Hospitals with solid organizational practices and policies, including better ergonomic practices, have lower injury rates among nurses, a new study finds.
Lower injury rates also were reported by nurses in units where they described better safety leadership, greater safety diligence, stronger people-oriented culture, and higher social support from coworkers.1
"We were interested in finding out the extent to which policies and procedures that were implemented at the unit level affected reported injury rates," says Les Boden, PhD, a co-author of the study and a professor of public health at the Boston (MA) University School of Public Health.
"We looked at the number of injuries on different units where nurses and aides worked and we asked nurses and aides on those units to describe different aspects of the unit, including the support they received from their supervisors and coworkers, the safety leadership on the unit, ergonomic practices on the unit, and the unit’s culture," Boden explained. "Was the culture oriented toward thinking about the lives of people working on the unit?"
Researchers looked at injuries where employees missed work, as well as injuries where they did not take a day off from work. Ergonomic injuries caused the most days-away-from-work injuries, Boden notes.
"These were predominantly back and shoulder injuries," he says. "Most of the non-day-away-from-work injuries were sharps injuries."
Four positive factors
Nurses were positively impacted by four policies: safety diligence, people-oriented culture, safety leadership, and ergonomics. In hospital units where these four factors received positive reports from nurses, injury rates among nurses were lower, Boden says.
From a hospital employee health perspective, the findings suggest that overall hospital injury rates can be lowered with strong policies and education related to ergonomics. Also, hospitals can reduce injuries among nurses with further policies and practices, including promoting safety leadership and a people-oriented culture, Boden suggests.
The study evaluated the four factors in these ways:
Safety diligence: Researchers asked nurses and aides about housekeeping on the unit and whether there were unsafe working conditions.
"We asked whether supervisors confronted and corrected unsafe behaviors and hazards and whether action was taken when safety rules were broken," Boden says.
Safety leadership: "We looked at whether supervisors were trained in recognizing job behaviors and safe practices," Boden says.
People-oriented culture: "We asked whether employees on the unit are involved in decisions affecting their daily work and whether working relationships on the unit are cooperative," Boden says.
The questions also focused on trust between employee and employer and whether a unit’s communication is open and whether employees feel free to voice concerns and make suggestions, he adds.
Ergonomics: "We asked whether the work is designed to reduce patient lifting and to reduce lifting heavy equipment, pushing and pulling, and bending, reaching, and stooping," Boden says.
There’s an inherent variation in the risks of injury between units.
For instance, a neonatal unit will have less risk of injury from lifting patients. Also, an emergency department will have greater risk of injuries from sharps or exposure to infectious diseases. And a psychiatry department has greater risk of violence, Boden explains.
"But we found in addition to these differences there were policies that generally tended to be associated with higher or lower risk," he adds.
"We found in general that units that have a focus on identifying and correcting hazards on units and paying attention at the unit level to potential injury risk appear to make a difference," Boden says. "In addition, a hospital that has supervisors who work to improve -- not just the health and safety of staff -- but also to improve the culture of the unit and cooperation and trust, have an additional effect on safety."
OSHA: Report all work-related hospitalizations
New recordkeeping rule effective Jan. 1, 2015 requires OSHA report within 24 hours
If an employee is hospitalized for a work-related injury, employers must now report the incident to the Occupational Safety and Health Administration within 24 hours.
OSHA updated its recordkeeping standard in September to expand the type of serious injuries that must be reported promptly. The agency previously required the reporting when three or more employees were admitted to the hospital for work injuries from the same incident.
Employers also must report any amputations or the loss of an eye within 24 hours and any fatalities within eight hours. The new requirements become effective on January 1, 2015.
With the recordkeeping changes, OSHA also is moving toward electronic submission and public reporting. The agency will make the information about these serious injuries available on its website.
The reporting of these serious injuries will spur greater efforts for prevention and trigger dialogue between employers and OSHA, OSHA administrator David Michaels, PhD, MPH, said in a press conference.
"We believe that as a result of this interaction the employer will be more likely to take the steps necessary to protect the lives and limbs of their employees," he said.
In November 2013, OSHA proposed a rule that would require employers with 250 or more employees to submit their injury and illness logs electronically each quarter. OSHA said the electronic reporting would provide more complete and timely data about occupational injuries and illnesses. Critics say that such public reporting is shaming and may backfire as employers would become more reluctant to report. (See related article in HEH, December 2013, p. 133.)
[Editor’s note: More information on the new OSHA recordkeeping requirements is available at www.osha.gov/recordkeeping2014/index.html.]
- Tveito TH, Sembajwe G, Boden LI, et al. Impact of organizational policies and practices on workplace injuries in a hospital setting. JOEM 2014;56(8):802-808.
