A new study by consumer advocacy organization Public Citizen has exposed the frequency and severity of workplace illness and injury suffered by healthcare workers each year. HRMR asks what can be learned from these findings.
Healthcare workers suffer more injuries and illnesses on the job each year than those in any other industry, but the Occupational Safety and Health Administration (OSHA) conducts relatively few inspections of healthcare facilities and is hamstrung in its ability to take action to resolve unsafe conditions by an absence of needed safety standards, according to a new report by consumer advocacy organization Public Citizen.
“OSHA is required by law to ensure safe conditions for every employee in the US,” says Keith Wrightson, worker safety and health advocate for Public Citizen, and a co-author of the report, Health Care Workers Unprotected. “The record is clear that the government has broken its promise to healthcare workers.”
Nurses, nursing aides, orderlies and attendants suffer more musculoskeletal injuries than workers in any other field. Costs associated with back injuries in the healthcare industry are estimated to be more than $7 billion annually.
Dr Teresa Bartlett, senior vice president, medical quality for Sedgwick, agrees that healthcare workers have a unique set of exposures because of the nature of their work.
“Healthcare workers have jobs that are both mentally and physically demanding,” she says. “They are essential to the direct patient care process. Ergonomic devices to assist with lifting, pushing and pulling are available and advancements have been made in trying to prevent falls, but the issue remains that patients may fall in a confined space that prevents the use of assistive devices. Emergencies require healthcare workers to do everything they can to save or preserve life.”
She adds that healthcare workers are also exposed to communicable illnesses. This can occur during an incubation period when the actual diagnosis is not known or in a needlestick/splash situation. “While every precaution is taken to prevent exposure to illness and disease, exposures still may occur,” she warns.
“Most Americans are not aware that hospitals and other medical facilities are actually the most frequent site for workplace injuries,” says Dr Toni Lewis, chair of the healthcare division of the Service Employees International Union (SEIU), which advised Public Citizen on its report.
“This is an issue that affects so many frontline workers—nurses, certified nursing assistants, radiologists, physical therapists—all women and men who are trying to meet the needs of their patients safely and effectively. The current patchwork approach is not working for workers.”
Furthermore, the absence of healthcare workers due to illness or injury can increase the risk to patients, warns Bartlett.
“Safety and risk are issues that impact everyone in a healthcare organization. If healthcare workers who are well trained are not able to work due to an injury or illness then replacement workers must be found. These workers often do not have the safety training or know every aspect or nuance of the jobs they perform. This has potential to lead to errors, injuries and safety issues.”
In 2010, healthcare employers reported 653,900 workplace injuries and illnesses, about 152,000 more than the next most afflicted industry sector, manufacturing. The construction industry is the subject of the most inspections, and even that industry needs more inspection and enforcement, according to Public Citizen. Although healthcare workers outnumber construction workers more than two to one, OSHA conducts just 5 percent as many inspections of healthcare facilities as those of construction sites.
“It’s alarming that healthcare workers rank right alongside laborers, truck drivers and those in other physical, labor-intensive jobs in terms of musculoskeletal injuries,” said Suzy Harrington, director of the American Nurses Association’s department for health, safety and wellness.
“This is a primary reason healthcare workers leave direct patient care. We can’t afford to lose healthcare workers to injury and still meet rising demands for healthcare services.”
OSHA’s leader, assistant secretary of labor David Michaels, has acknowledged that healthcare safety problems need to be addressed, saying in 2012: “It is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness.” In response to questions posed by Public Citizen for the report, OSHA argued that it does not have the resources necessary to develop certain specific standards.
Who’s to blame?
The fault for OSHA’s failure to protect healthcare workers does not rest entirely with the agency, says Public Citizen. Congress has impeded OSHA’s ability to carry out is mission. The agency’s $535 million budget is woefully inadequate to oversee the seven million workplaces in its purview.
Meanwhile, the agency’s rulemaking efforts have been obstructed. In 2000, the agency published a final standard to protect workers in all industries from ergonomic stressors. But Congress repealed the rule before it took effect. At the outset of the Obama administration, the agency proposed a rule to add a column on employers’ incident-reporting logs to designate whether workplace injuries were musculoskeletal disorders. But the administration delayed the proposed rule and Congress subsequently blocked it.
The agency is attempting to partially address the frequency of injuries among nursing home employees with a ‘national emphasis program’, which aims to address ergonomic stressors, bloodborne pathogens, tuberculosis, workplace violence, and slips, trips and falls.
But, warns Public Citizen, the program does not cover hospitals or other healthcare settings, where high injury rates also have been reported. In the absence of a specific standard for ergonomic safety, Public Citizen says the agency must rely on its catch-all ‘general duty clause’ to issue citations for unsafe ergonomic conditions. The general duty clause cases require a high evidentiary threshold, and only seven citations regarding ergonomics have been issued to nursing homes over the past two fiscal years.
Public Citizen recommends that OSHA should increase the number of inspections of the healthcare industry facilities by several fold and pursue binding standards to ensure that workers are protected from the risks posed by musculoskeletal disorders, workplace violence and other threats. The report also recommends that Congress significantly increases funding of OSHA.
As for the changes and safeguards that can be implemented now by healthcare organizations, Bartlett recommends:
• Training and education of functional ways to prevent injury;
• Mandating the use of personal protective equipment;
• Mandatory vaccination programs;
• Medical surveillance programs to monitor for high risk groups; and
• Daily safety meetings to understand the most current issues confronting the healthcare team.
She also recommends that organizations mandate the use of ergonomic equipment when available and stress the avoidance of taking short cuts; carry out a root cause analysis investigation on every incident; and encourage the use of a near-miss reporting system without punitive consequences to identify areas of potential opportunity for improvement.
“Enhanced documentation and quality measurements will most certainly be a positive outcome, however, how this will add a layer of complexity for the healthcare worker that has yet to be determined,” she says. N
Public Citizen, workplace illness, workplace injuries, Keith Wrightson
