The PHASE in Healthcare Project Nurses Voices About Health and Safety, Violence in the Workplace, Workplace Injuries, and the Restructuring of Healthcare Lee Ann Hoff, PhD, RN Kathy Sperrazza, MS, RN Carole Pearce PhD, RN Craig Slatin, ScD MPH The PHASE in Healthcare Project The title we gave when we submitted to APHA is actually Nurses Voices about Health and Safety, Violence in the Workplace, Workplace Injuries, and the Restructuring of Healthcare. Too long to use. This project is supported by a grant from the National Institute of Occupational Safety and Health Grant #R01-OH07381-04, “Health Disparities Among Healthcare Workers.”

PHASE in Healthcare Health Disparities Among Healthcare Workers – UMass Lowell Examine effects of working in healthcare industry Massachusetts Nurses Association is a partnering organization No union facilities Looking at health disparities and occupational injuries and the effects of restructuring

The Massachusetts Nurses Association (MNA) MNA activism on behalf of nurses’ health and safety Seven focus groups Fifty participants Elected leaders, staff, local leaders, health and safety advocates and staff nurses

Focus Groups General Health and Safety (2) Work Place Violence and Abuse (2) Diversity and Discrimination Post Injury and Return to Work Experiences Healthcare System Restructuring

Health and Safety/Injury and Illness Musculoskeletal Infection Abuse and assault Asthma Multiple chemical sensitivity Latex allergy Needle sticks

Work Environment Exposures Noise Lifting Stress Violence Poor equipment design Poor air quality Hazardous chemicals

What leads to Injury and Illness Lack of health and safety education Lack of prevention programs No value placed on H & S for nurses Understaffing, mandatory overtime, fast pace, shift rotation (healthcare restructuring) Patients: primary emphasis in healthcare

Nurses Voices About Health and Safety “The merry go round is turned too high, and in order to stay on… you have to increase the speed at which you work” “…It was like being in an abusive relationship and not being aware of all the stress you were feeling” Why? Adaptation “You do it because it is expected of you and eventually you don’t even realize how bad it is for you.”

Workplace Violence and Abuse Dangerous settings ER, Labor & Delivery, Detox, Psych, Home care At Risk Direct care providers Risk Factors Perpetrators: patients, visitors, coworkers, prisoners as patients, strangers Pervasive “It’s part of the job” mentality Inadequate security and violence prevention Stalking, disrespect, threats, held against will, released fire extinguisher, flying dinner plates,swearing, kicked, hit, spit upon, emotional abuse by system, legal harassment, rape Post traumatic stress,

Nurses Voices About Workplace Violence and Abuse “But he’s demented, you know, so you can’t blame the patient.” “Biggest issue, I could not feel like a nurse again.” “ …At the time…I am never going to do this again if I make it out of here.” “Supports make me feel better, not alone… validates experience… there are others, I thought I was the only one.”

Post Injury and Return to Work Issues Lack of reporting Hostile workers compensation system “Disposable workers” “expendable” Management intimidation Lack of return to work programs / support Failure to report related to lack of understanding about system, failure to identify injury or illness as work-related, fear, process too time consuming, can’t leave patients, loss of income, hostile system Cite experiences of intimidation, minimization of injuries /illness- not relating them to work, denials of claims, co-worker hostility, See difference in treatment when definitive injury vs. illness when “they can get away with denying claim “making you prove your illness is related” Cite non-union employees have no protections, no information, terminated if don’t return, Injured nurses angry about ways they were treated! discuss lack of value placed on their health and safety, impact of losing their profession, their income, their health without any regard from employers No return to work alternatives, no support, return too early, re-injure, compromise other staff, resentment from coworkers and management light duty OR nurse after returning put in to circulate, surgeon needed to adjust equipment no one else nurse needed to climb under the OR table

Nurses Voices About Workers Compensation and Return to Work “The lack of support was almost worse than the illness or what happened to you.” “It’s demeaning, dehumanizing.” “It was like I never existed, with my hospital.” “Questioned, What did you do wrong?” “Criticized and blamed for what happened.” “Traumatic, have to do a complete career change.” “No longer had my health”

Healthcare Restructuring Healthcare administration -- “suits” with MBA Bottom line mentality Lack of input from nurses Affects caregivers and patients Stress related to speed-up, increased acuity, understaffing, mandatory overtime, and lack of support Nurses relate restructuring to injuries / illnesses

Nurses Voices About Restructuring “It’s all this stress…stress, stress, stress…and it’s always faster, faster, faster.” “Managers have to keep their census up… to keep reimbursements coming in. They care less about the safety of the staff.” “If you don’t have time to relax, if you are just going home and falling into bed and coming back the next day then it piles up…people get burned out.” “…If you take on someone's physical and mental pain… and you don’t have a mechanism to get rid of that…” “Adaptation [to corporate culture & demands] is a horrible thing... You do it because it’s expected of you...[and] don’t even realize how bad it is for you.”

MNA/Union Impacts Grassroots nurses’ H/S movement MNA Occupational Health Program Education, advocacy and support Focus on prevention Contract provides protection Empowerment Changing the culture of nursing Prevention-needlestick legislation, no-lift legislation, hcw included in violence prevention in court system,

Conclusions Focus groups useful source of data collection Restructuring of system is changing nursing Increased health and safety risks Increased injuries and illnesses Violence and abuse is not prevented Poor support for injured nurses / return to work Strong union health and safety program helps nurses Adds a complementary source of data from first hand experiences to quantitative data