Psychosocial Risks (PSR) Among Healthcare Workers: A Major Challenge for Health and Quality of Care
Healthcare professionals, the essential pillars of our healthcare system, face daily challenges of rare intensity. Yet behind their unwavering commitment lies an alarming reality: high exposure to psychosocial risks (PSR). This issue, far from being anecdotal, poses a major challenge not only to the mental health of those who care for us, but also to the quality and safety of the care provided. In France, where expectations of hospital staff are particularly high, the phenomenon is exacerbated by budgetary constraints, difficulties in finding replacements, and peak periods that strain teams. Understanding, analyzing, and preventing these risks has become an absolute necessity to ensure a healthy work environment and the sustainable performance of healthcare facilities. The extent of psychosocial risks among healthcare workers in France: The figures speak for themselves and underscore the seriousness of the mental health situation among healthcare workers. According to the SPS (Healthcare Professionals Support) association, a significant proportion of healthcare workers are experiencing psychological distress: 30% are depressed, 25% have had suicidal thoughts, and 50 to 60% show signs of burnout. These statistics, although based on a specific association, reveal an underlying trend. In France, hospital staff face high expectations, intense stress, and constant exposure to the suffering of patients and their families, which exposes them to numerous psychosocial risks. A European study (NEXT-PRESST) showed that in 2003, 27.8% of healthcare workers across Europe had a high burnout score, with this percentage rising to 46% in France. When this survey was repeated in 2008 among paramedical staff at a Parisian university hospital, the burnout score remained high (2.90). The French Institute for Public Health Surveillance (InVS) estimated that burnout affected more than 30,000 people out of the 480,000 employees suffering from work-related psychological distress. Excessive workload is a major contributing factor to this distress. In France, work overload is exacerbated by budgetary constraints and difficulties in staff replacement. The lack of human resources, coupled with increasingly frequent peak periods, creates a vicious cycle where absences due to illness further worsen the situation. This time pressure, combined with high psychological demands, is a key element of psychosocial risks. The precarious nature of the public hospital system in France is also a factor to consider. Due to significant budgetary constraints, public health institutions have undergone major organizational changes that can lead to workplace suffering and occupational stress. This job insecurity—whether related to employment, salary, or career—is a source of dissatisfaction and is associated with increased anxiety and depression.
Psychosocial risks (PSR) are a multifaceted and subjective concept that encompasses various factors associated with workplace distress, including stress, burnout, harassment, and violence, as well as work addiction. An expert panel, chaired by Gollac and Bodier, clarified this concept by identifying six main risk factors. These factors, which are relevant to all professional settings, take on a particular significance in the healthcare sector:
- Work Intensity and Working Hours: This factor encompasses the volume of work, time pressure, and the complexity of tasks. Healthcare workers often face workweeks that exceed regulatory limits, frequent on-call duties, and an imbalance between their professional and personal lives. This heavy workload, exacerbated by staff shortages and budget constraints, reduces the time available for reflection and communication among caregivers, which has significant negative effects on burnout. The nursing profession, for example, is considered one of the most stressful due to the complexity of the tasks and the need to manage emergency situations. Emotional Demands: The work of caregivers involves constant confrontation with intense emotions related to the pain, death, and distress of patients and their families. They often have to make decisions with far-reaching implications and experience a unique kind of ethical pressure. "Emotional labor"—which involves controlling and shaping one’s own emotions to better manage those of others—is a prerequisite for their role. This constant exposure to emotional demands is associated with negative feelings, job dissatisfaction, and burnout. Emotional dissonance, resulting from a conflict between felt emotions and those required by the professional role, is also an aggravating factor. Lack of autonomy: This factor refers to the healthcare professional’s “decision latitude”—that is, their room for maneuver, the use and development of their skills, and their participation in decision-making. A lack of autonomy and accountability, as well as the feeling of not being recognized for one’s work, are associated with increased job dissatisfaction and burnout levels among healthcare professionals. Social relationships at work: This dimension encompasses the quality of relationships with colleagues and superiors, perceived social support, reward (recognition), organizational justice, and exposure to violence. Healthcare workers can face strained interpersonal relationships, exacerbated by complex hierarchies within the hospital. A lack of social support is strongly associated with burnout. Furthermore, nurses and paramedics are among the professions most affected by patient aggression (verbal or physical), which increases anxiety, burnout, and post-traumatic stress. Harassment from superiors also contributes to the occurrence of burnout. Value conflicts: These conflicts arise when a healthcare worker’s personal or professional values clash with those of other members of the organization or with the organization itself. This can lead to “ethical distress,” particularly when the healthcare worker feels they lack the necessary resources to perform quality work or when their “independent role” (providing human care and performing medical procedures) is not respected. These situations increase job dissatisfaction and contribute to burnout.
