Creating a Safer Workplace for Nurses

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By Debra Wood, RN, contributor

January 19, 2012 - Patient lifting equipment and safety needles are prevalent in today’s health care facilities, but a recent study from the American Nurses Association and statistics from the U.S. Department of Labor suggest that nursing remains a tough job, with opportunities to improve the work environment.

“Healthy and safe work environments allow nurses to provide the best possible care for the patients who depend on them,” said Jaime Murphy Dawson, MPH, senior policy analyst at the Center for Occupational and Environmental Health for the American Nurses Association (ANA) in Silver Spring, Md. “Also, protecting nurses from hazards, such as sharps injuries, musculoskeletal disorders and workplace violence, prevents nurses from leaving the workforce prematurely.”

The ANA’s 2011 Health and Safety Survey of 4,614 RNs found 13 percent of the respondents indicating they had been injured three or more times on the job within a year, compared to 7 percent in 2001.

The U.S. Bureau of Labor Statistics reported in November 2011 that of all occupations in 2010, registered nurses had the fifth-highest number of days away from work due to musculoskeletal injuries.

ANA’s survey showed 80 percent of nurses with neck, back or shoulder pain caused by the job frequently work, despite the pain.

The nursing association’s survey indicated greater availability of patient lift equipment and safer needles, with nearly two-thirds of nurses saying they have ready access to lift devices, compared to less than half of the respondents in 2001; less than a third of the nurses reported using the equipment frequently, however, suggesting the need for more education and an evaluation of the selection and placement of patient lift and transfer devices.

Safe Workplace for Nurses
June Marshall, DNP, RN, NEA-BC, says it’s important to educate nurses about safe ways to move patients and in the use of lift equipment.

June Marshall, DNP, RN, NEA-BC, director of advancing professional nursing practice at Texas Health Presbyterian Dallas, expressed concern that tired nurses may cut corners and not take the time to use the devices.

“It’s so important to make sure nurses know how to lift and safely move patients and have the lift equipment available,” Marshall said

Some nursing schools are placing a greater emphasis on safety. The Sinclair School of Nursing at the University of Missouri in Columbia has converted an unused locker room into a nursing safe practices room, with transfer stations and specialized lift equipment for students to practice using the devices.

But even with striking numbers of musculoskeletal injuries, that’s not nurses’ top concern, according to the ANA survey. Nurses’ top work environment concern was acute or chronic effects of stress and overwork, reported by 74 percent of respondents; followed by disabling musculoskeletal injury, 62 percent; and risk of contracting an infectious disease, 43 percent.

The ANA survey showed improvement in the availability of safe needle devices, with 96 percent of RN respondents indicating they are available, compared to 82 percent in 2001, something Dawson attributes to the Needlestick Safety and Prevention Act of 2000.

However, Dawson said that the survey indicated that RNs may benefit from a better understanding of their rights under the act, which requires that direct-care professionals participate in identifying and selecting safer needle devices. Of the ANA respondents, 62 percent either don’t know if nurses are involved in the selection process, or said they aren’t involved.

Providing lift equipment and safer needle devices are easier to address than relieving nurses’ stress and overwork. Many factors contribute, Dawson said, including professional and personal issues and staffing and shift work.

The ANA survey indicated that some staffing issues have improved. The percentage of nurses working more than 40 hours per week decreased from 64 percent to 55 percent, and RNs who work some mandatory or unplanned overtime each month decreased from 68 percent to 53 percent.

The ANA has established a “Healthy Nurse” program and plans to hold a conference this year. Dawson encourages nurses to be advocates for their health and safety.

“It’s important for nurses to address stress on a daily basis,” Dawson said.

The ANA survey also found nurses worry more about on-the-job assault now than in 2001, with 34 percent indicating that was a concern, up from 25 percent. At the same time, the actual number of assaults was down from 17 percent in 2001 to 11 percent in 2011. However, the majority of nurses still say they have been verbally abused or threatened on the job within a year, though the occurrence decreased since 2001 (57 percent to 52 percent).

Safe Workplace for Nurses
AnnMarie Papa, RN, MSN, CEN, NE-BC, FAEN, supports more education about how to handle violent patients and zero-tolerance policies.

“The consciousness and awareness of other departments and senior leadership in hospitals has been raised, and they are more aware of the [workplace violence] issue,” said AnnMarie Papa, RN, MSN, CEN, NE-BC, FAEN, 2011 president of the Emergency Nurses Association (ENA). In addition, more reporting may be raising nurses’ knowledge about assaults and that violence is not an accepted part of the nursing job.

An ENA study released in November 2011 found that rates of physical violence and verbal abuse against nurses did not decrease from May 2009 to January 2011. However, from January 2010 to January 2011, more than 53.4 percent of nurses reported experiencing verbal abuse and 12.9 percent reported experiencing physical violence over a seven-day period, compared with 54 percent and 11 percent respectively in the prior ENA violence study.

Papa said in-service training about how to handle violent patients, conducted in a multidisciplinary manner, can help reduce the risk. Learning with people from other departments provides a common language and expectations of each other. She also advocates for a zero-tolerance policy, setting an expectation for respect, and living by that policy. Executive leadership should call anyone who has experienced an assault to express concern and show caring.

Nearly 6 in 10 nurses in the ANA study said health and safety concerns influence their decision to continue practicing in the nursing field.

More than a third of emergency nurses in the ENA survey said they have considered leaving their current jobs because of workplace violence. Nearly 1 in 10 nurses have considered leaving nursing entirely.

Nurse safety reflects a commitment to improving the work environment and should be considered part of a comprehensive safety culture.

“Nurses need to make sure they are healthy and safe in order to provide optimal patient care,” Dawson said. “And employers need to be sure, too. It’s a team effort to have a culture of safety.”


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