Posts Tagged ‘nursing’

One of the most dangerous jobs in America

Wednesday, February 11th, 2015

NPR featured the first in a series of reports on one of the most dangerous jobs in America, one that they say has more debilitating back injuries than the construction industry or law enforcement. In Hospitals Fail To Protect Nursing Staff From Becoming Patients, Daniel Zwerdling investigates the high rate of back injuries that plague the nursing profession, largely the result of poor patient lifting practices, which are greatly exacerbated by the obesity epidemic.

The impact of obesity cannot be overstated – nurses are required to lift or support morbidly obese patients as many as 15 to 20 times a day. NPR puts this in context, citing NIOSH manager James Collins: “… before studying back injuries among nursing employees, he focused on auto factory workers. His subjects were “93 percent men, heavily tattooed, macho workforce, Harley-Davidson rider type guys,” he says. “And they were prohibited from lifting over 35 pounds through the course of their work.”

Yet nursing employees in a typical hospital lift far heavier patients a dozen or more times every day. Tom Lynch discusses safe lifting limits in a prior post:

“… according to NIOSH 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.”

A Case in Point

Zwerdling talks to a number of nurses who discuss their injuries and how they happened. He focuses on the experiences of nurses at Kaiser Permanante in Walnut Creek, which he notes is no worse and perhaps better than many healthcare facilities. Although the hospital had dedicated lifting equipment and teams, there were not enough machines and not enough teams to staff them when needed. When patients need help, the need is often urgent and immediate.

Nurses who worked at Kaiser Permanante asked for a state investigation into lifting practices shortly after California’s 2012 Hospital Patient and Health Care Worker Injury Protection Act went into effect. In January 2014, a state Administrative Law Judge issued an order that declared that Kaiser had failed to have “specific procedures in place to ensure that sufficient staff was available to perform patient handling tasks safely.”

While this report is one that frames the issue in terms of nursing injuries, it’s also a safety issue for patients.

The American Nurses Association tracks legislation related to safe patient handling and mobility (SPHM). They note that:

“…eleven states have enacted “safe patient handling” laws or promulgated rules / regulations: California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii.

Of those, ten states require a comprehensive program in health care facilities (California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Rhode Island, Texas and Washington), in which there is established policy, guidelines for securing appropriate equipment and training, collection of data, and evaluation.”

Exacerbating Factors

In our prior post cited above, Tom talks about some additional factors contributing to the problem – the aging work force and nursing shortages.

“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).”

Related Resources:

Prior Workers Comp Insider posts highlight other dangers involved in nursing:

New study reveals occupational chemical exposure risks for nurses’ reproductive health

Tuesday, March 13th, 2012

Female nurses who have occupational exposure to sterilizing agents and chemotherapy drugs are at least twice as likely to have miscarriages as those who do not have such exposure. Elizabeth Grossman of The Pump Handle offers a summary of a recent study on chemical exposures and nurses’ reproductive health, which was conducted by the National Institute of Occupational Safety and Health, Harvard School of Public Health, and Brigham and Women’s Hospital. The study encompassed more than 7,000 female nurses.
Grossman notes:

Similar effects have been reported before, but this is one of the largest studies ever to look at these exposures, explained Christina Lawson, a reproductive epidemiologist with NIOSH and study author. Because these results reflect adjustment for a number of variables — including age, hours worked, and shift-work — and because the study was designed to avoid overestimation, its findings may be conservative, said Lawson.

While further studies are needed to determine the exact chemical exposures, high on the suspect list are a variety of chemicals used to disinfect medical equipment and surgical instruments, such as formaldehyde and ethylene oxide. In her post, Grossman also talks about the dangers of formaldehyde exposure to beauty salon workers, an issue that was a recent NIOSH Science blog focus: Hair, Formaldehyde, and Industrial Hygiene. Both the Food & Drug Administration and OSHA have issued particular warnings about the Brazilian Blowout, a highly popular hair straightening treatment.

Violence in healthcare: 61% of all workplace assaults are committed by healthcare patients

Monday, March 5th, 2012

According to a recent NCCI Report on Violence (summary) (Full Report, PDF), “the majority of workplace assaults are committed by healthcare patients.” While there is good news in the fact that workplace homicides and assaults are on the decline, the NCCI report says this:
“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.”
In a post last year on healthcare workers and on-the-job violence, we talked about some of the perpetrators:
“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.”

