Safety in the Workplace: An Overview of Exhaustion in and Health Care Workers and Violence Against Staff Members

Safety in the Workplace: An Overview of Exhaustion in and Health Care Workers and Violence

Against Staff Members

Pursuant to the ideas generated from my Capstone project, I have developed a special interest in particularly in the field of safety in the workplace. The various shifts that the Emergency Department in which I work in has offered me diverse experiences pertaining to staff and patient safety. It has provided me with an insight on different safety issues relating to whether or not we are protected, our position in protecting our patients, as well as the need to be alert and healthy in an attempt to ensure safety to our patients and ourselves. Apparently, the 12.5 hours service we provide might appear to be long or short depending on the nature of the day of the nurse. This is determined by the level in which the nurse engaged his/her physical, mental and emotional strength in giving their best to their patients.

Research shows that over 74% of registered nurses perceive that stress and work overload is their greatest hindrance (American Nurses Association Health and Safety Survey, 2011). Caruso (2012) stated that over 10% of his respondents were victims of vehicle accidents following work shift and fatigue. Personally, I have been having a feeling that nurses and other hospital staff members have not been receiving the treatment that they deserved. The administration is always ready to scold at them whenever things do not work. Failure to realize the important role that staff members play in addition to the mistreatment, which they receive from the administration, would worsen the conditions in our health sectors. 

Notably, the health staffs are given minimum assistance by the administration yet they are expected to work tirelessly while giving their best. It is saddening that nursed are even forced to skip their breaks in their quest to care for patients yet they are treated inhumanly. Such work overloads imply that the staff will be wearied thus their Press Ganey scores in a domino effect would be lowered. Pursuant to such exhaustions, a health worker would be susceptible to alarm fatigue, sick calls as well as medication errors. Sometimes I am puzzled why it is hard for the administration to realize such an important relationship. In my work, I will be particularly interested in matters relating to staff safety and violence in the emergency department.

Another serious issue that most health workers face is verbal and physical abuse they receive at the workplace. It is true to say that the efficiency of an exhausted health worker who is also being abused will greatly be decreased thus the health care unit will be very unlikely to achieve its missions in such a scenario. Reports show that heath workers stand a chance of being harassed. According to a report by WHO (2016), between 8% and 38% of medical staffs have been victims of physical violence at one stage in their career while some have been exposed to verbal abuse. The perpetrators of violence have been established to be patients and visitors. 

Politicians particularly have also been attacking Heath workers fiercely on matters relating to disaster and conflict resolution. According to WHO (2016), the group of health workers who are at a risk of violence includes nurses, staff members who come into direct contact with patients, as well as staffs whom their routine work revolve around the emergency room and paramedics. Apparently, the seriousness of this matter can be justified by the fact that during my work today, I had to struggle to free myself from the hands of a drunken male patient two times without the help of security personnel. In an attempt to address this issue, this project shall consider the all health workers (nurses included), patients, and administration to be the stakeholders because safety in the healthcare units involves every individual around in addition to their families.

Problem Statement

In the present world, workplace violence has become a health and safety issue in most organizations since it poses negative effects to both the employees and the employers. As aforementioned, the violence can take two forms namely physical or verbal abuse. Most health institutions have identified four common types of violence. The first form of violence is the patient-related violence which takes place when a patient or his/her relatives are violent against a health worker or another patient. The second type originates when the perpetrator of violence does not relate with any stakeholder of the health care. Thirdly, the violence may be worker-to-worker and the violent individual may either be either an employee or a former employee of the organization. The final form of violence, which in most cases is not easily recognized by employers, is Personal Relationship Violence (PRV). 

A report in 2005 showed that 34% of Canadian nurses were victims of physical abuse 47% reported cases of being emotionally abused in the year 2004. In this regards, there is the need for the government to intervene in order to settle this matter, particularly in the health care field. Nevertheless, this shall highlight the effects of such types of violence on stakeholders, how the issue had been previously addressed as well as providing means that can be used to resolve the matter in the workplace. Reports have also established that patients abuse male nurses more frequently followed by female nurses. Male nurses are prone to attacks because most patients perceive that the nurse job is specific for females. Hospitals form a rich source of work-related violence since it is an emotional filled place. 

