Essentials of Nursing Leadership & Management, 4th Edition
CHAPTER 12
THE WORKPLACE
Essentials of Nursing Leadership & Management, 4th Edition
Introduction
 Over 50% of time is spent in the workplace
 Occupational hazards exist in work areas
 It is important to improve the “quality of life”
in the workplace
Essentials of Nursing Leadership & Management, 4th Edition
Workplace Safety
 Environmental hazards
 Physical safety
 Emotional safety
Essentials of Nursing Leadership & Management, 4th Edition
Reducing Risk
 Occupational Safety and Health
Administration (OSHA)
 Centers for Disease Control and
Prevention (CDC)
Essentials of Nursing Leadership & Management, 4th Edition
Reducing Risk
 Workplace programs
• Safety plan
– Consult federal, state, and local
governments
– Distinguish between real and
imagined risk
– Seek administrative support
– Calculate costs of program
Essentials of Nursing Leadership & Management, 4th Edition
OSHA Focus
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Biological
Chemical
Psychological
Physical
Environmental
Essentials of Nursing Leadership & Management, 4th Edition
CDC Focus
 Lead federal agency for protecting health
and safety of citizens at home and abroad
 Publishes updates on a variety of health
issues and concerns
 Partners with other agencies in
investigating health threats and research
Essentials of Nursing Leadership & Management, 4th Edition
NIOSH
 Part of the CDC
 Conducts research and makes
recommendations for preventing workrelated injuries and disease
Essentials of Nursing Leadership & Management, 4th Edition
American Nurses Association
 Quality indicators for acute care setting
 Commission on Workplace Advocacy
 Core initiatives
Essentials of Nursing Leadership & Management, 4th Edition
Core Initiatives
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Nursing shortage
Patient safety/advocacy
Workplace rights
Appropriate staffing
Workplace health and safety
Essentials of Nursing Leadership & Management, 4th Edition
JCAHO
 National patient safety goals
 Change each year
 Based on type of facility
 Ambulatory
 Assisted living
 Behavioral health
 Critical access
 Home care
Essentials of Nursing Leadership & Management, 4th Edition
Workplace Programs
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Identify potential hazard
Assess degree of risk
Develop a plan
Implement the program
Essentials of Nursing Leadership & Management, 4th Edition
Violence
 Violence is a social issue
 The rate of assaults on hospital workers is
much higher than that of private industry
 Threats
 Physical assaults
 Muggings
Essentials of Nursing Leadership & Management, 4th Edition
Violence
 Situations that increase workers’
susceptibility to homicide and assault
are
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Having routine contact with the public
Working alone or in small numbers
Working late
Poor security
Essentials of Nursing Leadership & Management, 4th Edition
Violence
 Situations that increase workers’
susceptibility to homicide and assault
are
 Patients and families who carry
weapons
 Lack of experienced staff members
 Units and patients that need seclusion
or restraint activities
Essentials of Nursing Leadership & Management, 4th Edition
What Nurses Should Know
 Does violence in the surrounding
community affect my workplace?
 Does the layout of the facility
invite violence?
 Is there a prompt response by
administration to violence?
Essentials of Nursing Leadership & Management, 4th Edition
What Nurses Should Know
 Are incidents being reported and
addressed by management?
 Would training that deals with
workplace violence be adequate
for employees and management?
 Which types of patients are more
prone to violence?
Essentials of Nursing Leadership & Management, 4th Edition
Behaviors
 History of violent behavior
 Delusional, paranoid, or
suspicious speech
 Aggressive and threatening
statements
 Rapid speech and angry tone of
voice
Essentials of Nursing Leadership & Management, 4th Edition
Behaviors
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Stiff posture, clenched fists, tight jaw
Alcohol/drug use
Male gender or a youth
Unrealistic policies
Essentials of Nursing Leadership & Management, 4th Edition
When Assault Occurs:
Placing Blame on Victims
Victim Gender
Women receive more blame than men
Subject Gender
Female victims receive a greater amount of blame
from women than from men
Severity
The more severe the assault, the more often the
victim is blamed
Essentials of Nursing Leadership & Management, 4th Edition
When Assault Occurs
Beliefs
The world is a just place; therefore, the
person deserves the misfortune
Age of Victim
The older the victim, the more he or she is
held responsible for the assault
Essentials of Nursing Leadership & Management, 4th Edition
Keep an Eye Out
 Look for clues indicating potential
violence
 Call patients, family members,
and visitors by their names
 Encourage the patient or the
patient’s family to vent anger
Essentials of Nursing Leadership & Management, 4th Edition
Keep an Eye Out
 If you feel uncomfortable,
trust your intuition
 Know your institution’s
policies and procedures
Essentials of Nursing Leadership & Management, 4th Edition
Preventing Workplace
Violence
 Have management commit to an ongoing
prevention program that addresses different
scenarios on workplace violence
 Require that all violent incidents be reported
