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Promoting a Healthy Work Environment

Chapter 11

Workplace Safety

Environmental hazards
Physical safety
Emotional safety

Reducing Risk

Occupational Safety and Health Administration (OSHA)
Centers for Disease Control and Prevention (CDC)
National Institute for Occupational Safety and Health (NIOSH)

Reducing Risk (cont'd)

American Nurses Association (ANA)
Joint Commission
Institute of Medicine (IOM)

Reducing Risk (cont'd)

Workplace programs: safety plan

Consult federal, state, and local governments.

Distinguish between real and imagined risk.

Seek administrative support.

Calculate costs of program.

Workplace Programs

Identify potential hazard.
Assess degree of risk.
Develop a plan.
Implement the program.

Violence

Social issue
High rate of assaults on hospital workers
Threats
Physical assaults
Muggings

Violence (cont'd)

Situations that increase workers’ susceptibility
Routine contact with the public
Working alone or in small numbers
Working late
Poor security

Violence (cont'd)

Situations that increase workers’ susceptibility (cont’d)
Patients and families under stress who carry weapons
Individuals
Lack of experienced staff members
Units and patients that need seclusion or restraint activities

What Nurses Should Know

Does violence in the surrounding community affect my workplace?
Does the layout of the facility invite violence?
Is there a prompt response by administration to violence?

What Nurses Should Know (cont'd)

Are incidents being reported to and addressed by management?
Would training that deals with workplace violence be adequate for employees and management?
Which types of patients are more prone to violence?

Behaviors

History of violent behavior
Delusional or paranoid speech
Aggressive and threatening statements
Rapid speech and angry tone of voice

Behaviors (cont’d)

Stiff posture, clenched fists, tight jaw
Alcohol/drug use
Male gender or a youth
Unrealistic policies

When Assault Occurs: Placing Blame on Victims

Victim gender
Women receive more blame than men.
Subject gender
Female victims receive a greater amount of blame from women than from men.
Severity
The more severe the assault, the more often the victim is blamed.

When Assault Occurs (cont’d)

Beliefs
The world is a just place; therefore, the person deserves the misfortune.
Age of victim
The older the victim, the more he or she is held responsible for the assault.

Keep an Eye Out

Look for clues indicating potential violence.
Call patients, family members, and visitors by their names.
Encourage the patient or the patient’s family to vent anger.

Keep an Eye Out (cont’d)

If you feel uncomfortable, trust your intuition.
Know your institution’s policies and procedures.

Preventing Workplace Violence

Have an ongoing prevention program.
Report all violent incidents.
Hold all patients, visitors, staff members, and management accountable for their behavior.
Adopt a zero-tolerance policy.

Participate in Workplace Safety

Assess the workplace regularly.
Know your clients.
Be alert for suspicious behavior.
Maintain behavior that helps to defuse anger.
If situation escalates, remove self and call security.

Participate in Workplace Safety (cont’d)

Report situation to supervisor.
Call the police.
Get medical attention.
Contact collective bargaining or state nurses’ association.
Participate in policymaking.

Sexual Harassment

Behaviors Defining Sexual Harassment

Pressuring another to participate in sexual activities
Asking another person about his or her sexual activities, fantasies, or preferences
Making sexual innuendos, jokes, comments, or suggestive facial expressions to another person

Behaviors Defining Sexual Harassment (cont’d)

Continuing to ask for a date after the other person has expressed disinterest
Making sexual gestures with hands or body movements, or showing sexual graffiti or visuals
Making remarks about a person’s gender or body

Sexual Harassment

Two forms of sexual harassment

Quid pro quo

A hostile environment

Sexual Harassment (cont'd)

Recommendations from the American Nurses Association (ANA) on fighting sexual harassment

Confront

Report

Document

Support

Latex Allergy

Contact dermatitis (most common)
Generalized hives
Urticaria
Rhinitis
Wheezing
Anaphylaxis

Decreasing the Potential for Latex Allergy

Reducing unnecessary exposure
Using alternative gloves (nitrile)
Employee education programs
Identifying workers at risk

Needlestick Injuries

“Needlestick Act”

Passed in 2001
Revised blood-borne pathogens standards
Obligates employers to consider safer needle devices

The Nurse’s Responsibilities

Always use universal precautions.
Use and dispose of sharps properly.
Get immunized against hepatitis B.
Report all exposures.
Know the human immunodeficiency virus/hepatitis B virus (HIV/HBV) status of your patient.