In the list above, we overlooked a huge and growing segment: elderly patients, patients with Alzheimer’s, and people suffering from mental illness.
Prevention Tools
OSHA: Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. See also the slide show overview version
The Emergency Nurses’ Association has issued a good Workplace Violence Toolkit.
We also found that WorkSafeBC has put together a series of excellent short video clips for various health care settings.




Risk, repackaged drugs, bizarre cases and other news notes

Wednesday, January 11th, 2012

Risk RoundupPolitical Calculations blog hosts this week’s Cavalcade of Risk, replete with a post rating system. Check it out.
Florida repackaged drugs issue redux – Dave DePaolo posts about a new effort to put a price cap on Florida’s repackaged drugs. He posits that changing economic and regulatory conditions might create a more favorable climate for passage. He also talks about how “capping the price of drugs has been hotly contested by the Florida Medical Association (FMA) and a company called Automated Healthcare Solutions (AHCS).” AHCS is a firm whose executives have contributed heavily to politicians to prevent such legislation. A Tampa Bay news report talks about how the state’s pill mill crackdown was held up by proponents of doc dispensing, including AHCS principals: “The two Miramar workers’ compensation doctors have helped pump about $3 million into the political system through a dozen companies in the past year.” A story in the Florida Independent covers an earnings report for top lobbyists, noting that, “Among the companies to have spent the most on lobbying is Automated HealthCare Solutions, a group whose co-chairmen have become fixtures on the political scene. According to the Current, Automated HealthCare has posted minimum lobbying expenditures greater than $300,000.” For more on why repackaging controls are needed, see Joe Paduda’s posts: Drug Dispensing by Docs and Repackagers and the myth of AWP.
The big five – Roberto Ceniceros reports that Top 5 workplace injury causes make up 72% of direct workers comp costs, according to a research report by Liberty Mutual Group. “Overexertion–or injuries caused by lifting, pushing, pulling, holding and carrying–costs businesses $12.5 billion in direct annual expenses and accounts for more than 25% of the national burden.” This was followed by falls on the same level, falls to a lower level, bodily reaction, and struck by object.
Violence in Nursing – In When it hurts to help, Victoria Ison reports on workplace violence in nursing. Many might assume most violence is perpetrated by patients or intruders but not so: “Assistant nursing professor Cindy Thomas said the most common form of violence currently seen in health care occurs between nurses. She said violence between physicians and nurses is second, and violence between patients and nurses is actually third most common.”
Strange suitsTop 10 Bizarre Workers’ Comp Cases for 2011. From an eye-related injury after hitting a bowling ball with a sledge hammer to a fall from a helicopter while attempting to capture a deer with a net – read Thomas Robinson’s picks for workers comp lawsuits with strange circumstances. Robinson reminds us that, “one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families.”
Brief takes

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.