and reviewed
 Hold all patients, visitors, staff members, and
management accountable for their behavior;
adopt a zero-tolerance policy related to
workplace violence
Essentials of Nursing Leadership & Management, 4th Edition
Preventing Workplace
Violence
 Follow current information and guidelines
from agencies such as your state nurses’
association and OSHA
 Insist on an ongoing education program
for all staff members that includes
comprehensive treatment for victimized
employees
Essentials of Nursing Leadership & Management, 4th Edition
Participate in Workplace Safety
 Assess the workplace regularly
 Be alert for suspicious behavior
 Maintain behavior that helps to defuse
anger
 If situation escalates, remove self and call
security
 Know your clients
Essentials of Nursing Leadership & Management, 4th Edition
Participate in Workplace Safety
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Report situation to supervisor
Call the police
Get medical attention
Contact collective bargaining or state
nurses association
 Participate in policy-making
Essentials of Nursing Leadership & Management, 4th Edition
Sexual Harassment
Essentials of Nursing Leadership & Management, 4th Edition
Behaviors Defining Sexual
Harassment
•Pressuring another to participate in
sexual activities
•Asking another person about his or her
sexual activities, fantasies, or
preferences
•Making sexual innuendos, jokes,
comments, or suggestive facial
expressions to another person
Essentials of Nursing Leadership & Management, 4th Edition
Behaviors Defining Sexual
Harassment
•Continuing to ask for a date after the
other person has expressed disinterest
•Making sexual gestures with hands or
body movements or showing sexual
graffiti or visuals
•Making remarks about a person’s
gender or body
Essentials of Nursing Leadership & Management, 4th Edition
Sexual Harassment
 Two forms of sexual harassment are
– Quid pro quo
– A hostile environment
Essentials of Nursing Leadership & Management, 4th Edition
Sexual Harassment
 Fight sexual harassment per American
Nurses Association (ANA)
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Confront
Report
Document
Support
Essentials of Nursing Leadership & Management, 4th Edition
Latex Allergy
 First identified in the 1970s
 Has become a major problem in the
workplace
 Estimated that 8%-12% of health-care
workers are sensitive to latex
Essentials of Nursing Leadership & Management, 4th Edition
Symptoms
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Contact dermatitis (most common)
Generalized hives
Urticaria
Rhinitis
Wheezing
Anaphylaxis
Essentials of Nursing Leadership & Management, 4th Edition
Decreasing the Potential for
Latex Allergy
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Reducing unnecessary exposure
Using alternative gloves (nitrile)
Employee education programs
Identifying workers at risk
Essentials of Nursing Leadership & Management, 4th Edition
Needlestick Injuries
Essentials of Nursing Leadership & Management, 4th Edition
“Needlestick Act”
 Passed in 2001
 Revised blood-borne pathogens standards
 Obligates employers to consider safer
needle devices
Essentials of Nursing Leadership & Management, 4th Edition
OSHA Blood-Borne
Pathogens:
Recommendations 1991
 Free hepatitis B vaccine
 Protective equipment that fits
 Immediate and confidential medical
evaluation
Essentials of Nursing Leadership & Management, 4th Edition
OSHA Blood-Borne
Pathogens:
Recommendations 1991
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Implement universal precautions
Provide adequate sharps disposal
Remove hazards in workplace
Provide annual training for
employees
Essentials of Nursing Leadership & Management, 4th Edition
The Nurse’s Responsibilities
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Always use universal precautions
Use and dispose of sharps properly
Get immunized against hepatitis B
Report all exposures
Know the human immunodeficiency
virus/hepatitis B virus (HIV/HBV) status
of your patient
Essentials of Nursing Leadership & Management, 4th Edition
The Nurse’s Responsibilities
 Comply with postexposure followup
 Support others who have been
exposed
 Become active in safety
committees
 Educate others
Essentials of Nursing Leadership & Management, 4th Edition
Ergonomics
Essentials of Nursing Leadership & Management, 4th Edition
Preventing Back Injuries
 Participate in safety committees
 Work in teams; do not be afraid to
ask for help
 Use transfer and lifting equipment
 Do back exercises
Essentials of Nursing Leadership & Management, 4th Edition
Repetitive Stress Injury (RSI)
 Usually affects individuals who spend long
hours at computers
 Most common injury is carpal tunnel
syndrome
 Mouse elbow
 Badly designed computer stations present
the highest risk
Essentials of Nursing Leadership & Management, 4th Edition
Preventing RSI
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Monitor placement
Keyboard alignment
Mouse position
Body alignment
Vary tasks
Use fingertips when typing
Keep fingernails short
Essentials of Nursing Leadership & Management, 4th Edition
Impaired Workers
Essentials of Nursing Leadership & Management, 4th Edition
Common Signs of Impairment
 Witnessing an employee consuming
alcohol or other substances on the job
 Apparent in employee’s dress,
appearance, posture, and gestures
 Employee’s use of slurred speech and
