General recommendations emerge from federal study
Needleless systems, lifting devices suggested
A federal report compiled by the Institute of Medicine (IOM) in Washington, DC, for the U.S. Congress makes several general recommendations for reducing injuries sustained by nursing personnel in hospitals, focusing mainly on such problematic areas as back injuries, needlesticks, workplace violence, and work-related stress.1
The major recommendation in the section reviewing a possible link between staffing and work-related injuries and stress calls for hospitals to "develop effective programs to reduce work-related injuries by providing strong leadership, instituting effective training programs for new and continuing workers, and ensuring appropriate use of existing and emerging technology, including lifting and moving devices and needleless medication delivery systems."
In the four problem areas targeted for discussion, the IOM report makes the following observations and suggestions:
Back injuries
* Hospital nursing staff are particularly vulnerable to the hazards of back injuries and associated pain. Those injuries result in lost work time, disability, reduced productivity, medical care expenses, and staff turnover.
* Factors implicated in hospital worker back pain and injury include poor lifting techniques, poor staff-to-patient ratios, ergonomics, inadequate communication, and physical constitution.
* Recently employed nursing staff are more likely to injure their backs than are more experienced personnel.
* High turnover rates for nurse assistants involve frequent additions of new staff who are more prone to injuries than staff with longer tenure or more expertise.
* This suggests the need for more aggressive training in the use of lifting devices and lifting teams, especially for new employees, including ergonomic training in lifting techniques to prevent back injuries.
Needlestick injuries
* Nursing staff are the primary victims of needlestick injuries, putting them at risk of contracting hepatitis B and C, as well as HIV.
* Conservative estimates place the incidence of needlestick injuries each year among U.S. health care workers at 800,000.
* Universal precautions promulgated by the federal Centers for Disease Control and Prevention and enforced by the U.S. Occupational Safety and Health Administration are not universally observed by HCWs, with infractions occurring in up to 60% of cases despite HCWs' participation in programs designed to ensure compliance.
* Reliance on needleless systems for medication administration and accessing lines for blood, as well as scrupulous adherence to proper technique during invasive exposure-prone procedures, appears to be the most cost-effective approach available for prevention of deep needlestick injuries and cuts from sharp objects.
* Further research is necessary to measure effectiveness of interventions such as improved staffing, equipment, and employee education; use of appropriate engineering controls; and surveillance programs.
Violence
* Workplace violence is a problem for nursing personnel, particularly in emergency rooms at inner-city hospitals and in psychiatric facilities.
* Violence in health care settings reflects increased violence in the community.
* Factors contributing to violence toward staff include alcohol and drug abuse, anger and high stress, emergency department overcrowding, open access to the emergency department, prolonged waiting times, psychiatric patients, gang-related activities, and presence of hidden weapons.
* Administrative and organizational factors associated with violent injuries in the workplace include limited training in managing violent behavior. Managers must facilitate staff awareness of the potential for violent situations and enhance staff capability to deal with them effectively.
* Hospitals must implement strategies to prevent assaults on workers and provide adequate security, especially in high-risk areas such as emergency departments and psychiatric units.
* Much of the violence toward hospital staff is preventable, and prevention is a shared responsibility of employers and employees.
Work-related stress
* Nursing work is stressful and can lead to absenteeism, staff conflict, staff turnover, morale problems, and decreased worker effectiveness.
* Factors associated with nurses' stress include overwhelming workload, limited facilities and space, inadequate help, too much responsibility, too little continuing education, poor organization, excessive paperwork, inadequate communication with physicians, intrastaff tensions, lack of administrative support and leadership, lack of recognition, and shift work.
* Work-related stress can lead to burnout, depression, and poor job satisfaction.
* RNs often leave nursing as a result of stress and burnout.
* Health care administrators must find new approaches to staff selection and recruitment, staffing flexibility, increased resources, and increased decision-making by nurses.
Reference
1. Wunderlich GS, Davis CK, Sloan FA, eds. Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes, Division of Health Care Services, Institute of Medicine. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate? Washington, DC: National Academy Press; 1996. *
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content