Posts Tagged ‘healthcare workers’

There’s No Fairy Godmother For This Cinderella

Monday, July 13th, 2015

I’d like to make a bet with you. Here it is. I bet you will answer “Yes” to at least one of the following three questions:

  1. Do you know anyone who works as a Personal Care Aide or a Home Health Aide?
  2. Has anyone in your immediate family, now or in the last 10 years, been taken care of by a Personal Care Aide or a Home Health Aide?
  3. Do you personally know anyone who  now or in the last year employed the services of a Personal Care Aide or a Home Health Aide?

I like my odds. According to the Bureau of Labor Statistics, six of the ten fastest growing occupations from 2012 to 2022 will be in the health care industry and numbers two and three on the list are – you guessed it – Personal Care Aides and Home Health Aides, growing by 49% and 48%, respectively, closely following Industrial-Organizational Psychologists, a profession that is expected to grow by 53% during the ten year period.

While Psychologists are projected to have the greatest rate of growth, they’ll only be adding about 900 jobs to the economy. This is dwarfed by the numbers of new jobs for the Aides, 581 thousand and 424 thousand, respectively. Taken together, they’ll be adding more than a million workers to the economy. A hefty number, indeed.

The rate of injury for both of the Aide groups is 2.5 times the rate for all public and private sector workers.¹ You would think that would get somebody’s attention, maybe somebody at OSHA, for example. And, you know what? It did. This from OSHA:

The Occupational Safety and Health Administration (OSHA) announced a new National Emphasis Program (NEP) to focus outreach efforts and inspections on specific hazards in nursing and personal care facilities with high injury and illness rates.

“Nursing and personal care facilities are a growing industry where hazards are known and effective controls are available,” said OSHA Administrator John Henshaw. “The industry also ranks among the highest in terms of injuries and illnesses, with rates about two and a half times (emphasis added) that of all other general industries. By focusing on specific hazards associated with nursing and personal care facilities, we can help bring those rates down.”

Only one problem with that: It was written exactly 13 years ago this month!

Now read this:

Non-fatal injuries to health care workers requiring days away from work are on the rise, according to new data from the Bureau of Labor Statistics released Nov. 9, and OSHA Administrator Dr. David Michaels has vowed to launch a National Emphasis Program on Nursing Home and Residential Care Facilities.

“It is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness,” said Michaels.

According to BLS, the incidence rate for health care support workers increased 6 percent to 283 cases per 10,000 full-time workers, almost 2.5 times the rate for all private and public sector workers (emphasis added) at 118 cases per 10,000 full-time workers. The rate among nursing aides, orderlies and attendants rose 7 percent, to 489 per 10,000 workers. Additionally, the rate of musculoskeletal disorder cases with days away from work for nursing aides, orderlies and attendants increased 10 percent to a rate of 249 cases per 10,000 workers.

“The rates of injuries and illnesses among hospital and health care workers underscore OSHA’s concern about the safety and health of these workers,” said Michaels.

That was written by OSHA in November, 2011.

A National Emphasis Program is becoming kind of predictable for OSHA. Maybe we’ll see another one around 2020. Until then, or until ever, Personal and Home Health Aides will be the Cinderellas of the health care universe. Except their story won’t have a “happy ever after” ending, and they’ll never get to meet a Prince.²

 

¹ And this rate of injury does not include the thousands of Aides who are hired to take care of Grandpa and Grandma in the home and who are paid minimum wage.

² Paying lip service to this issue goes back at least as far as 1997 when the BLS, using 1994 data, published an Issues Paper, and said this:

Overall, the 1994 injury rate in home
health care services (474 lost workday
cases per 10,000 workers) is about 50
percent higher than the injury rate in
hospitals, the institutional setting from
which many home-care patients are
released, and 70 percent greater than the
national rate.

