Nursing Staff in Hospitals and Nursing Homes Is It Adequate? (1996) / Chapter Skim
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Nursing Injury, Stress, and Nursing Care
Nursing Injury, Stress, and Nursing Care
Pages 503-532
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These relatively hazardous occupations include male-dominated work, such as construction and transportation; female-dominated activities, such as nursing care and housekeeping services; and gendershared activities, such as assembling products. Nurses' aides (NA)
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From page 504... ...
Also, there is evidence that stress related to work overload and staffing patterns, including shift work, can and does contribute to illness and injury in the nurse population (Jung, 1986; Phillips and Brown, 1992~. Many factors such as the physical work environment, organizational and institutional characteristics, and personal work practice habits contribute to health care workers' occupational risk for hazard exposure and the resultant injury and stress that occurs (Rogers and Travers, 1991~.
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retrospectively investigated occupational injuries among 9,668 university health science center and hospital employees during a 32-month period. During this time,1,513 injuries were reported with the most frequent being needlestick injuries (32.1 percent)
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From page 506... ...
Instructional methods on body mechanics, transfer maneuvers, exercise, and stretching were provided to the intervention group. Prior to the intervention, information specific to back pain and injury was collected, resulting in the following data: 86 percent reported work-related back fatigue; 74 percent reported that back pain interfered with the quality of work performance; 55 percent reported lost work time; 32 percent reported lost time of more than 3 days related to the injury; 60 percent required medical intervention; and 91 percent reported that patient handling put them at risk.
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units. For nurses working on the GH unit, 48 percent reported work-related back pain and 19 percent had lost work time, compared to 33 percent and 9 percent of the OD nurses, respectively.
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Evidence is clear that back pain and injury are a major problem in nursing, and they affect all practitioners who handle patients. The effect of these injuries can be measured in worker pain and suffering, disability, lost work time, absenteeism, medical care costs, personnel replacement costs, decreased productivity, and anger and confusion.
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Needlestick Injuries and Exposure Risk A new era of concern about occupational hazards for health care workers began in 1984 when the first case of human immunodeficiency virus (HIV) transmitted by needlestick injury was reported in The Lancet (Jagger, 1994a)
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of RNs and LPNs, needlestick injuries were the most frequently reported (69 percent and 50 percent respectively) and lifting injuries accounted for the most lost work time.
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In a somewhat contrasting study, van Servellen and Leake (1994) conducted a convenience sample survey of 153 hospital nurses from 7 California-based hospitals who provided nursing care to AIDS patients.
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Adequate evaluation of injury prevention programs is essential in order to determine the effectiveness of interventions, and continued research is critical to measure outcomes in terms of increased injury rates, attitudes and behavior, and intervention effectiveness. VIOLENCE TOWARD HEALTH CARE WORKERS An emerging occupational health concern related to both injury and stress in the workplace is the risk of violence in general and toward health care workers.
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Violence toward all health care workers appears to be on the rise (Lanza, 1992; Lipscomb and Love, 1992~. Some have speculated about the cause for the increased violence in hospitals.
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Risk factors such as poor staffing patterns, reduced staffing levels, and violence containment issues must be addressed by management in order to afford a safe work environment and reduce the emotional impact of this type of violence on workers. STRESS AND NURSING Packard and Motowidlo (1987)
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Medical Center ICU (MC-ICU) nurses reported more depression, hostility, and anxiety then did non-ICU nurses and nurses in the VAH critical care units (CCU)
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While there were no overall significant differences among the groups with respect to stress levels, significant differences did occur for subscales: ICU and hospice nurses perceived significantly more stress related to death and dying than did medical-surgical nurses; ICU and medicalsurgical nurses perceived significantly more stress related to floating than did hospice nurses; and medical-surgical nurses perceived significantly more stress related to work-overload and staffing than did ICU and hospice nurses. While the effects of job stress on the quality of patient and family care were not specifically addressed, stress management programs were encouraged, particularly in the area of death and dying, to alleviate burnout and facilitate more effective care.