Effects on Stakeholders

Effects on Employees

In any workplace, employees play an integral part in ensuring that an organization achieves its mission and vision. Therefore, there would be the need for organizations to ensure that its employees are happy and safe. Notably, workplace violence is the cause of poor performance from an individual irrespective of the industry in which he/she works in. Owing to such acts, an employee would be filled with rage, fatigue and impotence thus he/she will not be confident enough to give his/her very best. Workplace violence possesses detrimental effect on the overall performance of the employee. It causes a decline in concentration and morale, which on the other hand would lead to reduced productivity. Such environment makes them struggle so hard to achieve success in addition to dealing with fear and insecurity.

Workplace violence is directly associated with stress, which later on will grow to create family tensions thereby leaving the employees world falling apart. According to Stress Focus Online (2016), an increased level of stress disturbs the health of the employees and symptoms such as reduced appetite, and nausea may result. Sources have also shown that abuse, which tends to threaten an employee’s life often yield psychological disorders such as Post Traumatic Stress Disorder (PTSD). CMHA online (2016) stated that the traumatic events often reverberate in an individual’s mind through nightmares that inflict fear. Such incidents may lead to depression and drug abuse. 

Effects on Employers & the Organization

Violence at the workplace has a significant detrimental effect on the employer and the health organization as well. A decline in performance from the employee leads to a reduction in productivity of an organization, which will have a severe implication on its financial position. Notably, a health organization will lose a lot of money due to the failure of a staff member to show up for his/her duties or rather failure to give his/her best. In Britain for instance, studies elucidated that absenteeism caused by workplace violence costs hospitals up to GBP 125,000 annually. Basically, this poses a serious economic challenge to the employers whose employees are susceptible to workplace violence. The organization also has to incur an extra cost in implementing programs that are intended to eradicate such vices. Furthermore, employers are also likely to face legal implications if an employee successfully files a petition stating that the organization failed to provide safe working conditions. Such a move will cost an organization sumptuous amount of money to compensate the victims. 

The culture of the healthcare is also affected by workplace violence. The mistreatment that an employee faces in a particular department is indelible in the sense that it will always be felt throughout the healthcare facility. Such a feeling would damage the reputation of an organization since most employees would render it unsafe and undesirable to work in. this implies that the healthcare will have a difficult time in finding workers during times of shortages. In fact, poor hiring and retention rates would become characteristic of the organization.

Role and Responsibility of the Nurse in Mitigating Work Violence

As mentioned earlier, nurses are the most affected people when it comes to work-related violence in the healthcare sector since their daily work is centered on patients. Nonetheless, nurses are mandated to report such cases especially when they are abused by the patient or his/her relatives. Apparently, most cases of work violence go unreported, and this might be the primary reason why it is emerging to be a global crisis. In addition, there is the need for nurses to analyze the status of their patients so that they can report on whether they would need security personnel before they start attending to the patients. It is unfortunate that a nurse has to single-handedly handle the wrath of an intoxicated patient, and yet she is supposed to administer medical care to the patient. This is more than a double task and needs a serious redress. 

Self-assessment is also an important factor that nurses need to consider before engaging in any activity. In this case, a nurse should be able to assess his/her physical, mental and emotional state prior to offering his/her daily services to the organization. This would reduce instances of giving wrong medication that occurs due to exhaustion. Additionally, self-awareness would help in curbing cases of road carnage that is growing exponentially. An exhausted nurse ought to use public means of transport or seek services of a driver in order to protect his/her life.

Proposed Initiative In Resolving The Problem

There are many ways of mitigating work related violence. However, this paper will propose six methodologies that would be essential in ensuring the safety of staff members in hospitals and other medical care units. The proposals herein would be vital in ensuring that organizations buffer their present safety methodologies in an attempt to create a favorable working environment for its workers. The initiative will be discussed as below:

Restoring the Culture of Safety

Safety in health centers will begin if each and every individual starting from the administration to the lowly ranked employee is aware that it is a priority. Employers must be on the forefront in emphasizing the need for safety same way they do when it comes to dealing with their patients. In fact, there would be the need for them to organize frequent safety meetings to drill their workers on the basis of the same. Health facilities ought to advocate for a better employee-safety Committee engagement. The committee, in this case, should comprise of members of the administration who will be working cordially with employees in establishing the cause of work-related violence and how it can be mitigated (The Joint Commission, 2012). Staff safety goals need to be made public and employees should be encouraged to participate actively in finding solutions to the problem (Lori, 2011). It will also be imperative for the organization to establish the performance of the employees against the safety standards and post the results for all the staff members to monitor safety progress (The Joint Commission, 2012). 

