Ten ways to help protect hospital workers

The health care sector has more workplace injuries than any other in Canada. According to the most recent numbers from the Association of Workers’ Compensation Boards of Canada (AWCBC), health care workplaces had over 40,000 accepted lost-time claims in each year from 2009 to 2011.

These numbers have faces: Wendy, the registered nurse who suffered acute low-back pain after transferring a patient; Ron, the night cleaner whose lack of sleep was blamed in part for his spill of hazardous chemicals; Clara, the ICU nurse who poked herself with a needle when she stumbled on a chair beside a patient’s bed.

Incorporating evidence-based practices and policies is one way to help prevent injuries affecting hospital workers like Wendy, Ron, Clara and the thousands more like them—and help is available from the Institute for Work & Health (IWH).

As an independent, not-for-profit Canadian research organization based in Toronto, IWH promotes the use of evidence among work-health professionals. It develops research-backed resources in two main areas: (1) workplace injury prevention and (2) recovery and return to work.

Here is a quick look at some of the research from the Institute—and the practical tools and advice it gives rise to.

1. Implement a participatory ergonomics program to reduce musculoskeletal disorders. Participatory ergonomics (PE) is one approach to preventing work-related musculoskeletal disorders (MSDs). PE involves including workers, supervisors and others in the workplace to identify and come up with solutions to improve their work environments and reduce MSD risks.  Based on its findings that PE programs can reduce MSD symptoms, workers’ compensation claims and days lost from work, and further findings about what makes PE programs work, the IWH created a concise guide called Reducing MSD Hazards in the Workplace: A Guide to Successful Participatory Ergonomics Programs. It provides advice on what needs to be done up-front to give your PE program the best chance at success and to prevent problems down the road. For a copy of the concise PE guide, go to: www.iwh.on.ca/pe-guide.

2. Implement programs to overcome MSD risks. Some years ago, IWH reviewed the research to determine what programs might help reduce the risk of MSDs among health care workers. It found two programs in particular are most likely to be effective.

The first is a patient-lifting program with three components: (1) a worksite policy change, such as zero-lift policies; (2) new patient handling equipment, such as overhead or floor lifts; and (3) training on the equipment and on patient handling. The other program is exercise training, consisting of aerobic or strength-training exercises, or both. For more information, see: www.iwh.on.ca/sbe/prevention-programs-for-health-care-workers.

In more recent research, IWH teamed up with the Centre for Addiction and Mental Health (CAMH) in Toronto, to create and pilot an evidence-based online ergonomics program. The nine-module program is based on the latest evidence from ergonomics research, and complies with established office ergonomics standards from the Canadian Standards Association (CSA) and American National Standards Institute (ANSI). The pilot at CAMH showed workers who took the online training increased their knowledge about the risks of computer work, made appropriate changes to the set-up of their workstations, improved their working postures, and experienced less pain and/or discomfort at the end of their workday. The training program is expected to be online in 2014. Watch for details (or sign up for IWH e-alerts to learn when it’s available: www.iwh.on.ca/e-alerts).

3. Understand the barriers to implementing needlestick injury prevention programs. In 2007, Ontario introduced a regulation to promote the adoption of safety-engineered needles for the prevention of needlestick injuries. Yet needlestick injury declines in the province have not been substantial.  To explore why, IWH looked at the implementation of these needles at three acute-care hospitals.

Although all three hospitals responded with integrity, the research showed evidence of inconsistent implementation and outcomes. Some front-line workers developed strategies to avoid using the safety-engineered needles, and a conflict sometimes existed between the values health care workers placed on performance and patient care and the learning curve associated with the initial use of the needles. You can hear a presentation on this research at: www.iwh.on.ca/plenaries/2013-nov-19.