 

Related: A Living Wage For Caregivers, New York Times, 10 July 2015

 

Ebola, Workers Comp, worker safety & other insurance considerations: an A to Z industry round up

Wednesday, October 22nd, 2014

What’s the verdict on Ebola and workers’ comp? We’ve gathered a roundup of what industry leaders are saying on this topic, as well as broader insurance issues. While Ebola and workers comp claims might be a relatively negligible issue, the larger issue of protecting workers from infectious disease is always one worth considering. Plus, there are other ways that Ebola may impact the business environment in general and business insurance specifically: business travel, supply chain disruptions, business interruptions, liability, malpractice and new coverage options, to name a few considerations.
Workers at highest risk would be health care and humanitarian workers in the countries most directly affected, Here in the U.S., hospital staff, public health personnel, humanitarian workers and first responders would be on the front lines for any additional outbreaks. Other workers with potential exposure might include waste disposal workers, cleaning staff, morticians, laboratory researchers and scientists, airline workers and business travelers.
Before we look at some of the insurance and prevention considerations, a little perspective from Vox by way of a brief and compelling video.
But remember, when you scare people enough, facts don’t always matter. Case in point: A Maine teacher who was placed on leave after visiting Dallas — even though she had no contact whatsoever with anyone associated with the Ebola outbreak. Journalist Maryn McKenna logs more Ebola overreactions under the category of Ebolanoia on her blog “Further Adventures of Germ Girl.” (Her articles on Ebola at Wired at worth following.)
Ebola, Workers Comp & Other Insurance Considerations
Christopher J. Boggs of Insurance Journal takes a nuts & bolts look at the two-part litmus test of compensability under workers comp and how Ebola claims would stack up in Is Ebola Compensable Under Workers’ Compensation?
Dave DePaolo looks at Ebola & Work Comp and expresses concern about our capacity to handle an outbreak, noting that “If ever there was a situation where there should be no distinction between workers’ compensation medical treatment and general health, the current Ebola situation is it. Delivery of medical care in workers’ compensation is just fine for broken bones, even for something like black lung disease.
The way medical care in workers’ compensation is delivered creates a real, and significant, national health problem when confronted with a potential pandemic like Ebola.”
Katie Siegel of Risk & Insurance says that although risk to US health care workers remains low, an Ebola outbreak could pose a workers’ comp risk to the industry: Ebola’s Impact on the Health Care Industry
MARSH offers an overview of Six Types of Insurance Coverage That May Apply to Ebola, with workers’ comp at the top of the list.
Dr. Steven N. Weisbart, CLU discusses the insurance industry ramifications of the spread of the Ebola virus, from life/health implications to property/casualty in Insurance Information Institute: Facts and Perspectives on the Ebola Pandemic .
Logan Payne of Lockton has issued a whitepaper, Ebola Outbreak: Risk Management and Insurance Considerations. He looks at the real impact on companies with operations in the affected areas: “…oil and gas operators, mining companies, and humanitarian aid organizations as well as those who rely on the raw materials or commodities in the area. The outbreak of Ebola has caused curfews to be enforced in countries like Liberia as well as voluntary evacuation of employees by many companies, causing work sites and retail locations to completely cease operation. Global supply chains have been disrupted as ports and borders are partially or completely closed, and companies across Western Africa have closed their doors. In general, many companies have seen an abrupt halt in productivity coupled with a rise in prices for many critical services in countries like Liberia, Sierra Leone, and Guinea.”
Melissa Hillebrand of PropertyCasualty360 offers a list of what you may not know ib 30 Ebola facts that will make you cringe, plus 7 ways to manage the risk. She covers how how the Ebola virus impacts economies and supply chains, insurance issues including evacuation, exposures and policy exclusions, and what you and your companies can do to prevent and control Ebola risk.
Arthur D. Postal of Property Casualty 360 looks at what Ebola will mean for the P&C industry over the long term.
At Business Insurance, Douglas McLeod says that Ace excludes Ebola claims for some new and renewal general liability policies. Sarah Vesey discusses new insurance coverage options related to Ebola: Brokers launch business interruption cover for Ebola, other pandemics
Related: Ebola: Insurance’s new way to deal with an outbreak and Businesses wrestle with insurance in Ebola’s wake
Joe Palazzola of the Wall St Journal Lawblog explains why Ebola suits against Texas Hospital likely wouldn’t be easy to win.
Thomas Benjamin Huggett of Littler looks at The Ebola Exposure: U.S. Workplace Considerations
Michael Oliver Eckard and Jean Kim of Ogletree Deakins discuss Emerging Concerns for Healthcare Facilities and Employers
General Information on Ebola
CDC: Ebola
Facts, FAQs, signs & symptoms, transmission, prevention, treatment, clinical guidance, updates & more
WHO: Ebola Virus Disease
Here’s how you can (and can’t) get Ebola
15 charts, maps, and photos that explain the Ebola outbreak
Worker Health & Safety
National Institutes on Health: Ebola Virus Disease: Information for U.S. Healthcare Workers
NYCOSH: Essential Information for Aircraft Cabin Cleaners and Cargo Handlers
NIH: Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries
CDC: Health care workers: Could it be Ebola?
CDC: Detailed Hospital Checklist for Ebola Preparedness
MA Nursing Association- Ebola: Screening and Managing a Patient While Protecting Yourself
OSHA: Ebola
WHO: Ebola Virus Disease: Occupational Safety and Health – joint WHO/ILO briefing note for workers and employers
NYCOSH: Essential Information for Workers
Ebola Medical Waste Management
Travel health notices
Infectious Diseases Related To Travel
In closing, Josh Cable of EHS Today reminds us that risk is relative. He offers a gallery of Safety and Health Threats that Are Deadlier than Ebola

