A recent survey of 1,000 workers from various healthcare professions in Lower Austria found that, in the rapidly expanding healthcare sector, high levels of satisfaction with the work itself is found alongside high work pressures and poor working conditions. The study differentiates between four major factors – work organisation, psychological stress, physical health risks and client contact. Its authors consider it to be highly representative of the sector.
The demographic development of European society means healthcare is a rapidly expanding sector and field of employment, with a growing demand for qualified workers. Attractive working conditions in the sector are crucial to meeting this huge future challenge.
A recent quantitative survey of 1,000 respondents investigated these issues in the Austrian federal state of Lower Austria. The study focused on healthcare professions including nurses, healthcare assistants, home helps, midwives, masseurs, paramedics, psychologists and pharmacists. Based on data from member companies provided by the Lower Austrian Chamber of Labour (NÖ Arbeiterkammer, AKNO), the authors selected a random sample of 1,000 of the 1,800 healthcare professionals who responded to the postal questionnaire; the response rate was 4.5%. Despite some differences compared with the general population, the authors regard the study as highly representative.
First, the survey shows high levels of satisfaction among healthcare workers with their occupation and work, with 23% claiming to be very satisfied and 62% satisfied with their jobs (Figure 1). Overall, this means that 85% of all respondents expressed general satisfaction with their work, with only 13% less satisfied and 2% unsatisfied.
The authors of the survey report (in German, 1.15MB, PDF) explain this high job satisfaction rate as follows: on the one hand, healthcare workers seem to base their occupational choice on highly intrinsic and altruistic motives (30% reported interest in the field of work and helping others as their main motivation); on the other hand, support from private networks (family 23%, friends 19%) and colleagues (23%) plays an important role.
Figure 1: Job satisfaction in healthcare professions (%)
Source: Brunner et al, 2010
This high level of job satisfaction among healthcare professionals is all the more interesting in view of the enormous work pressures and poor working conditions reported by the respondents. The study differentiates between four major factors:
Working time is the main stress factor in the way healthcare work is organised. According to the survey, working overtime is an everyday aspect of healthcare work. The study tries to quantify these findings by comparing contractual working time in healthcare with the actual working hours reported by respondents.
While 56% of healthcare professionals are on part-time contracts of less than 35 hours a week, only 51% of respondents report actual working hours of no more than 35 hours (Figure 2). The disparity is even more pronounced among workers on contracts of 35–40 hours; 42% of healthcare employees work under such contracts but only 24% of respondents manage to stick to a 35–40 hour working week. In the category of 40 hours and more, the distribution of contractual and actual working hours is the other way around; only 1% of healthcare employees work under such contracts, and 20% of these respondents work more than 40 hours a week.
The study concludes that these high levels of overtime work cause problems in coordinating and planning family life, social life and leisure time activities.
Figure 2: Differences between contractual and actual working time
Source: Brunner et al, 2010
Another major issue related to working conditions in the healthcare professions is psychological stress, in particular the danger of burnout. The study bases its definition of burnout on the Maslach Burnout Inventory (MBI), which constructs the syndrome as a process of erosion of one’s work ability consisting of three phases:
These three phases are consecutive steps in a process ending in burnout.
The survey found a small proportion of interviewed healthcare workers affected by the advanced phases of burnout, depersonalisation (2%) and reduced personal accomplishment (2%). Nevertheless, a fifth of respondents are subject to emotional exhaustion and thus to the risk of burnout.
The authors argue that the resources available to healthcare professionals at work, such as a team, competences and supervision, and outside work, such as family and social networks, have a stabilising effect in balancing out high work pressures and stress levels. However, they also assume that many healthcare workers who have experienced the more advanced stages of burnout are likely to have already changed jobs and left the sector.
Among possible physical health risks, ‘standing, walking’ (19%), ‘moving, lifting people’ (19%) and ‘tiring, painful positions’ (16%) are the most frequently mentioned risk factors. An interesting result in this respect is the fact that younger employees report being affected by ‘moving, lifting people’ more frequently than older ones. The authors believe that older workers may often be able to delegate such physically exhausting tasks to younger colleagues.
Demands made by patients and their families are named as a fourth source of stress and pressure at work even though they are also mentioned as a source of job satisfaction. A quarter (25%) of respondents claimed that demands made by ‘family members’ and ‘annoying patients’ (24%) cause them stress and pressure at work.
The study shows that, overall, high job satisfaction based on high intrinsic motivation can cover up for poor working conditions and high levels of pressures and stress at work. As the alarmingly high staff turnover rates in the healthcare sector indicate, these are not conducive to the sustainable working environment required for this sector.
Brunner, A., Bürg, T.M., Bobens, C., Schmid, T., Troy, C.D. and Wagner, A., Arbeitsbedingungen und Arbeitsbelastungen in den Gesundheitsberufen Neiderösterreich (1.15Mb PDF) [Working conditions and work pressures in healthcare professions in Lower Austria], Vienna, Sozialökonomische Forschungsstelle, 2010.
Manfred Krenn, FORBA