Workplace safety is a topic of major concern and discussion for individuals in a variety of occupations and workplace settings. In nursing, there has been an emphasis on providing safe nursing care to enhance patient safety. However, intertwined in the promotion of safe patient care is the critical issue of nurse safety. How safe are nurses in the work setting? Have the risks of nurse safety been addressed? In this 21st century, one may easily assume that nurse safety has been addressed. This belief is especially true with the demands placed on nurses in the fast-paced, high technologic health care environment. However, the answer is not clear. The issue of nurse safety is pervasive and includes all settings where nurses practice, not only acute care settings, but in the community and home.
Have you ever heard nurse colleagues or yourself say "....but we have always done it this way"? In reflecting on nursing practice and nurse safety, there are many areas in which the paradigm of nurse safety has dramatically changed in clinical practice, and there are areas where the paradigm is slow to change. For example, reflect on changes that have occurred over the years in the area of nurse safety that have altered your own nursing practice. Clinical nursing practice methods in the United States and many other countries have changed from resterilization of glass syringes and needles to using disposable, single-use syringes and needles, from recapping used needles and disposal of used needles through manually breaking off the used needle to mandatory use of sharps containers, from never wearing gloves for nonsterile procedures such as performing personal hygiene, to mandatory use of gloves and protective equipment when exposed to body fluids, from serving as the medication nurse for 20 to 40 patients and preparing medications from the unit stock supply, mixing and administering hazardous intravenous (IV) chemotherapy drugs (e.g. nitrogen mustard) to having pharmacy prepare and package hazardous drugs using a laminar flow hood, and from frequent use of restraints for confused and violent patients to identifying alternative nursing interventions in place of restraints as mandated by policies and regulations.
The paradigm for promoting nurse safety is changing, but slowly. Protection of nurses from musculoskeletal injuries incurred from hazardous lifting and patient transfers in a variety of clinical settings have not kept up with the technology to prevent injury. Unfortunately, musculoskeletal injuries are here to stay, and the current approach for educating and training nurses and healthcare professionals about the prevention of musculoskeletal injuries is not addressing the problem. The on the job ergonomic safety hazards that nurses face in implementing patient care is creating job stress. Perhaps, as we continue to reflect on the changes in nursing practice, our reflections in the next five years will include a paradigm shift with a focus on safe patient handling and movement and a drastic decrease in nurses’ job-related musculoskeletal injuries.
The six initial articles in this OJIN Nurse Safety posting present to nurses, administrators, educators, researchers, and other health care workers updates on several critical areas of nurse safety, that of musculoskeletal injuries, needlestick and sharps injuries, exposure to hazardous drugs, and violence in the workplace. Progress that has been made in the area of nurse safety will be addressed along with information and updates on current initiatives, legislative, and political influences, and discussion of work that still needs to be done to help answer the question: Nurse safety: Have we addressed the risks?
In Caring for Those Who Care: A Tribute to Nurses and Their Safety, Foley provides an introduction to the safety risks that nurses are exposed to and strategies to reduce the risks. A description of the occupational health approach framework, Hierarchy of Controls, is provided for evaluating safety risks and developing interventions. The American Nurses Association (ANA) commitment to safety of nurses is illustrated through a discussion of the 2001 ANA survey addressing nurses’ health and safety concerns.
In Handle with Care: The American Nurses Association’s Campaign to Address Work-Related Musculoskeletal Disorders, de Castro focuses on back injuries and musculoskeletal disorders in nurses from manual patient handling that includes lifting and transferring of patients. These activities in daily nursing care place nurses and nursing personnel (aides, orderlies, and attendants) at higher risk for musculoskeletal injures than construction laborers. A detailed description of the ANA’s Handle With Care Campaign is presented. The focus of the initiative is "...to build a healthcare-industry-wide effort to prevent back and other musculoskeletal injuries." The accomplishments of the international community on the issue of manual patient handling and the institution of no lift policies is addressed as well as the historical summary of the impact of national policy and federal regulation on workplace ergonomic hazards.
