A new report from the Institute for Research and Documentation in Health Economics (Irdes) analyzes how the transition of nurses from hospital employment to private practice contributes to reducing their exposure to psychosocial risk factors and improving their health. It is based on two complementary components: the study of risks for all hospital health professionals and the analysis of the evolution of the state of health after installation in the private sector specifically for nurses.
Beyond salary, the challenge of working conditions appears to be a key issue in promoting the health of caregivers and their loyalty, particularly in hospitals. IRDES report no. 602, published this April, is in fact part of a context of global shortage of health professionals. In ten years, France has observed a much more marked increase in the number of nurses in the liberal sector (+28.5%) than in hospital employees (+6.9%). This dynamic reflects major difficulties in attracting hospitals, fueled by a continued deterioration in working conditions. The Irdes study thus analyzes how the transition to independent practice reduces exposure to psychosocial risks (RPS) and improves the health of professionals.
Generalized anxiety disorders and major depressive episodes
The first part of the report highlights the weight of psychosocial risks in a hospital environment for all caregivers: high work intensity, lack of autonomy and insufficient recognition. These factors have a direct and deleterious impact on mental health, notably promoting generalized anxiety disorders and major depressive episodes, particularly among nurses and midwives. « THE constraints to which hospital professionals are exposed are multiple: intensity work, lack of professional autonomy, emotional overload, recognition insufficient, quality prevented, weak hierarchical support and conflicts of values. These dimensions refer to what the literature refers to as psychosocial risk factors, that is to say all the characteristics of the organization of work and professional activity likely to affect the physical and mental health of workers when imbalance persists between professional demands and professional resources available to deal with it“, specifies the report. If social support and recognition play a protective role, autonomy in the hospital often remains too restricted by protocols to effectively compensate for the workload. This deterioration of working conditions “ is also the result of organizational transformations in the hospital sector, in a context of pricing to activity (T2A), which imposes increased pressure on caregivers“, underlines the IRDES report. “ This logic of profitability, aimed at improving productivity while reducing costs, generated a feeling of hindered quality and reinforced conflicts of values, particularly due to a lack of human and material resources to carry out the work correctly. The authors describe thus: a massive psychological impact” on caregivers: “increase in post-traumatic stress, anxiety, addictive behaviors and depression« .
Better health in private practice
The second part of the study invalidates the received idea of a selection effect which would suggest that only nurses in good health choose the liberal one. On the contrary, the data show that those who leave the hospital initially have a worse state of health and a higher consumption of hospital care than those who remain employed. After settling into private practice, however, we observed an improvement in their health, illustrated by a significant drop in the use of emergency care and hospitalizations. « The hypothesis retained is that the differences in organization of the work between these two modes of exercise result in distinct levels of exposure psychosocial constraints“, say the authors.
To conclude, they assert that the liberal exercise offers a “sufficient autonomy” which acts as a beneficial lever for health, despite a workload that remains significant. « After the installation in private practice, we observe a reduction in the use of hospital care, suggesting an improvement in health“, note the authors. “ On the population of nurses, and more specifically general care nurses, the results corroborate the relative improvement in the state of health after the transition to liberal exercise. Otherwise said, for those nurses initially exposed to high levels of psychological demand, low control over activity and an effort-reward imbalance, the exit from hospital setting is associated with better health. This development is consistent with the hypothesis according to which liberal exercise, by offering greater organizational autonomy and decision-making, could mitigate the deleterious effects of hospital constraints on health« .
The report recommends that public policies should no longer be limited to salary increases, considered insufficient for retaining health professionals in the long term. Sustainable improvement of the system requires a profound transformation of hospital work environments, involving increased room for maneuver, organizational support and effective recognition of the profession.
To find out more:
• Between hospital and private practice: professional trajectories and health in the face of psychosocial risk factors for nurses, Augé E., Mousquès J., Gousset C. (Irdes). Report No. 602 – April 2026 – 96 pages.
