Workplace Safety In The Healthcare Setting | E. 76

The Healthcare Leadership Experience

As nursing shortages continue, occupational risks for healthcare workers are on the rise. Janelle Barowski discusses effective strategies to combat this growing issue with Jim Cagliostro.

Episode Introduction

Janelle draws on her nursing and writing experience to explain why staffing levels are at the root of workplace safety issues, how unsafe ratios are leading to unsafe choices and the need to shift the mindset away from martyrdom. She also reiterates why the General Duty Clause of the OSHA Act should be recognized, and why being positive, kind, and forgiving of mistakes is essential in nursing leadership.

Show Topics

• CDC statistics on workplace safety hazards

• Why a mindset shift is the first step

• Effective management strategies to improve safety

• The General Duty Clause of the OSHA Act

• Removing barriers to reporting concerns

• Nurses are turning to non-traditional roles

• Responding to workplace incidents

08:11 CDC statistics on workplace safety hazards

Janelle said that unsafe ratios can lead to unsafe choices if nurses don’t have sufficient support.

‘’I already had my opinions on what I thought the most pressing workplace safety hazards were, but I wanted to see what the officials were saying on this. And according to the CDC, the most common workplace safety hazards were: sharps injuries; chemical and drug exposure, so for cancer medications, radiation exposures; back injuries from repetitive tasks, which has happened to me multiple times so I can definitely speak to that; violence, which we've seen in the news lately, stress and latex allergies from exposure over time, which I learned in school, but I had totally forgot. And in my opinion, I have really zoned in on stress because that's something that I speak to all the time, is chronic stress and burnout, particularly in acute healthcare facilities where they might not have much of a work-life balance or control on patient ratios and order, things like that. And I just want to highlight that unsafe ratios can lead to unsafe choices due to not having enough support. And that can compound some of those other issues that we mentioned there. So not having enough support might lead you to pick up a patient that you really shouldn't be picking up, in a way that isn't supportive for body mechanics. So suddenly you have a back injury. And that also relates back to having to miss work, which can cost the facility money having a robust per diem pool to have people to plug into those spots. So it also always comes back to what affects the facility as well as what affects the floor and the cohesiveness there.’’

11:55 Why a mindset shift is the first step

Janelle said a mindset shift away from profit to nursing safety can help to improve conditions for healthcare workers.

‘’I think it definitely has to start with the mindset shift. I think that so many things need to be shifted in the mindset, especially with the healthcare industry. I understand that profit is so important. We really can't run anything without profit, but at what point are we sacrificing the healthcare workers that have our feet on the ground? …you can fix the nursing shortage by bringing in more nurses, but if you don't fix the root problem, those nurses are just going to leave the next year. So I think that really speaks so loudly to the issue. And I also looked up another statistic and it said, the average cost of turnover for a bedside nurse is $40,000, and that can range from $28,000 to $51,000. So the average hospital can lose $3.6 million to $6.5 million per year just on nurse turnover, which I think is wild. So even if you don't necessarily shift that mindset from profit, if you're still thinking about profit, it's still a huge loss. So I think we should shift from profit, but even if you're not. …. And fixing these issues also can reduce medication errors. It can reduce the OSHA fines, which sometimes are over a $100,000 for these hospitals. Nevermind jury awards, which can be more than $3 million. So these fines, they really stack up on top of losing a good nurse, which is really expensive too.’’

14:45 Effective management strategies to enhance workplace safety

Janelle highlighted effective steps from increasing staff levels to training and education.

‘’…the most obvious one is increased staffing so that everyone feels safe. No one should want to call out for help for lifting a patient, for anything like that, and not to get anything back. Increasing the wages to make it a more competitive field, especially because you see other areas right now, like tech, that are just soaring past the wages for nurses. In other growth industries too, engineers, other growth industries where nursing has stayed pretty stagnant….. I also think that there should be limits on shift duration just across the board. I think it's wildly unsafe for nurses to have to stay past their 12-hour shifts if someone calls out, because they legally can't leave their patient. And that also leads to unsafe choices like needle stick injuries, back injuries, chronic stress. No one should be working these 16 hour shifts. It's just not safe. And then in a perfect world, mandating staff ratios too, where you're not running around for hours and doing long med passes to the point where you can't take care of your own physiological needs like hunger or using the restroom. I think that that should just be a basic human right that's built into your nursing day. And then there should be training and education and policies on proper lifts, reminders like that. And also, I think it should be more commonplace to say no to shifts from management, because it just compounds on that chronic stress and also that guilt.’’

19:06 The General Duty Clause of the OSHA Act

Janelle said employers are legally required to provide a safe place of employment, an issue which needs highlighting.

