Commonwealth Nurses Federation Sierra Leone Nurses Association€¦ · BSc(Hons)Nursing (USL, 2008)...

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Michael M. Koroma

RGN. Dip(Ghana, 2002) BSc(Hons)Nursing (USL, 2008)

Vice President(SLNA)

Commonwealth Nurses Federation in Conjunction with the

Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010

!   INTRODUCTION It is a pressing reality. Health systems worldwide are

increasingly challenged – faced with a growing range of health needs and financial constraints that limit services� potential to strengthen health sector infrastructures and workforces.

We are immersed in a global nursing workforce crisis – one marked by a critical shortage of nurses. The reasons for the shortage are varied and complex, but key among them are unhealthy work environments that weaken performance or alienate nurses and, too often, drive them away − from specific work settings or from the nursing profession itself.



As professionals, nurses need a practice environment that acknowledges the social and health mandate of their discipline and the scope of practice as defined by country/regulatory legislation

(Rowell 2003).



In quality professional practice environments, the needs and goals of nurses are met and patients are assisted in meeting their individual health objectives. This takes place within the cost and quality framework mandated by the organisation in which the care is provided.



BACKGROUND !   In almost every country nurses provide the

majority of health services – up to 80 percent in some cases.

!   In Ghana, more than 500 nurses left the country in 2000 for higher-paying jobs in richer countries − three times the total recorded for 1999 and more than double the number of nursing graduates Ghana produced that year.



!   The current shortage is undermining the goals of health systems globally and challenging our ability to meet the needs of our citizens.

!   The reasons for the health care and nursing crisis are varied and complex, but evidence underlines that unhealthy work environments are key among them.

!   Unhealthy environments affect nurses� physical and psychological health through the stress of heavy workloads, long hours, low professional status, difficult relations in the workplace, problems carrying out professional roles, and a variety of workplace hazards.

!   Evidence indicates that �long periods of job strain affect personal relationships and increase sick time, conflict, job dissatisfaction, turnover, and inefficiency� (Baumann et al. 2001).

!   Nurses who are stressed because of heavy workloads, friction with colleagues, inappropriate tasks, insufficient skills and knowledge, poor management or unsafe working conditions are challenged to provide the highest standards of care.



DEFINITION !  A healthy work environment is a

practice setting that maximizes the health and wellbeing of nurses, quality patient outcomes and organisational performance (RNAO 2006d).



The focus is on the prevention of injuries and the fair and equitable treatment of nurses who are injured at work or develop a work- related illness.

Nurses have the right to work in an environment that does not threaten their health, safety or welfare.



!   COMPONENT OF WORKPLACE HEALTH AND SAFETY

!   1.  Safe work environments 2.  Healthy work environments 3.  Safe workplace design 4.  Safe work processes and systems 5.  Safe work procedures and practice

6.  Safe patient care



!   1. Safe Work Environments means the existence of: •  Safe equipment •  Hygienic conditions •  Safe walking and working surfaces •  Freedom from violence •  Non-hazardous and toxic materials, and if they are present, provision for safe handling,

storage and disposal of them



!   2. Healthy work environments It means that:

Safety measures are in place in relation to blood borne and body fluid pathogens to prevent contamination of nurses and patients



!   3. Safe workplace design Good ergonomics in relation to:

•  Seating

•  Equipment use

•  Adequate lighting

•  Safe exits/egresses (clearly marked, open and well-lit)



4. Safe work processes and systems

!  Written and up-to date standards, protocols, policies, procedures !   Adherence and compliance with these !   Adequate staffing !   Safe delegation of duties



!   5. Safe Work Procedures and Practices

!   Lifting techniques !   Prevention of needle stick and other

injuries !   Adequate break times for nurses to

prevent tiredness and increase the risk of medication and other errors



!   6. Safe patient care •   Safe administration of medication and other skills •   Competent staff (skilled and knowledgeable) •  Adherence to proper work standards and ethics



CHARACTERISTICS OF A SAFE WORK PLACE

(Kristensen, 1999) There must be: "   demands that fit the resources of the person (absence of work

pressures); "   a high level of predictability (job security and workplace safety); "   good social support from colleagues and managers and access to

education and professional development opportunities ((team work, study leave);

"   meaningful work (professional identity); "   a high level of influence (autonomy, control over scheduling,

leadership); and "   a balance between effort and reward (remuneration, recognition,

rewards).



