Healthy Work Environments

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Healthy Work Environments
2008
Workplace Health, Safety and Wellbeing A
Cornerstone of Healthy Work Environments.

• Best Practice Guideline Panel
• Aug 13th, 2008
• RNAO Creating Healthy Work Environments Summer
  Institute,
• Delta Pinestone Resort

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WORKPLACE HEALTH, SAFETY AND WELL-BEING OF THE
NURSE A Summary of the RNAO BEST PRACTICE
GUIDELINE
3
Just a thought

• The adult human form is an awkward burden to
  lift or carry. Weighing up to 200 pounds or more,
  it has no handles, it is not rigid, and it is
  susceptible to severe damage if mishandled or
  dropped. When lying in bed, a patient is placed
  inconveniently for lifting and the weight and
  placement of such a load would be tolerated by
  few industrial workers.
• T.C. Tsolakas, J.P. Davies and S. Oram, The
  Nurses Load (Lancet, 1965)

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Learning Objectives

• Describe the core components of the Conceptual
  Model for Workplace Health and Safety and the
  Guideline Recommendations,
• Outline organizational programs and supports to
  promote/enhance the health, wellness and safety
  of nurses in their workplace,
• Discuss the impact of health, wellness and
  safety-focused environments for nurses on quality
  of outcomes for clients, nurses, organizations
  and systems,
• Discuss the potential uses and application of the
  guideline in the work setting.

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Panel Members

• Jill King
• Paul Howe
• Gurjit Sangha
• Sylvia Zanon Heacock
• Sue Bookey-Bassett
• Amy Taus
• Carolyn Hoffman

• Mary Ferguson-Paré (Chair)
• Mickey Kerr
• Janet Roberts
• Claire Mallette
• Theresa McMillan
• Penny Katz
• Brenda Marsh
• Sharon Chadwick

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Conceptual Model for Healthy Work Environments
for Nurses - Components, Factors Outcomes
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Guiding Principles

• Overall HWE model
• Literature related to Healthy Workplaces and
  impact on nurses health
• Occupational health and safety legislation
• Nurses connectedness with their work
  (well-being)

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Organization Practice Recommendations

• 1.0 Organizations / nursing employers create and
  design environments and systems that promote safe
  and healthy workplaces including strategies such
  as
• Creating a culture, climate and practices that
  support, promote and maintain staff health,
  well-being and safety.
• Ensuring that the organizations annual budget
  includes adequate resources (human and fiscal) to
  implement and evaluate health and safety
  initiatives.
• Establishing organizational practices that foster
  mutual responsibility and accountability by
  individual nurses and organizational leaders to
  ensure a safe work environment.

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Creating a culture, climate and practices that
support, promote and maintain staff health,
well-being and safety.

• Leadership and culture are critical to the
  successful establishment of healthy and safe work
  environments
• Staff safety and well-being ? patient safety and
  satisfaction
• Strong and visible commitment
• role of the leaders
• goals objectives in corporate strategic plan
• open disclosure and chat about safety at all
  levels

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Adequate resources to implement and evaluate
health safety initiatives

• Human Resources
• Staffing -gt classification numbers
• Budget
• Capital equipment
• lifts beds replacement
• Operating Budget
• ensure right supplies available at all times
• safe needle systems PPE

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Establishing organizational practices that foster
mutual responsibility and accountability by
individual nurses and organizational leaders to
ensure safe work environment

• Mutual responsibility and accountability
• Safety is everyones responsibility
• Role of the individual nurse
• Role of Management Staff
• Role of
• Occupational Health and Safety
• Risk Manager
• Physical Facilities
• Environmental Services

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1.1 Organizations/nursing employers create work
environments where human and fiscal resources
match the demands of the work environment

• Safety initiatives form the foundation for the
  development of departmental and organizational
  budgets
• Appropriate systems in place to ensure supplies
  and staffing are available and equipment is
  maintained to promote safe work practices and
  environments

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1.2 Organizations/nursing employers implement a
comprehensive Occupational Health and Safety
Management System based on the applicable
legislation, regulations and best practice
guidelines
Components could include

• Analysis of health and safety hazards
• Measures to eliminate or reduce risks
• Clearly stated policy and commitment
• Staff training and competency
• Workplace inspection program
• Emergency response planning
• Incident investigation
• Program administration

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2.0 Organizations/nursing employers are aware of
the impact of organizational changes (such as
restructuring and downsizing) on the health,
safety and well-being of nurses and be
responsible and accountable for implementing
appropriate supportive measures.

