La signification de la qualité de vie au travail pour des infirmiers œuvrant en CSSS, mission CLSC et déclarant avoir une qualité de vie positive au travail

Abstract

Depuis le début des années 90, le réseau de la santé au Québec est soumis à une vaste restructuration qui a eu des conséquences négatives sur la qualité de vie au travail (QVT) des infirmières et infirmiers. Les hommes se retrouvent en nombre croissant dans toutes les sphères de la pratique infirmière, mais les études existantes ne font malheureusement pas mention de la qualité de vie au travail de ceux-ci. Alors, il apparaît pertinent de s’attarder au phénomène de la qualité de vie au travail des hommes infirmiers dans la profession infirmière, et ce, plus précisément en CSSS mission CLSC. Le but de cette étude phénoménologique consiste à décrire et à comprendre la signification de la qualité de vie au travail pour des infirmiers œuvrant en CSSS mission CLSC. L’essence du phénomène, les huit thèmes et les 35 sous-thèmes qui se dégagent directement des entrevues énoncent que la signification de la qualité de vie au travail pour des infirmiers œuvrant en centre de santé et des services sociaux (CSSS), mission CLSC et déclarant avoir une qualité de vie positive au travail, signifie « un climat empreint de caring qui favorise l'épanouissement de l'infirmier en CLSC en œuvrant pour le maintien de l'harmonie entre les sphères professionnelle et familiale ». Si certains résultats corroborent ceux d’études antérieures, d’autres apportent des éléments nouveaux favorisant la santé des infirmiers par le biais de la qualité de vie au travail. Enfin, des avenues concrètes visant la mise en place de programmes d’optimisation de la qualité de vie au travail, sont proposées.

In the 1990s, health care organizations in Québec underwent sweeping reforms that disrupted the work climate and practices of nurses (Bourbonnais et al., 2000; Pérodeau et al., 2002). These reforms had a negative impact on nurses’ quality of working life (QWL), leading decision makers and researchers to investigate the QWL phenomenon from several perspectives (Delmas, 1999; 2001; Gascon, 2001; O’Brien-Pallas & Baumann, 1992). Most of the studies of this phenomenon were conducted in hospital settings and were based on paradigms of psychological distress (Bourbonnais et al., 1998, 2000) or burn-out (a pathogenic perspective) (Duquette et al., 1995) rather than a health paradigm (a salutogenic perspective) (Gascon, 2001). A salutogenic perspective represents a positive vision of an approach to health (Antonovsky, 1996; Delmas, 2001, Duquette & Delmas, 2002). The scientific literature (Brooks et al., 1996; Ekstrom, 1999; Evans, 2001) suggests that, in addition to living through the same upheavals as their female colleagues, some male nurses also have negative feelings related to sex discrimination, feelings of isolation, and the conflict between masculine values (strength, aggressiveness) and the feminine values (gentleness, flexibility) of the nursing profession. These feelings can only hamper nurses’ QWL, yet they are not mentioned in studies of male nurses (Boughn, 2001; Ekstrom, 1999; Evans, 1997, 2001). The aim of the study, using Giorgi’s (1985, 1997a) descriptive phenomenology as a method, is to describe and understand the significance of phenomena through people’s experiences. The findings were derived from semi-structured individual interviews of 60 to 90 minutes with five male nurses who reported a positive quality of life at work. Data analysis consisted of: collecting the data, reading and rereading the results, dividing the data into meaningful units, organizing and stating the raw data in the language of the discipline and, finally, synthesizing the findings and letting the essence of the phenomena emerge. Watson’s (1988, 2005) human caring philosophy served as a backdrop for the entire process. The analysis of verbatim transcripts revealed eight themes that defined the significance of the quality of working life for male nurses practising in community settings: 1) autonomy in their professional practice; 2) job satisfaction; 3) a healthy workplace setting; 4) relations with the administration characterized by support and respect; 5) caring relationships with other members of the interdisciplinary team; 6) working in partnership with female peers; 7) commitment to clients and their families; and 8) professional work-life balance. The essence of the phenomenon stems directly from the themes that emerged during the interviews; it states that for male nurses working in health and social service centres (CSSSs), as part of CLSCs, working life means “a caring climate that fosters the vitality of male CLSC nurses by trying to maintain a balance between their professional and family lives.” If some of the findings confirm what has been reported in other studies, others have added new information on how to promote the health of male nurses by targeting quality of working life. Concrete avenues are proposed for implementing quality of working life optimization programs.