Occupational Safety and Health Administration
The Occupational Safety and Health Act of 1970 and the Mine Safety and Health Act of 1977 were the first federal guidelines and standards related to safe and healthful work- ing conditions. Through these acts, the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) were formed. OSHA regulations apply to most U.S. employers who have one or more employees and who engage in businesses affect- ing commerce. Under OSHA regulations, the employer must comply with standards for providing a safe, healthful work environment.
Employers are also required to keep records of all occupational (job-related) illnesses and accidents. Examples of occupational accidents and injuries include burns, chemical exposures, lacerations, hearing loss, respiratory exposure, musculoskeletal injuries, and exposure to infectious diseases.
OSHA regulations provide for workplace inspections that may be conducted with or without prior notification to the employer.
However, catastrophic or fatal accidents and employee complaints may also trigger an OSHA inspection. OSHA encourages employ- ers and employees to work together to identi- fy and remove any workplace hazards before contacting the nearest OSHA area office. If the employee has not been able to resolve the safety or health issue, the employee may file a formal complaint, and an inspection will be ordered by the area OSHA director (United States Department of Labor, 1995). Any vio- lations found are posted where all employees can view them. The employer has the right to contest the OSHA decision. The law also states that the employer cannot punish or dis- criminate against employees for exercising their rights related to job safety and health
hazards or participating in OSHA inspections (United States Department of Labor, 1995).
OSHA inspections focus especially on blood-borne pathogens, lifting and ergonomic (proper body alignment) guidelines, confined- space regulations, and respiratory guidelines (National Safety Council, 1992). More recent- ly, OSHA has also been committed to pre- venting workplace violence (United States Department of Labor, 1996). The U.S. De- partment of Labor publishes fact sheets relat- ed to various OSHA guidelines and activities.
They can be obtained from your employer, at the local public library, or via the Internet.
There is also an extensive government Website developed by OSHA where extensive infor- mation on preventing workplace violence for healthcare workers can be found (http://
www.osha-slc.gov/SLTC/workplaceviolence/
guideline.html).
Centers for Disease Control and Prevention
Although not directly involved in workplace safety, the Centers for Disease Control and Prevention (CDC) is another good resource for the nurse. The CDC publishes continuous updates on recommendations for prevention of HIV transmission in the workplace and universal precautions related to blood-borne pathogens, as well as the most recent infor- mation on other infectious diseases in the workplace, such as tuberculosis and hepatitis.
Information can be obtained by consulting the Mortality and Morbidity Weekly Report (MMWR) in the library, via the Internet, or through the toll-free phone number 1-800- 232-1311. Interested healthcare workers can also be placed on the CDC’s mailing list to receive any free publications.
Box 11–1 lists the most important federal laws enacted to protect individuals in the workplace.
Programs
The primary objective of any workplace safe- ty program is to prevent staff members from harm and to protect the organization from lia- bility related to that harm. The first step in development of a workplace safety program is to recognize a potential hazardand then take steps to control it. Based on OSHA regula- tions (United States Department of Labor, 1995), the employer must inform staff mem-
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bers of any potential health hazards and pro- vide as much protection from these hazards as possible. In many cases, initial warnings come from the CDC, NIOSH, and other federal, state, and local agencies. For example, employers must provide tuberculosis testing and hepatitis B vaccine; protective equipment such as gloves, gowns, and masks; and imme- diate treatment after exposure for all staff members who may have contact with blood- borne pathogens. They are expected to remove hazards, educate employees, and establish institution-wide policies and proce- dures to protect their employees (Herring, 1994; Roche, 1993). For example, nurses who are not provided with latex gloves may refuse to participate in any activities involving blood or blood products. The employee cannot be
discriminated against in the workplace, and reasonable accommodations for safety against blood-borne pathogens must be provided.
This may mean that the nurse with latex aller- gies is placed in an area where exposure to blood-borne pathogens is not an issue (Strader & Decker, 1995; United States Department of Labor, 1995).
The second step in a workplace safety pro- gram is a thorough assessment of the degree of risk entailed. Staff members, for example, may become very fearful in situations that do not warrant such fear.
Nancy Wu is the nurse manager on a busy geri- atric unit. The majority of the clients require total care: bathing, feeding, positioning. She has observed that several of the staff members
142 ❖ Essentials of Nursing Leadership and Management
BOX 11–1
FEDERAL LAWS ENACTED TO PROTECT THE WORKER IN THE WORKPLACE
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Equal Pay Act of 1963: Employers must provide equal pay for equal work regardless of sex.❖
Title VII of Civil Rights Act of 1964:Employees may not be discriminated against in employment on the basis of race, color, religion, sex, or national ori- gin.
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Age Discrimination in Employment Act of 1967: Private and public employers may not discriminate against persons 40 years of age or older except when a cer- tain age group is a bona fide occupa- tional qualification.❖
Pregnancy Discrimination Act of 1968:Pregnant women cannot be discriminat- ed against in employment benefits if they are able to discharge job responsi- bilities.
