Losing patience

Canada’s health care sector is always struggling to make ends meet. Whenever they do have money to invest, health executives tend to devote spending on new hospitals, better medical equipment or surgical suites, to help improve patient care.

What that means, says Cameron Mustard, President of the Institute for Work & Health (IWH), is that “over the last 15 years there hasn’t been a lot to spare for investments in efforts to protect the health of workers in the sector.” 
Canada’s health care sector is always struggling to make ends meet. Whenever they do have money to invest, health executives tend to devote spending on new hospitals, better medical equipment or surgical suites, to help improve patient care.

What that means, says Cameron Mustard, President of the Institute for Work & Health (IWH), is that “over the last 15 years there hasn’t been a lot to spare for investments in efforts to protect the health of workers in the sector.”

Health care workers have higher-than-average rates of work injuries and illnesses, absences from work and related costs. One estimate, as cited in the IWH’s 2005 Annual Report, suggests that more than 16 million nursing hours are lost to injury and illness yearly in Canada. The report also says that in 2002, the absentee rate for full-time registered nurses in Canada was 83 per cent higher than that of the general labour force.

“Traditionally, the emphasis has been on ‘the patient comes first,’” says Joseline Sikorski, CEO of the Ontario Safety Association for Community & Healthcare  (OSACH). “In fact, that’s part of one’s healthcare education — putting the patient first. The thought of protecting the staff has traditionally been secondary.”

The sector is starting to see things differently. Studies show that healthier staff who are less tired are better able to effectively care for patients. The well-being of patients and staff, while once considered mutually exclusive, are undeniably linked.

“People enter into the profession of caregiving with a great deal of commitment to the role, but they do get tired,” says Mustard. “They get hurt, too.”

Getting to the sore spots
Health care staff in acute care, long-term care, community services and group homes are at high risk of experiencing musculoskeletal disorders (MSDs), a condition that tops the list of occupational risks in the sector. Slips and falls are also responsible for a significant number of injuries.

Among the other priority concerns are needlestick injuries, which can expose a healthcare worker to a transmissible disease. Violent behaviour from angry or upset patients and their family members, or aggression from patients with dementia, is another real threat to nurses and other staff. Mental stress and fatigue are also rampant among health care workers, which not only compromises the quality of their lives but increases their risk of injury.

The health care sector’s lack of resources is a challenge that labour, government, and the research community are aggressively tackling. Finding answers isn’t the problem. It’s funding them. There are examples, however, of facilities that have found a way, through research studies and other means, to justify investing in safer equipment and processes. The results are encouraging.

Ceiling-mounted lifts
Musculoskeletal disorders are the most common type of worker injury in healthcare. Whether it’s back pain, shoulder or neck pain or other pain of varying degrees, MSDs are very often the result of client handling. When a health care worker (these days, it’s usually an aging healthcare worker) attempts to move or lift a human being, aches and pains can easily follow.

In 2001, in a move toward safer practices, an extended care unit at Queen’s Park Care Centre in New Westminster, B.C., replaced its older, floor-based patient lifts with ceiling-mounted equipment. The floor-based lifts, while an improvement over manual lifting, had their shortcomings.

A report from the Workers’ Compensation Board of British Columbia says that before installing the ceiling-mounted lifts, MSDs at the facility averaged eight lost-time patient handling injuries a year. No such injuries have occurred since installation. The facility went from $39,874.96 in patient handling claims costs to zero. Based on the project’s success, efforts are under way to design and implement similar comprehensive ceiling-lift programs across the region as resources become available.

The work done in B.C. was very influential, says Mustard, in subsequent discussions in Ontario about implementing ceiling-mounted lifts. “There has been good evidence accumulating now for 10 years that this technology works,” says Mustard. He says that while ceiling lifts were being used in other countries most Canadian provinces have been slow to adopt them.

A subsequent, systematic review by the IWH of several other studies in this area confirmed that lifts, in combination with training and policy changes, prevented injury.

New funds available
In December, 2005, the Ontario Ministry of Health and Long-Term Care took advantage of a federal funding program that gave provincial ministries funds to support the acquisition of medical technology. 

“Ontarians have been fortunate,” says Mustard. “The way the objectives of this fund were described in the media were things like purchasing more MRIs, and CATs, again, for the patients. But what the Ministry of Health and Long-Term Care did, which I think was very clever, was to say, we see a technology need that will benefit patient care but will be primarily beneficial to the health of the health care workforce.” That was patient lifting equipment.

Safer needles
Every day, an estimated 190 needlestick injuries happen in Canadian health care facilities. On January 1, 2006, Manitoba became the first province in Canada to mandate the use of safety-engineered needles in the health care sector. Changes to the Workplace Safety and Health Act required, among other things, that workers use safety-designed needles, such as retractable or safety-shielded devices, to prevent injuries, where reasonably practical.

Shortly thereafter, similar legislation came into effect in Saskatchewan that the province calls “the most rigorous occupational health and safety regulations in the country for protecting health care and other workers from sharps-related injuries.” More than 130 groups representing both employers and employees participated in the consultation process that led to these regulations, which went into effect July, 2006.

“There was a very strong message given to us, that the workers thought this was very important,” says Rita Coshan, Manager, Risk Management and Toxicology for Saskatchewan Labour.

What’s different about Saskatchewan’s regulations is that they do not use the “reasonably practical” qualifier. Referring to the Manitoba regulations, Coshan says, “If it’s a high risk procedure, and it doesn’t cost much to switch [to safer needles], it would be required,” says Coshan. “But if the risk is somewhat lower and it’s expensive to switch, you could argue that it’s not required.

“Ours is an absolute requirement,” she says. “If a needle can get blood or body fluids, then you have to use the needle safe alternative.”

The difficulty is that the safer needles “can be anywhere from one and a half times to more than eight times as expensive,” says Coshan. “That’s why the ‘reasonably practicable’ qualifier was problematic. If you don’t make it an absolute requirement, it’s very difficult to get people to switch to more costly devices.”

The sector is seeing that when it comes to protecting health care workers from sharps. Training and procedures alone might not be enough. “Covering a sharp actually removes the hazard,” says Coshan. “You don’t have to rely on workers using good practices. You just take it out of the equation.”

Labour groups in other provinces have been urging their own ministries of labour to implement regulations similar to those in Saskatchewan and Manitoba.

Ontario followed suit in August 2007 by amending its Occupational Health and Safety Act to make safety-engineered or needle-less systems mandatory as of September 1, 2008. This followed a strong push for safer needles by the Service Employees International Union and the Ontario Nurses Association.

Ontario has also announced its commitment to purchase up to 55 million new N-95 respirators to protect members from contracting SARS, influenza, or other infectious disease.

The various players in health care are aggressively working on addressing these and other health and safety problems. Mustard says these efforts are to improve the quality of work and increase the number of people who are training for health professional careers — because without addressing the issue of staff shortages, progress will be limited.

“It takes a long time to change the direction of a boat like that,” says Mustard. “You can much faster get 25,000 lifting devices into the long-term care facilities than you can prepare 10,000 people to be nurses. It just takes longer.”

Sikorski agrees, calling these current improvements “the beginning of a journey.”

“If you look at the aging workforce and the body and the wear and tear,” she says, “and the accommodation around special safety requirements so people can continue to work longer in a healthy work life, there’s a great need to focus on retention. And safety is a big piece of this.”

Freelance writer Michelle Morra is a former COS editor and an award-winning journalist. You can reach her at: [email protected]