What ails Canadian nurses: hazards to health care practitioners

Badges of honour or heroic status, but they are injured more often than police officers and firefighters. They also endure more strain on their mental health than people in other occupations, which partly explains why they have one of the highest rates of work absence in the country.
People in the field know all about the occupational hazards in health care facilities, but researchers are helping to spread the evidence.

Health-Care Rx: Reducing Work Absences Among Canadian Nurses, a study published by the Institute for Work and Health, was based on information collected from almost 12,000 female, direct-care Canadian nurses from Statistics Canada’s 2005 National Survey of the Work and Health of Nurses. The IWH wanted to look at combined factors, something no one had been able to do before. They were able to in this case because of the 2005 Statistics Canada data, which researcher Renee-Louise Franche said was “a rare and beautiful database with a rich set of variables.”

The study found that while individual factors like pain and depression were important, work conditions were extremely important, such as a lack of respect and support at work.

“Another very strongly associated factor we found was the level of abuse they were facing at work,” Franche says. “The most frequent cause of abuse was from co-workers.”

Being abused or assaulted on the job is strongly associated with prolonged work absences among nurses. This is indirectly connected with poorer workplace culture in general, and lower respect and support from co-workers, both of which are associated with increased duration of work absence, says the IWH study.

It seems even nurses, many of whom enter the field because they are caring by nature, have a threshold. Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU), provided a real-world snapshot:

“We run short-staffed all the time. And because we’re taking care of people, time is always of an essence. When you’re dealing with people there’s no lens to stop you from working too hard or to remind you to bend properly, or to use a bed-lift or do a task with two people when it’s quicker to do it alone.

“You can’t take a break. We try to force everyone to take a break, but if you know your co-worker is going to be alone you try to take your break at the unit. You can’t leave the facility at lunch hour, so you stay within those walls for eight to 12 hours, and then you’re dealing with patients. They’re anxious and scared, so are their families, and if something goes wrong and you don’t have appropriate time to deal with them, anxiety builds into aggressiveness.”

Sore spot
The big picture of the problem goes far beyond the scope of what health and safety managers ordinarily deal with. According to the CFNU, Canadians have the highest uses of emergency rooms among the world’s richest countries. Fifty-eight per cent of Canadians use emergency because they have nowhere else to go. Seniors use it because they can’t get home care or long-term care facilities.

The Canadian Nurses Association (CNA) reports at the rate health needs are changing, without policy interventions Canada will be short almost 60,000 full-time equivalent registered nurses by 2022.

Another perspective is the number of currently employed nurses who are off work.

In Saskatchewan, 61,790 days of work missed in 2011 translates to 309 full-time vacant positions, says Bonnie Hender, director of operations and programming with the Saskatchewan Association for Safe Workplaces in Health (SASWH), a safety association dedicated specifically to eliminating injuries among workers in the health care sector.

“People don’t realize that of all those injuries, all of those are likely patients, and all of those people are off work,” she says.

According to the CFNU, close to $700 million a year is spent on sick time for nurses.

Demographics come into play as well. The average age of nurses today is 47. The IWH study found the four most common chronic conditions in nurses were back pain, migraines, arthritis and depression. The more pain severity they have, the more pain-related interference they have. And it’s not surprising older people have chronic conditions. Older age combined with a higher number of conditions and higher level of pain severity means more absence.

The CNA has proposed to the government funding that enables more senior nurses to work in ways — such as mentoring younger nurses or developing preceptor manuals — that tap into their experience while freeing them from the intensity of the workload. But this isn’t just a government issue.

“Certainly, nurses want to be the best they can be for their patients. Employers have a big role to play in helping nurses be their best,” says CNA president Barbara Mildon.

The association intends to call on organizations to establish safe scheduling practices — specifically, a limit of 12 hours in a single workday, and 48 hours in a seven-day period, including on-call hours. It also recommends health care facilities provide secure, quiet places for nurses to take their breaks, including some kind of sleep facility for a half-hour nap when needed.

While talks about health care usually involve lack of dollars, lack of equipment and lack of staff, SASWH’s Hender says, “If you look at the money you’re spending on injuries you could probably have 10 MRI machines. The government funding is getting tighter and tighter… so we have to find more creative ways to address the problem.”

Last frontier
Occupations long considered “high-risk” ones have made great strides in reducing injuries and shifting the workplace culture. Has that happened yet in health care?

“In industry, there’s more money allocated to OH&S because it’s associated with dollars,” Silas says. “We would need to take an industrial approach for managing health and safety, like they do in manufacturing, where they allocate the dollars and are very proud of their safety standards. They publicize how many accident-free months they’ve had and give out awards for safety. Health care doesn’t do that.”
The operations team of the SASWH has spent months developing a safety management system specific to the health care sector.
The system has six elements: hazard ID and control, training and communications, inspections, reporting and investigation, emergency response and, the truly unique part, management and leadership.

“I believe the approach to safety has been one of band-aids and piecemeal solutions to whichever issue raises its head on a given day,” Hender says, speaking as a former radiological technician and health care manager. “But there are good things happening out there that can be used in developing our safety management system. I am cautiously optimistic.”