Chapter 11 Promoting a Healthy Work Environment Copyright © 2015. F.A. Davis Company Workplace Safety • Environmental hazards • Physical safety • Emotional safety Copyright © 2015. F.A. Davis Company Reducing Risk • Occupational Safety and Health Administration (OSHA) • Centers for Disease Control and Prevention (CDC) • National Institute for Occupational Safety and Health (NIOSH) Copyright © 2015. F.A. Davis Company Reducing Risk (cont'd) • American Nurses Association (ANA) • Joint Commission • Institute of Medicine (IOM) Copyright © 2015. F.A. Davis Company Reducing Risk (cont'd) • Workplace programs: safety plan – – – – Consult federal, state, and local governments. Distinguish between real and imagined risk. Seek administrative support. Calculate costs of program. Copyright © 2015. F.A. Davis Company Workplace Programs • • • • Identify potential hazard. Assess degree of risk. Develop a plan. Implement the program. Copyright © 2015. F.A. Davis Company Violence • Social issue • High rate of assaults on hospital workers – Threats – Physical assaults – Muggings Copyright © 2015. F.A. Davis Company Violence (cont'd) • Situations that increase workers’ susceptibility – Routine contact with the public – Working alone or in small numbers – Working late – Poor security Copyright © 2015. F.A. Davis Company Violence (cont'd) • Situations that increase workers’ susceptibility (cont’d) – Patients and families under stress who carry weapons – Individuals – Lack of experienced staff members – Units and patients that need seclusion or restraint activities Copyright © 2015. F.A. Davis Company What Nurses Should Know • Does violence in the surrounding community affect my workplace? • Does the layout of the facility invite violence? • Is there a prompt response by administration to violence? Copyright © 2015. F.A. Davis Company What Nurses Should Know (cont'd) • Are incidents being reported to and addressed by management? • Would training that deals with workplace violence be adequate for employees and management? • Which types of patients are more prone to violence? Copyright © 2015. F.A. Davis Company Behaviors • • • • History of violent behavior Delusional or paranoid speech Aggressive and threatening statements Rapid speech and angry tone of voice Copyright © 2015. F.A. Davis Company Behaviors (cont’d) • • • • Stiff posture, clenched fists, tight jaw Alcohol/drug use Male gender or a youth Unrealistic policies Copyright © 2015. F.A. Davis Company When Assault Occurs: Placing Blame on Victims • Victim gender – Women receive more blame than men. • Subject gender – Female victims receive a greater amount of blame from women than from men. • Severity – The more severe the assault, the more often the victim is blamed. Copyright © 2015. F.A. Davis Company When Assault Occurs (cont’d) • Beliefs – The world is a just place; therefore, the person deserves the misfortune. • Age of victim – The older the victim, the more he or she is held responsible for the assault. Copyright © 2015. F.A. Davis Company Keep an Eye Out • Look for clues indicating potential violence. • Call patients, family members, and visitors by their names. • Encourage the patient or the patient’s family to vent anger. Copyright © 2015. F.A. Davis Company Keep an Eye Out (cont’d) • If you feel uncomfortable, trust your intuition. • Know your institution’s policies and procedures. Copyright © 2015. F.A. Davis Company Preventing Workplace Violence • Have an ongoing prevention program. • Report all violent incidents. • Hold all patients, visitors, staff members, and management accountable for their behavior. • Adopt a zero-tolerance policy. Copyright © 2015. F.A. Davis Company Participate in Workplace Safety • • • • • Assess the workplace regularly. Know your clients. Be alert for suspicious behavior. Maintain behavior that helps to defuse anger. If situation escalates, remove self and call security. Copyright © 2015. F.A. Davis Company Participate in Workplace Safety (cont’d) • • • • Report situation to supervisor. Call the police. Get medical attention. Contact collective bargaining or state nurses’ association. • Participate in policymaking. Copyright © 2015. F.A. Davis Company Sexual Harassment Copyright © 2015. F.A. Davis Company Behaviors Defining Sexual Harassment • Pressuring another to participate in sexual activities • Asking another person about his or her sexual activities, fantasies, or preferences • Making sexual innuendos, jokes, comments, or suggestive facial expressions to another person Copyright © 2015. F.A. Davis Company Behaviors Defining Sexual Harassment (cont’d) • Continuing to ask for a date after the other person has expressed disinterest • Making sexual gestures with hands or body movements, or showing sexual graffiti or visuals • Making remarks about a person’s gender or body Copyright © 2015. F.A. Davis Company Sexual Harassment • Two forms of sexual harassment – Quid pro quo – A hostile environment Copyright © 2015. F.A. Davis Company Sexual Harassment (cont'd) • Recommendations from the American Nurses Association (ANA) on fighting sexual harassment – Confront – Report – Document – Support Copyright © 2015. F.A. Davis Company Latex Allergy Copyright © 2015. F.A. Davis Company Latex Allergy • • • • • • Contact dermatitis (most common) Generalized hives Urticaria Rhinitis Wheezing Anaphylaxis Copyright © 2015. F.A. Davis Company Decreasing the Potential for Latex Allergy • • • • Reducing unnecessary exposure Using alternative gloves (nitrile) Employee education programs Identifying workers at risk Copyright © 2015. F.A. Davis Company Needlestick Injuries Copyright © 2015. F.A. Davis Company “Needlestick Act” • Passed in 2001 • Revised blood-borne pathogens standards • Obligates employers to consider safer needle devices Copyright © 2015. F.A. Davis Company The Nurse’s Responsibilities • • • • • Always use universal precautions. Use