!  OCCUPATIONAL HEALTH SAFETY

ILO Convention No: 155 Concerning Occupational Safety and Health and the Working Environment.

22 June 1981

Workplace or occupational health and safety legislation can provide a framework, but what is required is the development of a culture of safety in health care.



ISSUES OF OCCUPATIONAL HEALTH

1)!Exposure to hazardous drugs and blood borne pathogens 2)!On the job exposure to chemicals 3)! Burning out 4)! Heavy lifting and moving of patients and medical equipment, 5)! Workplace violence and abuse (intruders, patients, relatives,

other staff) 6)! Needle stick injuries 7)!Working on night shift: an emerging health risk 8)! Excessively long working hours and heavy workloads



The ICN Guidelines on Occupational Health and Safety (2007)

1. �Exposure to biological hazards, such as HIV, Hepatitis B and C, is estimated to have a serious impact on nursing. In countries where the prevalence of HIV is the highest in the world, nurses suffer an average of two to four needlestick injuries per year, thereby increasing their chances of contracting HIV, Hepatitis B or C.



2. Working on night shift: an emerging health risk

"!Most people have routine work hours with time left for recreation and rest.

"!At night the body usually turns its attention to growth, repair, rest and recovery.

"!Today experts are recognising the significant stress and biological changes due to continuous night shift work.

"!Other associated effects are sleep problems, fatigue, gastro intestinal complaints, depression, anxiety and heart disease.



"!Studies have also reported social problems associated with shift work such as high alcohol consumption – drug use – divorce and spousal abuse.

"!Humans are biologically programmed as a day-oriented species.

"!The human body contains genetic codes for critical life rhythms such as heart beat, breathing, blood pressure, temperature, hormones and digestion that rise and fall in predictable 24-hour cycles known as circadian rhythms. Changes in its rhythms can lead to changes in hormonal levels which may result in disturbed sleep and fatigue.

"! In acute phases it may take days or weeks for the body to readjust.



!!We fall asleep as adrenal hormone levels and body temperature drop and we return to wakefulness as the levels rise again.

!! Ability to concentrate, alertness and attentiveness decreases when this level is at its lowest point, typically occurring between 4-6 am.

!!This is the vulnerability hours for shift workers as surgeons, nurses and anaesthetists.

!! Accidents and medical errors are more common on night shift.



!!Nurses may use the evidence to claim compensation. In certain countries, the additional stress and social disruption experienced by nurses working night shifts are compensated by “hardship” allowances (additional income). In others, access to longer rest periods or more frequent leave has been negotiated. In any case, nurses need to be aware of the higher incidence for accidents and adverse events during night shift hours.

Source: Wellness Milestones – Article by Sandra Tanajak – Director, Council for Public interest in

Anesthesia. AANA – News Bulletin – June 2007 – www.aana.com



3. On the job exposure to chemicals pose health risks for nurses

A recent study suggests that occupational exposure to hazardous materials may put nurses at risk for adverse events such as cancer, asthma and miscarriages.

The survey examined nurses’ medical histories and job-

related exposure to chemicals used in health care, including “cleaning products, radiation, mercury and latex.”



According to findings, !! “nurses reporting high exposure to radiation had a 20 percent

higher rate of breast cancer than nurses with low or no radiation exposure.

!! High exposure to medications of any type, meanwhile, correlated with a 14 percent increase in cancer incidence relative to nurses reporting low or no exposure, and the data linked high exposure to ethylene oxide and antineoplastic drugs to a 20 percent rise in miscarriages.

!! Respondents with high exposure to disinfectants, cleansers and latex had asthma rates as much as 50 percent higher than nurses with less exposure to those substances.

Source: Robert Wood Johnson Foundation (2007)

Workplace Chemical Exposure May Increase Nurses’ Risk for Adverse Health Events, Survey Finds.



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"!Persons providing routine nursing care (38%) and cleaning (15%)are the most common situations where needle stick injuries occur.

"!Invasive procedures such as injections and venipuncture are the most commonly reported causes of injury.

