Chpt. 11 Promoting a healthy work environment

Enhancing quality of work life

American Association of Critical-care nurses published a standards for a healthy work environment. STANDARDS INCLUDE: -skilled communication -real collaboration -effective decision making -adequate staffing -meaningful recognition -effective leadership increase pt satisfaction and reduces nurse burnout & stress

Behaviors: q's practices

Endangering a client's health or safety Abuse of authority Violation of rules, regulations, or standards of professional ethics Gross waste of funds

ANA (American Nurses Association)

Professional organization for all RNs. Concerned with licensure, collective bargaining and education. Provides current info r/t workplace advocacy & safety for all nurses.

Whistleblower Protection Act

Prohibits reprisal against employees who reveal information on white collar crime

Workload

Rotating shifts Mandatory overtime Staffing ratios

quid pro quo harassment

Sexual favors are solicited in exchange for favorable benefits or continuation of employment ex: an administrator approaches a nurse for a date in exchange for the promise of a promotion

Violence in work place

Social issue High rate of assaults on hosp. workers -threats -physical assaults -muggings

CDC (Centers for Disease Control and Prevention)

a federal agency that conducts/investigates health prob and supports health promotion, prevention strategies and preparedness activities in the United States with the goal of improving overall public health & promote safe environments.

Back injuries

contribute to- improper lifting technique, size/shape/deformities of pts balance, combativeness, uncooperativeness, and contractures, limited space, equipment, beds, chairs, commodes. prevent- proper technique, assistive devices, safe transfers.

IOM and Joint Commission will continue to impact

workplace safety issues. Support the ANA.

Evidence of nurse impairment

• Witnessed consumption of alcohol or controlled substances on the job • Changes in dress, appearance, posture, gestures • Slurred speech; abusive/incoherent language • Reports of impairment or erratic behavior • Witnessed unprofessional conduct • Significant lack of attention to detail • Witnessed theft of controlled substances • Assigned patients routinely requesting pain medication within a short period of being medicated impaired nursing programs- conducted by state boards of nursing, work w/ employer to assist the impaired nurse to remain licensed while receiving help. Mandatory for nurses to report suspected impairment.

Participate in workplace safety

-Assess the workplace regularly. -Know your clients. Be alert for suspicious behavior. -Maintain behavior that helps to defuse anger. -If situation escalates, remove self and call security -Report situation to supervisor. -Call the police. -Get medical attention. -Contact collective bargaining or state nurses' association. -Participate in policymaking.

Recommendations from the ANA on fighting sexual harassment

-Confront -Report -Document -Support

Dealing w/ horizontal violence

-Develop a zero-tolerance policy -develop a code of conduct -administrators, supervisors, & managers can model appropriate behaviors -discuss strategies for handling much behavior in staff meetings -report bullying behavior to the nurse manager -confront bullying and belittling behavior, and express your concern objectively

Employee Responsibilities r/t needle sticks

-always use universal precautions -use and dispose of sharps properly -obtain immunization against Hep B -get involved in sharps selection -keep your training up to date -report all exposures immed. following your facility's protocol -Comply w/ post-exposure follow-up procedures/policies -Know the human immunodeficiency virus/hepatitis B virus (HIV/HBV) status of your patient. -Support others who have been exposed. -Become active on safety committees. -Educate others.

How to decrease potential of latex allergy prob

-evaluate cases of hand dermatitis or other latex allergy -use latex-free trays and crash carts -use nonlatex gloves that don't involve contact w/ infectious material -avoid using oil-based creams or lotion, deteriate gloves -seek ongoing training and latest info -wash, rinse, and dry hands thoroughly after removing gloves or when changing gloves -use powder-free gloves -Employee education programs -Identifying workers at risk

Violence in the Workplace; behaviors that indicate a potential for violence

-hx of violent behavior -delusional, paranoid, or suspicious speech -aggressive -threatening statements -rapid speech -angry tone of voice -pacing -tense posture -clenched fists -tightening of jaw -alcohol or drug use -policies that set unrealistic limits

Repetitive stress injury preventions:

-keep the monitor screen straight ahead of you, about an arm's length away. The top of the screen should be at eye level -align the keyboard so that your forearms, wrists, and hands are parallel to the floor. tilt if needed to keep wrists in neutral position. Position the mouse if used directly next to you and on the same level as keyboard -keep thighs parallel to the floor as you sit on the chair. Feet should touch the floor and the chair should be be ergonomically sound. -vary tasks. avoid long sessions of sitting. do not use excessive force when typing or clicking the mouse. -Keep fingernails short

Signs/symptoms of stress, reality shock, and burnout

1- High expectations and idealism (first enthusiastic, energy, pos) 2- Pessimism and early job dissatisfactions (frustration, disillusionment, or boredom, physical and psych stress) 3- w/drawal & isolation (anger, hostility, negative, worsening physical and psych stress, simple changes may reverse) 4- detachment and loss of interest (severe emotional/physical stress symptoms, exhibits low self-esteem, chronic absenteeism, cynicism, and total negativity. Remains for a long time, burnout is inevitable)

Preventing violent behavior

1- participate or initiate regular workplace assessments 2- be alert for behaviors that precede violence 3- know your pts 4- maintain behavior that helps to defuse anger 5- If you can't defuse the situation, remove yourself from it Have an ongoing prevention program. Report all violent incidents. Hold all patients, visitors, staff members, and management accountable for their behavior. Adopt a zero-tolerance policy.