Training 

For organizations to solve the issue of workplace violence, it is imperative for it to focus on preventive measure. This can be achieved through training the workforce on how to prevent and how come up with violent. Organizations and the government must take workplace violence seriously. Workplace needs to be safe since it would be illogical to put the careers of employees at stake. Due to depression and psychological torture, that violence at workplace brings in their lives. Employees need to equip their employees with the necessary skills to enable them handle potential harassment at workplace. A health institution that fails to ensure safety to its workers stands a chance of failing to attract the interests from student nurses who often undergo their internships in medical institutions. In most cases, colleges would not allow their students to undertake their attachment in institutions that are not accredited.

Health centers need to have proper systems that will help in reminding the employees about the vital safety protocols regularly. The training programs ought to be proactive rather than being reactive because staff safety relies on them. New employees will also need to be thoroughly trained on the safety measures in the organization as well as the need to report any form of injuries and illness they encounter while performing their duties. Annual refresher training on security and workplace violence prevention as well as how to handle patients and ergonomics need to be conducted.

Improve Patient Handling 

Notably, moving patients from one place to another has resulted in serious injuries among health workers. Hospitals have invested heavily on safe patient handling methodologies, and it has proved to be working. According to the Bureau of Labor Statistics (2013), 48% of injuries that medical staff succumbed were as a result of patient handling during bending or lifting. The compensation that workers get pertaining to the injuries they sustained in their attempt to move the patient was $10,127 (Beecher, 2013).In order to improve on patient handling, hospitals ought to use of patient lifting equipment so that the organization can be saved from paying compensations to its employees. In addition, such equipment would help in reducing the injuries sustained by patients during the process of movements.

Record Keeping 

According to the worker safety laws, health facilities just like other organizations are required to keep an up to date records on matters pertaining to workers safety. In this regards, such facilities need to develop a system for recording injuries as well as work related violence that occurred to its employees. Notably, some types of injuries incurred need to be reported to OSHA and other state agencies. Apparently, the most puzzling question is that are the employees really encouraged to report cases of violence? A study of nurses working in ER showed that majority of nurses failed to launch a formal report on the physical or verbal abuse they face from their patients (Jill et al., 2011). 

The report also shows that 65.7% opted to inform security officers, 64.2% notified their supervisors, 63.2% told other medical partners while 54.6% informed emergency physicians (Jill et al., 2011). This is a clear indication that the reporting systems are not fully utilized therefore it becomes difficult for health administrators to establish a clear picture of the situation in their organization. The report also indicated that nurses faced lower chances of being physically abused while working in health facilities that have zero-tolerance legislations pertaining to violence and obligatory reporting governance. Therefore, health institutes should encourage their employees to report instances of physical or verbal abuse so that they can understand how to deal with the situation (Jill et al., 2011). 

Adjustments to Staff Levels, Schedules, Shifts and Nurse-To- Patient Ratios

Healthcare personnel work for very long hours thus the need to establish how they can be scheduled will bear some significant effect on their safety as well as that of the patient. A report by American Nurses association (ANA) (2016), suggested that proper staffing of the nurses is essential in reducing medical errors, mortality rates, as well as improving patient’s satisfaction. Working for longer hours is seen as a common practice among nurses. However, ANA reported that due to such practices, 96% of nurses experience fatigue at the onset of their shifts. Information from the Staff Nurse Fatigue and Patient Safety showed that fatigue made nurses be more prone to errors. In addition, they will reckon about their past decisions while treating their patients (Scott et al., 2014). Hospitals ought to consider shorter shifts so that the nurses can give their best thereby reducing instances of burnouts and dissatisfaction (Amy et al., 2012).Additionally, Leigh et al., (2014) advocates for the need to have fewer nurse-to-patient ratios. In California for instance, injuries to nurses dropped by 32% after implementing the minimum nurse-to-patient (Leigh et al., 2014).

Night Shifts

In organizations that operate 24-hours, having night shift would be indispensable. However, other factors need to be considered so that the safety of the employee is guaranteed. For instance, in mental care units incidents of physical abuse to nurses during night shifts have been rampant (Ridenour et al., 2014).Alternating nurses between day and night shifts tends to have the most adverse effects since it affected the circadian rhythms and it led to fatigue. Studies revealthat individuals who work on a day-night shift rotational basis exhibited a nodding syndrome. Such individuals nodded twice on their way to or from work hence making them susceptible to accidents while driving. 

Need to Embrace Technology

It can also be used to ensure the safety of the employees. For instance, implementing the electronic health records (EHR) can be important in monitoring a patient’s aggressive behavior thus the care team would have prior information on how to deal with the patient. Real-Time Location Systems (RTLS) can also be instrumental in ensuring staff safety. RTLS provides instant information about the location of the patient, staff care or other vital equipment that might be needed during emergency cares. 

