Respirator or mask? Occ health has answer
Webkit boosts competency on resp protection
Most occupational health nurses learn about respiratory protection on the job. They may manage the program, but still have little time to train their hospital’s employees about the difference between a mask and a respirator.
But thanks to the work of professional organizations, new, free resources are available to help guide them.
The American Association of Occupational Health Nurses (AAOHN) released a webkit with 10 modules and 1.5 units of continuing education credit for nurses. Its content was shaped by a survey of occupational health nurses conducted with the Association of Occupational Health Professionals in Healthcare (AOHP), the American Board of Occupational Health Nurses (ABOHN) and the American Nurses Association (ANA).
"There was a gap in the education," says Annette Byrd, RN, MPH, educational consultant to AAOHN, who noted that many occupational health nurses said they felt uncomfortable with their ability to create policies related to respiratory protection.
The new resources could become a foundation for education of nurses in selecting and using respiratory protection and managing PPE programs, says Debra Novak, RN, DSN, senior service fellow with the National Personal Protective Technology Laboratory (NPPTL) of the National Institute for Occupational Safety and Health (NIOSH).
"We want this to be available for schools of nursing to include in their curriculum for the next generation of health care providers," she says.
Confusion about N95 use
Frontline nurses are often confused about what type of protective equipment they need and how to wear it, according to a study involving 98 hospitals in six states. In REACH II (Respirator Use Evaluation in Acute Care Hospitals), about 1,500 health care workers and managers were surveyed about respirator use. They were "least knowledgeable" about scenarios involving seasonal influenza and aerosol-generating procedures and a suspected or confirmed infectious disease that required airborne precautions.1
In other words, health care workers were most uncertain about when to use N95s. Observations also showed that many health care workers don’t know how to properly don or doff respirators.
Occupational health nurses need to help fill the gap in training and education, an Institute of Medicine panel said in 2011. The panel called on occ health nurses to "take responsibility for achieving and maintaining knowledge and skills in respiratory protection that are appropriate to their scope of practice. They should provide instruction and demonstrate leadership in motivating others to use respirators appropriately."2
The panel specifically named AAOHN, and the association responded. "They challenged us to do a survey and to find out what the real situation was," says Byrd, "and then to develop materials, disseminate those materials widely and work with organizations and institutions to get information and training into educational curriculum."
A survey of about 2,300 occupational health nurses found that most (83%) felt they were competent, proficient or expert in respiratory protection. But that overall comfort level dropped off when occupational health nurses were asked about explaining the difference between a surgical mask and an N95 respirator. Some 28.5% of the respondents said they had little or no comfort with that task.3
Eight aspects of competency
The webkit is based on the OSHA Respiratory Protection standard and incorporates information from NIOSH and California. It is free, but requires users to register. (www.aaohn.org)
There are three levels of competency (competent, proficient and expert) and the following eight categories:
- clinical practice
- workplace surveillance
- regulation and litigation
- management/ business/leadership
- health promotion and disease prevention
- health and safety education/training
- research
- professionalism
HCWs protect themselves, patients
The required elements for a respiratory protection program include: Procedures for selecting respirators; medical evaluation of employees; fit-testing for tight-fitting respirators; procedures for use of respirators in routine and emergency situations; procedures to ensure adequate air quality, quantity, and flow; training employees about potential respiratory hazards in routine and emergency situations; training employees in the proper use of respirators; and program evaluation.
"The educational module we developed will help you become more proficient," says Byrd, who notes that there is valuable information even for occupational health nurses who are knowledgeable about respiratory protection. For example, the webkit provides resources to draft respiratory protection policies.
Eventually, Byrd says she would like to see the materials incorporated into nursing curricula "so every nurse realizes how to use a respirator to protect themselves and to protect their patients."