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From page 517... ...
In addition, a sample of 155 members of the Association of Pediatric Oncology Nurses reported that the relapse or sudden death of a favorite patient was their greatest source of stress. The second most common stressor was a workload perceived as too great to give quality patient care (Emery, 1993~.
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From page 518... ...
Three predominant job stressors were examined and designated respectively as: the overload stressor, because it was composed of items that dealt primarily with conflict and overload due to too many expectations; the quality concern stressor, which included stress generated by poor quality of nursing staff, medical staff, and patient care; and the lack of support stressor, which included stress items measuring lack of support from hospital administration and from immediate subordinates, and difficult relationships with other departments. These executives perceived high role conflict, moderately high role ambiguity, and moderately high levels of depression symptoms.
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Shift workers have reported a lower sense of well-being with lower participation rates in social organizations, engagement in more solitary activities, higher incidences of family and sexual problems, higher rates of divorce than day workers, and decreased work performance. Gold and colleagues (1992)
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Using the Maslach Burnout Inventory, Kandolin (1993) studied 286 Finnish nurses to determine if burnout was more common among those who experienced shift work compared to those who did not.
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In another study by Dolan (1987) that comprised each of 30 psychiatric, general duty, and administrative nurses, the study subjects completed the Maslach Burnout Inventory and job satisfaction questionnaire.
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In this model, vocational nurses were given an 8-week education and orientation program termed the "licensed vocational nurse critical care specialty program." Certain aspects of direct and indirect nursing care were taught that were then to be considered tasks delegated to the licensed vocational nurse extenders. Evaluation of the program revealed statistically significant increases in nurse job satisfaction; perceptions of reduced workload and stress; a perception by RNs and physicians of increased nursing care quality; decreased RN turnover and sick time; and a positive perception of the role of the LPN in the critical care unit.
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From page 523... ...
The work of nurses is repeatedly cited as being highly stressful for its practitioners and can result in burnout. While inadequate staffing levels are considered the major cause of stress for nurses, other factors such as the dying and death of patients, work overload, shift work, decreased job satisfaction, inadequate resources, replacement orientation, role conflict, and lack of management support are frequently implicated as significant causes of stress and burnout in nursing.
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As nursing and nursing-related work is performed mostly by women, this clearly becomes an issue in the nursing work force. Because of a nearly $1 million cost associated with nursing absenteeism and concern about loss of productivity, quality of patient care, and decreased morale, an analysis of absenteeism was conducted in a 3-hospital system in the mid-southern region of the United States.
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. nJunes Stress Health status Bumout Turnover Absenteeism Job satisfaction Productivity FIGURE 1 Examples of factors affecting nursing and practice.
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From page 526... ...
Noncompliance with Universal Precautions Policy: Why Do Physicians and Nurses Recap Needles? American Journal of Infection Control 17(46)
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A Registered Nurse-Licensed Vocational Nurse Partnership Model for Critical Care Nursing. Journal of Nursing Administration 22(12)
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From page 528... ...
Perceptions and Beliefs of Nursing and Medical Personnel About Needle-Handling Practices and Needlestick Injuries. American Journal of Infection Control 14(1)
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Effect of Educational Programs, Rigid Sharps Containers, and Universal Precautions on Reported Needlestick Injuries in Health Care Workers. Infection Control and Hospital Epidemiology 12(4)
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Occupational Hazards to Health Care Workers: Diverse, Ill-Def~ned, and Not Fully Appreciated. American Journal of Infection Control 18(5)
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A Comparison of Sources of Nursing Stress and Job Satisfaction Among Mental Handicap and Hospice Nursing Staff. Journal of Advanced Nursing 13(6)
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Adverse Exposures and Universal Precautions Practices Among a Group of Highly Exposed Health Professionals. Infection Control and Hospital Epidemiology 11(7)
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