4. Understand and address the effects of shift work. Shift work is a fact of life in hospitals, so knowing its potential health effects and what can be done to decrease these effects is important. IWH and the Occupational Cancer Research Centre have held two symposiums to outline what we know so far, and the outcomes of these collaborations are available at: www.iwh.on.ca/topics/shift-work. The most recent research from IWH in this area confirmed again that workers are more likely to be injured on the job during the evening, night or early morning hours than during a regular daytime shift. The study found that about 12 per cent of work injuries experienced by women and six per cent of work injuries experienced by men were attributed to the higher risk of work injury during evening, night and early morning hours. Two possible reasons for this are worker fatigue due to sleep disturbance and/or long work hours, and lower levels of supervision and co-worker support during non-daytime hours. (For more information, see: www.iwh.on.ca/at-work/73/night-and-evening-shifts-linked-to-higher-risk-of-injuries-study.)

5. Help newcomers understand their health and safety rights and responsibilities. If you have recent immigrants working in your hospital, this 11-item toolkit from IWH may be a welcome addition to your prevention resources. It provides the modules needed to teach recent immigrants to Ontario about occupational health and safety and workers’ compensation. (A version is also available for Manitoba workplaces.) The toolkit, called Prevention is the Best Medicine, was born out of IWH research that shows newcomers are more likely than Canadian-born workers to be in jobs with a higher number of health and safety hazards. The toolkit includes a fact sheet and vocabulary list for newcomers, lesson plans and presentation slides for instructors. It is available at: www.iwh.on.ca/pbm.

6. Improve the outcomes of your return-to-work program.  What can you do to enhance a worker’s return to work (RTW) after an injury or illness? IWH has a guide that can help. Called Seven Principles for Successful Return to Work, it is based on an IWH review of RTW studies, which identified the elements contributing to a successful return to work. You can download the guide from: www.iwh.on.ca/seven-rtw-principles.

7. Solve return-to-work problems. Although most workers resume their jobs and recover in a predictable way, a few run into problems that complicate their recovery and return to work (RTW). Another RTW guide from IWH, based on research into complex workers’ compensation claims, provides advice to help identify and solve these problems. Red Flags/Green Lights: A Guide to Identifying and Solving Return-to-Work Problems lays out warning signs (or “red lights”) and helpful practices (or “green lights”) in four contexts faced by workers: the workplace, health care, vocational rehabilitation and the compensation claims process. The guide shows the full picture of what an injured worker is experiencing, which individual decision-makers may not easily see.  To download the guide, go to: www.iwh.on.ca/rtw-problems-guide.

8. Provide helpful advice to workers with back pain. Based on a review of evidence about managing acute back pain, IWH produced a booklet called So Your Back Hurts…, which was reviewed by the Cochrane Back Review Group (housed at the Institute). The booklet provides advice about staying active, the use of over-the-counter pain-relieving drugs, and the potential short-term benefits of spinal manipulation, heat and massage. For a copy, go to www.iwh.on.ca/so-your-back-hurts.

9. Identify workers with acute low-back pain who are at high risk of poor outcomes. A recent review of studies by IWH showed that certain factors predict the likelihood and timing of return to work among workers with acute low-back pain. The factors—workers’ recovery expectations, interactions with health-care providers, self-reported pain and physical limitations, and physical demands of the job—could be used to screen those workers at high risk of long-term or permanent disability.

Workers’ recovery expectations are the strongest predictor of return to work, according to the IWH review. That is, those who expect to recover and return to work more quickly, do so. Therefore, a simple question asking about recovery expectations during the screening or assessment of workers in the early stages of acute low-back pain could help identify those at high risk of long work absences and, therefore, in need of extra attention to help them recover and return to work more quickly.

10. Develop respectful workplaces to help decrease absences among nurses. According to an IWH study of Canadian nurses, emotional and physical abuse at work, as well as disrespectful and unsupportive work environments, are associated with prolonged work absences among nurses. This suggests hospitals with an absenteesim issue may want to consider implementing violence prevention programs, giving nurses a sense of control over their work, and offering self-management programs that focus on pain. For more on this study, go to: www.iwh.on.ca/at-work/66/health-care-Rx-reducing-work-absences-among-Canadian-nurses.