Jane Lipscomb

Perceived physical demands and reported musculoskeletal problems in registered nurses

BACKGROUNDnNursing is physically demanding, and nurses have higher rates of musculoskeletal disorders (MSDs) than most other occupational groups. The physical demands of nursing may lead some nurses to leave the profession, contributing to the shortage of registered nurses in many workplaces that is a major concern today. As a first step toward reducing MSDs and their consequences, this study was designed to examine the relationship between perceived physical demands and reported neck, shoulder, and back MSDs in nurses.nnnMETHODSnData were collected anonymously from 1163 randomly selected working nurses (74% response rate) using a cross-sectional survey. The 12-item survey scale (internal reliability coefficient=0.89), rated perceived physical demands such as force, awkward postures, and heavy lifting. Nurses with a presumed MSD case reported relevant past-year symptoms in the neck, shoulder, and/or back lasting >or=1 weeks, or at least monthly, with moderate or more pain, on average.nnnRESULTSnModerate and high perceived physical demands were significantly associated with reported neck, shoulder, and back MSD cases, even after adjustments for demographic and lifestyle-related covariates. Adjusted odds ratios for highly demanding work (vs low) ranged from 4.98 to 6.13 depending on body site. When analyses were restricted to staff nurses only, the odds ranged from 9.05 to 11.99.nnnCONCLUSIONSnPerceived physical demands are associated with reported MSD in registered nurses, and the association is stronger in staff nurses.

Work schedule, needle use, and needlestick injuries among registered nurses.

OBJECTIVEnTo examine the association between working conditions and needlestick injury among registered nurses. We also describe needle use and needlestick injuries according to nursing position, workplace, and specialty.nnnDESIGNnThree-wave longitudinal survey conducted between November 2002 and April 2004.nnnSETTING AND PARTICIPANTSnA probability sample of 2,624 actively licensed registered nurses from 2 states in the United States. Follow-up rates for waves 2 and 3 were 85% and 86%, respectively. Respondents who had worked as a nurse during the past year (n=2,273) prior to wave 1 were included in this analysis.nnnRESULTSnOf the nurses, 15.6% reported a history of needlestick injury in the year before wave 1, and the cumulative incidence by wave 3 was 16.3%. The estimated number of needles used per day was significantly related to the odds of sustaining a needlestick injury. Hours worked per day, weekends worked per month, working other than day shifts, and working 13 or more hours per day at least once a week were each significantly associated with needlestick injuries. A factor combining these variables was significantly associated with needlestick injuries even after adjustment for job demands, although this association was somewhat explained by physical job demands.nnnCONCLUSIONSnDespite advances in protecting workers from needlestick injuries, extended work schedules and their concomitant physical demands are still contributing to the occurrence of injuries and illnesses to nurses. Such working conditions, if modified, could lead to further reductions in needlestick injuries.

How long and how much are nurses now working? Too long, too much, and without enough rest between shifts, a study finds

Objective:Extended work schedules—those that vary from the standard eight hours per day, 35 to 40 hours per week—are common in nursing and contribute to problems with nursing recruitment and retention, in addition to compromising patient safety and the health and well-being of nurses. This study describes the nature and prevalence of such schedules across nursing settings. Methods:Quantitative survey data collected as part of the Nurses Worklife and Health Study were analyzed. The sample consisted of 2,273 RNs. Demographic data, information about respondents’ primary jobs (position, workplace, and specialty), and specific work schedule variables were analyzed, including data on off-shifts, breaks, overtime and on-call requirements, time off between shifts, and how often respondents worked more than 13 hours per day and on scheduled days off and vacation days. Respondents were also asked about activities outside of work, commuting time, and other nonnursing activities and chores. Results: More than a quarter of the sample reported that they typically worked 12 or more hours per day, as did more than half of hospital staff nurses and more than a third of those with more than one job. A third of the total sample worked more than 40 hours per week, and more than a third worked six or more days in a row at least once in the preceding six months. Nearly a quarter rotated shifts.Almost one-quarter of nurses with more than one job worked 50 or more hours per week, and they were more likely to work many days consecutively, without sufficient rest between shifts, and during scheduled time off. Single parents were as likely as those with more than one job to work 13 to 15 hours per day, 50 to 60 hours or more per week, and many days consecutively. Seventeen percent of all nurses worked mandatory overtime, as did almost a quarter of the single parents. Nearly 40% of the total sample and more than 40% of hospital staff nurses had jobs with on-call requirements. Conclusions: The proportion of nurses who reported working schedules that exceed the recommendations of the Institute of Medicine should raise industry-wide concerns about fatigue and health risks to nurses as well as the safety of patients in their care.