Flighty Health Wonk Review and sundry other news blurbs

Thursday, August 5th, 2010

Jaan Sidorov has an air travel themed Health Wonk Review posted over at Disease Management Care Blog, which he calls “frequent flyer miles for your brain.” There’s a roundup of assorted news on the health care policy front ranging from a post on the growth of MinuteClinics to a look at hospital quality surveys. Get your dose of the news from some of the brightest braniacs in the health policy blogosphere.
Here are a few other health-care related news items we noted in our travels: Katharine Van Tassel of HealthLawProfBlog posts the disturbing news revealed via a survey that 36% of responding physicians don’t believe in reporting impaired colleagues. And at Managed Care Matters, Joe Paduda talks about the results of a Kaiser Health Tracking Poll that demonstrates the power of mis-information: “Half of seniors (50%) say the [heathcare reform] law will cut benefits that were previously provided to all people on Medicare, and more than a third (36%) incorrectly believe the law will “allow a government panel to make decisions about end-of-life care for people on Medicare.”
The Weekly Toll – If you haven’t visited in awhile, stop by The Weekly Toll to read about US workers who died on the job this past week. Many seasonal hazards are represented with a high toll of tractor and farming-related fatalities and construction-related deaths in this week’s grim list. And the list does not include the 8 employees of Hartford Distributors who were killed by a coworker.
Whistleblowers – Michael Fox of Jottings By An Employer’s Lawyer tell us that the difference between cloth and leather gloves is just over $1 million in his post about a Maine court’s ruling in favor of a whistleblower who was terminated after making complaints about safety and working conditions. Maine courts aren’t the only ones who are taking a dim view of retaliation against employees who report safety problems: at Today’s Workplace, Mike Hall posts that OSHA takes whistleblowers seriously and has established a website to offer a Whistleblower Protection Program.
Teen workers – Elizabeth Cooney writes about young employees who face injury or even death on the job in an article in the Boston Globe. Teens often are employed in some of the most dangerous jobs and have little in the way of training, as evidenced by the fact that the nonfatal injury rate for 15- to 17-year-olds in the United States was 5.2 per 100 full-time equivalent workers per year, double the rate for adults 25 and older. She discusses research from the state’s Teens at Work initiative, which revealed that of “208 teens under age 18 who had been injured at work from 2003 through 2007, about half said they had no safety training. About 15 percent said there was no supervisor on site when they were hurt. Almost a quarter said they had no work permit.”
Remarkable storyChrissy gets a new face from Work Comp Complex Care: “…her story of recovery is incredible on several levels – for the medical technology involved; for the reminder that dedicated health care professionals have the power to make a huge difference in a patient’s quality of life; and for the grace and attitude of the woman who suffered a devastating, life-changing injury and did not let it defeat her.”
Protecting football players – In Hitless or Witless?, Skip Rozin of WSJ.com discusses new NFL safeguards to protect football players from serious head injuries. Long overdue, and more is needed. The biggest hurdle will be overcoming the culture. As Rozin puts it “One of the biggest obstacles here is the athletes’ code of playing hurt.”
Nursing shifts – A new study from the University of Maryland-Baltimore reveals that long shifts pose health hazards for nurses – and may increase the risk to patients, as well. Study authors said that “the most common problems with an overemphasis on 12-hour shifts are needle-stick injuries, musculoskeletal disorders, drowsy driving, and other health breakdowns related to sleep deprivation.”
Legal briefs – In South Carolina, the court ruled that free living quarters offered as inducement for employment are considered wages. In a case involving horseplay, an Iowa court ruled in favor of a butt-shaking employee on appeal. A Washington court found that a fitness for duty test did not violate the ADA.
OSHA – Dwayne Towles of Advanced Safety Health News Blog warns employers that OSHA is scrutinizing safety incentive programs and may be asking for any written policies or details of any contests or promotions. They are looking for programs that might discourage employees from reporting injuries. Towles offers his thoughts for how to handle matters should OSHA come calling. And while on the topic of OSHA visits, SafetyNewsAlert offers additional suggestions in prepping for an inspection: top 10 dos and don’ts for OSHA inspections from 2 OSHA inspectors.

Health Wonk Review and other bloggy news notes

Thursday, September 4th, 2008

Hank Stern has posted a fresh roundup of news from the health wonkosphere over at InsureBlog – check it out: Health Wonk Review: Early September Edition.
ADA update – The folks at George’s Employment Blog has been keeping an eye on changes to the ADA. In July, George Lenard posted on what the ADA amendments will mean if they become law, and more recently, Karen Tofte has posted a second part in the series. She examines how the substantial limitation of major life activities element of the ADA’s definition of disability would be altered.
MA health care – Bob Laszewski of Health Care Policy and Marketplace Review comments on a recent NY Times editorial that looks at the Massachusetts health insurance experience and finds it less costly than expected. Bob points to some problems that must be factored in when assessing the program.
Technology risksErgonomics in the News points us to the article The Downside of Mobility: Injury: “As Wi-Fi–and laptops and mobile devices–become more ubiquitous, users from kids to adults find themselves suffering from injuries ranging from carpel tunnel syndrome to “BlackBerry thumb.” The first in a series of features and reviews on the ergonomics of Wi-Fi-induced mobility, this article offers tips on how to prevent injuries.”
Going and coming – Judge Robert Vonada of Pennsylvania Workers’ Compensation Journal reports that PA courts upheld compensability in the case of a home health nurse injured while traveling to her patient’s home. The case was complicated by the fact that she provided services to several employers in the course of her day.
Safety – BLR’s Daily Safety Advisor offers tips on Getting the most from your safety committee.