Patient Handling: Another Big Log on the Healthcare Fire

Tuesday, November 26th, 2013

Muscular Skeletal (MS) injuries to nurses and nursing aides have become an epidemic in America. At least, according to the American Society of Safety Engineers (ASSE) recent Safety Culture in Healthcare, The $13 Billion Case, a peer-reviewed feature in the October issue of Professional Safety, the Society’s journal .
The article’s author, Scott Harris, Ph. D., MSPH, says, “Pick any other industry, and the injury rate is less.” And he’s pretty much right.
Patient handling is the driver. According to NIOSH (National Institute for Occupational Safety & Health), the most a nurse or aide in the 90th percentile of strength should lift at any one time is 46 pounds. But a typical 8-hour workday in this field involves lifting about 1.8 tons. Twelve percent of registered nurses who quit the field report that they do so because of back pain due to patient handling.
This resonates with me. Lynch Ryan opened its doors in 1984. Our very first paying client was a community hospital, where patient handling injuries had caused the hospital’s experience modification factor to balloon to 2.77. Working with the nursing staff and Human Resources VP, we were able to introduce necessary management policies and procedures as well as a sophisticated modified duty program that cut workers comp losses by more than 80%. However, the muscular skeletal injuries kept happening, because patients kept having to be moved. So, the hospital bought two Hoya Lifts – yes, there were Hoya Lifts in 1984.
Getting staff to use the Hoya Lifts was an entirely different problem. It was actually harder than creating and systematizing the modified duty program, because using the lifts significantly increased the time it took to move the patient, and one thing nursing staff didn’t have a lot of, and still don’t, was time. Instituting the new patient handling protocols involved a lot of training. We had to create rules, procedures, metrics and accountability. Even so, it was incredibly difficult.
Over the year’s we’ve worked successfully for more than 120 hospitals, from tertiary care systems to single site community hospitals. But regardless of how much we’re able to help reduce workers comp loss costs, the patient handling problem never goes away.
Back to the Future
Now, nearly thirty years from that first engagement, the only thing that seems to have changed is that the problem has become more dire, turning into an industrial many-head Hydra.
The average age of a registered nurse is now nearly 47. For Home Health Aides (HHA), it’s 46; for Certified Nursing Assistants (CNA), 39. Wages for the aides and assistants average between $11 and $12. Forty percent have been on food stamps and many get their own healthcare through Medicaid. (See: HHS Direct Care Workforce) The BLS (Bureau of Labor Statistics) estimates that the demand for HHAs between 2010 and 2020 will grow by 69%; CNAs, 40%. Collectively, we are confronted with a critical shortage of healthcare talent. According to the U.S. Department of Health & Human Services, “Direct care work is difficult, the wages are low and fringe benefits are often limited.”
It’s the same with registered nurses where, oftentimes, the shortage is self-inflicted. A study of 21 hospitals in the Twin Cities found that when registered nursing positions were decreased by 9%, work-related illnesses and injuries among nurses increased by 65% (Trinkoff, et al., 2005).
Nonetheless, the BLS reports that between 2010 and 2020 the fastest growing occupation in America will be Registered Nursing (HHAs and CNAs follow close behind). The need is an additional 1.2 million nurses. In 2011 one out of every five new jobs created in America was in Healthcare. We should be graduating 30% more nurses than we are per year. But a shortage of nursing faculty prevents nursing schools from expanding to accommodate the demand. In 2011, nearly 76, 000 otherwise qualified candidates were turned away by nursing schools. This means that there will be fewer nurses and aides to go around at a time when hospital populations are growing much larger (both in numbers and size), meaning that the stresses involving patient handling will continue to intensify.
Patient handling injuries account for 53% of healthcare workers compensation loss costs. The mean average costs are five times higher for injured employees over the age of 45 than for those under the age of 25. Muscular skeletal losses per full time equivalent are well over $300, regardless of age.
I asked Rick Graham about this. Rick is Corporate Director, Insurance & Risk Control for Crozer Keystone Healthcare System in Delaware County, PA, and a Lynch Ryan client. Patient handling bedevils Crozer Keystone in general and Rick in particular. Crozer, like many hospital systems has been wrestling with the issue for decades. Through Rick’s efforts, the system has introduced a number of initiatives to deal with the issue, and, while many have proven somewhat successful, the problem remains. Rick now concludes that the only answer is to remove the people factor from the lift factor.
He also realizes that having lifting equipment built into every patient room is the only way to significantly increase patient handling protocol compliance. The system has done this in an acute care setting and has seen a significant decrease in injuries and costs. It’s the simplest solution, but the costliest. Trained lift teams could work (they’ve been shown to in one California hospital study dating from 1997), but lift team members get hurt, too, and they present logistical difficulties. Rick estimates that the ROI from installing the equipment is two years, but the budget issue is still daunting.
The bottom line is this: As Crozer Keystone is demonstrating, the healthcare industry, confronted with a tsunami of personnel, safety and workers comp issues, has got to begin – finally – to meet these challenges with the resources necessary to overcome them. Anything less will send healthcare in America to a far worse place than the rocky place it now inhabits.