abusive/incoherent language
Essentials of Nursing Leadership & Management, 4th Edition
Common Signs of Impairment
 Reports from patients/coworkers
 Witnessing unprofessional
employee conduct
 Employee has significant lack of
attention to detail
 Witnessing an employee
stealing controlled substances
Essentials of Nursing Leadership & Management, 4th Edition
Impaired Nurse Programs (INPs)
 Most employers and 37 boards of nursing
have strict guidelines
 INPs conducted by boards of nursing work
with employers to assist impaired nurses
 Compassion from coworkers is of utmost
importance
Essentials of Nursing Leadership & Management, 4th Edition
Professional Responsibilities
 Nurses need to uphold the
standards of their profession
 Ignoring substance abuse places
clients and other nurses in danger
 It is important to “help a colleague
obtain help”
Essentials of Nursing Leadership & Management, 4th Edition
Microbial Threats
 SARS
 Tuberculosis
 MDR-TB
Essentials of Nursing Leadership & Management, 4th Edition
Workload
 Rotating shifts
 Mandatory overtime
 Staffing ratios
Essentials of Nursing Leadership & Management, 4th Edition
Reporting Questionable Practices
 Most employers have policies regarding
reporting behaviors that affect the
workplace environment
 Code for Nurses (2001) is specific
regarding this responsibility
Essentials of Nursing Leadership & Management, 4th Edition
Behaviors
 Endangering a client’s health or safety
 Abuse of authority
 Violation of rules, regulations, or standards
of professional ethics
 Gross waste of funds
Essentials of Nursing Leadership & Management, 4th Edition
Whistleblower
 Describes an employee who reports
employer violations to an outside agency
 Do not assume “doing the right thing” will
protect you
Essentials of Nursing Leadership & Management, 4th Edition
Guidelines
 Gather the facts
 Does the practice violate any actual law
 Know the state law requiring mandatory
reporting
 Type your documentation and include day,
date, time, and circumstances
Essentials of Nursing Leadership & Management, 4th Edition
Guidelines
 Identify witnesses
 Do not breach confidentiality in any way
 Send a copy of your complaint to the CNO
or nursing department or any other
department affected
 Utilize the ethics committee of your
institution
 Keep copies of your records
Essentials of Nursing Leadership & Management, 4th Edition
Nursing Responsibilities in
Terrorism
 Know the evacuation procedures and routes in
your facilities
 Develop your knowledge regarding the most
likely and most dangerous biological weapons
 Monitor for unusual disease patterns
 Know the back-up systems for communication
and staffing
Essentials of Nursing Leadership & Management, 4th Edition
Enhancing the Quality of Work
Life
 Social environment
 Working relationships
 Support your peers and supervisors
 Involvement in decision-making
Essentials of Nursing Leadership & Management, 4th Edition
Enhancing the Quality of Work
Life
 Professional growth and innovation
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Encourage critical thinking
Seek educational opportunities
Encourage new ideas
Reward professional growth
Essentials of Nursing Leadership & Management, 4th Edition
Understanding Cultural
Diversity
 Communication
 Space
 Social organization
Essentials of Nursing Leadership & Management, 4th Edition
Understanding Cultural
Diversity
 Time
 Environmental control
 Biological variations
Essentials of Nursing Leadership & Management, 4th Edition
Organization Diversity Fitness
 Personnel reflect the current and potential
population that the organization serves
 Silence and gestures are respected
Essentials of Nursing Leadership & Management, 4th Edition
Organization Diversity Fitness
 Awareness of special family and
holiday celebrations
 Individuals first; culture second
Essentials of Nursing Leadership & Management, 4th Edition
Managing Diversity
 Be aware of and sensitive to your own
culture-based preferences
 Explore your own biases and values
 Be knowledgeable about other cultures
Essentials of Nursing Leadership & Management, 4th Edition
Managing Diversity
 Be respectful of and sensitive to
diversity among individuals
 Be skilled in using and selecting
culturally sensitive intervention
strategies
Essentials of Nursing Leadership & Management, 4th Edition
Dos and Don’ts for Managing
Diversity
DO
DON’T
Recognize diversity
Pretend everyone is alike
Value diversity
Expect everyone to conform to
the prevailing culture
Develop informal supports
Seek a quick solution
Ensure fairness
Develop different standards of
performance
Make the preceding principles
an integral part of your
philosophy
Expect one workshop to solve
the problem
Essentials of Nursing Leadership & Management, 4th Edition
Nursing’s Agenda for the Future
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Leadership and planning
Delivery system
Legislation/regulation/policy
Professional/nursing culture
Recruitment/retention
Essentials of Nursing Leadership & Management, 4th Edition
Nursing’s Agenda for the Future
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Economic value
Work environment
Public relations/communication
Education
Diversity
Essentials of Nursing Leadership & Management, 4th Edition
Conclusion
 Workplace safety is a growing concern
 IOM and JCAHO will continue to impact
workplace safety issues
 Support the ANA