Nursing Staff in Hospitals and Nursing Homes Is It Adequate? (1996) / Chapter Skim
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7 Staffing and Work-Related Injuries and Stress
7 Staffing and Work-Related Injuries and Stress
Pages 169-188
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From page 169... ...
Specifically the committee charge was to explore possible linkages between staffing levels and skill mix of nursing personnel and the incidence of work-related injuries and stress among nursing personnel. Nursing personnel work in a wide range of health services settings including hospitals, nursing homes, and ambulatory and community-based environments.
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From page 170... ...
Evidence also exists of abusive and violent behavior of staff toward patients, at times resulting from stress and overwork and at other times from a breakdown of quality controls and appropriate supervision. This chapter provides a brief overview of the incidence of work-related injuries in hospitals and nursing homes, violence and abuse of nursing staff, and violence and abuse directed toward residents of homes and stress among nursing personnel in hospitals and nursing homes.
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From page 171... ...
. Workers in nursing and personal care facilities had the highest rate of injuries among all private industries due to overexertion or falling to the same level (BLS, l995b)
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From page 172... ...
172 NURSING STAFF IN HOSPITALS AND NURSING HOMES TABLE 7.2 Percent Distribution of Nonfatal Occupational Injuries and Illnesses Involving Days Away from Work, for Selected Occupations and Worker Characteristics, United States, 1993 Nurse Assistants, Licensed Orderlies, All Registered Practical and Characteristics Occupations Nurses Nurses Attendants Total number of injuries and illnesses Sex Men Women Health services industry 2,252,591 31,422 66.2 32.7 91.0 15,014 103,944 Percent of total workers 8.2 4.6 10.5 94.6 88.9 Nursing and personal care facilities 4.0 10.2 32.4 57.6 Hospitals 5.0 77.5 51.4 20.8 Length of service with employer Less than 1 year 30.6 17.8 20.2 38.9 1 to 5 years 33.5 36.4 39.6 38.4 More than 5 years 26.5 35.5 29.7 15.0 Not reported 9.4 10.4 10.5 7.7 Nature of injury, illness Sprains, strains 42.6 62.1 64.7 65.5 Back pain 2.6 3.4 3.7 5.0 Part of body affected Trunk B ack Source of injury, illness Floors ground surfaces Health care patient Median days away from work 38.6 54.6 56.1 60.1 27.3 44.7 41.3 45.6 15.1 14.5 15.0 10.9 4.4 45.4 48.7 61.3 Days 6.0 5.0 5.0 6.0 SOURCE: BLS, Survey of Occupational Injuries and Illnesses, 1993.
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From page 173... ...
Nursing staff in hospitals and nursing homes, by the very nature of their work, are particularly vulnerable to the hazards of back injuries and associated pain. These injuries result in time lost from work, disability, reduced productivity, and expense of medical care, and staff turnover.
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From page 174... ...
The situation clearly suggests the importance of and need for more aggressive training related to the use of lifting devices and lifting teams especially for new employees, including ergonomic training in lifting techniques to prevent back injuries. Staffing levels in nursing homes have not kept pace with the increased demands for more and better-trained nursing personnel.
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From page 175... ...
Such efforts would improve the quality of life for health care workers and would represent a significant savings to the health care industry. Needlestick Injuries Needlestick incidents put nursing personnel at risk of contracting hepatitis B
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From page 176... ...
Further research is critical, however, to measure the outcomes and effectiveness of all such interventions. In summary then, the committee is struck by the high rates of injuries to nursing personnel in both the hospital and the nursing home setting but it only found conclusive evidence of a strong link between nurse staffing per se and injuries for the category of back injuries.
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From page 177... ...
in reducing the probability of certain types of injuries. RECOMMENDATION 7-1: The committee recommends that hospitals and nursing homes develop effective programs to reduce work-related injuries by providing strong leadership, instituting effective training programs for new and continuing workers, and ensuring appropriate use of existing and emerging technology, including lifting and moving devices and needleless medication delivery systems.
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From page 178... ...
Hospitals Workplace-related violence has been increasingly recognized as a particular problem for nursing personnel, especially in settings located in inner cities, and particularly in emergency departments and psychiatric facilities. The committee heard many reports during site visits and in testimony about assaults in hospitals, especially those located in inner cities, and particularly in emergency departments.
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From page 179... ...
These include limited training in the management of violent behavior (e.g., containing or restraining an assailant) ; staffing levels and patterns, including the use of agency nursing staff; and the day shift tour of duty.
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From page 180... ...
It also concludes that staff training in effective ways to control violent patients is essential as part of a long-term strategy by which health facilities and institutions can prevent or minimize the harms that may stem from violence and abuse directed at health care workers. Violence and Abuse Against Patients and Residents Physical, verbal, and psychological abuse can and does occur in all settings, from hospitals and nursing homes to personal residences, and it can be inflicted by family members as well as health care personnel (including nursing staff)
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From page 181... ...
, and more stressed (Heine, 1986~. Nursing home residents are very vulnerable, given that their average age is around 80 years, that many may be quite frail, and that many may be relatively isolated from family and friends.
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From page 182... ...
Although it recognizes that the main difficulties probably lie in the nursing home arena, it also takes note of the fact that employment of NAs and other types of ancillary nursing personnel in hospitals is increasing. In the end, the committee came to consensus on a broad recommendation concerning the responsibilities of health facilities in not employing problematic staff.
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From page 183... ...
WORK-RELATED STRESS Extensive information documents that nursing work is stressful and that it can lead to a variety of work-related problems such as absenteeism, staff conflict, staff turnover, morale problems, and decreased worker effectiveness (Doering, 1990; Hiscott and Connop, 1990; Rees and Cooper, 1992; Fielding and Weaver, 19944. Exacerbated stress can lead to burnout and turnover of nursing personnel.
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From page 184... ...
Other research studies on shift work also reported adverse effects on performance, workers' health, performance, and mental and physical fitness (Gold et al., 1992~. Nursing personnel who work with the elderly confront many complex and potentially stressful situations in nursing homes where the work is highly demanding and labor intensive.
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From page 185... ...
poor or low job satisfaction, which involves effective orientation of nursing personnel toward the work situation; and (4) work involvement, defined as the degree to which nursing personnel identify with their job.
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From page 186... ...
causal model, developed from research on work-related stress and morale among nursing home employees, highlights both the antecedents and consequences of stress. The investigators suggest a variety of interventions to address organizational responses to stress.
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From page 187... ...
Further, compelling evidence exists that social support serves to mitigate the adverse effects of stress and to reduce burnout among nursing staff (Constable and Russell, 1986~. SUMMARY The committee has reviewed the literature on work-related injuries, violence and abuse, and stress afflicting nursing personnel in hospitals and nursing homes.
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From page 188... ...
It also urges hospitals and nursing homes to develop and implement strategies to prevent or reduce the incidence of injuries, violence and abuse, and stress and burnout in these health care workplaces.
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