Environmental Evaluation for Workplace Violence in Healthcare and Social Services

PROBLEMnFederal policy recommends environmental strategies as part of a comprehensive workplace violence program in healthcare and social services. The purpose of this project was to contribute specific, evidence-based guidance to the healthcare and social services employer communities regarding the use of environmental design to prevent violence.nnnMETHODnA retrospective record review was conducted of environmental evaluations that were performed by an architect in two Participatory Action Research (PAR) projects for workplace violence prevention in 2000 and, in the second project in 2005. Ten facility environmental evaluation reports along with staff focus group reports from these facilities were analyzed to categorize environmental risk factors for Type II workplace violence.nnnRESULTSnFindings were grouped according to their impact on access control, the ability to observe patients (natural surveillance), patient and worker safety (territoriality), and activity support.nnnDISCUSSIONnThe environmental assessment findings reveal design and security issues that, if corrected, would improve safety and security of staff, patients, and visitors and reduce fear and unpredictability.nnnIMPACT ON INDUSTRYnHealthcare and social assistance employers can improve the effectiveness of violence prevention efforts by including an environmental assessment with complementary hazard controls.

Occupational blood exposure among unlicensed home care workers and home care registered nurses: Are they protected?

BACKGROUNDnLittle is known about the risk of blood exposure among personnel providing care to individual patients residing at home. The objective of this study was to document and compare blood exposure risks among unlicensed home care personal care assistants (PCAs) and home care registered nurses (RNs).nnnMETHODSnPCAs self-completed surveys regarding blood and body fluid (BBF) contact in group settings (n = 980), while RNs completed mailed surveys (n = 794).nnnRESULTSnPCAs experience BBF contact in the course of providing care for home-based clients at a rate approximately 1/3 the rate experienced by RNs providing home care (8.1 and 26.7 per 100 full time equivalent (FTE), respectively), and the majority of PCA contact episodes did not involve direct sharps handling. However, for PCAs who performed work activities such as handling sharps and changing wound dressings, activities much more frequently performed by RNs, PCAs were at increased risk of injury when compared with RNs (OR = 7.4 vs. 1.4) and (OR = 6.3 vs. 2.5), respectively.nnnCONCLUSIONnBoth PCAs and RNs reported exposures to sharps, blood, and body fluids in the home setting at rates that warrant additional training, prevention, and protection. PCAs appear to be at increased risk of injury when performing nursing-related activities for which they are inexperienced and/or lack training. Further efforts are needed to protect home care workers from blood exposure, namely by assuring coverage and enforcement of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard [Occupational Safety and Health Administration. 1993. Frequently Asked Questions Concerning the Bloodborne Pathogens Standard. Available at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS &p_id=21010#Scope. Accessed May 30, 2008].

Healthcare workers: protecting those who protect our health.

The nations healthcare system is in a transition of potentially historic proportions, driven by the need for cost-effectiveness under pressures of cost containment and competition, but also made possible by scientific and technological breakthroughs. This transition presents new challenges and opportunities for protecting the health and safety of our nations healthcare workers. Toward the goal of maximizing future opportunities for the primary prevention of illnesses and injuries among healthcare workers, a brief review of history in relationship to this work force should assist us in identifying successful models for future action. In the United States, the practice of occupational health dates back to the late 1800s. National professional societies in occupational medicine and nursing were established in 1916 and 1942, respectively. The hospital and healthcare environments did not become a focus of study and prevention strategies until much later. In fact, as recently as the 1950s, there still was no consensus regarding the occupational risk of tuberculosis (TB) exposure. It has been suggested that a number of factors drove this lack of consensus, including the fear that young women would avoid nursing if they knew the risks involved and that liability might surface. It was not until TB declined significantly in the general public but remained elevated in the medical profession that TB was recognized fully as an occupational hazard.2 Professional associations and the federal government began to address healthcare-worker health and safety in subsequent years. In 1958, the American M dical Association (AMA) and American Hospital Association (AHA) issued a joint statement in support of worker health programs in hospitals; the Centers for Disease Control and Prevention (CDC)s National Institute for Occupational Safety and Health (NIOSH) published criteria for effective hospital occupational health programs in 1977; and, in 1982, the CDC published the Guideline for Infection Control in Hospital Personnel. This last document focused on infections transmitted between patient-care personnel and patients, not exclusively on healthcare workers risk of infectious diseases. The CDC guidelines for blood and body fluid precautions (1982) and universal precautions (1987) were published to provide guidance to healthcare workers. In 1987, the Departments of Labor and Health and Human Services issued a Joint Advisory Notice entitled Protection Against Occupational Exposure to HBV and HIV. In 1988, NIOSH published comprehensive guidelines for protecting the safety and health of healthcare workers. In late 1991, the Occupational Safety and Health Administration (OSHA) promulgated the Bloodborne Pathogens Standard, which required the observance of Universal Precautions, the offering by the employer of hepatitis B (HBV) vaccine, and the implementation of engineering controls to protect workers from the health hazards related to bloodborne pathogens. OSHA is scheduled to publish a proposed TB standard in the Federal Register in mid-1997.