News roundup: risk, happiness, state fund in Illinois, new hire compliance & more

Wednesday, March 20th, 2013

Risk Roundup – Check out this week’s Cavalcade of Risk #179 – March 20th, 2013 Edition posted at My Personal Finance Journey
Taking care of business – At WorkCompWire, Joe Paduda poses the question What business are you in?” He hazards a guess that most of us would say “the insurance business” but he argues that we are really in “the medical and disability management business – with medical listed first in order of priority.” He suggests that, “Senior management misunderstands their core deliverable – they think it is providing financial protection from industrial accidents, when in reality it is preventing losses and delivering quality medical care designed to return injured workers to maximum functionality.” We could quote the whole thing, he makes a compelling argument so be sure to check it out. It echoes one of the Lynch Ryan founding tenets. When many of us got into this business, we did not come with insurance backgrounds. We felt at its core, managing injuries required a focus on the human event and not the dollars. We believed then and still believe now that if you took excellent care of the injured worker, got them quality medical care and helped them get well and back to work, the dollars would follow.
Smile – it’s March 20 – Did you know that March 20 is International Day of Happiness? Now you do. It’s also the first day or Spring, and if, like us, you wondered why Spring isn’t commencing on the usual March 21 date, Joe Rao at SPACE.com explains Why Spring Begins Early This Year.
New State Fund in Illinois?Illinois Bucks Trend in Other States; Looks to Establish Competitive Workers’ Comp State Fund – “Illinois state legislators are running counter to a national trend by proposing creation of a state workers’ compensation insurance fund that would compete with the private system. The development is generating deep angst amongst Illinois insurers and industry trade groups.”
Other state news

New Citizenship Verification form – As of 3-8-13, a revised US Citizenship & Immigration Service (USCIS) Verification Form I-9 has been issued. There is a 60-day grace period to come into compliance – new USCIS I-9 Formsforms must be in use by May 7, 2013.
When healthcare workers are unsafe, patient quality suffers – “Many medical work environments are unsafe for health professionals, adding stress and distraction that can expose patients to harm,” according Kevin B. O’Reilly who writes about a recent report by the National Patient Safety Foundation’s Lucian Leape Institute. In an article in amednews.com entitled Warning sounded on demoralized health care work force, he cites a high injury rate that is 33% higher than private industry as one factor, as well as “the lingering problem of disruptive behavior in health care, which can create a culture of fear and intimidation that inhibits safe, high-quality care.”
Fatalities Report – The March Monthly Labor Review has a report on Hispanic/Latino fatal occupational injury rates (PDF). The fatality rate for Hispanic/Latino workers is much higher than that of other demographic groups. Studies also show that, “… foreign-born Hispanic/Latino workers have higher rates than native-born Hispanic/Latino workers in certain occupations, a statistic that is explainable by differentials in employment between the two groups.”
Worker Costs – According to the latest Department of Labor report, the Northeast leads the U.S. in worker costs. “Hourly costs per employee in the Northeast – which includes the New England states, New York, New Jersey and Pennsylvania – averaged $33.10 in December, higher than the national average of $28.89. The next costliest region was the West, which consists of the mountain and Pacific coast states, at $30.29. The average hourly wage in the Northeast was $22.85, while the average per-hour employer cost in benefits was $10.25, both the highest in the U.S.”
More news of note