Implications for Nursing and Health Care

The proposal herein provides the care staff with a chance to participate directly in reaching out for solutions to work related violence. It explicitly explores the need to train the staff on matters pertaining to their health as well as that of the patient. Above all, this proposal emphasizes the need for health centers to embrace technology in its efforts to curb work violence. Technology is important for the nursing and health sectors since it enables the staff to move quickly where help is needed. In the case of emergencies, it is vital to send an appropriate person to help. The right person, in this case, is not necessarily a medical attendant but somebody who can in a position to rescue the situation as fast as he/she can. RTLS in this perspective will be an integral tool for directing staff members where the need is needed and what to expect before arriving at the incident. 

Furthermore, technology helps staff members to identify the location of the patients in real time. RTLS permits the medical staff with a chance to scrutinize patients without establishing a physical contact with them. This equipment can notify the staff when a patient enters in areas where they are not authorized. Additionally, this will reduce instances of patients injuring themselves or even the staff members. Cases of elopements can also be reduced in hospitals. Technology guarantees the safety of a patient. For instance, patients can be given a button to summon medical staffs for help in any location whatsoever within the hospital premises. In addition, a wireless RTLS can be installed such that it can alert the care staff when a patient has not moved for a particular period. This would enable the staff to respond promptly to accord the patient with the necessary assistance. 

The efficiency of the health workers can also be improved if the proposal herein is followed to the later. For example, the use of technology can provide information on the whereabouts of patients, medical equipment as well as the movement of staff members within an organization. Health centers can spot areas that need improvement thereby improving patient’s satisfaction. It should be noted that RTLS can be integral in identifying the cause of delays in care units such as lack of equipment or staffing problem. In this regards, the administration can be aware oftime, thus, it can step in to resolve the matter. 

Hospitals usually require nurses and other staff members to enter certain restricted areas like patient rooms or medical stores. Apparently, such locations exhibit low visibility and low population is also a characteristic of such areas. It has been discovered that most cases of violence happen in these areas since the perpetuators of this vice cannot be seen or interrupted. Nonetheless, the best method to ensure the safety of staff members in such locations is by equipping them with a panic button that will send a distress alarm. Additionally, it will provide the location of the incidence thus the victim can be helped on time and the offender be brought to justice. The RTLS in this case would be a key gadget at ensuring that these devices are tracked with ease. It helps to reduce emergency responses since it will allow security officers to establish the position of the victim without the need to call or checking up on the hospital map.

The benefits of the RTLS go beyond staff security. For instance, it can benefit the company since it has the ability to locate equipment that is needed to offer prompt medical care. A report by Nursing Times (2009) indicated that over one-third of nurses worldwide spend at least one hour every day searching for equipment that they need to treat their patients. That is around 30 hours monthly, and it forms about 16% of the working time. In most cases the nurse often gives up on the search prior to finding the equipment. However, with the use of RTLS the staff working hours can be effectively utilized without instances of exhaustion and fatigue. This technology saves the medical staff time by automating most medical processes. It has the ability to monitor the position of tagged assets thus employees can search such items electronically.

Conclusion

In conclusion improved staff safety is beneficial to all stakeholders which include, care providers, patients, members of the administration plus the organization in which they work in. The investment in safety programs will not only save lives but also it will help health facilities to cut down the costs they incurred in compensating employees and patients. It provides an organization with a chance to be profitable in its endeavors. Safety in hospitals elevates the reputation of a hospital as well as ensuring patient’s satisfaction. Many ways exist that can be used to improve the safety of employees in healthcare facilities such as the need to embrace the culture of safety by all stakeholders. Notably, practices like training of staff on safety issues, improved patient handling, proper record keeping in addition to proper staffing and scheduling play an important role in ensuring safety at the workplace.

Above all, information technology such as Real-Time Location System (RTLS) seems to hold the future of hospitals on matters relating to staff safety and service delivery. This technology provides the administration with myriad benefits like the ability to instantly track employees, patients, as well as medical appliances. As aforementioned, the benefits that RTLS offers to an organization goes beyond staff safety in the sense that hospitals can work on patient flow as well as staff effectiveness which on the other hand leads to an increase in profitability and cost reduction. RTLS solutions which have inbuilt RFID over Wi-FiTM are easy. Additionally, they are affordable and can utilize the Wi-Fi previously installed in hospitals for purposes of instant location identification. 

References

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