Methods for dealing w/ violence in the workplace

1. Development of workplace safety programs and to recognize a potential hazard 2. Thorough assessment of the amount of risk entailed 3. Create a plan to provide optimal protection for staff members without interfering with the provision of quality patient care. -Distinguish real from imagined risks -Consult federal, state, and local regulations and experts on work safety -Seek evidence-based practice related to the problem -Develop a plan to reduce risks -Calculate the costs of the programs/plan -Seek administrative support for the plan 4. Implement the plan

Latex allergies

2 major routes of exposure to natural rubber latex: 1- skin 2- inhalation reactions: range from contact dermatitis (most common) w/ scaling, drying, cracking, & blistering skin, to generalized urticaria, rhinitis, wheezing, swelling, SOB, and anaphylaxis. Blood test can detect latex antibodies, complete medical hx can reveal sensitivity. Skin testing and glove testing are available. complete avoidance is best, meds, medical bracelet, careful during medical/dental care. Alternative are gloves of vinyl or nitrile. If have to use NRL gloves, uses w/ lower protein content and those that are power-free. Good housekeeping to remove latex-containing dust. LEGALLY ORGANIZATIONS HAVE TO SUPPLY NONLATEX GLOVES.

Employer's responsibility r/t needle sticks

ALL HC facilities have a written plan to prevent them annually, staff receives training during work hrs, and right to choose safety devices. - the employee must be evaluated & tx w/ 2 hrs of sharp injury, including free hep B vaccine -Safety & efficacy of sharps purchased must be evaluated -Recapping of needles & r/ practices should be prohibited - Contaminated work surfaces must be cleaned according to estab. guidelines - Employers must provide PPE of good quality, including gloves, gowns, and masks in all needed sizes

Steps to implement in the workplace to better prepare for natural disasters or Terrorism threats:

ANA provides nurses w/ valuable info on how to better care for pts, protect themselves, and prepare hospital and community for bioterrorism. - Know the evacuation procedures and routes for your facility -Develop your knowledge regarding the most likely and most dangerous biological weapons. -monitor your pt caseload for any unusual dx patterns and notify appropriate authorities prn -know the backup systems available for communication & staffing in the event of emergencies -become familiar w/ the disaster policies in your facility

Ineffective coping strategies

Abandon professional ideals- when faced w/ reality shock, new grads abandon their professional ideals. This may eliminate their conflict but puts the needs of the organization before their needs or the pt. Leave the profession- escape the conflict.

Reducing the risk w/ workplace programs: safety plan

Consult federal, state, and local governments. Distinguish between real and imagined risk. Seek administrative support. Calculate costs of program. Workplace Programs Identify potential hazard. Assess degree of risk. Develop a plan. Implement the program.

Easing transition as a new nurse

Develop a professional identity - opportunities to challenge competence (school) Learn about the organization Use your energy wisely Communicate effectively Seek feedback often and persistently Develop a support network Mentoring

Promoting a health work environment : workplace safety in 3 areas

Environmental hazards physical safety Emotional safety

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

OSHA (Occupational Safety and Health Administration)

Goal is to prevent injuries & illness & save the lives of employees across the U.S.

Needles stick injuries ANA calls for more attention to

Greater safety in surgical settings Sharps safety outside the hospital Including nurses in selection of safety devices Encouraging product design and development to fill existing gaps Increasing staff training

horizontal behavior

Incivility or bullying which may include verbal abuse, punishment, humiliating comments, & malicious gossip. The joint commission suggests that this may pose a threat to pt safety

Staffing ratios: increases in pts results in

Increase in patient: staff ratios -Increase in mortality rate -Failure-to-rescue rate -Nursing job dissatisfaction increase -Burnout rate increase

Toxic environements

Inside air pollution is more recently identified prob. Digoxin emissions, mercury, batter waster not handled properly. Disinfectants, chemicals, waster anesthesia gases, laser plumes that float in the air. Avoid use- polyvinyl chloride, mercury, providing convenient collection sites for battery and mercury waste, and making waste management education for employees mandatory. Recycled paper and products, minimizing use of toxic disinfectants, and waste disposal choices that reduce incineration to a minimum.

Common concerns and types of injuries

Latex allergy needle stick ergonomic

Types of Discrimination

Laws that prohibit discrimination in the work are based on the 5th and 14th amendment to the constitution, mandating due process and equal protection under law. EEOC (Equal Employment Opportunity Commission) oversees the administration and enforcement of issues r/t workplace equality. There may be discrimination based on color, sex, age, disability, religion, or national origin.

