1. 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-OH , “Health Disparities Among Healthcare Workers.”

2. 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

3. 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

4. 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

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

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

7. 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

8. 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.”

9. 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,

10. 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.”

11. 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

12. 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”

13. 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

14. 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.”

15. 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,

16. 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