Where the nurse gets hurt:
Understanding the social
organization of injury management
in Ontario hospitals
Dedicated to Ellen Pence
By: Laurie Clune RN, PhD
Associate Dean Research and Graduate Programs
What to expect in this
presentation
1
2
To building from my doctoral
work and develop a program of
research
To discuss how IE approaches can be
used in research teams
•My doctoral work
Boss text
Professional
discourses and
Ideologies
Early Return to work
The social
organization of
health care
The social
organization
nursing work
The Injured Nurse
•Early Return to Work
Domestic
Work
Rehab
Work
Accommodation
Work
• Experienced
nurses are being removed
terminated from their jobs.
• Boss
text: Ontario Workplace safety and
insurance board act
• If after 2 years you fail to return to your preinjury position the employer can terminate
Occupational health nurse 1 (3, 4)
“Working in a hospital (OHS department)
is totally different than working in private
industry”.
Post Doc ?!#%*
• The
Institute for Work and Health
1.
Primarily quantitative researchers
(STATS, STATS, STATS and boot
strapping ), economic evaluation,
epidemiologic, and systematic review
approaches
2.
Non- nurse researchers doing
research about nurses
The Project
Collaboration: Co-PI
An economist - “I like your maps!”
Funder:
Workplace Safety and Insurance Board of Ontario
Research Advisory Council
Title:
OHS economic evaluation resource needs for the
health care sector in Ontario
•The Grant
•This project
Worker
Compensation
Legislation
Discourse of abuse
A nurses body
must be an able
body
The social
organization
nursing work
Decision making in
health care
surrounding
occupational
health
•Methodology
•
An exploratory approach using schema mapping, indepth in person interviews and telephone interviews
•
Stakeholder guides (n=10)
•
Who to ask : purposive sampling
•
What to ask: Initial interview guide
•
Where to ask: create connections
•
What are we seeing: refining interview guide, immersion
and crystalization
Stakeholder guide map: How does it work?
Data discovery approaches
INTERVIEWS
•
•
•
In person n = 20
• 22 informants
Telephone n= 25
• 28 informants
Roles
• OHS operations
• OHS directors, managers
• OHS coordinators
• Senior VP
SITES
•
•
•
•
•
•
•
Hospitals
Long term care
Community nursing
Ministry of Health
Urban and rural
Size (> 10,000, under 250)
Speciality hospitals (children,
cancer, orthopaedics)
Scaffold map:
Guiding the interview
Idea for
OHS
initiative
Planning
Decision-making
Implementation
Evaluation
There’s a difference
NOT FOR PROFIT
VS
FOR PROFIT
Scaffold map: Creating Work
• Incident
•
Idea for
OHS
initiative
reporting trends
Technology tracking
Prevention hunches
Health Promotion Months
(Jan= quit smoking; Feb =
heart; March = nutrition)
Scaffold map: Planning Work
• Business
plan for the
board
Benefits to patients
• Budget
•
Planning
DECISION MAKING: “I am not sure. It goes
to the Board. I have no idea how they
make the decision”
How decisions are made?
•
Initiatives that have a direct effect
on improving patient outcomes
• Eg:
•
flu shot
Ministry directives (labour and
health)
• Eg:
harassment, over bed lifts
• Most
initiatives generated from
OHS department
• “no
money”
•This project
Worker
Compensation
Legislation
Discourse of abuse
Ontario Hospital
Act (funding)
A nurses body
must be an able
body
The social
organization
nursing work
Decision making in
health care
surrounding
occupational
health
•Hospital funding mechanisms
Hospitals
are funded for patient care and capital initiatives
only
Hospital

funding is based on a comparative approach based on

Facility size

Case types codes

Lengths of stays

Key performance indicators (eg: infection rates, wait times)
Hospitals that perform well are rewarded financially
No
funds are allocated from the Ministry for occupational
health and safety
Going back to the occupational
health nurses’ comments:
“Working in a
hospital (OHS
department) is
totally different than
working in private
industry”.
Money for occupational
health and safety
initiatives are not a part of
funds received by
hospitals.
• OHS initiatives that do
take place in hospitals are
•
•
•
Mandated by the Ministry
of health or labour
To protect the patient
Thank you