4. NEEDLE STICK INJURIES

Risk of infection after needle stick injury !   Source Risk

HBV 6.0-30.0% 1:3 HCV 1.8% HIV 0.3% 1:300



Prevention of injury:

!   * Use instruments to retract

!   * Use safety needles and re-cappers

!   * Pass instruments correctly and safely

!   * Use sharps containers and replace before full



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5. Workplace violence.

Violence in the workplace is a reality for many nurses. Potential perpetrators include: •!fellow nurses, •!other professionals, •!patients, •!or their families. In the past, prevention measures have focused on training of the carers. However, there is growing recognition that organisational and environmental factors (e.g. job design, patient flow, management style, ward structure, noise/heat levels) must also be addressed in order to stop the increasing spiral of workplace violence.

!! Overload of work. Constant dealing with illness and death. Rotating shifts, night shifts disturbing biological rhythms.

!! Fear of contagion or exposure due to poor occupational health and safety measures.

!! Frequent use of casual or temporary work contracts. !! Stress dealing with family as well as professional

responsibilities. !! Unhealthy work climate, e.g. bureaucracy, lack of

autonomy, rigid management hierarchy. !! High technical competence while failing to provide

training in psychosocial aspects of providing nursing care.

6. BURNING OUT



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The patients’ rights are the nurses’ responsibilities (professional, ethical, legal) The nurses’ rights are the employers’ responsibilities (liability laws, ILO conventions, labour laws, occupational health and safety legislation)

www.commonwealthnurses.org



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A nurses’ right to safety is the employers’ responsibility The law mandates of the employer: 1.! Safe systems of work 2.! Safe Climate 3.! Safe equipment 4.! Competent colleagues

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1. Safe systems of work

•! Written practice standards •! Written policies, protocols and procedures •! Appropriate documentation systems(NP) •! Systems of accountability for care given, or not given and actions taken(nursing process-NP) •! Adequate staffing systems

2. SAFE CLIMATE

Safety climate comprises: !! Safety within the organisation and safety related

to policies, procedures, and rewards (Brown & Leigh, 1996).

Safety within the organisation is both physical and psychological.

The physical aspects include: !! the provision of adequate equipment, !! Safe physical structures, !! an appropriate practice environment.



The psychological component of safety

includes !  rewards for employees and !  requires employees to feel comfortable

asking questions without fear of reprisal. Griffin and Neal (2000) described safety climate

as an antecedent of safety performance.



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3. Safe equipment It is: •! Available •! In good working order •! Well maintained •! Operational by staff who is well knowledgeable in its use

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4. Competent colleagues

•! Continuing education •! Fair system of appraisal •! Supervisors and managers with the necessary skills to manage •! Requires: recruitment, training, deployment, promotion and retention strategies

Nurses, at all levels, need to

embrace safety and consider it

an integral part to the way work

is planned, resourced, performed,

monitored and evaluated



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SAFE STAFFING The environment in which health care is provided influences not only the quality of care delivered but also the safety and well being of the care provider.



The American Federation of Teachers (1995) defines Safe staffing as �an appropriate number of staff with a suitable mix of skill levels . . . available at all times to ensure that patient care needs are met and that hazard-free working conditions are maintained.�



!  NURSE -PATIENT RATIO

Examples of the nurse patient ratios applied on day shifts are: Medical/surgical wards: Group A hospitals 1:4+In Charge Group B 1:5+In charge Accident/Emergency 1:3+In Charge+Triage Labour Wards 1:1 Ante/Post natal 1:5+In Charge Operating Rooms: General cases 3 nurses per theatre, Complex cases 4 High Dependency Unit 1:2+In Charge Palliative Care 1:4+In Charge



Nurses need their sleep and they need their breaks at work

!   The effects of fatigue on the brain from sleep deficiency are similar to those of alcohol

!   Fatigue appears more rapidly with irregular work schedules

!   Risk of accidents is 7 times higher between midnight and 8 am



Measures that promote a safe work

environment

!   Ongoing employee education !   Adequate staff so there are reasonable shift

lengths and workloads !   Supervision and support for inexperienced staff !   Measures to prevent stress, isolation and burnout !   Adherence to universal precautions !   Provision of personal protective equipment



The challenge for us nurses is to further improve work practices to ensure we do not risk our life

making a living.

THANK YOU FOR YOUR ATTENTION

Commonwealth Nurses Federation Sierra Leone Nurses Association€¦ · BSc(Hons)Nursing (USL, 2008)...

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