The Nurse’s Responsibilities (cont’d)

Comply with post-exposure follow-up.
Support others who have been exposed.
Become active on safety committees.
Educate others.

Ergonomics

Preventing Back Injuries

Participate in safety committees.
Work in teams; do not be afraid to ask for help.
Use transfer and lifting equipment.
Do back exercises.

Repetitive Stress Injury (RSI)

Usually affects individuals who spend long hours at computers.
The most common injury is carpal tunnel syndrome.
Another injury is mouse elbow.
Badly designed computer stations present the highest risk.

Preventing RSI

Monitor placement
Keyboard alignment
Mouse position
Body alignment
Vary tasks.
Use fingertips when typing.
Keep fingernails short.

Impaired Workers

Common Signs of Impairment

Witnessing an employee consuming alcohol or other substances of concern on the job
Apparent in employee’s dress, appearance, posture, and gestures
Employee’s use of slurred speech and abusive/incoherent language

Common Signs of Impairment (cont’d)

Reports from patients/coworkers
Witnessing unprofessional conduct
Employee has significant lack of attention to detail
Witnessing an employee stealing controlled substances

Impaired Nurse Programs (INPs)

Most employers and 37 boards of nursing have strict guidelines.
INPs conducted by boards of nursing work with employers to assist impaired nurses.
Compassion from coworkers is of utmost importance.

Professional Responsibilities

Nurses need to uphold the standards of their profession.
Ignoring substance abuse places clients and other nurses in danger.
It is important to “help a colleague obtain help.”

Workload

Rotating shifts
Mandatory overtime
Staffing ratios

Reporting Questionable Practices

Most employers have policies regarding reporting behaviors that affect the workplace environment.
Code for Nurses (2001) is specific regarding this responsibility.

Behaviors

Endangering a client’s health or safety
Abuse of authority
Violation of rules, regulations, or standards of professional ethics
Gross waste of funds

Whistleblower

Describes an employee who reports employer violations to an outside agency
Do not assume “doing the right thing” will protect you.

Whistleblower Guidelines

Gather the facts.
Does the practice violate any actual law?
Know the state law requiring mandatory reporting.
Type your documentation and include day, date, time, and circumstances.

Whistleblower Guidelines (cont’d)

Identify witnesses.
Do not breach confidentiality in any way.
Send a copy of your complaint to the chief nursing officer or nursing department or any other department affected.
Utilize the ethics committee of your institution.
Keep copies of your records.

Nursing Responsibilities Related to Threats of Terrorism

Know the evacuation procedures and routes in your facilities.
Develop your knowledge regarding the most likely and most dangerous biological weapons.
Monitor for unusual disease patterns.
Know the back-up systems for communication and staffing.

Enhancing the Quality of Work Life

Social environment
Working relationships
Supporting your peers and supervisors
Involvement in decision making

Enhancing the Quality of Work Life (cont'd)

Professional growth and innovation
Encourage critical thinking.
Seek educational opportunities.
Encourage new ideas.
Reward professional growth.

Understanding Cultural Diversity

Communication
Space
Social organization

Organization Diversity Fitness

Personnel reflect the current and potential population that the organization serves.
Silence and gestures are respected.

Organization Diversity Fitness (cont'd)

Awareness of special family and holiday celebrations
Individuals first; culture second

Managing Diversity

Be aware of and sensitive to your own culture-based preferences.
Explore your own biases and values.
Be knowledgeable about other cultures.

Managing Diversity (cont'd)

Be respectful of and sensitive to diversity among individuals.
Be skilled in using and selecting culturally sensitive intervention strategies.

Do’s and Don’ts for Managing Diversity

DO	DON’T
Recognize diversity	Pretend everyone is alike
Value diversity	Expect everyone to conform to the prevailing culture
Develop informal supports	Seek a quick solution
Ensure fairness	Develop different standards of performance
Make the preceding principles an integral part of your philosophy	Expect one workshop to solve the problem

Conclusion

Workplace safety is a growing concern.
IOM and Joint Commission will continue to impact workplace safety issues.
Support the ANA.