• Increased stress levels may lead to
• Job dissatisfaction
• Emotional fatigue
• Depression and anxiety
• Increased fear and concern related to job
  insecurity
• Impact on individual and departmental morale
• Provide supportive practices

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2.1 Organizations/nursing employers form
partnerships and work with researchers to conduct
evaluations of specific interventions aimed at
improving nurses health and well-being

• Examples might include
• Length of shift
• Burnout / mental health
• Patient lifting
• Infection control

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l

• 3.0 Organizations/nursing employers implement
  and maintain education and training programs
  aimed at increasing awareness of health and
  safety issues for nurses

• Examples could include
• safe lift initiatives
• employee rights under OSHA
• hazard awareness

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3.1 Organizations/nursing employers provide
ongoing training and education programs to ensure
staff possess the knowledge to recognize,
evaluate and control or eliminate hazardous work
situations

• Staff must possess the knowledge to recognize,
  evaluate and manage hazardous work situations
• Urgent and non-urgent
• Defective/broken equipment
• Infection Control Precautions
• Creative Teaching/training strategies
• Orientation
• Train in the nurses environment

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3.2 Organizations/nursing employers employ
qualified individuals with knowledge and
expertise in health and safety, policy and
legislative requirements to lead training and
education programs

• Specialized education/certification in
• Infection Control
• Occupational Health
• Industrial and Occupational Safety

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3.3 Organizations/nursing employers promote and
support initiatives related to the physical and
mental health and well-being of the nurse. This
includes but is not limited to fitness programs,
health promotion and wellness activities and
fitness-to-work initiatives

• Health promotion programs and activities
• Fitness, Smoking cessation, Heart health
• Return to Work
• Early return in appropriate role
• Reduced work demands
• Change in Status
• Part-time/casual
• Late career initiative

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3.4 Organizations/nursing employers provide
nurses with opportunities for personal,
professional and spiritual development with
regard to healthy work environments, professional
competencies and work/life balance

• Support for
• Professional development activities
• Ongoing learning
• Communication/conflict resolution
• Health and Safety
• Involvement in organizational committees
  activities
• Caring for self

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4.0 Workplace health and safety best practices
be embedded/integrated across all sectors of the
health care system

• Health care sector not recognized as a HS leader
  compared to other sectors and poor performances
  need to be addressed in all areas
• Acute care
• Home care
• Long-term care
• Mental health
• Public health

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4.1 Organizations/nursing employers engage in
knowledge transfer activities that promote best
practices regarding the health and safety and
well-being of nurses

• Use of networks, professional associations,
  conferences and education events to share
• Best practices
• Lessons learned

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4.2 Organizations/nursing employers support and
contribute to the development of health and
safety indicators at the local, provincial and
national level to assist in data collection and
comparable analysis across the health care sector.

• 4.3 Organizations/nursing employers develop
  standardized databases for sharing best practices
  related to nurse health, safety and well-being.

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Research Recommendations

• 5.0 Researchers actively collaborate with
  healthcare partners to demonstrate the
  effectiveness of interventions aimed at improving
  nurse health, safety and well-being using
  rigorous research and evaluation methodologies.