Report on violence & aggression to Maine’s caregivers; Injuries include bites, kicks, being hit

Wednesday, August 15th, 2012

When it comes to on-the-job assaults, healthcare workers are on the front lines. Earlier this year, NCCI issued a report on Violence in the Workplace, which showed that homicides and assaults are trending down. Good news, overall, but let’s take a closer look at assaults:

“The decline in the rate of workplace assaults has lagged the steady decline in the rate for all lost work-time injuries and illnesses. This reflects a notable change in the composition of the US workforce and, in particular, the ongoing increase in the share of healthcare workers, who experience remarkably high rates of injuries due to assaults by patients. This is especially common in nursing homes and other long-term care facilities. In fact, 61% of all workplace assaults are committed by healthcare patients. For assaults, coworkers make up just 7%, and someone other than a healthcare patient or coworker comprises 23%. The remainder is unspecified.”

Now, a new research report from Maine offers a close-up snapshot of the issue of workplace violence as it relates to caregivers. The Research and Statistics Unit of the Maine Department of Labor compiled data from First Reports of Injury for 2011 and issued a report on 2011 Violence Against Caregivers in Maine.
The report encompassed about 100,000 workers in healthcare and affiliated professions. Of the nearly 10,000 thousand injuries reported by those workers, 13.4% were related to violent and aggressive acts by patients and care recipients.
Key report findings include:

  • Where incidents occurred – Mental health care settings and other residential care facilities accounted for 52% of all violent/aggressive incidents in 2011. These were followed by nursing care facilities for the elderly and people with disabilities, 18.9%, and general medical and surgical hospitals and services, 16.8%.
  • What types of jobs were involved – Nurses at all levels (including nursing assistants) were involved in 21.27% of the cases; education technicians were involved in 18.6% cases; direct support professionals (personal care, hygiene, life skills, etc) were involved in 9.4% cases; Other occupations with significant numbers of cases included psychiatric technicians, behavioral health technicians and analysts, mental health and social workers and child care and senior child care workers.
  • What types of assaults occurred – The most prevalent type of assault – being hit – accounted for 21.3% of all incidents. Bites were the second highest reports, at 16.6%, of the incidents. Other identifiable assault categories included kicks, 9.45%, and being grabbed, 9.4%.

Due to the high number of bite incidents, a specific section of the report focuses on bite injuries and references information from the Federal Bureau of Prisons’ 2009 Clinical Guidelines regarding viral and bacterial exposures and the potential for infections if the skin is broken. The report also cites NIOSH publications and reports, including common risk factors for violence and a list of potential prevention strategies.
The full report is available in PDF: Maine’s Caregivers, Social Assistance and Disability Rehabilitation Workers Injured by Violence and Aggression in the Workplace in 2011.
(Hat tip to WorkersCompensation.com for pointing us to this news item.)

OSHA Announces National Emphasis Program for Nursing and Residential Care Facilities

Monday, April 30th, 2012

According to the U.S. Bureau of Labor Statistics, nursing and residential care facilities experienced some of the highest rates of lost workdays due to injuries and illnesses. In response to this, OSHA has announced a new National Emphasis Program for Nursing and Residential Care Facilities to protect workers from serious safety and health hazards that are common in medical industries. These hazards include exposure to blood and other potentially infectious material; exposure to other communicable diseases such as tuberculosis; ergonomic stressors related to lifting patients; workplace violence; slips, trips and falls, and exposure to hazardous chemicals and drugs. See OSHA’s complete directive PDF).
Safe Lifting
Injuries resulting from patient transfer and patient lifting are a particular area of concern. According to OSHA:

“The incidence rate for cases involving days away from work in the nursing and residential care sector was 2.3 times higher than that of all private industry as a whole, despite the availability of feasible controls to address hazards. The data further indicate that an overwhelming proportion of the injuries within this sector were attributed to overexertion as well as to slips, trips and falls. Taken together, these two categories accounted for 62.5 percent of cases involving days away from work within this industry in 2010. For this NEP, OSHA will target facilities with a days-away-from-work rate of 10 or higher per 100 full-time workers.”