- Job insecurity: This factor is based on job security, salary, and career prospects, as well as unanticipated changes in the work environment. Budgetary constraints in the hospital sector have led to a deterioration in working conditions (outdated facilities, faulty equipment) and salaries that are considered insufficient. This increased job insecurity, particularly in the French public hospital system, is an additional factor contributing to job dissatisfaction and fosters anxiety and depression.
The devastating consequences of psychosocial risks on the health of healthcare workers
Prolonged exposure to psychosocial risks has profound repercussions on the physical and mental health of healthcare workers, with burnout being the most common manifestation. Burnout is a state of physical, emotional, and mental exhaustion caused by intense and prolonged involvement in demanding situations. It is characterized by three main dimensions:
- Emotional exhaustion (EE): profound demotivation and a feeling of emotional depletion.
- Depersonalization (DP): the development of impersonal and negative attitudes toward patients or colleagues, accompanied by a loss of empathy and cynicism.
- Reduced sense of personal accomplishment (PA): a loss of confidence in one's abilities and in the idea of achieving fulfillment through one's profession.
Studies reveal a high prevalence of these factors: 29% of healthcare professionals have a high EE score, 25.9% a high PA score, and 36.9% a low PA score. In Morocco, one study even showed a total burnout prevalence of 59.7% among hospital healthcare professionals. Beyond burnout, healthcare workers exhibit numerous symptoms and conditions related to chronic stress: Psychosomatic manifestations: autonomic nervous system disorders such as palpitations (37.3%), chest pain (36.6%), dry mouth, nausea, digestive problems (31.2%), chest tightness (29.4%), sweating (27.3%), and muscle aches (41.3%). Signs of nervous tension: headaches at the end of the day (54.8%), feelings of malaise (51.4%), tremors in the extremities (16.9%). Mood disorders: anxiety (39.5%), irritability (38.5%), and depressive states (22.2%). Cognitive disorders: difficulty concentrating (32.6%) and memory problems (21.3%). Sleep disorders: difficulty falling asleep (46.1%), insomnia (39.4%), and feeling as though one has not slept (31.2%). Healthcare workers experiencing burnout also tend to engage in compensatory behaviors and self-medicate with psychoactive substances or painkillers in an attempt to maintain a high level of performance or reduce anxiety. Coffee/tea consumption (>4 cups/day) is common (72.5%), as is the use of painkillers (46.1%) and psychotropic medications (16.2%). Smoking and alcohol or cannabis use are also observed. This distress can have even more serious consequences, including suicidal thoughts and even suicide. Work-related distress among healthcare professionals is not limited to their professional sphere; it also affects their well-being outside of work. The impact of psychosocial risks on the quality of care and hospital performance
The link between the mental health of healthcare workers and the quality of care provided is undeniable and direct. Work-related distress among hospital staff has systemic consequences that affect the entire organization and, ultimately, the patients.
One of the most critical consequences of psychosocial risks is a decline in the quality of care. Studies have shown that burnout and stress are linked to errors in judgment and the occurrence of patient incidents. Healthcare workers experiencing stress or burnout are more likely to make mistakes, including medication errors. The lack of clarity regarding patient monitoring criteria and the organization of care, as well as ambiguity, contributes to these errors. The distress experienced by healthcare workers also manifests as operational failures: increased absenteeism and high staff turnover. Burnout and stress are strongly linked to healthcare workers' intention to leave the profession. Healthcare workers who left their facility initially had higher burnout scores and less favorable working conditions (effort/reward ratio, quality of teamwork).
Patient satisfaction is also affected. Patients cared for in units where staffing levels are adequate, administrative support is strong, and doctor-nurse relationships are positive report more than twice the level of satisfaction with care compared to other units. The overall level of nurse burnout clearly impacts patient satisfaction. Poor work organization and deteriorating professional relationships are key factors. Large team sizes, lack of familiarity among colleagues, staff and assignment instability, and the absence of a shared objective are recurring obstacles that can lead to errors. Communication breakdowns are cited as the most common cause of harm suffered by patients.
Aggravating Factors and At-Risk Populations: An In-Depth Analysis
While all healthcare professionals are potentially exposed to psychosocial risks, certain occupational groups or situations significantly increase the risk of developing burnout or work-related distress.