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Strength of Evidence
Experiments remain the research paradigm for
quantitative studies i.e. it is the model on
which to base other design options.
1. Evidence more convincing to policy makers
2. Most direct cause-effect evidence
3. Least influenced by bias (equal across groups)
4. Direct control over independent variable(s)
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Causal Model for Lift Evaluation
Process outcomes
Primary outcomes
Assessing delivery
Assessing perceptions
Assessing behaviour
Assessing effects
Intervention
Biomechanics improved?
Lift Policy
Caregivers Aware?
Lift Properly?
Caregivers Trained?
Comfort improved?
Injury rates reduced?
Patient care improved?
Lower costs?
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Research Recommendations contd

• 6.0 Researchers make full use of existing
  databases on nurse health, including the National
  Survey on the Work and Health of Nurses, in order
  to improve understanding of the key factors
  contributing to healthy work environments for
  nurses and to develop and test best practice
  indicators.

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National Survey of Work Health of Nurses

• Purpose
• CIHI, HC-ONP, and Statistics Canada conducted a
  survey exploring issues related to the work and
  health of nurses across Canada
• Results of this Study will Inform Research by
• Providing baseline measures for health status
• Identifying key factors associated with health
  and indicate differences in health status amongst
  across Canada
• Determining if any relationship exists between
  work/life stressors and the key health measures
• Contributing to a better understanding of stress
  and health pathways and tools used to assess
  work-related stress and health
• Conclusion
• Survey sent out to over 20,000 nurses using
  samples obtained via provincial registration
  databases (data collection now complete)
• Results available on CIHI website (also on
  StatsCan and ONP websites) (http//secure.cihi.ca/
  cihiweb/dispPage.jsp?cw_pagehhrdata_survey_work_h
  ealth_nurses_e)

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Education Recommendations

• 7.0 Nursing education institutions model the
  integration of health, safety and well-being into
  their own workplace culture.

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(No Transcript)
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Example of Educational Culture University of
Western Ontario

• .

Community Leadership Expectations Appreciation Res
pect

• A positive workplace culture can be created
  for all faculty and staff in the Faculty of
• Health Sciences through a CLEAR vision of how
  we all work together to achieve the
• goals of the Faculty.

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Education Recommendations contd

• 8.0 Nursing education institutions
  incorporate information about the health, safety
  and well-being of the nurse into the core
  curriculum of nursing education programs.

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Recognizing workload issues
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Nursing curriculum should address

• Ergonomics
• Safe work procedures
• Personal protective equipment
• WHMIS and other safety legislation
• Self-care and self-advocacy
• Development of effective coping and communication
  skills
• Assessment of benchmarks for healthy work
  environment
• Signs and symptoms of burnout
• Violence prevention

At a time when faculty are challenged to consider
more extensive curriculum requirements it is
necessary that health, wellness and safety become
part of the culture of learning and of the
professional practice of nursing. In order to
accomplish this, it is important that these
attributes and behaviours be explicitly embedded
in curriculum from the beginning of the nursing
programme.
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System Recommendations

• 9.0 Governing/accreditation bodies
  incorporate the Organization Practice
  Recommendations from this RNAO Healthy Work
  Environments Best Practice Guideline in their
  quality health and safety standards for health
  care service and education organizations.

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Implementation in the Workplace

• 3 Implementation Sites
• William Osler Health Centre
• Centre for Addiction and Mental Health (CAMH)
• Kingston General Hospital

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Common Challenges

• Survey length demanding on workload (getting good
  response rates required effort)
• Interpretation of cultural recommendations
• Extent of organizational changes/issues in some
  areas was a significant barrier to adoption
• Uncertain sustainability following implementation

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Common Strengths

• High level of staff involvement during
  implementation
• Strong leadership from nursing staff
• Dedicated staff used to support implementation
• Able to successfully implement selected aspects
  of the HWE guideline and be creative with
  processes used

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Lessons Learned

• Gained insight into research process and
  empowered staff members to conduct research
• Importance of HWE guideline easily recognized by
  staff
• Building relationships and better teamwork skills
• Need dedicated staff and project team approach
  for the process of guideline adoption

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Summary

• This guideline is of direct relevance to the
  health and well being of your nursing staff.
  Providing a healthy work environment for nurses
  will have a direct impact on how well they can
  perform their jobs and how much they will like
  their work, both of which can impact patient
  outcomes. The challenge before you is how to best
  implement these guidelines in your setting.