According to the American Nurses Association, 12% of nurses leave the profession due to back pain. Nursing is one of the top 10 most hazardous jobs for injuries to muscles and joints. Many heavy labor industrial jobs have weight lifting limits of 50 pounds, yet nurses routinely bear many times that weight when transferring, repositioning or lifting patients. Nursing home workers in particular are at higher risk of injury than underground coal miners, construction workers, and tire manufacturers. Of the 16 million US workers employed in health care and social assistance, more than 3 million are employed in US nursing and residential care facilities.
NCCI study on safe lifting programs for long-term care facilities
A few years ago, an important NIOSH study on nursing home lifting equipment demonstrated that the benefits outweigh the costs. In addition to recapping the equipment investment in less than three years, NIOSH found a 61% reduction in resident-handling workers’ compensation injury rates; a 66% drop in lost workday rates; and a 38% decline in restricted workdays. Plus, the rate of post-intervention assaults during resident transfers dropped by 72%. Study authors found that the initial investment in equipment was recovered in less than three years based on post-intervention savings in workers’ compensation costs
More recently, further evidence was released via a study by NCCI: Safe Lifting Programs at Long-Term Care Facilities and Their Impact on Workers Compensation Costs (PDF). The study was a collaborative effort with the University of Maryland School of Medicine. It was limited to facilities that have had safe lift programs in place for more than three years. Originally, researches intended to compare the experience of facilities with and without such programs, but during the course of the research, the rate of adoption of safe lifting devices was so great that close to 95% of facilities had them and about 80% of those used them regularly.
NCCI summarizes the study results:

“After controlling for ownership structure and differences in workers compensation systems across states, the statistical analysis performed as part of this study shows that an increased emphasis on safe lift programs at long-term care facilities is associated with fewer workplace injuries and lower workers compensation costs. More precisely, higher values of the safe lift index are associated with lower values for both frequency and total costs. The safe lift index captures information on the policies, training, preferences, and barriers surrounding the use of powered mechanical lifts. The institution’s commitment to effectively implementing a safe lift program appears to be the key to success.”

According to the earlier NIOSH study, training alone is ineffective as a prevention strategy because “lifting the weight of adult patients is intrinsically unsafe.” It’s also important to note that the equipment alone won’t do it – workers also need to be trained how to use the equipment and management must implement and enforce a “zero lifting” policy.
Many states have safe patient handling laws
In recent years, a number of states have enacted legislation mandating safe patient lifting – and that no doubt has contributed to the rapid adoption rate noted by NCCI researchers. According to the American Nursing Association, a strong advocate for such legislation, 10 states have implemented safe patient handling laws. These include California, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. In addition, they are tracking 6 states with pending legislation currently: California, Illinois, Maine, Massachusetts, Missouri and Vermont.
Tools & Resources

Inadequate: Protections for mental health workers

Friday, August 19th, 2011

Sometimes, system redress seems painfully inadequate.
Such is the case with the $7,000 OSHA penalty recently imposed for inadequate safeguards related to the case of murdered mental-health worker Stephanie Moulton. $7,000 is the maximum fine available for “a serious violation of the agency’s “general duty clause” for failing to provide a workplace free from recognized hazards likely to cause serious injury or death.” It’s not just that the dollar amount seems paltry in light of the loss of life – it simply doesn’t seem substantial enough to have any deterrent value.
And in truth, while the OSHA citation points to the employer, one could make the case that the employer is also a victim of an economic squeeze play, which has resulted in inadequate staffing and safety controls. State budget cutbacks worry mental health workers – a scenario that is no doubt playing out throughout the country – in mental health budgets, in public safety budgets, and in regulatory enforcement, just to name a few areas that affect the health and safety of workers — and of the public.
Stephanie Moulton was working alone at one of the North Suffolk Mental Health Association’s group homes in Revere when she was brutally murdered by a patient with a violent record. A week later and just miles away at the Lowell Transitional Living Center, a shelter for the homeless, a worker named Jose Roldan was also killed by person who had slipped through the cracks in the mental health system. Both these murders were discussed in-depth in stories that appeared in The New York Times: A Schizophrenic, a Slain Worker, Troubling Questions recounted Moulton’s death, and Teenager’s Path and a Killing Put Spotlight on Mental Care discussed the case related to Roldan’s death.
An investigation into Moulton’s death resulted in the issuance of a report in June: Report of the Massachusetts Department of Mental Health Task Force on Staff and Client Safety. The report found that:

  • Years of budget cuts have negatively impacted service delivery and safety issues in the following areas:
    –Inadequate numbers of, and inadequate pay for, direct-care staff
    –Inadequate numbers of clinical staff with relevant training and experience
    –Deficiencies in the overall number of acute and intermediate hospital beds and community-based services and beds
    –Decrease in the role of psychiatrists and other highly-trained professionals in the care and treatment of individuals with the most serious mental illnesses
    –Requiring some staff to work under conditions that do not provide for adequate safety
  • There is an absence of system-wide use of a well-designed risk assessment process
  • There is lack of clarity in policies and procedures for incorporating risk variables into Individualized Action Plans
  • There is lack of sufficient access to and sharing of critical safety information
  • There is lack of adequate coordination of care across different components of the service system

OSHA’s citation includes recommendations the employer could take to address the workplace violence issue:

  • Creating a stand-alone written workplace violence prevention program that includes implementation of workplace controls and prevention strategies; hazard/threat/security assessments; a workplace violence policy statement outlining and emphasizing a zero tolerance policy for workplace violence; incident reporting and investigation; and periodic review of the prevention program.
  • Establishing a system to identify clients with assaultive behavior problems and train all staff to understand the system used.
  • Putting in place procedures to communicate any incident to staff so that employees without access to client charts are aware of previous violent or aggressive acts by a client.
  • Identifying the behavioral history of new or transferred clients, including conducting criminal and sexual offender records checks.
  • Conducting more extensive training so that all employees are aware of the facility’s workplace violence policy and where information about it can be found, including training employees to clearly state to clients that violence is not permitted or tolerated; how to respond during a workplace violence incident; recognize when individuals are exhibiting aggressive behavior and how to de-escalate the behavior; and identify risk factors that can cause or contribute to assault.
  • Installing and positioning panic buttons, walkie-talkies, recording security camera systems and smart phone GPS applications to better monitor employee safety and increase staff communication and support; implement and maintain a buddy system on at least the second and third shifts, based on a complete hazard assessment.

Mouton’s family is rallying for enactment of Stephanie’s law, which would mandate panic buttons in mental health facilities. A good start and one among recommendations issued by OSHA in their Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. But such measures may be woefully inadequate in the face of reduced staffing. In an ongoing climate of budget cuts and a strong public appetite for decreased regulatory controls, mental health workers are likely to continue being at greater risk — along with public safety workers such as police, firefighters, and healthcare workers, who also face dire staffing shortages.

Are nurses and health care workers facing more on-the-job violence?

Monday, March 14th, 2011

If you asked the average person to list professions with the highest rates of violent assault, few would put health care professionals high up on that list. But the reality is that when it comes to workplace violence, nurses, nursing aids, and paramedics have the dubious distinction of being very high up on the list; only police and correctional officers suffer a higher rate of on-the-job assaults. And many nurses say that the violence is only getting worse.
In a fact sheet on violence, The International Council of Nurses, a federation of more than 130 national nurses associations representing the millions of nurses worldwide, says that:

  • Health care workers are more likely to be attacked at work than prison guards or police officers.
  • Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.
  • General patient rooms have replaced psychiatric units at the second most frequent area for assaults.
  • Physical assault is almost exclusively perpetrated by patients.
  • 97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.
  • 72% of nurses don’t feel safe from assault in their workplace.
  • Up to 95% of nurses reported having been bullied at work.
  • Up to 75% of nurses reported having been subjected to sexual harassment at work.