- Stradtman L, Krah J, and Novak D. Reaching towards a healthier, safer workplace: NIOSH looks at healthcare worker familiarity with recommended respiratory protection practices. NIOSH Science Blog, June 26, 2014. Available at http://blogs.cdc.gov/niosh-science-blog/2014/06/26/reach/.
- Institute of Medicine. Clever LH, Rogers B, Schultz AM and Liverman CT, eds. Occupational Health Nurses and Respiratory Protection: Improving Education and Training Letter Report. August 2, 2011. The National Academies Press, Washington, DC.
- Burgel BJ, Novak D, Burns CM, et al. Perceived competence and comfort in respiratory protection: Results of a nationwide survey of occupational health nurses. Workplace Health & Safety 2013; 61:103-115.
Understand, reduce HCW absenteeism
Why do most workers call in sick?
The answer should restore a little of your faith in humanity. For the most part, health care workers call in with legitimate illness.
In an era when the media image of nurses and other health care workers is tainted by cynicism, that conclusion may be somewhat surprising, but a recent study found that almost three-quarters of workers who call in sick are indeed suffering an illness.1
"I worked in occupational health in a hospital for 13 years and have been working in occupational health in manufacturing for 12 years, so I’ve seen a number of employees who have missed time from work," says Candace Sandal, DNP, MBA, an occupational health nurse practitioner who was principle author of the study about workers using sick time.
"It turns out that workers really are sick when they say they’re sick," Sandal says. "I found in the study that workers do feel guilty when they miss work and they consider the impact it will have on their coworkers."
Investigators surveyed students of a large university who held jobs in various industries.
"We chose a university so the study wouldn’t be linked to a particular workplace survey," she notes. "Of the people who responded, 73% said they call in sick because they are sick."
Of the 27% who called in sick when they were well, the non-sick reasons were varied, but included the need to take care of a sick child, disliking their job, and needing a mental health day, Sandal says.
The study’s findings suggest that hospital employee health programs could help reduce worker absenteeism through strategies that prevent and mitigate common worker illnesses, Sandal says.
"If they were in contact at the start of an illness then we can intervene and treat, so they don’t need to miss work," she says. Instead, what typically happens is people hang in there with a burgeoning cold or sinus infection or other illness until they get sicker and sicker and have to miss work, she says.
Sandal offers these suggestions for hospital employee health programs:
Educate staff about common symptoms and need for early treatment. Pamphlets could be placed in hospital work stations, listing common symptoms of early upper respiratory infections, gastrointestinal illness, eye diseases, and rashes, which could indicate chicken pox or shingles. It’s particularly important for hospital employees to report their symptoms early because of the potential of being contagious when working with or around patients, Sandal says.
Promote an on-site employee health clinic. When new employees are hired, it’s a good practice to give them a tour of the employee health clinic.
Meet with employees who have high rates of calling in sick. "It’s not always what it seems, and this is an occupational health nurse’s role not a manager’s role because managers shouldn’t get involved in health issues," she says.
Reducing stress in a stressful profession
Provide stress reduction education and programs: Every unit in a hospital has its own unique stressors, Sandal says. "I worked in ICU for a long time," she notes. "I understand that critical care stress, but I haven’t seen any research trend showing that one hospital unit is more vulnerable to stress than another."
Employee health can address hospital-wide employee stress by offering staff a stress reduction program. This could include providing a limited number of free visits with a provider who is skilled in stress reduction, on or off-site, she suggests.
Change health care worker’s "me-last" culture. Nurses and other health care workers often operate within a culture in which they care about everyone else’s health and welfare before thinking of their own, Sandal says.
Having an easily accessible onsite clinic for workers can help encourage them to seek help when they’re beginning to feel unwell.
"Employee health programs should advertise what they’re doing for workers and show the effect they’re having on that population," Sandal says. "It’s time and money well spent."
- Sandal CL, Click ER, Dowling DA, et al. The decision-making process of workers in using sick time. Workplace Health Saf 2014;62(8):318-324.
