Workplace Violence

Nurses: Your Health & Safety Risks at Work

09.15.2009

From the Massachusetts Nurse Newsletter
September 2009 Edition

By Peg Tayler Careau, MEd MS RN
Developed during graduate practicum experience with the MNA Division of Nursing Worcester State College, Spring 2009

  • Nursing has the second highest incidence of all non-fatal work related injuries in the U.S.
  • Underreporting of injuries is widespread among health care workers
  • An estiamted 75 to 95 percent of all injuries among nurses go unreported

Some risks to nurses' health include:

Workplace Violence The National Crime Victimization Survey revealed RNs had almost double the amount of assaults when compared to all other workers
Musculoskeletal Disorders Nursing is the riskiest occupation for musculoskeletal disorders with double the rate of musculoskeletal disorders of all other industries combined
Infectious Diseases Health care providers are exposed to multiple sources of infection from the known (the common cold) to the unknown (H1N1 or swine flu) of the current time


Common threads

  • Educate yourself
  • Take care of yourself—your health is most important
  • Access available resources: health & safety officer, OSHA, NIOSH, CDC, MNA Web site
  • Inform management of concerns
  • Get involved. Become a member of facility committees on issues effecting your practice and your health
  • Document occurrences. Reports provide data for change. No report = No data.

Workplace Violence

Facts

  • The National Institute for Occupational Safety and Health with the Centers for Disease Control and Prevention defines workplace violence as “violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty.”   
  • Bureau of Labor Statistics data show that in 2002, 43 percent of all non-fatal injuries from occupational assaults and violent acts occurred in the health care sector.
  • In health care settings workplace violence can be perpetrated by patients, families, friends, visitors, co-workers, physicians, supervisors and managers.

Some of the major factors that contribute to violence in health care settings…

  • Prevalence of and access to weapons
  • Increased use of hospitals for criminal holds and care for acutely disturbed, violent individuals
  • Increase in numbers of acute and chronic mentally ill patients being released from services without follow-up care
  • Availability of drugs and/or money at hospitals or clinics
  • Increased presence of gang members, substance abusers, trauma patients or distraught family members
  • Low staffing levels or working alone
  • Lack of staff training to be able to recognize and manage escalating hostile and assaultive behaviors
  • Poorly lit hallways, parking lots and other areas

Being informed is your best line of defense

Greatest risk occurs during patient transfers, emergency responses, mealtimes, change of shifts and at night. Risks are present in all health care settings. Nurses and aides who have direct contact with patients are at higher risk.

Recognize the signs of impending violence…

  • Red face, distended neck veins, heavy breathing, and/or huffing and puffing
  • Pacing or agitation
  • Body language such as threatening postures (making a fist with a hand) and gestures
  • Verbal expression of anger and/or frustration
  • Loud, pressured speech
  • Signs of alcohol or drug use
  • Actual threats of harm
  • Presence of a weapon

Be prepared to intervene in the situation…

  • Stay calm and present a calm, respectful, caring attitude
  • Avoid using “threatening” body language (moving rapidly, crossing your arms, getting too close or touching the person) that can make a person think you are angry and a danger to them
  • Speak soft and slowly
  • Acknowledge the person’s feelings
  • Do not give orders. Do not engage in threatening exchanges

And, most of all, keep yourself safe…

  • Evaluate all encounters for potential violence
  • Do not isolate yourself with a potentially violent person
  • Maintain distance from the violent person
  • Always keep an open path for exiting a room—do NOT allow the person to block your exit
  • Call security for help as soon as you sense a threat
  • Move near an exit, such as a door or stairs

When all else fails…

  • Remove yourself from the situation
  • Call for help as soon as possible
  • Report all violent situations to management and the police, if indicated

What you can do…

  • Advocate for violence prevention programs—use NIOSH resources
  • Recognize risk factors that cause or contribute to violence and/or assaults
  • Recognize signs that indicate escalating behaviors
  • Develop strategies to prevent or diffuse volatile situations occurring with patients and/or visitors
  • Contact the MNA for programs to become informed about current issues

