Hospitals don’t have enough safety devices

Regulations may keep devices from nurses

Lack of government regulation in some key areas is keeping safer devices from nurses, an on-line survey by the American Nurses Association (ANA) suggests. Fewer than half of the 4,826 respondents reported having access to lifting and transfer devices. Some 60% said their facilities continue to use latex powdered gloves, which have been associated with greater sensitization to latex proteins.

Yet only 18% said they still don’t have safe needle devices for injections, IV insertions, or phlebotomy. That is the only one of the three areas that is covered by federal legislation and regulation, notes Karen Worthington, MS, RN, COHN-S, occupational safety and health specialist at the ANA in Washington, DC. "What this seems to bear out is that without regulation and enforcement, health care facilities may not be taking the initiatives as seriously as they need to be made to protect nurses," she says.

The result is injured and stressed out workers who may ultimately leave nursing, Worthington says. For example, 83% of respondents said they continue working despite experiencing back pain. More than 70% cited the acute and chronic effects of stress and overwork as one of their top three health and safety concerns. Although the survey isn’t a representative sample of nurses around the country, the demographics of respondents closely match the National Sample Survey of Registered Nurses, conducted by the Health Resources and Services Administration, Worthington says. About 70% of the respondents have worked in nursing for more than 10 years; 53% work in acute care hospitals.

In many ways, the survey confirms the hazards that have received increased attention over the past few years. After stress and overwork, nurses were most concerned about suffering from a disabling back injury and contracting HIV or hepatitis from a needlestick injury. Those concerns impact both the retention of nurses and quality of care, respondents indicated. Some 31% of nurses said health and safety concerns would influence "to a great extent" their decision to continue in the field.

About a third said "unsafe working conditions interfere with [the] ability to deliver safe, high quality nursing care" to a great or a moderate extent. About a third of respondents (38%) said their employers were not keeping them adequately informed about dangerous or unhealthy conditions they may be exposed to at work.

Strive to improve working conditions

"The message to nursing leaders of this country was absolutely include strategies for improving health and safety [in the] consideration of all working conditions," says Worthington. "This is an integral part of what nurses are looking at when they consider working at your health care facility."

The survey validates the need to continue working to reduce certain risks, agrees Elise Handelman, RN, MEd, director of the office of occupational health nursing at the Occupational Safety and Health Administration (OSHA). For example, 17% of nurses reported having been physically assaulted in the past year. OSHA recently held a workshop on workplace violence in psychiatric hospitals as part of an outreach program to encourage facilities to address this issue, Handelman says. (See HEH, October 2001, "Stop the violence: Assault risk high for health care workers.")

Should back pain be expected?

The high percentage of nurses working with back pain indicates they are at risk of cumulative trauma that could lead to serious injuries, she notes. "Nurses have for years been told [back strain] is part of the job. It is so widespread people almost don’t comment on it until it gets to the point where it’s incapacitating. We’re trying to change that perspective and let them know it doesn’t have to be part of the job. There are ways to design out the risk."

The survey also shows nurses are willing to adapt to using safer devices, Handelman notes. Some 92% said they use needle safety devices whenever possible. "Obviously, it’s clear the workers are willing to support these kind of design changes and use them when provided."

[Editor’s note: OSHA’s office of occupational health nursing provides technical support to employee health departments around the country. They can be reached at (202) 693-2120.]