Keep an eye out for violent behavior

Look for clues indicating potential violence. Call patients, family members, and visitors by their names. Encourage the patient or the patient's family to vent anger (appropriately).

hostile work environment sexual harassment

Most common type of sexual harassment claim and the most difficult to prove. The employee making the claim must prove that the harassment is based on gender & that it has affected condition of employment so offensive that the employee could not effectively discharge the responsibilities of the job.

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.

Reporting questionable practices

Most employers have policies that encourage reporting of behavior that may adversely affect the the workplace environment, including: 1- endangering a pt's health or safety 2- abusing authority 3- violating laws, rules, regulations, or standards of professional ethics 4- grossly wasting funds Code for nurse- ANA specific to nurses' responsibility to report questionable behavior that may affect the welfare of a pt.

Professional responsibilities of the nurse r/t impaired nurses

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."

Identify agencies responsible for overseeing workplace safety

OSHA: CDC ANA Joint commission Institute of medicine (IOM)

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.

"Needlestick Act"

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

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 expression to another person 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 person's gender or body

Sexual harassment (behaviors that could be defined as sexual harassment)- 2 forms

Quid pro quo Hostile work environment

Enhancing the Quality of Work Life

Social environment Working relationships Supporting your peers and supervisors Involvement in decision making Professional growth and innovation Encourage critical thinking. Seek educational opportunities. Encourage new ideas. Reward professional growth.

Whistleblower- protect indiv (anonymous)

Someone who brings to public attention gross governmental inefficiency or an illegal action. Employee who reports employer violations to an outside agency. Do not assume "doing the right thing" will protect you. Washington State Whistleblower Law Speaking up could get you fired unless protected by a union contract or other formal employment agreement. Your professional organization (ANA) may also protect you.

Impaired nurses (definition)

Substance-abuse by nurses that impede safe and prudent work

Mandatory overtime

The ANA opposes the use of mandatory overtime, stating that nurses should be allowed to refuse overtime if they believe that they are too fatigued to provide quality care. o if it is an emergency- a nurse may be required to do mandatory overtime o 24 hr period- no longer required to work over 12 hrs vs. optional o KNOW THE LAW!!!! But if it is chronic understaffing- the nurse is not required to work mandatory overtime.

Repetitive stress injuries

The use of long hours on computers, switchboards, where repetitive motions are performed. The most common RSI are carpal tunnel syndrome and mouse elbow. Badly designed computer workstations present the highest risk of RSI.

When assault occurs; placing blame on

Victim gender Subject gender Severity Beliefs Age of victim

Joint commission

a not-for-profit organization that evaluates and accredits different types of healthcare facilities Focuses on hospital and pt safety goals

Institute of Medicine (IOM)

a private, nonprofit organization created by the federal government to provide science-based advice on matters of medicine and health Mission is to improve the health of people everywhere, this the topics it studies are broad.

Whistleblower- most important to report by working through the chain of command and internal procedures:

a- make sure that whistleblowing is addressed at your facility, either through a collective bargaining contract or workplace advocacy program, b- contact your state nurses association to find out if your state offers whistleblower protection or has such legislation pending c- be politically active by contacting your state legislators and urging them to support a pending bill or by educating your elected state officials on the need for such protection for all health care workers d- contact your U.S. congressional representatives and urge them to support the pt. safety act.

Ergonomic Injuries

are a risk factor for persons who perform repetitive or physical work Safety concern for pt. and nurses Back injuries Repetitive stress injuries

If you develop a latex free allergy, be aware of the following

avoid all types of latex exposure wear a medical alert bracelet carry an Epipen w/ auto-injectable epi alert employer & colleagues about your sensitivity carry nonlatex gloves one-stick rule for pts allergic to latex (possible NRL in pharm vials) keep freq observations for 2 hrs (VS)

Recommendations for addressing risk of needle sticks in the surgical setting

d/t intense pressure, open wound susceptible to contamination, & extensive use of sharp instruments -Use blunt tip suture needles where possible -Use safety scalpels, either sheathed or retractable -Initiate the hands-free technique or natural passing zone (container or sterile towel) instead of passing instruments hand-to-hand -Double glove to increase protection from punctures -Share info (educate) w/ staff about sharps injury precautions

Who is at greater risk for latex allergy

hx of allergies to pollens, grasses, certain foods, plants (avocados, banana, kiwi, chesnut) and hx of multiple surgeries

Criteria for mandatory reporting. Please read the text and review state law.

· Incident Report: An unintended event or circumstance that could have resulted, or did result, in unnecessary damage, loss or harm, such as physical or mental injury · What to Report: § When there is reasonable cause to believe violations have occurred involving abuse, neglect, abandonment, significant injuries of unknown source, or personal and/or financial exploitation; § Any reasonable suspicion of a crime, including physical or sexual assault, has been committed against a resident; § Any act, when there is reasonable cause to believe the act caused a fear of imminent harm; § Substantial injuries of unknown source not related to suspected abuse or neglect (because under some circumstances the failure to take preventive measures may constitute abuse or neglect). § Chemical spills § Fires § Workplace violence of any kind § Slips, trips and falls § Accidents or near misses involving use of machinery, equipment § Bullying and harassment § Repetitive injuries § Disease outbreak