10 actions a nurse should take if assaulted at work

  1. Get help. Get to a safe area
  2. Call 911 for police assistance, (it is your civil right to call police)
  3. Get relieved of your assignment
  4. Get medical attention
  5. Report the assault to your supervisor and union
  6. Get counseling for critical incident stress debriefing to address concerns related to post traumatic stress disorder
  7. Exercise your civil rights: file charges with the police
  8. Get copies of all reports and keep a diary of events
  9. Take photographs of your injuries
  10. Return to work only when you feel safe and supported

 

Musculoskeletal Disorders (MSD’s)

Facts

  • During the 1992–2003 period, musculoskeletal disorders for women were the primary source of nonfatal injuries and illnesses.
  • Disabling back injuries and pain affect 38 percent of nursing staff with more than 52 percent of nurses suffering from chronic pain.
  • Musculoskeletal disorders refers collectively to a group of injuries and illnesses that affect the musculoskeletal system, to include:
    • Back • Wrists • Shoulders • Knees • Elbows
  • Studies of MSD worker’s compensation claims reveal that nursing personnel have the highest claim rates of any occupation or industry.

Occupational risk factors

  • Patient Handling
    • Transferring, lifting, boosting and positioning patients*day after day, causing repetitive motion injuries
    • Lifting alone or with help
  • No mechanical lifts
  • Moving heavy equipment
  • Nursing shortage
  • Heavier patients
  • Aging workforce—with prior cumulative injuries

*A nurse lifts an average cumulative weight of 1.8 tons in every eight-hour shift

What you can do…

  • Advocate for
  • Mechanical lift equipment and/or lift teams
  • Friction reducing devices
  • Keep yourself healthy
  • Use equipment that is provided
  • Report all injuries, no matter how small
  • Encourage co-workers to report injuries

Increase your odds – stay strong

  • Assess the situation Regularly perform strengthening exercises
  • Stomach
  • Lower back
  • Back and leg muscles Utilize proper body mechanics
  • Bend your knees to get up and down
  • Pivot: don’t twist
  • Respect your limits

     

Infectious Diseases

Facts

  • The Centers for Disease Control and Prevention (CDC), estimate that each year 385,000 needlestick and sharps-related injuries are sustained by hospital-based health care personnel. (Many occurrences go unreported)
  • Exposure to infectious diseases is inherent with almost any occupation in health care. The list of pathogens continues to expand as do the variations and mutations of some organisms.

How pathogens are transmitted in health care settings

  • Direct contact – handshake
  • Bloodborne
  • Airborne – talking, singing, coughing and sneezing
  • Vector borne – carriers from animals to humans

How the pathogen enters the new host

  • Inhalation
  • Ingestion
  • Injection – skin breaks

Risk Factors

The risk of transmission varies, dependent on a number of factors:

  • Mode of transmission
  • Pathogen involved - known or unknown
  • Type of exposure
  • Amount of pathogen involved in the exposure
  • Concentration of pathogen the patient is experiencing at the time of exposure
  • Individual health status
  • Failure to use effective personal protective equipment (PPE)
  • Not complying with standard and/or expanded precautions
  • Lack of training

What you can do…

  • Practice proper hand hygiene
  • Attend training programs
  • Wear PPE appropriate to the situation
  • Get fit tested for a surgical N95 respirator
  • Use safety sharps products and dispose properly
  • Disinfect areas and sterilize equipment per protocol
  • Do not work if you are sick
  • Practice and teach others about cough etiquette
  • Isolate infected patients
  • Put the mask on the coughing patient!

Proper use of personal protective equipment

  • Think of how the pathogen travels and what is needed to prevent its path to you
  • Learn what to wear and when to wear it – follow CDC guidelines
  • Learn the sequence of putting on and taking off PPE

    Putting on:
    Gown • Mask or Respirator • Goggles or Face Shield • Gloves
    Taking off:
    Gloves • Goggles or Face Shield • Gown • Mask or Respirator

    During times of uncertainty, use a second pair of gloves for extra protection
    For example:
    Putting on:
    Gown • Mask or Respirator • Goggles or Face Shield • Gloves • Gloves
    Taking off:
    Gloves • Goggles or Face Shield • Gown • Mask or Respirator • Gloves