and dispose of sharps properly. Get immunized against hepatitis B. Report all exposures. Know the human immunodeficiency virus/hepatitis B virus (HIV/HBV) status of your patient. Copyright © 2015. F.A. Davis Company The Nurse’s Responsibilities (cont’d) • • • • Comply with post-exposure follow-up. Support others who have been exposed. Become active on safety committees. Educate others. Copyright © 2015. F.A. Davis Company Ergonomics Copyright © 2015. F.A. Davis Company Preventing Back Injuries • • • • Participate in safety committees. Work in teams; do not be afraid to ask for help. Use transfer and lifting equipment. Do back exercises. Copyright © 2015. F.A. Davis Company Repetitive Stress Injury (RSI) • Usually affects individuals who spend long hours at computers. • The most common injury is carpal tunnel syndrome. • Another injury is mouse elbow. • Badly designed computer stations present the highest risk. Copyright © 2015. F.A. Davis Company Preventing RSI • • • • • • • Monitor placement Keyboard alignment Mouse position Body alignment Vary tasks. Use fingertips when typing. Keep fingernails short. Copyright © 2015. F.A. Davis Company Impaired Workers Copyright © 2015. F.A. Davis Company Common Signs of Impairment • Witnessing an employee consuming alcohol or other substances of concern on the job • Apparent in employee’s dress, appearance, posture, and gestures • Employee’s use of slurred speech and abusive/incoherent language Copyright © 2015. F.A. Davis Company Common Signs of Impairment (cont’d) • • • • Reports from patients/coworkers Witnessing unprofessional conduct Employee has significant lack of attention to detail Witnessing an employee stealing controlled substances Copyright © 2015. F.A. Davis Company Impaired Nurse Programs (INPs) • Most employers and 37 boards of nursing have strict guidelines. • INPs conducted by boards of nursing work with employers to assist impaired nurses. • Compassion from coworkers is of utmost importance. Copyright © 2015. F.A. Davis Company Professional Responsibilities • Nurses need to uphold the standards of their profession. • Ignoring substance abuse places clients and other nurses in danger. • It is important to “help a colleague obtain help.” Copyright © 2015. F.A. Davis Company Workload • Rotating shifts • Mandatory overtime • Staffing ratios Copyright © 2015. F.A. Davis Company Reporting Questionable Practices • Most employers have policies regarding reporting behaviors that affect the workplace environment. • Code for Nurses (2001) is specific regarding this responsibility. Copyright © 2015. F.A. Davis Company Behaviors • Endangering a client’s health or safety • Abuse of authority • Violation of rules, regulations, or standards of professional ethics • Gross waste of funds Copyright © 2015. F.A. Davis Company Whistleblower • Describes an employee who reports employer violations to an outside agency • Do not assume “doing the right thing” will protect you. Copyright © 2015. F.A. Davis Company Whistleblower Guidelines • • • • Gather the facts. Does the practice violate any actual law? Know the state law requiring mandatory reporting. Type your documentation and include day, date, time, and circumstances. Copyright © 2015. F.A. Davis Company Whistleblower Guidelines (cont’d) • Identify witnesses. • Do not breach confidentiality in any way. • Send a copy of your complaint to the chief nursing officer or nursing department or any other department affected. • Utilize the ethics committee of your institution. • Keep copies of your records. Copyright © 2015. F.A. Davis Company Nursing Responsibilities Related to Threats of Terrorism • Know the evacuation procedures and routes in your facilities. • Develop your knowledge regarding the most likely and most dangerous biological weapons. • Monitor for unusual disease patterns. • Know the back-up systems for communication and staffing. Copyright © 2015. F.A. Davis Company Enhancing the Quality of Work Life • Social environment – Working relationships – Supporting your peers and supervisors • Involvement in decision making Copyright © 2015. F.A. Davis Company Enhancing the Quality of Work Life (cont'd) • Professional growth and innovation – Encourage critical thinking. – Seek educational opportunities. – Encourage new ideas. – Reward professional growth. Copyright © 2015. F.A. Davis Company Understanding Cultural Diversity • Communication • Space • Social organization Copyright © 2015. F.A. Davis Company Organization Diversity Fitness • Personnel reflect the current and potential population that the organization serves. • Silence and gestures are respected. Copyright © 2015. F.A. Davis Company Organization Diversity Fitness (cont'd) • Awareness of special family and holiday celebrations • Individuals first; culture second Copyright © 2015. F.A. Davis Company Managing Diversity • Be aware of and sensitive to your own culture-based preferences. • Explore your own biases and values. • Be knowledgeable about other cultures. Copyright © 2015. F.A. Davis Company Managing Diversity (cont'd) • Be respectful of and sensitive to diversity among individuals. • Be skilled in using and selecting culturally sensitive intervention strategies. Copyright © 2015. F.A. Davis Company Do’s and Don’ts for Managing Diversity DO DON’T Recognize diversity Pretend everyone is alike Value diversity Expect everyone to conform to the prevailing culture Develop informal supports Seek a quick solution Ensure fairness Develop different standards of performance Make the preceding principles an integral part of your philosophy Expect one workshop to solve the problem Copyright © 2015. F.A. Davis Company Conclusion • Workplace safety is a growing concern. • IOM and Joint Commission will continue to impact workplace safety issues. • Support the ANA. Copyright © 2015. F.A. Davis Company
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