- Gender: Several studies indicate that women are more affected by burnout than their male counterparts. The European NEXT-PRESST survey reveals that women are twice as likely as men to have a high burnout score (adjusted OR = 2.27). This higher prevalence of burnout among women can be explained, in part, by cultural and traditional factors that require working women to also take care of their homes. Age and professional experience: Healthcare workers at both ends of their careers appear to be the most affected. Younger workers (30 years old or younger) and older workers (over 50 years old) have higher burnout prevalence rates (71.3% and 72.2%, respectively). Similarly, professional experience reveals a similar trend: healthcare workers with 2 to 5 years of experience (61.1%) and those with more than 15 years (63.3%) are more affected. This vulnerability among younger professionals could be due to a lack of experience and sudden exposure to poor working conditions early in their careers, while older professionals at the end of their careers may face professional disillusionment or an accumulation of fatigue and stress. The professional category: Studies highlight a disparity between professions. Nurses are statistically more affected by work-related stress, burnout, and its related issues than doctors. This can be explained by often more precarious working conditions, lower salaries, socio-economic difficulties, greater stress, and closer, more direct contact with patients. Nursing assistants are particularly vulnerable, having a high burnout score twice as often as registered nurses (adjusted OR = 2.29). Family situation and work-life balance: Family situation plays a crucial role. People living alone have a higher prevalence of burnout (69.1% compared to 56.5% for those in a couple). Living as a couple seems to stabilize anxiety and prevent burnout. Being a single parent is very strongly linked to burnout (adjusted OR = 1.48). More broadly, work-family conflict is a set of factors with very strong explanatory power regarding the occurrence of burnout, with high levels of conflict potentially tripling or even quadrupling the incidence of burnout (adjusted OR = 3.03). This imbalance is even considered more significant than working hours themselves, especially since atypical schedules increase the difficulty of balancing work and family life. Compensatory behaviors and lack of leisure activities: Healthcare workers experiencing burnout tend to resort more frequently to compensatory behaviors such as the use of psychoactive substances and/or painkillers. Conversely, the absence of regular sports or leisure activities significantly increases the incidence of burnout (adjusted OR = 1.51). Sports and leisure activities play a vital role in creating a state of balance, strengthening self-esteem, and alleviating stress.
Strategies for Preventing Psychosocial Risks in Hospitals: A Comprehensive and Integrated Approach
Preventing psychosocial risks (PSR) in hospitals is essential, not only from an ethical standpoint but also from an operational one, given their impact on the health of healthcare workers and the quality of care. While it is impossible to completely eliminate risky situations, it is crucial to identify and implement priority actions. The employer is required to combine appropriate workload management, training, and emotional and psychological support to help healthcare workers cope with the inherent difficulties of hospital work. Analytical models have shown that the effort/reward ratio (Siegrist model) and the quality of teamwork are the most relevant criteria for understanding and preventing burnout. Prevention strategies must therefore be structured around these key areas, addressing each identified risk factor: Emotional management and psychological support: Intense emotional exposure and ethical pressure require targeted actions. This includes emotional management training, the establishment of listening spaces, support groups, stress management workshops, and psychological support services. Enabling healthcare workers to talk about their suffering is crucial.
Holicare: A digital solution for identifying and addressing psychosocial risks
Given the complexity of detecting and preventing psychosocial risks, innovative solutions are emerging. Holicare is a digital tool designed to help quickly identify burnout and manage it effectively.
This solution offers:
- A rapid test to assess the mental health of healthcare professionals.
- Clinically proven results, achieved in minutes.
- Access to a personalized and ready-to-implement prevention program for psychosocial risks within the hospital.
Holicare addresses the need to consider various aspects of healthcare professionals' daily lives (workload, emotions, interpersonal relationships, and organizational factors) in order to determine which aspect to prioritize when a risk to mental health is suspected. This solution demonstrates the ability to leverage technological tools to support the well-being of healthcare personnel.
Conclusion
Psychosocial risks among healthcare workers are a major, multifaceted challenge, the extent of which in France is alarming. Burnout, stress, and violence—fueled by high work intensity, intense emotional demands, a lack of autonomy, sometimes strained social relationships, value conflicts, and job insecurity—have devastating consequences on the mental and physical health of healthcare workers. This suffering is not confined to the individual sphere; it directly impacts the quality and safety of patient care, leading to errors, absenteeism, and high staff turnover. Studies confirm that factors such as the imbalance between effort and reward and the quality of teamwork are the most powerful determinants of burnout, alongside work-life conflict. Nurses and nursing assistants, as well as women and healthcare workers at the beginning or end of their careers, appear to be particularly vulnerable. To reverse this trend, a genuine prevention policy is essential in hospitals. This requires a comprehensive and integrated approach, addressing several key areas: appropriate workload and scheduling management, training in emotional intelligence and compassionate communication, strengthening social support and teamwork, improving autonomy, role clarity, and job security, and actively supporting work-life balance. The flow of information within teams is essential to reduce uncertainty and improve recognition. Ultimately, the well-being of healthcare professionals at work must be considered an indicator of the quality and safety of care. Investing in the prevention of psychosocial risks means protecting those who protect us, while ensuring a more efficient and humane healthcare system. Tools like Holicare can contribute to this by facilitating the detection and personalized management of risks. Team solidarity, efficient work organization, and coordinated rest periods are essential for a sustainable world where care is both high-quality and respectful of human capital.
Sources
https://www.relyens.eu/fr/newsroom/blog/prevenir-rps-hopital
