Nurse Safety: Have We Addressed the Risks?

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    sedlak, c. (september 30, 2004) "overview and summary: nurse safety: have we addressed the risks?" online journal of issues in nursing. vol. #9 no. #3, overview and summary. available:

    [color=#995522]overview and summary
    nurse safety: have we addressed the risks?
    carol a. sedlak phd, rn, onc
    guest editor
    article published september 30, 2004

    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 the first article, 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 the second article, 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 " 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 third 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 fourth article, needlestick and sharps injury prevention, 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
    Last edit by NRSKarenRN on Oct 8, '04

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  3. 21 Comments...

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    it's so interesting that you post this now... i was think about posting something similiar re: violence towards nurses...

    i was assaulted by a patient on my last set of shifts... this patient is a head injury patient (alert, oriented to person, sometimes place/time, RLA scale 4 to 5) who's in 4 point restraints and resistive to care at times, but usually not this aggressive... my co-worker and i were toileting the patient and the next thing i know, i'm being pushed out of the bathroom, cussed out and repeatedly hit (thank god they had neuro mitts on, because i actually would have been hurt otherwise)... i have no idea what set the patient off, but something did... and you couldn't reason with them at this point, so nothing i was going to say would help calm them down...

    i pulled the emergency call bell but it was one of those weird moments where there was no one at the front desk... no one answered it and, finally, i managed to snag two orderlies who were walking down the hall... i removed myself from the room (since i seemed to be triggering the patient) and let the 3 guys get the patient back in bed...

    we had a PRN order for Haldol for the patient, so i went to draw up the max dose (5 mg)... as i'm entering the room to give it, the attending just happened to be rounding (i had been telling the residents for the last few shifts that the patient's agitation was increasing for all staff, according to report, but they kept saying that they wanted to "move away from using Haldol to sedate him")... the attending totally gave it to the residents, saying that this patient obviously NEEDS Haldol and to listen to the nursing staff when they tell you about a patient's agitation level... he told me to give 10 mg now and repeat in 4-6 hours... one of the rare times i actually felt supported by a doctor!

    i was in total shock for about 20 minutes after this whole thing... i've been nursing since 2000 and i've never had a patient react like this to me before... it scared me, because i obviously wanted to protect myself, but i felt like i had to stay with this patient because they could seriously harm themselves if left alone... it was a catch 22... i didn't want to abandon the patient, but where does self-preservation fit into that?

    of course, i charted up a storm on the incident :chuckle and was advised by the NM that i could file assault charges... but honestly, this person isn't competent... you couldn't reason with them and even if they knew what they were doing was wrong, i don't believe that they could have controlled themselves (given their level of head injury and agitation at that point)... how could i file charges?

    goyavo likes this.
  5. 0
    This is one of the most important articles every posted here.
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    Quote from oramar
    This is one of the most important articles every posted here.
    I agree. Thanks Karen. Something I didn't see addressed in the artical is the exposure to toxic substances over a period of years...I wonder what that may do to us. All the chemicals we are exposed to, breathing, touching surfaces, the chemical hand cleaners, etc.

    I'm glad this issue is getting a hard look.
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    For the past three months I have watched one of my dear friends who is a nurse who was involved in a hostage crisis go from confident, love-her-job super nurse to I don't know if I can go back and try it again nurse. She was involved in jail take-over in Panama City, Florida and was not physically injured so she was not able to draw worker's compensation. She was a contract nurse with an agency when this incident happened. The nursing agency would not pay for her trauma counseling and told her she would have to reapply if she was not better in 90 days. Because she was physically able to work and not mentally able to return to work she was denied unemployment. These laws need to be changed. Got any ideas/suggestions?
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    Hi. I don't think that workplace safety is addressed properly in the work place. Wouldn't it make all of our jobs safer and less stressful if hospitals had a much more restrictive visiting time frame? ie less family and therefore less stress. I had someone "grab" me last year. He was upset because his wife hadn't urinated yet, after having a foley removed less than two hours previous. I had explained she had about 8 hours before she needed to urinate. Anyhow, I had a patient who had a respiratory emergency which took priority. He waited outside the room till I came down the hall put his hand on my right arm and shoulder and pulled me into the room, and squeezed very hard. I had black and blue marks all over my arm. Luckily no soft tissue damage to my shoulder. Actually it was so bad you could see the outline of his thumb and three fingers in the bruise on my arm. My manager was not very supportive. She said "it's always something isn't it"? And then being sarcastic she said "let's call the news". This coming from someone who is an RN herself. Anyhow, it became very political because I pressed charges against him. In the end she said that I could be terminated or I could resign. I chose to resign, and I left the facility. I know for a fact they put on my file "ineligible for rehire" because I spoke to human resources. So,,,,, I lost a job with really good state benefits because someone hit me and the manager was a apathetic.
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    By the same token, I can't bear the thought of being unsafe at work. I will never step foot on that campus again.
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    Two years ago I was working on PCU, we mostly took care of patients before and after a cardiac cath. I had a man who was just plain mean and nasty. I was warned that he was nice when his family was around, but could turn into a devil after they left. I wondered in around bedtime to check on him, see if he needed anything. A nurses aide just entered after me. He seemed ok, receptive for the offer. I told him I was just going to straighten out his blankets, ok he said. As I leaned forward to do it, he took his foot and rammed it into my throat knocking me into the wall and causing me to hit the wall with my head and right arm and then I just slid down the wall. I had no support from this hospital. I filed a assault charge against this man on my own in case of further injuries that could turn up. He got away with alot. I suffer from vertigo, which has still yet to be dx . This is a dangerous profession, I don't care what anyone says.
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    We all know that as nurses the patient consists of all the dynamics surrounding them including the family. Maybe our discipline should spend more time in patient and family teaching to decrease these incidents. Would risk management be a good place to begin developing a response to dissatisfied family/patients.
  12. 0
    Quote from clarity
    For the past three months I have watched one of my dear friends who is a nurse who was involved in a hostage crisis go from confident, love-her-job super nurse to I don't know if I can go back and try it again nurse. She was involved in jail take-over in Panama City, Florida and was not physically injured so she was not able to draw worker's compensation. She was a contract nurse with an agency when this incident happened. The nursing agency would not pay for her trauma counseling and told her she would have to reapply if she was not better in 90 days. Because she was physically able to work and not mentally able to return to work she was denied unemployment. These laws need to be changed. Got any ideas/suggestions?
    If your friend is suffering from, and I am sure she is, Post Traumatic Stress, she falls under the American's with Dissibilities Act. Now is the time for her to call a lawyer. If she is not getting treatment, please make sure she does. Trauma is not always physical.

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