title: Demographic and occupational predictors of stress and fatigue in French intensive-care registered nurses and nurses' aides: a cross-sectional study.
abstract: BACKGROUND
  Healthcare workers (HCWs) working in intensive-care units (ICUs) are exposed to high physical and mental demands potentially affecting their health or having repercussions on patient care. Although several studies have explored the links between some aspects of working conditions in hospitals and HCW health, the complex dynamics at play are not fully understood.
  
  
  OBJECTIVE
  This study aimed to explore the impact of a wide array of demographic, employment and organizational factors related to fatigue and stress of French ICU HCWs.
  
  
  METHODS
  A cross-sectional study was conducted in ICUs of Paris-area hospitals between January 18, 2013 and April 2, 2013. All types of adult ICUs were included (medical, surgical and polyvalent).
  
  
  METHODS
  Included in the study were HCWs with patient contact (doctors, residents, registered nurses, nurse's aides and physical therapists). Participation was proposed to all eligible HCWs present during on-site visits. Temporary staff not typically assigned to the given ICU was excluded.
  
  
  METHODS
  Data were collected using an individual questionnaire administered in interviews during day and night shifts (N=682). Stress and fatigue outcomes included the 10-item Perceived Stress Scale (PSS10), the Nottingham Health Profile sleep and energy level rubrics and the current fatigue state at the interview. Multivariate analysis was restricted to nurse and nurse's aide data (n=536).
  
  
  RESULTS
  Doctors and residents reported fewer sleep difficulties but were more likely to report a tired current state. Female gender was associated with higher stress levels and greater fatigue for all outcomes, while greater social support of supervisor or colleagues decreased stress and fatigue. At the organizational level, longer shifts (12 h vs. 8 h) were associated with tired current state and greater sleep difficulties. Personnel on rotating shifts had lower stress and a better current state, while those on night shifts had greater sleep and energy level difficulties.
  
  
  CONCLUSIONS
  Even when controlling for demographic factors, employment and organizational elements remained significantly associated with stress and fatigue outcomes. To improve HCW health it is important to consider simultaneously factors at the individual and organizational level.
authors.affiliation: Laboratoire Modélisation et Surveillance des Risques pour la Sécurité Sanitaire, Conservatoire national des arts et métiers, Paris, France. Electronic address: gabrielle.jones@ars.sante.fr.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Jones
authors.affiliation: Laboratoire Modélisation et Surveillance des Risques pour la Sécurité Sanitaire, Conservatoire national des arts et métiers, Paris, France.
authors.forename: Mounia
authors.initials: M
authors.lastname: Hocine
authors.affiliation: Laboratoire Modélisation et Surveillance des Risques pour la Sécurité Sanitaire, Conservatoire national des arts et métiers, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Salomon
authors.affiliation: Laboratoire Modélisation et Surveillance des Risques pour la Sécurité Sanitaire, Conservatoire national des arts et métiers, Paris, France.
authors.forename: William
authors.initials: W
authors.lastname: Dab
authors.affiliation: Laboratoire Modélisation et Surveillance des Risques pour la Sécurité Sanitaire, Conservatoire national des arts et métiers, Paris, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Temime
mesh_terms: D003430:Cross-Sectional Studies; D005221:Fatigue; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D015999:Multivariate Analysis; D009728:Nursing Assistants / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D013315:Stress, Psychological; D000078329:Workforce
keywords: Fatigue; Intensive care units; Nursing; Occupational health; Shift work; Stress; Workplace organization