THE WORKPLACE

1
CHAPTER 12

• THE WORKPLACE

2
Introduction

• Over 50 of time is spent in the workplace
• Occupational hazards exist in work areas
• It is important to improve the quality of life
  in the workplace

3
Workplace Safety

• Environmental hazards
• Physical safety
• Emotional safety

4
Reducing Risk

• Occupational Safety and Health Administration
  (OSHA)
• Centers for Disease Control and Prevention (CDC)

5
Reducing Risk

• Workplace programs
• Safety plan
• Consult federal, state, and local governments
• Distinguish between real and imagined risk
• Seek administrative support
• Calculate costs of program

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OSHA Focus

• Biological
• Chemical
• Psychological
• Physical
• Environmental

7
CDC Focus

• Lead federal agency for protecting health and
  safety of citizens at home and abroad
• Publishes updates on a variety of health issues
  and concerns
• Partners with other agencies in investigating
  health threats and research

8
NIOSH

• Part of the CDC
• Conducts research and makes recommendations for
  preventing work-related injuries and disease

9
American Nurses Association

• Quality indicators for acute care setting
• Commission on Workplace Advocacy
• Core initiatives

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Core Initiatives

• Nursing shortage
• Patient safety/advocacy
• Workplace rights
• Appropriate staffing
• Workplace health and safety

11
JCAHO

• National patient safety goals
• Change each year
• Based on type of facility
• Ambulatory
• Assisted living
• Behavioral health
• Critical access
• Home care

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Workplace Programs

• Identify potential hazard
• Assess degree of risk
• Develop a plan
• Implement the program

13
Violence

• Violence is a social issue
• The rate of assaults on hospital workers is much
  higher than that of private industry
• Threats
• Physical assaults
• Muggings

14
Violence

• Situations that increase workers susceptibility
  to homicide and assault are
• Having routine contact with the public
• Working alone or in small numbers
• Working late
• Poor security

15
Violence

• Situations that increase workers susceptibility
  to homicide and assault are
• Patients and families who carry weapons
• Lack of experienced staff members
• Units and patients that need seclusion or
  restraint activities

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What Nurses Should Know

• Does violence in the surrounding community affect
  my workplace?
• Does the layout of the facility invite violence?
• Is there a prompt response by administration to
  violence?

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What Nurses Should Know

• Are incidents being reported and addressed by
  management?
• Would training that deals with workplace violence
  be adequate for employees and management?
• Which types of patients are more prone to
  violence?

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Behaviors

• History of violent behavior
• Delusional, paranoid, or suspicious speech
• Aggressive and threatening statements
• Rapid speech and angry tone of voice

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Behaviors

• Stiff posture, clenched fists, tight jaw
• Alcohol/drug use
• Male gender or a youth
• Unrealistic policies

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When Assault Occurs Placing Blame on Victims
Victim Gender Women receive more blame than
men Subject Gender Female victims receive a
greater amount of blame from women than from
men Severity The more severe the assault, the
more often the victim is blamed  
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When Assault Occurs
Beliefs The world is a just place therefore,
the person deserves the misfortune Age of
Victim The older the victim, the more he or she
is held responsible for the assault
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Keep an Eye Out

• Look for clues indicating potential violence
• Call patients, family members, and visitors by
  their names
• Encourage the patient or the patients family to
  vent anger

23
Keep an Eye Out

• If you feel uncomfortable, trust your intuition
• Know your institutions policies and procedures

24
Preventing Workplace Violence

• Have management commit to an ongoing prevention
  program that addresses different scenarios on
  workplace violence
• Require that all violent incidents be reported
  and reviewed
• Hold all patients, visitors, staff members, and
  management accountable for their behavior adopt
  a zero-tolerance policy related to workplace
  violence

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Preventing Workplace Violence

• Follow current information and guidelines from
  agencies such as your state nurses association
  and OSHA
• Insist on an ongoing education program for all
  staff members that includes comprehensive
  treatment for victimized employees

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Participate in Workplace Safety

• Assess the workplace regularly
• Be alert for suspicious behavior
• Maintain behavior that helps to defuse anger
• If situation escalates, remove self and call
  security
• Know your clients

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Participate in Workplace Safety

• Report situation to supervisor
• Call the police
• Get medical attention
• Contact collective bargaining or state nurses
  association
• Participate in policy-making

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Sexual Harassment
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Behaviors Defining Sexual Harassment

• Pressuring another to participate in sexual
  activities
• Asking another person about his or her sexual
  activities, fantasies, or preferences
• Making sexual innuendos, jokes, comments, or
  suggestive facial expressions to another person

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Behaviors Defining Sexual Harassment

• Continuing to ask for a date after the other
  person has expressed disinterest
• Making sexual gestures with hands or body
  movements or showing sexual graffiti or visuals
• Making remarks about a persons gender or body

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Sexual Harassment

• Two forms of sexual harassment are
• Quid pro quo
• A hostile environment

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Sexual Harassment

• Fight sexual harassment per American Nurses
  Association (ANA)
• Confront
• Report
• Document
• Support

33
Latex Allergy

• First identified in the 1970s
• Has become a major problem in the workplace
• Estimated that 8-12 of health-care workers are
  sensitive to latex