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Fair Credit Reporting Act of 1970: Job applicants and employees have the right to know of the existence and content of any credit files maintained on them.❖
Vocational Rehabilitation Act of 1973:An employer receiving financial assis- tance from the federal government may not discriminate against individuals with disabilities and must develop affirmative action plans to hire and promote individ- uals with disabilities.
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Family Education Rights and Privacy Act–the Buckley amendment of 1974:Educational institutions may not supply information about students without their consent.
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Immigration Reform and Control Act of 1986: Employers must screen employ- ees for the right to work in the United States without discriminating on the basis of national origin.❖
Are you experiencing more physical symp- toms, such as headaches or stomachaches?❖
Do you feel like avoiding people?❖
Do you feel as if you are “burning the candle at both ends”?❖
Americans with Disabilities Act of 1990:Persons with physical or mental disabili- ties and who are chronically ill cannot be discriminated against in the workplace.
Employers must make “reasonable accommodations” to meet the needs of the disabled employee. These include such things as installing foot or hand controls; readjusting light switches, tele- phones, desks, table and computer equipment; providing access ramps and elevators; offering flexible work hours;
and providing readers for blind employ- ees.
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Family Medical Leave Act of 1993:Requires employers with 50 or more employees to provide up to 13 weeks of unpaid leave for family medical emer- gencies, childbirth, or adoption.
Source: Adapted from Strader, M., & Decker, P. (1995).
Role Transition to Patient Care Management.Norwalk, Conn.: Appleton and Lange.
working on the unit use poor body mechanics in lifting and moving the clients. In the last month, several of the staff members have been referred to employee health for back pain. This week, she noticed that the clients seem to remain in the same position for long periods of time and frequently are never out of bed or are in a chair for the entire day. When she confronted the staff, the response was the same from all of them: “I have to work for a living. I can’t afford to risk a back injury for someone who may not live past the end of the week.’’ Nancy Wu was concerned about the care of the clients as well as the apparent lack of information her staff had about prevention of back injuries. She decided to seek assistance from the nurse practitioner in charge of employee health in developing a back injury prevention program.
These same individuals may be complacent about such risks as radiation or clean air, which cannot be seen or felt as one works with clients.
Assessment of the workplace may require con- siderable data-gathering to document the inci- dence of the problem and consultation with experts before a plan of action is drawn up.
Healthcare organizations often create formal committees comprising experts from within the institution and representatives from the affect- ed departments to assess these risks. It is impor- tant that staff members from various levels of the organization be allowed to give input into an assessment of safety needs and risks.
The third step is to draw upa plan to pro- vide optimal protection for staff members. It is not always a simple matter to protect staff members without interfering with the provi- sion of client care. For example, some devices that can be worn to prevent transmission of tuberculosis interfere with communication with the client (“Federal agencies clash,’’
1993). Some attempts have been made to limit visits or withdraw home healthcare nurses from high-crime areas, but this leaves home- bound clients without care (Nadwairski, 1992). A threat-assessment team that evalu- ates problems and suggests appropriate actions may reduce the incidence and severity of problems with violent behavior, but it may also increase employees’ fear of violence if not handled well.
Developing a safety plan includes the fol- lowing:
•
Consulting federal, state, and local regula- tions•
Distinguishing real from imagined risks•
Seeking administrative support and enforcement for the plan•
Calculating costs of a programThe final stage in developing a workplace safety program is implementing the program.
Educating the staff, providing the necessary safety supplies and equipment, and modifying the environment contribute to an effective program. Protecting client and staff confiden- tiality and monitoring adherence to control and safety procedures should not be over- looked in the implementation stage (CDC, 1992; “Federal agencies clash,’’ 1993;
Jankowski, 1992).
An example of a safety program is the one for healthcare workers exposed to HIV instituted at the Department of Veterans Affairs Hospital, San Francisco, California (Armstrong, Gordon, & Santorella, 1995). An HIV exposure can be stressful for both health- care workers and their loved ones. This employee assistance program includes as many as ten 60-minute individual counseling sessions on the meaning and experience of this trau- matic event. Additional counseling sessions for couples are also provided. Information about HIV and about dealing with acute stress reac- tions is provided. Additional counseling assists workers to identify a plan to obtain help from their individual support systems, the healthcare
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BOX 11–2
RESPONSIBILITIES OF THE NURSE:
TRANSMISSION OF BLOOD-BORNE PATHOGENS
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Use of universal precautions❖
Respect sharps❖
Immunize against hepatitis❖
Report exposures❖
Follow agency/OSHA regulations regarding post-exposure follow-up❖
Participate with safety committees in developing ongoing safety pro- grams❖
Support peers who are potentially exposed to infectious diseasesSource: Adapted from American Nurses Association (1993). HIV, Hepatitis-B, Hepatitis-C:
Blood-borne Diseases.Washington, DC: ANA.
worker’s practice methods of dealing with blood-borne pathogens, and helping the client to return to work.
The American Nurses Association (ANA) has published a brochure entitled HIV, Hepatitis-B, Hepatitis-C: Nurses’ Risks, Rights, and Responsibilities (ANA, 1993). A free copy of the brochure can be obtained by calling 1-800-274-4ANA. Box 11–2 lists the responsibilities of the nurse in dealing with transmission of blood-borne pathogens.