inadequate staffing | 8.6 ± 3.8 | 9.5 ± 3.8 | < 0.001 a |
| Poor team communication | 7.6 ± 2.3 | 6.6 ± 2.3 | < 0.001 a |
| Interruptions | 11.2 ± 2.9 | 10.2 ± 3.0 | < 0.001 a |
| Poor team relationships | 5.8 ± 2.3 | 5.0 ± 2.6 | < 0.001 a |
| Lack of shared work values | 6.8 ± 2.9 | 6.6 ± 3.2 | 0.20 b |
| Lack of support from the administration | 11.7 ± 3.1 | 11.1 ± 3.4 | < 0.001 b |
| Changes in time off | 7.5 ± 3.4 | 7.4 ± 3.3 | 0.37 a |
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