Nurse Safety

The Impact of Violence Against Nurses and Their Employers

Posted in Hospitals, Nurse Employers, Nurse Safety, Nursing, Nursing News

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When people talk about violence in the workplace, they don’t often think of the healthcare field. While post offices are the most stereotypical place for violent events, (lending us the phrase “going postal”) other locations that are usually considered to be more violent than hospitals include business offices and schools.

As late as 2007, however, workers in health care support systems averaged an injury rate of 20 per 10,000 for assaults, and health care professionals garnered an average of 6 assaults per 10,000 people. In the general population, the rate was only 2.1 assaults per 10,000 people. And these numbers are likely low, given the underreporting of violence in the health care field.

Nurses and patient care aides suffer the highest rate of violence in the health care field, with emergency department nurses experiencing the highest number of physical assaults. In one study of Minnesota nurses, emergency department nurses reported four times as many assaults as nurses on other units of the hospital.

Physical effects of violence against nurses include: physical injury, disability, chronic pain, muscle tension. Often, the psychological effects of violence have much more of a lasting impact on the nurse and affect her work and stress level. Several studies have shown that loss of sleep, flashbacks, anger, sadness, frustration, anxiety, irritability, decreased feeling of safety and fear of future assaults are prevalent enough after a violent incident at work that the effects may seep into a nurse’s job performance and personal life. One study found that nurses suffer enough symptoms to meet the full criteria for a PTSD diagnosis.

The employer also experiences a cost when health care violence occurs. Word gets around in the healthcare profession, and nurses do not want to work in a setting prone to workplace violence, no matter how attractive the salary. An increase in absenteeism, a high turnover rate, increased worker’s compensation, decreased morale and job dissatisfaction are some of the things that can result from workplace violence. One study on Minnesota employers found 344 nonfatal assaults cost over $5.8 million in lost wages, legal fees, insurance costs and lost fringe benefits.

Nurses admit that unless they are injured, they usually carry on with work after a physical assault. Incidents are not always reported. Sometimes nurses worry that a report will be ignored, or that it will be brushed off as something that is just an occupational hazard. Some feel a certain amount of responsibility for the assault — that they should have been able to prevent it. Meanwhile, hospital executives may feel reports of violence undermine patient satisfaction scores. One nurse reported needing to take a moment to compose herself and then putting her “game face back on…[to] get out there.” Nurses usually reported they were able to return to work, but had suffered either cognitive or emotional challenges in remaining focused on the job.

In 2010 in an effort to improve protections for both employees and patients against health care setting violence, the Joint Commission re-released a Sentinel Event Alert on the increase in health care setting violence and set forth the steps for hospital management teams to take to improve safety standards and deal with the effects of the violence.

Combatting Night Shift Health Risks

Posted in Hospitals, Nurse Safety, Nursing, Nursing News, Nursing Specialties

It’s not all bad on the night shift. Night shift nurses don’t have to deal with visitors, doctors or supervisors, and have fewer interruptions. The night hours may work best for a nurse’s family situation as well. But could working at night, when 80 percent of the world sleeps, actually be hazardous to a nurse’s health?

The International Agency for Research on Cancer has determined that the disruption of the natural circadian rhythms that happens with night shift work is “probably carcinogenic.” Circadian rhythms involve regulation of body temperature, blood pressure, sleep/wake cycles, mental clarity, and hormonal secretions. The rhythm is cued by exposure to light and darkness. Over time, disruption to circadian rhythms can put a nurse in a constant stage of sleep deprivation.

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Numerous studies have shown that night shift workers are at greater risk for type 2 diabetes, developing breast and colorectal cancer, irregular menstrual cycles and other fertility problems, strokes, higher blood pressure, cardiovascular disease, type 2 diabetes, and increased risks of anxiety and depression.

Nurses operating with a pervading sense of fatigue that night shift work causes may have slower reaction times, less attention to detail, decreased problem solving skills and impaired psychomotor skills. They may become irritable, forgetful, and complain of chills, nausea and eye-strain. The more consecutive night shift a nurse works, the worse it all gets and the higher the likelihood of making an error.

So what can be done to combat the increased health risks to both the nurse and subsequently, the patient?

- Whether working the night shift or off for a few days, try to stick as closely as possible to the same sleep schedule.
- Use blackout shades to keep the room as dark as possible.
- Use sunglasses to block out blue light when driving home from work.
- Keep the lights bright; this prevents the body from wanting to lower its temperature during the 0400-0600 hours.
- Avoid caffeine and nicotine before sleeping.
- Avoid large meals before sleeping.
- Sleep at least four hours.
- Expose your body to bright light upon waking.
- Most importantly, try to nap when you can.

The National Sleep Foundation recommends night shift napping for every person working at night in order to combat fatigue and increase mental clarity. In a study done with critical care nurses, 10 out of 13 nurses reported they’d felt more alert and had better moods when they napped on the job. Many healthcare facilities have adapted rooms to accommodate napping nurses by providing couches, recliners, blankets and pillows. These facilities not only tolerate but expect nurses to take nap breaks as part of their night shift routine. In order for nurses to care for their patients, they must first tend to their own needs. And that includes the need for sleep.