Prevalence of cytomegalovirus antibody in nursing personnel.

To evaluate the risk to nurses of childbearing age of acquiring cytomegalovirus (CMV) infection during the care of patients at high risk of the infection, 374 female hospital employees (288 nursing personnel) were interviewed and screened for antibody to CMV. Fifty-six percent of the population surveyed had antibody to CMV as measured by an immunofluorescent assay. Among nursing personnel, analysis of antibody prevalence by job title, work area, and duration of work showed no association between seropositivity and either current or past exposure to high-risk patients, such as infants and immunosuppressed individuals. Age, race (non-white), and the number of pregnancies reported by participants were significantly associated with the presence of antibody. Among 73 employees of a childrens hospital, the prevalence of CMV antibody was 41%. This survey suggests that hospital nursing is not a major risk factor for acquiring CMV infection. However, this finding needs further evaluation in a prospective study of seroconversion rates among seronegative nurses.

Reducing Occupational Risk for Blood and Body Fluid Exposure Among Home Care Aides: An Intervention Effectiveness Study

The purpose of this quasi-experimental pretest/posttest research study was to examine the effectiveness of an intervention designed through a participatory process to reduce blood and body fluid exposure among home care aides. Employer A, the intervention site, was a large agency with approximately 1,200 unionized home care aides. Employer B, the comparison group, was a medium-sized agency with approximately 200 home care aides. The intervention was developed in partnership with labor and management and included a 1-day educational session utilizing peer educators and active learning methods to increase awareness about the risks for occupational exposure to blood and body fluids among home care aides and a follow-up session introducing materials to facilitate communication with clients about safe sharps disposal. Self-administered preintervention and postintervention questionnaires identifying knowledge about and self-reported practices to reduce bloodborne pathogen exposure were completed in person during mandatory training sessions 18 months apart. Home care aides in the intervention group for whom the preintervention and postintervention questionnaires could be directly matched reported an increase in their clients’ use of proper sharps containers (31.9% pre to 52.2% post; p = .033). At follow-up, the intervention group as a whole also reported increased use of sharps containers among their clients when compared to controls (p = .041).

Workplace Violence Training Programs for Health Care Workers: An Analysis of Program Elements:

Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration’s (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.

Client history and violence on direct care workers in the home care setting

BACKGROUNDnHealth care workers providing home care are frequently unaware of their clients history of violence or mental illness/substance abuse disorder, recognized risk factors for workplace violence. This study estimated the associations between these factors and experiencing client violence among direct care workers in the home settings (DCWHs).nnnMETHODSnActs and threats of violence were estimated using data from an anonymous survey among DCWHs (nu2009=u2009876) working at two large home care agencies. Logistic regressions were performed to produce odds ratios.nnnRESULTSnPhysical acts and physical or verbal threats of client violence were associated with providing homecare to clients with a violence history (adjusted ORsu2009=u20096.60 and 10.78, respectively), whereas threats of client violence (adjusted ORu2009=u20095.80) were associated with caring for clients with a mental illness/substance abuse disorder.nnnCONCLUSIONSnPolicy and practices that support the communication of appropriate client risk information may reduce the likelihood of workplace violence among DCWHs. Am. J. Ind. Med. 59:1130-1135, 2016.