The OSHA/NIOSH toolkit contains an appendix that is an editable document any hospital can use to draw up its respiratory protection program.

Better Care for the Caregivers

Solutions are needed to address safety concerns of America's caregivers—nurses.

Nearly 3.4 million men and women serve our nation as nurses, providing more one-on-one care than any other category of health care professionals. Each found a calling in providing comfort and care to patients in some of their most vulnerable, critical moments—births, emergency procedures, chronic illness complications, debilitating diagnoses, and death.

Nurses also outnumber doctors six to one.1 They are also credited as the most trusted profession in America.2

While the workforce represents the largest group of professionals in health care today, the physical and emotional impact their work leaves behind is not as well known. Case in point: The on-the-job safety risks of nurses rival those in construction3 and public safety.

A recent investigative report from NPR shed light on the severe back pain and musculoskeletal problems that have long plagued nurses. The report stated that according to surveys by the Department of Labor's Bureau of Labor Statistics (BLS), there are more than 35,000 back and other injuries among nursing employees every year that are severe enough that they have to miss work.

In addition to back pain, a new study revealed nurses may suffer from contact dermatitis 4.5 times4 more than any other profession, as a result of hand hygiene compliance measures such as constant hand-washing, scrubbing, and sanitizing. "Campaigns to reduce these infections have been very successful and many lives have been saved. However, we need to do all we can to prevent skin irritation among these front-line workers," said Dr. Jill Stocks, who led the research.

The emotional toll on caregivers is also becoming a greater concern. What nurses witness and experience in 12-hour shifts covers more than what most people might experience in a lifetime. It's no wonder that "compassion fatigue" is trending among clinicians. Providing the tools to help and support them is absolutely critical.

And in some respects, there's no clear-cut definition around the nurse role. Most people generally understand that nurses comfort and care for patients. But talk to any nurse, and their role spans beyond that. Nurses may get bitten, slammed to the ground, scratched, and shoved. I know this because all of it has happened to me. As a nurse, it's not in your DNA to point out that you were hurt, when your job is to treat people who are ill and need help.

And while nurses have been in demand consistently for the past decade, there still continues to be a shortage. A registered nurse is among the top five occupations with the highest projected job openings until 2022, BLS data show. Openings for RNs are expected to jump 19.4 percent from 2.7 million to 3.2 million. Meanwhile, today's nurse is getting older. The average professional has aged another two years to 44.6 years old, according to the American Nurses Association.

Studies have uncovered that "nurses' negative feelings about their jobs, including their feelings of burnout, tend to be influenced more by the organizational practices governing the workplace than by the challenges inherent in caring for others,"5 according to the American Nurses Association's Online Journal of Issues in Nursing. Additionally, a report based on the National Sample Survey of Registered Nurses indicated that it was the "structure of the job, rather than the composition of the work" that influenced nurses' job satisfaction.

Eighty-six percent of ER nurses experience moderate to high levels of compassion fatigue, while 20 percent of nurses in a survey report symptoms of depression, an incidence twice as high as the general population.

Health Care Organizations Beginning to Address Problems
So what needs to be done to support and care for our nation's caregivers? Health care organizations must step up in addressing these concerns. In addition to implementing new solutions and programs, it takes staff buy-in, comprehensive training, outcomes management, and follow-through.

To address lower back pain due to patient moves, an issue nearly half of all nurses6 struggle with, one health system implemented a safe patient handling program that decreased workers' compensation costs by $430,000. Avalon Health Care Group in Salt Lake City, Utah, implemented assistive technology and a robust training program. The eight facilities that incorporated it reported no staff injuries for the first six months and a boost in employee satisfaction. "Staff retention increased, staff morale increased, and we were able to receive a considerable decrease in our insurance renewal premiums for the following year," said Jessie Alexander, Workers' Compensation Employee liaison for Avalon Health Care Group.

A solution to protect and soothe caregivers' skin from ongoing hand-washing is also starting to make waves with nurses who have yet to find a remedy for their irritated, dry hands. Many are beginning to turn to a new nitrile glove coated with colloidal oatmeal. Colloidal oatmeal is a USP skin protectant drug that can temporarily protect and help relieve minor skin irritation and itching from rashes or eczema, as indicated by the Food and Drug Administration.

An Evolving Profession
The reasons why nurses joined the profession have not changed. One must be passionate and completely dedicated to the mission of saving lives. "When your heart is in healing and caring for the sick, you're not thinking about your own safety or well-being," Alexander said.

Hospitals and health care organizations need to help solve the problems with innovative thinking, new strategies, and understanding what clinicians need to do their jobs. Nurses need compassionate, committed champions in their organizations to see these solutions through.

To ensure that organizations are protecting the safety of their employees, organizations must develop goals, defined milestones, and the right metrics to measure success. Behavior and mentality toward these issues are changing. While nurses are charged with being empathetic and compassionate at every moment of interaction, their organizations must support them.

The biggest question that needs to be answered going forward: How are health care organizations ensuring the safest practices for their nurse employees?

References
1. http://www.fiercehealthcare.com/story/npr-documentary-explores-how-nurses-handle-stress-burnout/2015-02-18 and http://www.huffingtonpost.com/david-freudberg/helping-nurses-handle-their-professional-stress_b_6699008.html
2. http://www.theamericannurse.org/index.php/2014/03/03/nurses-retain-top-spot-as-most-ethical/
3. http://www.npr.org/2015/02/04/382639199/hospitals-fail-to-protect-nursing-staff-from-becoming-patients
4. http://www.manchester.ac.uk/discover/news/article/?id=13861
5. http://gm6.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/WhyEmotionsMatterAgeAgitationandBurnoutAmongRegisteredNurses.html
6. http://journals.lww.com/ajnonline/Abstract/2012/02000/Original_Research___Nurses__Presenteeism_and_Its.21.aspx

Nurse Occupational Safety Facts
Musculoskeletal disorders cases in 2013 -- number of cases, incidence rate, and median days away from work:

 Registered nurses
 11,430  55.7 8  
 Nursing assistants
 22,000  208.4 7  
 

Source: http://www.bls.gov/news.release/osh2.t18.htm

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