Rosemary Rogers

Violence and bullying

Violence in health services is a major problem. But it is not confined to patients or relatives abusing or attacking staff. More and more instances are coming to light of staff being bullied by managers or colleagues. This chapter discusses these issues and offers suggestions on how nurses can deal with them.

Work injury and work-related illness

‘The NHS chews you up, sucks you dry, and spits you out.’ Many nurses feel like this about working in the health service, but it is surely unacceptable. In an ideal world no nurse would have an accident or develop an illness as a result of her work; although these things do happen, it is not enough simply to try to pick up the pieces ad hoc. Health service employers should actively develop good employment and human resources policies and practice to respond to individual and corporate needs in a humane, balanced and sympathetic manner. The reality is less than ideal, however, and often it is the unfortunate nurse who is blamed, discriminated against, left to muddle through or even summarily dismissed.

Manual handling: time to stop?

‘No one working in a hospital, nursing home or community setting should need to lift patients manually any more’ (RCN, 1996a). Such a statement would have been thought fanciful by most nurses as little as a decade ago. Since the introduction of the Manual Handling Operations Regulations in 1992, however, it is a realistic goal for most safety and cost-conscious health care employers.

The healthy nurse

Working in an environment so fraught with hazards and risks, it may seem there is very little your work could actually do to promote health; most employers still have a long way to go in properly tackling hazards. Yet a great deal can be done to create a healthy working environment, one that encourages health and healthy living instead of threatening it. As organisations that are supposedly concerned with health promotion, health services are appallingly bad at this, and many private companies do far better in all areas, from recreational facilities to health screening. This final chapter looks at the positive dimensions of health and safety and provides a charter for the healthy nurse.

The working environment

The word ‘nurse’ still conjures up the image of someone working in a hospital, although one of the most remarkable recent changes in UK health services is the focus on delivering health care in any and every setting — wherever the patient lives or works and wherever she or he prefers to be treated. There is greater recognition that nurses can, should and do work in all settings. The idea of a ‘hospital without walls’ is now more familiar, with the shift of emphasis in mental health nursing to community teams; generalist nurses working in schools, health centres, universities, airports, in the air, at sea, in refugee camps, industry and commerce; working with homeless people and travellers, on housing estates, with women and men in the sex industry and with people with learning difficulties; and still as district nurses, health visitors, family planning advisers, Macmillan nurses and so on. Most nurse educators are now employed in higher education, and most nurses undergo their initial professional training outside hospital as full-time bursaried students.

Health and safety: the legal framework

The most important piece of legislation affecting occupational health and safety in the United Kingdom is the Health and Safety at Work Act, passed in 1974. The 1974 legislation underpinned all other health and safety legislation and provided, for the first time, a broad and integrated legislative framework to promote, encourage and enforce high standards of health and safety in the workplace. The Health and Safety Commission (HSC) was established as a result of the Act, and government inspectorates were unified into the Health and Safety Executive (HSE). And for the first time, NHS employers were required by statute to provide for the health and safety of their employees.

Infection and infection risks

Hospitals and other health care settings are full of germs whose hazards are particularly insidious because they are not visible. Dangers that cannot be seen tend to be ignored, played down or forgotten.

Toxic substances and agents

Health workers are exposed to a huge range of toxic substances in the drugs, chemicals and gases they work with. The hazards these substances present, particularly their long-term effects, are often incompletely understood even by the manufacturers and scientists. And the people who have to handle them may not think to associate periodic headaches, skin complaints, dizziness or nausea with the workplace.

Health services: bad for your health?

Are you inspired by health and safety at work? If not, it’s likely you are not alone. It conjures up visions of tedious regulations and being told to do your work in ways which seem utterly impractical in the daily hurly-burly of health care. Yet what could be more important to each nurse than her or his own welfare? Evidence suggests that the mental and physical health of the nurse is frequently put at risk by work, and that many nurses suffer serious problems, sometimes resulting in the loss of a job or permanent disability. Why, then, is a subject which should be near the top of the nursing agenda so often neglected or ignored?