2. Where the nurse gets hurt: Understanding the social organization of injury management in Ontario hospitals By: Laurie Clune RN, PhD Associate Dean Research and Graduate Programs Dedicated to Ellen Pence

3. What to expect in this presentation To building from my doctoral work and develop a program of research To discuss how IE approaches can be used in research teams 1 2

4. My doctoral work My doctoral work The social organization of health care Professional discourses and Ideologies Boss text The social organization nursing work The Injured Nurse Early Return to work

5. Accommodation Work Rehab Work Domestic Work Early Return to Work

6. Experienced nurses are being removed terminated from their jobs. Boss text : Ontario Workplace safety and insurance board act If after 2 years you fail to return to your pre- injury position the employer can terminate

7. “Working in a hospital (OHS department) is totally different than working in private industry”. Occupational health nurse 1 (3, 4)

8. The Institute for Work and Health The Institute for Work and Health 1. Primarily quantitative researchers (STATS, STATS, STATS and boot strapping ), economic evaluation, epidemiologic, and systematic review approaches 2. Non- nurse researchers doing research about nurses Post Doc ?!#%*

9. Collaboration: Co-PI An economist - “I like your maps!” Funder: Workplace Safety and Insurance Board of Ontario Research Advisory Council Title: OHS economic evaluation resource needs for the health care sector in Ontario The Project

10. The Grant

11. This project A nurses body must be an able body Discourse of abuse Worker Compensation Legislation The social organization nursing work Decision making in health care surrounding occupational health

12. An exploratory approach using schema mapping, in- depth in person interviews and telephone interviews Stakeholder guides (n=10) Who to ask : purposive sampling What to ask: Initial interview guide Where to ask: create connections What are we seeing: refining interview guide, immersion and crystalization Methodology

13. Stakeholder guide map: How does it work?

14. INTERVIEWS In person n = 20 22 informants Telephone n= 25 28 informants Roles OHS operations OHS directors, managers OHS coordinators Senior VP Hospitals Long term care Community nursing Ministry of Health Urban and rural Size (> 10,000, under 250) Speciality hospitals (children, cancer, orthopaedics) SITES Data discovery approaches

15. Scaffold map: Guiding the interview Idea for OHS initiative Decision-making Implementation Evaluation Planning

16. There’s a difference NOT FOR PROFIT FOR PROFIT VS

17. Incident reporting trends Technology tracking Prevention hunches Health Promotion Months (Jan= quit smoking; Feb = heart; March = nutrition) Scaffold map: Creating Work Idea for OHS initiative

18. Business plan for the board Benefits to patients Budget Scaffold map: Planning Work Planning

19. DECISION MAKING: “I am not sure. It goes to the Board. I have no idea how they make the decision”

20. Initiatives that have a direct effect on improving patient outcomes Eg: flu shot Ministry directives (labour and health) Eg: harassment, over bed lifts Most initiatives generated from OHS department “no money” How decisions are made?

21. This project A nurses body must be an able body Discourse of abuse Worker Compensation Legislation The social organization nursing work Decision making in health care surrounding occupational health Ontario Hospital Act (funding)

22. Hospitals are funded for patient care and capital initiatives only Hospital funding is based on a comparative approach based on Facility size Case types codes Lengths of stays Key performance indicators (eg: infection rates, wait times) Hospitals that perform well are rewarded financially No funds are allocated from the Ministry for occupational health and safety Hospital funding mechanisms

23. “Working in a hospital (OHS department) is totally different than working in private industry”. Money for occupational health and safety initiatives are not a part of funds received by hospitals. OHS initiatives that do take place in hospitals are Mandated by the Ministry of health or labour To protect the patient Going back to the occupational health nurses’ comments:

24. Thank you