At 43, Marcos (not his real name at the request of the interviewee) is unable to practice the profession for which he was trained and in which he has practiced for two decades, that of nurse. A recent judgment, now final, determined that the pathologies from which he suffers and for which he was referred to a mental health unit are “intimately linked to the work environment.” In the last ten years, he has accumulated more than a dozen victims, most of them long-term. In the opinion of the expert who judged that Marcos suffered from the so-called burnout syndrome or professional exhaustion (burnout), his condition “will tend to worsen” if he remains in his usual job, “it being necessary to leave it to see any possible improvement”.
The nurse started working at the El Sabinal Social and Health Centre, on the island of Gran Canaria, in 2003. He has fond memories of the early years. “It was practically my first job, I had just graduated and the work environment was great. I have always been very involved, I consider myself a good professional. Marcos places the turning point in a change in the management area, in the supervision of the centre. From that moment on, he began to perceive “an increasingly impersonal treatment”, an environment of “tension at work” that ended up having an impact on the assistance to users. He noticed “greater aggressiveness” in the treatment of geriatric patients. He also felt that the organisation did not take its staff into account, that it did not give them “room for decision-making”.
The pandemic was the trigger. “The work itself is quite hard and has a very strong emotional charge, because you have to deal with pain, illness and death. And the pandemic was a brutal stressor. I saw patients die alone because they couldn’t have family visits,” he says. At that time, the differences and conflicts with his superiors were increasing and the opening of a file was the straw that broke the camel’s back. “I took leave. I didn’t want to go back to being a nurse. “I was reluctant to work in a health care environment.” Marcos then got in touch with Fany Barreto, who currently works as a lawyer but was previously a midwife and obtained a pioneering judgment recognizing her inability to do the job due to burnout.
“From there, I went to a psychologist, then a psychiatrist, they did some tests and detected several problems. That’s when we started thinking about the possibility of applying for disability due to a mental disorder,” he explains. The National Social Security Institute (INSS) denied it, but on June 3, the Social Court 5 of the capital of Gran Canaria issued a judgment (now final) recognising her total and permanent incapacity to practice her usual profession as a nurse.
This judge signed another resolution on the same day also granting total disability to a burned worker. Ana (56 years old) had worked as an agent at the Gran Canaria airport for more than 35 years and for a decade she had accumulated several work stoppages due to “anxiety or acute reaction to stress”. “I had to deal with several fronts and there were few means,” he recently told this editorial staff. Marcos and Ana were represented in these processes by Fany Barreto.
Occupational disease
Since January 2022, the World Health Organization (WHO) has included burnout syndrome in its classification of occupational diseases. According to data recently provided by the Ministry of Inclusion, Social Security and Migration to the ABC newspaper, in 2023, almost 600,000 sick leaves related to “mental and behavioral disorders” were recorded in Spain, double the figure from seven years ago. “The World Health Organization (WHO) and the International Labor Organization (ILO) have studies that predict that by 2030, more than 50% of sick leaves will be due to psychosocial risks. That is, in the mental health of workers,” explains Carmen Marrero, occupational health delegate of the Comisiones Obreras (CCOO) union in the Canary Islands.
Naira Delgado, a doctor in social psychology at the University of La Laguna (ULL), says that these risks remain “an elephant in the room that we don’t want to see.” Or in other words, “the great void in the scope of organizations.” “Many companies understand that evaluating them exposes them and that is not the case. We must start from the fact that certain professions involve these risks,” explains the expert, who refers to the case of jobs with “high emotional demand” and interaction with people “in situations of vulnerability, difficulty,” such as health personnel.
Delgado regrets that these psychosocial risks are not addressed in the workplace. “At most, the professional is granted a work stoppage, but this problem will not improve over time. We must intervene from a psychological point of view and also from the point of view of the organization, analyze what generates this syndrome (burnout) and rethink the working conditions that can be adapted,” he says.
For the expert, the comparison is “very clear”. “In the construction sector, we cannot imagine workers working on scaffolding without helmets or safety harnesses, because we are aware that if they fall, there will be nothing to cushion the shock. If the characteristics of the work can lead to emotional exhaustion and this burnout syndrome, we cannot fail to provide them with tools and resources to face the work safely, at least with the guarantees that we can give them.
Carmen Marrero places the root of psychosocial risks in the “poor organization of work”. “When there is no good balance between professional and personal life, when work rhythms are not adequate, when orders are not given in a friendly manner or when they consider you as a simple machine, when they do not value your work, generate these situations” that lead to a series of sick leaves and, ultimately and above all, to the declaration of permanent disability.
Marrero refers to the European Health and Safety Strategy, which already includes the need to address “clearly and directly” all psychosocial risks, because “they are increasing at an exponential rate and in more and more sectors.” And he maintains that this process must be participatory, that it must include workers’ representatives. “We must break down this barrier, so that companies understand that the benefit is mutual, that they gain when the person works in better conditions, when their work is recognized. There are companies that are beginning to understand this and to assess psychosocial risks, but it cannot be said that it is generalized. In cases where it has been done and done well, the results are optimal for the company and the worker.
Exhaustion and depersonalization
Naira Delgado explains that burnout syndrome is progressive, that there is an “escalation” of the situation. It begins with a “significant difficulty” in managing situations of stress and high emotional demand that last over time. One of its components is mental fatigue. Another, depersonalization, “treating others in a harsh and hostile way”, a result of “this emotional exhaustion, the inability to manage it in any other way and low personal fulfillment, the feeling that one’s work is useless.” , that no matter how much you do, it makes no sense, that nothing is achieved. ”
The syndrome can occur “with many limiting symptoms,” experts point out. “They start with disorders that are often not work-related, such as sleep problems, digestive problems, tachycardia …,” explains Marrero. Then there can be “irritability, anxiety, depression, concentration problems, conflicts within the team, feelings of guilt,” adds Delgado.
“There begins to be a mental distance with work and there is a feeling of inefficiency, lack of fulfillment, this affects your personal and professional projection,” says Carmen Marrero. “The demands placed on the worker increase, the loads, the rhythms, the objectives increase. After the pandemic, in many centers, the staff is reduced and the workload is greater to carry out the work,” he says.
Experts agree that this syndrome occurs more frequently in sectors with high professional qualifications and in health services. “For some companies, it has a brutal economic cost, because sick leave persists over time. Sometimes it is not easy to replace certain profiles. In addition, it generates a dysfunction in a work team, because these absences must be covered with the resources available, which in turn generates a greater overload and a greater risk of having burnout in the future,” explains Naira Delgado. “Any organization that is dedicated to this sector, to helping professions, must take into account that this is going to happen and that the fact that there are cases of burned workers in their organization does not speak badly of them, but rather gives us indications that we must do things and improve,” adds the social psychologist.
“It is still very difficult for us to understand that psychosocial problems with fundamentally psychological symptoms are real. If we see the injury, the broken leg or collarbone, there is no doubt. But when it comes to psychological problems, and most of the risks that certain professions face are psychosocial, we minimize them because they do not have characteristics that are observable at first glance,” he laments.
Delgado explains that many workers “are not aware of the problem, they do not identify what is happening to them”, so this difficulty in managing stress “usually becomes chronic” over time “without anyone intervening”. “Sometimes you have to reorganize tasks or functions or certain activities within the work, have more support, more social support also at work to be able to talk about what is happening, what you feel when faced with certain very strong emotional situations”, concludes the expert. , who insists on the need to assess psychosocial risks. “Looking elsewhere will only make the problem worse”, he says.
