Dealing with suffering at work: statistic and ergonomic comparison of doctors and nurses working in palliative care, oncology/haematology and geriatric care

Introduction
We investigated whether the multidisciplinary organization of work adopted in palliative care protects against burnout and intent to leave the profession (ITL).

Methods
Questionnaires from Representative Samples of 2674 state-registered Nurses (RSN) and 1924 Doctors (RSD) were analyzed with SPSS.12 software and compared with data for palliative care nurses (PCN), palliative care doctors (PCD), oncologists/hematologists and geriatric care doctors. Ergonomic real tasks analysis of total work days of Health care workers (HCWs), were conducted in order to understand where, when and with whom they are able to give social support for patients and obtain it for themselves.

Results
A high burnout score (CBI) was less frequent among PCN than among RSN (28.8% vs. 46.3%) and among PCD than among RSD (14.1% vs. 23.1%). For RSN, the most important factors linked to burnout were high work/family conflict (adjOR=5.21), poor teamwork (adjOR=2.26), harassment by a superior (adjOR=1.92) and fear of making mistakes (adjOR=1.86). For the RSD, the most important factors were high W/FC (adjOR=4.47) substantial quantitative demand (adjOR=3.32), poor teamwork (adjOR=2.21), fear of making mistakes (adjOR=1.87), and bad interpersonal relations (adjOR=1.71). A serious lack of quality of teamwork appears to be associated with a higher risk of ITL (adjOR=4.18 among RSN and 3.92 among RSD), as well as burnout (adjOR=3.55 for RSN and 2.21 for RSD) in multivariate analysis. All these risk factors were less frequent in palliative care. Ergonomic observations demonstrate that possibilities to share information between HCWs, to adapt holistic care to each patient and to obtain psychological support are developed only in palliative care units.

Discussion
This study highlights the importance of multidisciplinary teamwork. It demonstrates its positive effects for PCN and PCD. It is of utmost importance to reduce W/FC, working processes through collaboration, and to develop team training approaches and ward design to facilitate multidisciplinary teamwork.