‘’So one interesting thing that I found when I was researching this, is that the General Duty Clause of the OSHA Act actually addresses workplace safety issues and requires employers to furnish employees with employment in a safe employment place, by recognizing hazards that are likely to cause death or serious physical harm. I feel like a lot of people don't know that, and I feel like I didn't know that until I saw those words and I was like, they're supposed to do that? It makes sense. But to see that clause that there's actually a built-in clause that says that your employer is supposed to recognize and fix hazards that cause death and physical harm. So it's their responsibility, and I think that's saying that there's a clause out loud, just brings that light to it. So yeah, I think that's huge to just recognize that for a second.’’

20:57 Removing barriers to reporting concerns

Janelle said fear can make people nervous about raising safety issues.

‘’I think there's a lot of caveats and there's a lot of issues to why these things aren't addressed and why nurses and healthcare workers face issues in reporting safety concerns….. And I also think that some healthcare workers are afraid. They don't want to lose their jobs, rock the boat, or be targeted by their peers or administrators. I think there is a definite feeling of fear of reporting and thinking that their shifts are going to get cut or that they're going to be assigned really heavy patients or that there's going to be some sort of a retaliation….. I think the first thing (admin) can do is develop a no retaliation policy and let their facility know that they will not be retaliated on for bringing their concerns to light, and have that policy posted. And I think also having shift meetings or team meetings to bring up issues periodically in case people don't want to find the time or can't find the time. Because also, like we said before, nurses sometimes don't even have time to use the restroom. So really, when do you have time in your shift to find a manager, when you don't even know where they are, to tell them this thing? Sometimes it's out of sight, out of mind. So I also think it's the responsibility of the administrator to find the time to check in with their employees. And I think sometimes a group meeting could be helpful because one nurse might speak up and then three other nurses are like, "Oh my gosh, yes, I experienced that too, but I'm just whizzing through my day and I didn't think to say it."

28:54 Nurses are turning to non-traditional roles

Janelle said healthcare is failing to pick up on trends that impact workplace safety.

‘’I'm starting to see a lot of nurses turn into non-traditional nursing roles. So roles that are against the bedside. I mean, look at me. I am now a writer. I am still at the bedside at a diminished role, but I have left for the most part. And I'm starting to see more and more nurses that are interested in other non-traditional roles like writing, podcasting, consulting, health coaching, that type of thing. So I think I'm definitely seeing a rise in that. And you can't blame them. Who wants to be abused, who wants to not use the restroom for 12 hours, who wants to starve their entire shift? When you're working remotely, you're not abused, you're working your own hours, you're setting your own wage, and you're making your own clients. So I mean, it's a no-brainer. And it's sad because we need bedside nurses, but they need to be treated correctly. So it's also sad because you're waiting for the healthcare industry to pick up on these trends, and they're just not, and the nurses are leaving.

31:51 Responding to workplace incidents

Janelle outlined steps to address potential issues for abuse, which again comes back to the same root cause.

‘’So once again, I think an increase in staffing really is the root cause of a lot of these issues. So I think if you get to that moment and your deescalation techniques don't work, you should activate the protocol that you've been trained on. I think that there should be a clear protocol with every single facility. I think that the nurse should immediately remove themselves from the situation, and alert an appropriate team that has already been designated to respond. And I don't think it should be that nurse's responsibility to respond. I think that at that point, that nurse should be removed and should start putting their selves into a recovery mode. And I also think that the patient should be taken care of as well. I think it's important to notice that you're not leaving the patient in a deficit and you're not sacrificing the nurse. It's like a two-part system there. So whether it be trained security guards that are also trained on an empathetic communication level, or nurses that are somehow like a response team, but you call a code, an alarm goes off, and it's also subtle and someone responds in that way. And then the nurse should be given a break and a cool off period, and their caseload should be temporarily managed by a float nurse so that they just have a moment to just decompress. Because also you have to think about what care that nurse is going to be providing after they have been physically or verbally assaulted. It's not going to be the best care that they can. So it's also about taking care of the nurse, but it's also about taking care of the patient, patient-centered care. So making sure that their caseload is covered, once again, appropriately staffed.’’

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You’ll also hear:

From anatomy classes with mom, to Reddit reptile pages, via nursing: Janelle’s varied career journey to becoming a medical writer.

The impact of fatigue on nurse safety: ‘’Working long hours, particularly for nursing, doesn't give the body time to recover from fatigue and can also increase the risk for other musculoskeletal disorders.’’

How workplace safety hazards are interconnected: ‘’I think that when you would start to fix one, you would see a chain reaction and you would start to see other facets being fixed.’’

Moving away from ‘’martyrdom’’ as a mindset: ‘’Why is this a badge of honor that we wear? Martyrdom is not acceptable in any other industry. Why is it acceptable in ours? And this is what is leading to the nursing shortage among other things.’’

Leadership advice: Why it’s important to be outspoken but well-spoken in leadership, and why being positive, kind, and forgiving of mistakes is essential. ‘’… because everyone at the end of the day is a person who's just trying their best. I think that mindset really helps.’’

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