Last fall, the issue of safety for nurses and allied health professional was brought to the forefront after the deaths of two California healthcare workers in separate incidents. In October, psychiatric technician Donna Gross was strangled to death and robbed at Napa State Hospital. Days later, nurse Cynthia Barraca Palomata died after being assaulted by an inmate at Contra Costa County’s correctional facility in Martinez. The deaths have sparked a new push for better security and stronger worker safeguards, particularly in settings treating prisoners and psychiatric patients.
While the occupational danger in environments like prisons and psychiatric hospitals is recognized and real, these are hardly the only high-hazard settings in which nurses work. Hospital emergency rooms are widely recognized as a hazardous environment, but violence occurs in other wards, too. Last year, the Well, a NY Times healthcare blog, featured an article by RN Theresa Brown entitled Violence on the Oncology Ward. And the CDC recently spotlighted research focusing on an increase in assaults on nursing assistants in nursing homes. In that study, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. There are no healthcare settings that are immune. Assaults routinely occur in general hospitals, in health clinics, and in patients’ homes.
The perpetrators of violence are varied: While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence brought into the workplace. And it’s unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.
Some are seeking legislative relief that would require hospitals and healthcare facilities to have safety and security plans and training in place. In a posting on KevinMD.com, respected physician Kevin Pho suggests that the rising tide of violence against healthcare workers might be emblematic of a dysfunctional health system, where healthcare is viewed as a commodity, and the caregiver-patient relationship is deteriorating. He says:

“Sometimes the simplest approaches are the most effective. Rather than adding security or installing metal detectors to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under stress when they are hospitalized or are angry because they’ve waited hours for medical care. At the same time, patients must realize that health care professionals are doing the best they can with an overtaxed health care system and should never resort to violence or abuse.”

In HealthLeaders Media, John Commins discusses an innovative approach undertaken by the University of Wisconsin Hospital and Clinics – a program to codify risk of hospital violence.
Recently, the Emergency Nurses Association issued a Workplace Violence Toolkit, targeted specifically at emergency department managers or designated team leaders.

The lighter side: medical people having fun

Friday, August 13th, 2010

Friday afternoon in August – who wants to be too serious? We think it’s the perfect time to deploy the secret stash of medical-humor related videos we’ve been collecting,
The first is a feel-good clip performed by staff at Providence St. Vincent Medical Center in Portland, Oregon to raise awareness for breast cancer.

The next clip is a Gilbert & Sullivan parody created by the Neuroscience Education Institute to be a little video played at the beginning of lectures presented by Dr. Stephen Stahl.
The Model of a Psychopharmacologist

The third clip is performed by the Laryngospasms, a group of practicing Certified Registered Nurse Anesthetists who create and perform medical parodies for audiences throughout the United States.

Other gems
The Colorectal Surgeon Song – OK, this is not performed by actual medical folk, but well worth a listen anyway!
UAB Emergency Room Tap – created by ER nurses for a National Nurses’ Week contest and celebration. UAB nurses and other staff members are featured in the video.
Breathe – another ditty by the Laryngospasms. More can be found at www.Laryngospasms.com
Footloose: Nursing School Style – Baylor Louis Herrington School of Nursing cuts footloose.

Readers reply: Premium comparison and safe patient handling

Friday, April 21st, 2006

State Premium Ranking – Thanks to Mike Manley for pointing us to the 2004 Oregon Workers’ Compensation Premium Rate Ranking Summary, which offers a comparison of premium by state. Mike is the Research Coordinator at the Information Management Division of Oregon’s Department of Consumer and Business Services. He also points us to some other workers comp studies that look very valuable – thanks, Mike.
Safe patient handling – Ann Hudson, RN, BSN commented on our recent post about Washington passes “Safe Patient Handling” legislation, noting that: “Substantial savings could be realized by insurance carriers and employers, and the nurse shortage could be eased, if workers’ comp carriers assisted employers to retain back-injured nurses in other non-lifting nursing positions.”
Her comment led us to the Working Injured Nurses Group or WING USA, a site that provides information, advice, and support to injured nurses. Anne is a founder of this group as well as co-author of Back Injury Among Healthcare Workers: Causes, Solutions, and Impacts. She has been active in championing the cause of back-injured nurses – both in terms of prevention and also in advocating for reemployment of injured nurses in positions that don’t require lifting.
We appreciate informed comments from our readers. If you have resources, information, or just opinions, we encourage you to jump in!