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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
This project is supported by a grant from the National Institute of Occupational Safety and
Health Grant #R01-OH07381-04, “Health Disparities Among Healthcare Workers.”
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
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
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
Health and Safety/Injury and
Illness
 Musculoskeletal
 Multiple chemical
 Infection
sensitivity
 Latex allergy
 Needle sticks
 Abuse and assault
 Asthma
Work Environment Exposures
 Noise
 Poor equipment
 Lifting
design
 Poor air quality
 Hazardous
chemicals
 Stress
 Violence
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
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.”
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
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.”
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
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”
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
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…”
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
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