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Tutkimus ja kehitys
 
18.03.2015
Work-related injuries among nurses cost money
 
Physical and psychological work-related injuries continue to occur frequently among nurses. They affect nurses’ well-being and patient care negatively and cause considerable economic losses for healthcare systems worldwide. Despite the attempts to reduce the prevalence of injuries, healthcare workers continue to frequently get injured at work. Knowledge of factors that contribute to the occurrence of job-related injuries among nurses could provide useful information to reduce the number of injuries in the future.
Research has shown that the following factors are strongly associated with the occurrence of both physical and psychological injuries. The results of systematic literature review show that there are seven main factors closely related with the frequent occurrence of work-related stress and injuries. These factors are working overtime, underestimated staff resources, unsatisfying management, poor social support for the staff, poor fitness level of nurses, challenging patients and increased age of nurses. Some of these factors were found to be unique for certain types of injuries.

The literature points to five major risk factors for occupational injuries: heavy workloads, the aging nursing workforce, obesity, work environment, and work schedules.
 
Work-related injuries establish a risk for patients’ safety – many reasons
Across the United States, nursing and residential care facilities ranked third among the top 10 industries with the highest rates of nonfatal injuries and illnesses in the workplace. Injuries at work impose considerable costs to employers.

Expenditures of work-related injuries of nurses are very high, 90 million dollars annually in the United States.

Findings also suggest that the factors that contribute to the occurrence of work-related injuries negatively affect the quality of patient care.
 
Job-related psychological injuries
Nurses’ coping strategies, skills of managers, social support, overtime, and frequent confrontations with sudden death or serious injuries were associated with job-related psychological injuries.

Nurses’ perceptions of staffing in their department, staff training and workplace safety policies and programmes in hospitals were other factors that were found to be associated with the occurrence of injuries.

Nursing is considered a stressful and emotionally demanding job. The prevalence of anxiety and depression in nurses is higher than that in the general population. Overtime is frequently used in hospitals to meet staffing needs. However, it may negatively affect patient safety and nurses’ health.

Furthermore, injuries and stress contribute to the nurse shortage, as they are common reasons why nurses leave their jobs.
 
Musculoskeletal injuries
Musculoskeletal injuries were found to be the most common of work-related injuries. Most of them were caused by patient handling activities. Manual lifting was found to be the most frequent cause of back injuries among nurses.

Manual lifting, especially without assistance, inaccessibility to patient lifting devices and nurses’ non-adherence to work safety precautions were found to be negatively associated with the occurrence of musculoskeletal injuries. Furthermore, inadequate staffing, unskilled managers, poor social support, obesity in both patients and nurses, nurses’ poor fitness level, presence of illnesses in nurses and the increased age of nurses were reasons for occurrence of musculoskeletal injuries.

The mean age of nurses in this study was calculated to be 42 years. This may suggest that the nurse population is aging and that the rates of musculoskeletal injuries could increase in the future.

Musculoskeletal injuries were found to be the most common type of injuries. Most of them were caused by patient handling activities.

Nurses routinely encounter risk-prone working conditions associated with musculoskeletal disorders. Patient handling is a cause of injuries that accounts for 25% of all claims in the United States.
 
Needle-stick and other sharp object injuries
This research also found nurses to be regularly exposed to needle-stick and other sharp object injuries.

Poor availability of needle safety devices, nurses’ non-adherence to safe needle precautions, overtime, staffing shortages and time pressure were found to have a strong negative effect on the occurrence of such injuries.

The prevalence of needle-stick injuries is also high worldwide. United States Center for Disease Control reported that up to 800 000 needle stick injuries occur annually among health care workers in the country.
 
This literature review includes more than 20 000 nurses
Only the articles that concerned nurses working in general hospitals were included in this literature review. A total of eight articles were included in the review, all of which were quantitative, cross-sectional studies and were published between 2007 and 2013. Four out of the eight articles were conducted in the US; one article was from Brazil, one from Canada, one from Belgium and one from Australia. These eight populations comprised 24 068 nurses.

The large literature review suggests that the understanding of the interrelationships among the contributing factors and the occurrence of work-related injuries could help to reduce injuries among nurses. The findings of this review indicate that physical and psychological work-related injuries continue to occur frequently among nurses.
 
Main conclusion and recommendations
Ill health and absence from work due to sickness in one individual is likely to cause increased work and stress for the other members of staff. Overtime is frequently used in hospitals to meet staffing needs. However, it may negatively affect patient safety and nurses’ health.

Approaches to employee safety in most healthcare organisations have been only of modest benefit in reducing injuries. There is a need for a theoretically sound understanding of the interrelationships among individual, environmental, and organisational factors that affect safe job performance.

The results of the research also suggest that the factors that contribute to work-related injuries among nurses also contribute to the occurrence of adverse events in patients. More research on this important topic is warranted and attention should be paid to the prevention of musculoskeletal, psychological and, probably most importantly, on needle-stick injuries.
 
Kirjoittaja(t):
Ba-student in Nursing Ekaterina Pik & RN, PhD, Proncipal Lecturer DN in Nursing Heikki Ellilä