Caps On Mandatory Nursing Overtime Effective

Posted in Hospitals, Nurse Employers, Nurse Safety, Nursing News

A new study that is part of the RN Work Project has shown that state-mandated caps on mandatory nursing overtime has a positive effect on patient safety. The laws effectively reduce overtime hours, which have been shown to reduce fatigue and the problems that come along with it, such as increased mistakes.

Nurses routinely work shifts as long as 12 hours. The overtime laws were designed to prevent hospitals from adding mandatory overtime on top of those lengthy shifts.

An article on Renal Business’ website quotes one of the study’s leaders, Carol Brewer, as saying, “The laws seem to be accomplishing their objective.”

At issue in the study was the extent to which those laws or regulations had actually affected the workplace. Researchers examined NLRNs’ self-reported mandatory and voluntary overtime hours, as well as their total work hours to find the answer.

They found that in the states with rules governing mandatory overtime, NLRNs were 59 percent less likely to work mandatory overtime than their colleagues in unregulated states. (Not all states with overtime rules prohibit mandatory overtime; some simply limit total work hours). Overall, 11.6 percent of nurses said they worked mandatory overtime in a typical work week, averaging 6.1 hours of mandatory overtime.

In addition, in the states regulating overtime, NLRNs worked an average of 50 fewer minutes per week than their colleagues in states without overtime regulations.

Researchers anticipated that caps on mandatory overtime might lead to increased voluntary overtime, thus defeating, to at least some degree, the purpose of the restrictions. But the data demonstrated no relationship between mandatory and voluntary overtime hours. Nevertheless, more than 50 percent of NLRNs reported working voluntary overtime in a typical work week.

“While safety is the principal objective of caps on mandatory overtime, the laws probably also have a positive effect on nurse retention,” said Kovner. “Nurses have lives and families outside the workplace just like everybody else, and they probably prefer to have a schedule they can rely on. One way to make their jobs and lives more manageable is to avoid mandatory overtime, which should lead to nurses staying in their jobs, and indeed, in the profession longer. That’s particularly important in light of the looming nursing shortage. Every nurse who stays in the profession is one fewer nurse we need to recruit.”

“It’s important to policymakers to understand the impact of the remedies they devise for particular problems,” said Bae. “In this case, the states developed caps on mandatory overtime with safety issues in mind, reasoning that fewer mandatory overtime hours would translate into fewer hours overall. What we learned in this study is that it’s working. The tool is effective. Other states with similar objectives can follow suit and expect similar results.”

The RN Work Project is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes―including intent, satisfaction, organizational commitment and preferences about work. To date, researchers have learned that more RNs work in hospitals than any other settings early in their careers―nearly nine in ten (88.3 percent) work in hospitals six to 18 months after being licensed and 78.8 percent work in hospitals 31 to 54 months after licensure. The study has also revealed that nearly one in five (18.1 percent) new nurses leave their first employer within a year of starting a job and more than one in four (26.2 percent) leave within two years. Nine in ten of those who leave stay in the nursing field.

Subsequent studies will determine why nurses stay in or leave their jobs, what influences their first job choice, how the job settings they work in vary over time, and whether they move in and out of nursing.

The Robert Wood Johnson Foundation focuses on the pressing health and healthcare issues facing our country. It’s the nation’s largest philanthropy devoted exclusively to health and healthcare and works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change.

Study: When Nurses are Safer, Patients are Safer

Posted in Hiring Nurses, Nurse Employers, Nurse Safety, Nursing, Nursing News

Making the workplace better for nurses turns out to not only benefit them, but their patients as well. United Press International reports:

Dr. Jennifer Taylor of the Drexel University School of Public Health found the safety climate was associated with both patient and nurse injuries, suggesting patient and nurse safety may be linked outcomes.

The study included data from a large urban hospital, including 28,876 patient discharges on 29 nursing units employing 723 registered nurses.

For each nursing unit, researchers collected nurses’ responses to a survey of safety attitudes — a measure of safety climate — as well as hospital-reported nurse and patient injury data collected the following year.

Patient injury data included commonly-preventable hospital injuries: falls, pulmonary embolism/deep vein thrombosis and decubitus ulcers — pressure ulcers or bedsore. Nurse injury data included needle-sticks, splashes, slips, trips and falls.

 

The study, published in the BMJ Quality and Safety, found the increased turnover of nurses should be considered a risk factor for nurse and patient injuries. With each 10 percent increase in a unit’s nurse turnover rate, researchers observed a 68 percent increase in the odds of nurse injury, as well as increased patient risk for pulmonary embolism/deep vein thrombosis.

This makes a lot of sense; notice that “falls” appear on both lists, for example. (If the floors are slippery, both nurses and patients are at risk.) This highlights the importance of good recruiting and employee retention practices in terms of safety in the workplace.

 

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