Because "efforts to reduce injuries associated with patient handing have often been based on tradition and personal experience rather than scientific evidence" Nelson and Baptiste, in the Nurse Safety article, Evidence-Based Practices for Safe Patient Handling and Movement, share a comprehensive summarization of the evidence addressing interventions to help reduce caregiver injuries. Solutions are presented using the Hierarchy of Controls organizational framework and are categorized into controls that are engineering-based, administrative, and work practice focused. Emphasis is placed on the fact that education and training on body mechanics have been ineffective. Unfortunately, the evidence reveals that staff members are not educated well on the use of patient handling equipment. New models of education are needed for promoting staff competence when using patient handling equipment. The way nurses have been educated and trained regarding body mechanics and lifting techniques have failed to reduce the job-related injuries in patient care settings. The use of clinical tools such as algorithms can be helpful in applying research to clinical practice by promoting standardization to making decisions for safely performing high risk patient care activities.
The Needlestick and Sharps Injury Prevention article, by Wilburn, addresses the infectious risks from needlestick and sharps injuries and the progress that has been made in prevention of those risks. The impact of legislation is discussed. Health care workers’ exposure to hepatitis and HIV as a result of needlestick and sharps injuries are preventable. The fist step in preventing infection with bloodborne pathogens is the elimination of unnecessary injections and unnecessary sharps.
The fifth article in this series, Safe Handling of Hazardous Drug, by Polovich addresses the risky work of health care workers in the handling of hazardous drugs and the risk of occupational exposure. Current issues related to handling hazardous drugs are discussed including, a historical review of safe handling guidelines, current recommendations, barriers to implementing guidelines, organizational challenges and personnel compliance in health settings. While most hazardous drugs are used in treatment of cancer, many of the drugs are also indicated for non-oncology use such as rheumatoid arthritis, thus increasing the numbers of workers potentially exposed. Health care workers involved in both direct and indirect care of individuals receiving such drugs should be considered potentially exposed.
In the last article of this nurse safety topic, Violence Toward Health Care Workers: Recognized but not Regulated Workplace Violence From Patients, McPaul and Lipscomb discuss the dangerous and complex occupational hazard of workplace violence that nurses face in the health care environment. They include a critique of the conceptual, empirical and policy progress of the past decade along with a discussion of the need for methodologically rigorous intervention effectiveness research. A description of joint labor management research is included that focuses on documenting a process to decrease violence in a state mental health system. "Individual nurses and direct care providers have very little influence over the level of violence in their workplaces, but through collective action are poised to influence policies designed to protect the health care workforce."
As you reflect on the various nurse safety issues and viewpoints presented by nurse experts, take the time to reflect not only on the perspectives presented but also on your own perspectives and nursing practice experiences and imagine what a nurse-safe environment means to you. You are invited to express your response to this Online Journal of Issues in Nursing (OJIN) Nurse Safety topic in the form of either a Letter to the Editor or through the development of an article. Through participating in either form of response, you will be taking advantage of a unique aspect of the Internet to actively participate in a timely dialogue about a current nursing issue.
Carol A. Sedlak PhD, RN, ONC
Dr. Sedlak is a graduate of St. Alexis Hospital School of Nursing in Cleveland, Ohio. She received her BSN, MSN, and PhD from Kent State University. She is an Associate Professor at Kent State University, College of Nursing and Associate Editor of OJIN. She is certified in orthopaedic nursing and serves on the Editorial Board of Orthopaedic Nursing, the journal for the National Association of Orthopaedic Nurses. She is the author of numerous papers on various topics of orthopaedic nursing and on nursing education including critical thinking. The focus of her nursing research is women’s health, specifically osteoporosis prevention. She recently completed a three year study funded by the National Institute of Nursing Research on DXA Health Beliefs and Osteoporosis Prevention in Postmenopausal Women.