News roundup: health care reform, nursing safety, blog discoveries, retaliation, falls & more

Monday, June 25th, 2007

Health Care Reform – Joe Paduda was blogging the Democratic candidates’ positions on health care all last week. He offers a handy summary of where candidates stand on issues related to health care and offers his own prescription for the basics in health care reform. And in today’s post, he tells us what voters want in health care.
Nursing safetyMassachusetts nurses are seeking stronger protection against on-the-job violence. Fifty percent of the nurses responding to a 2004 Massachusetts Nurses Association survey reported being punched at least once in the previous two years. Many say the problems are getting worse, and are looking to the state legislature to extend protections. Lawmakers are considering a bill that would require hospitals to conduct an annual violence risk assessment and violence prevention plans.
Blog discovery – We are happy to see that Claire Wilkinson of the Insurance Information Institute is blogging at Terms and Conditions. Her most recent post (as of this writing) is a notice about a carrier evaluation survey conducted by Willis on performance metrics.
And speaking of nurses as we have today, it’s a good day to do a shout-out to Emergiblog, a nursing blog by Kim, a San Francisco-based nurse who deals with nursing-related issues and who often manages to infuse humor and style in her presentation. She also launched Change of Shift, a carnival for blogging nurses.
Falls in construction – rawblogXport reminds us of the heavy toll that falls take, particularly in construction. See our prior post on Falls and human fall traps: Fatalities in the construction industry.
Wrongful terminations – an in-house safety inspector was awarded $2 million in back pay, punitive damages and what the jury called “aggravation, inconvenience, humiliation, embarrassment and loss of dignity.” He was formerly employed at a mine owned by Massey Energy Co. and was fired after reporting safety problems at the mine to the federal Mine Safety and Health Administration. And in New Jersey, a forklift operator for Weyerhauser Company won an award of more than $600,000 because he was fired within two months of his having been injured on the job. Most states don’t take kindly to retaliatory firings. Jurors seem to like them even less.
Briefs

News Roundup: Health Wonkery, DBA, NLRB ruling, and more

Thursday, October 5th, 2006

Health Wonk Review – Joe Paduda hosts Health Wonk Review – the Harvest Moon Edition – a meaty issue with lots ‘o links to substantive posts. With 57 percent of the claims dollar going to medical costs, we are inextricably linked to the larger health-care market. HWR is a good way to keep an eye on the trends.
Additions to the blogroll We’re adding a few links to our blogroll in the sidebar: Labor and Employment Law Blog by George Kittredge and The HR Lawyer’s Blog by Texas labor and employment attorney Christopher J. McKinney – both are worth checking out.
Absolute Shocker of the Week – Worksafe Victoria’s construction safety program publishes weekly photos of dangerous construction work sent in by inspectors and subscribers so that they can be used for safety training or tool-box meetings. Safteng.net hosts and archives these Weekly Shockers and Bodgey Scaffolding photos.
Defense Base Act (DBQ) – The Defense Base Act extends workers’ compensation benefits to employees working for private employers affiliated with the military or certain government-related business outside the continental. Learn more about coverage and 10 Things You Should Know About the DBA. Actually, the article lists 17 things you should know. Regardless of the number, it’s a good overview.
Topical funThe Drugs I Need – an amusing animated music video clip about prescription drugs by the Austin Lounge Lizards.
NLRB rulings – Jordan Barab provides an in-depth analysis of the National Labor Relations Board’s recent Kentucky River rulings from the labor perspective. The rulings set parameters about who is considered a manager and who is considered an employee. Jordan discusses how this ruling excludes millions of workers – notably nurses – from union membership. He quotes extensively from the dissension offered by two Board members. Wilma Liebman and Dennis Walsh.

“Liebman and Walsh point out that the legislative history of the act distinguished between real supervisors “vested with such genuine management prerogatives as the right to hire or fire, discipline, or make effective recommendations with respect to such action ” and “straw bosses, leadmen, set-up men, and other minor supervisory employees.”

“… Walsh and Liebman note that unlike real supervisors, charge nurses do not have the ability to hire, fire or discipline, nor do they have any formal role in the employee grievance process. In addition, they spend the vast majority of their time in line work “a fact that strongly tends to establish their status as s minor supervisory employees.”

“… Today’s decision threatens to create a new class of workers under Federal labor law: workers who have neither the genuine prerogatives of management, nor the statutory rights of ordinary employees. Into that category may fall most professionals (among many other workers), who by 2012 could number almost 34 million, accounting for 23.3 percent of the work force.”