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Symptoms

• Contact dermatitis (most common)
• Generalized hives
• Urticaria
• Rhinitis
• Wheezing
• Anaphylaxis

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Decreasing the Potential for Latex Allergy

• Reducing unnecessary exposure
• Using alternative gloves (nitrile)
• Employee education programs
• Identifying workers at risk

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Needlestick Injuries
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Needlestick Act

• Passed in 2001
• Revised blood-borne pathogens standards
• Obligates employers to consider safer needle
  devices

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OSHA Blood-Borne Pathogens Recommendations 1991

• Free hepatitis B vaccine
• Protective equipment that fits
• Immediate and confidential medical evaluation

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OSHA Blood-Borne Pathogens Recommendations 1991

• Implement universal precautions
• Provide adequate sharps disposal
• Remove hazards in workplace
• Provide annual training for employees

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The Nurses Responsibilities

• Always use universal precautions
• Use and dispose of sharps properly
• Get immunized against hepatitis B
• Report all exposures
• Know the human immunodeficiency virus/hepatitis B
  virus (HIV/HBV) status of your patient

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The Nurses Responsibilities

• Comply with postexposure follow-up
• Support others who have been exposed
• Become active in safety committees
• Educate others

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Ergonomics
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Preventing Back Injuries

• Participate in safety committees
• Work in teams do not be afraid to ask for help
• Use transfer and lifting equipment
• Do back exercises

44
Repetitive Stress Injury (RSI)

• Usually affects individuals who spend long hours
  at computers
• Most common injury is carpal tunnel syndrome
• Mouse elbow
• Badly designed computer stations present the
  highest risk

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Preventing RSI

• Monitor placement
• Keyboard alignment
• Mouse position
• Body alignment
• Vary tasks
• Use fingertips when typing
• Keep fingernails short

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Impaired Workers
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Common Signs of Impairment

• Witnessing an employee consuming alcohol or
  other substances on the job
• Apparent in employees dress, appearance,
  posture, and gestures
• Employees use of slurred speech and
  abusive/incoherent language

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Common Signs of Impairment

• Reports from patients/coworkers
• Witnessing unprofessional employee conduct
• Employee has significant lack of attention to
  detail
• Witnessing an employee stealing controlled
  substances

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Impaired Nurse Programs (INPs)

• Most employers and 37 boards of nursing have
  strict guidelines
• INPs conducted by boards of nursing work with
  employers to assist impaired nurses
• Compassion from coworkers is of utmost importance

50
Professional Responsibilities

• Nurses need to uphold the standards of their
  profession
• Ignoring substance abuse places clients and other
  nurses in danger
• It is important to help a colleague obtain help

51
Microbial Threats

• SARS
• Tuberculosis
• MDR-TB

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Workload

• Rotating shifts
• Mandatory overtime
• Staffing ratios

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Reporting Questionable Practices

• Most employers have policies regarding reporting
  behaviors that affect the workplace environment
• Code for Nurses (2001) is specific regarding this
  responsibility

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Behaviors

• Endangering a clients health or safety
• Abuse of authority
• Violation of rules, regulations, or standards of
  professional ethics
• Gross waste of funds

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Whistleblower

• Describes an employee who reports employer
  violations to an outside agency
• Do not assume doing the right thing will
  protect you

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Guidelines

• Gather the facts
• Does the practice violate any actual law
• Know the state law requiring mandatory reporting
• Type your documentation and include day, date,
  time, and circumstances

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Guidelines

• Identify witnesses
• Do not breach confidentiality in any way
• Send a copy of your complaint to the CNO or
  nursing department or any other department
  affected
• Utilize the ethics committee of your institution
• Keep copies of your records

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Nursing Responsibilities in Terrorism

• Know the evacuation procedures and routes in your
  facilities
• Develop your knowledge regarding the most likely
  and most dangerous biological weapons
• Monitor for unusual disease patterns
• Know the back-up systems for communication and
  staffing

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Enhancing the Quality of Work Life

• Social environment
• Working relationships
• Support your peers and supervisors
• Involvement in decision-making

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Enhancing the Quality of Work Life

• Professional growth and innovation
• Encourage critical thinking
• Seek educational opportunities
• Encourage new ideas
• Reward professional growth

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Understanding Cultural Diversity

• Communication
• Space
• Social organization

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Understanding Cultural Diversity

• Time
• Environmental control
• Biological variations

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Organization Diversity Fitness

• Personnel reflect the current and potential
  population that the organization serves
• Silence and gestures are respected

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Organization Diversity Fitness

• Awareness of special family and holiday
  celebrations
• Individuals first culture second

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Managing Diversity

• Be aware of and sensitive to your own
  culture-based preferences
• Explore your own biases and values
• Be knowledgeable about other cultures

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Managing Diversity

• Be respectful of and sensitive to diversity among
  individuals
• Be skilled in using and selecting culturally
  sensitive intervention strategies

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Dos and Donts for Managing Diversity
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Nursings Agenda for the Future

• Leadership and planning
• Delivery system
• Legislation/regulation/policy
• Professional/nursing culture
• Recruitment/retention

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Nursings Agenda for the Future

• Economic value
• Work environment
• Public relations/communication
• Education
• Diversity

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Conclusion

• Workplace safety is a growing concern
• IOM and JCAHO will continue to impact workplace
  safety issues
• Support the ANA