From the Massachusetts Nurse Newsletter
August 2004 Edition
By Kathleen Sperrazza, MSLR, BSN, RN,
Lee Ann Hoff, PhD, RN,
Craig Slatin, ScD, MPH
About 50 nurses, made up of MNA elected leaders, staff, local unit leaders, occupational health advocates and staff nurses, employed in the hospital environment participated in a series of seven focus groups held between September and December of 2003. The focus groups addressed the following topics: general health and safety; workplace violence and abuse; diversity and discrimination issues; post injury return to work experiences; and healthcare system restructuring. The nurses discussed their concerns about theses issues in the healthcare work environment. Relaying their experiences, they identified what they believe are the causes of workplace injuries and illnesses, as well as what can and should be done to prevent them.
The focus groups were held as part of the University of Massachusetts Lowell (UML), PHASE (Promoting Healthy and Safe Employment) in Healthcare Study. The MNA, with the support of Evie Bain, occupational health and safety coordinator, and Chris Pontus, associate director for occupational health and the congress on health and safety, collaborated with the National Institute of Occupational Safety and Health (NIOSH) funded study. The team of researchers is conducting this five-year study to examine how working in the healthcare industry affects workers' health.
The healthcare workforce spans jobs from maintenance, housekeeping, and food service, to patient care workers (professional and non-professional), technicians, administrators, clerical workers and managers. These workers' educational backgrounds and wage levels cover a wide range. The workforce, which includes many women and members of minority communities, is exposed to a variety of known health and safety hazards at work. The main goal of the PHASE study is to examine how the physical and social/behavioral occupational health risks interact in ways that lead to differences in these workers' health and safety.
Preliminary analysis of the rich and poignant information shared by focus group participants suggests dominant themes. The nurses who participated in the focus groups identified ergonomic concerns such as continuous lifting, walking and bending as well as pulling and pushing patients on stretchers, beds and in wheelchairs. Lifting and moving equipment and using other technology that does not appropriately meet ergonomic standards was also raised as a cause of injury. Other potential causes discussed were exposure to blood and body fluids, particularly in the ER, OR, trauma and ICU environments. Nurses also raised concerns about the impact of: the noise level, shift rotation, exposure to toxic chemicals and materials, infectious diseases and workplace violence.
Lack of adequate staffing, higher patient acuity levels and the use of mandatory overtime were discussed as contributing factors that increase the pace of work, raise stress levels, and contribute to burnout. One ICU nurse said, "I feel like the merry go round is turned on too high and in order to stay on and not fall off you have to increase the speed at which you work." The nurses believe this increases the rate of injuries and illness.
Nurses discussed how health care restructuring affects the work environment for nurses. They cited the detrimental impacts of mergers and cost-cutting efforts that utilize industrial models which essentially speed up the assembly line and treat all "healthcare consumers" the same as "widgets" in a factory. The nurses believe the virtual elimination of their input into decision-making is having a negative effect on their ability to care for their patients and on their own health and safety.
Nurses were asked how workplace injuries and illnesses vary across the diverse healthcare workforce. While the nurses think that diversity is a key factor in deciding who works in a particular role (e.g., nurses vs. housekeepers), most of them believe that direct-care providers are at the highest risk for injury. Nurses participating in the workplace violence focus groups identified the lack of prevention programs and a general attitude that violence is an accepted "part of the job" as major factors that contribute to risk. Prevention programs with a "zero tolerance" policy were identified as the most effective tools for change.
Nurses taking part in the return-to-work focus group discussed the effects of being an injured nurse, and the loss of both benefits and salary and their identity as a nurse. Most felt betrayed by a lack of support from management, and for many, by a hostile workers' compensation system. The nurses discussed the lack of support for returning to work after injury. They cited unrealistic returns to "light duty" that make little provision for staffing, which increases the burden on other staff and sets the returning nurse up to fail.
Many other factors related to overall nurses' occupational health and safety were discussed. This invaluable data is being analyzed and will be used together with other data from the study to draw conclusions about the occupational health of nurses and other healthcare workers. The data from the MNA focus groups will be presented at the American Public Health Association meeting in Washington D.C., this November. Further analysis will be reported in scientific and professional journals.
The UML PHASE in Healthcare research team is deeply grateful to the MNA, its liaison to the project, Evie Bain, and to the MNA members for contributing to this study of the health status of healthcare workers who are injured on the job.
The authors work for the PHASE in Healthcare Study. Kathleen Sperrazza and Lee Ann Hoff are research consultants and Craig Slatin is principal investigator.