Nursing's OTJ Hazards

Do you remember the television series Hack? It told the story of a disgraced former policeman, trying to make ends meet by driving a taxi, and somehow getting involved in dangerous situations. The trouble is that the creators of the show had it backwards. According to the United States Bureau of Labor Statistics (BLS), driving a cab is the eighth most dangerous occupation there is, while policemen don't even make it into the top 10.

Danger depends on how you define it. Some jobs are dramatically dangerous, like being a skydiving instructor or a member of the local bomb squad. Others may be even more dangerous, but it doesn't show. According to the BLS, the most dangerous job, measured by deaths, is commercial fishing. Logging comes in second. Aircraft pilots are third, but most of those fatalities are among pilots of crop dusters and of other small planes, while commercial aircraft remain the safest form of transportation there is. For the record, structural ironworkers and steelworkers and refuse and recyclable materials collectors complete the top five. The healthcare occupations don't seem particularly dangerous, but they are.

Nursing's Physical Hazards

The difference is that in the occupations where the danger is evident, there's generally just one type of risk. Bullfighting looks dangerous, but after the obvious job risk, what's left? Nursing, on the other hand, doesn't have the same big dramatic hazards, but it has lots of little ones. Here's what the BLS has to say about on-the-job hazards for nurses:

Nursing has its hazards, especially in hospitals, nursing care facilities, and clinics, where nurses may care for individuals with infectious diseases. RNs must observe rigid, standardized guidelines to guard against disease and other dangers, such as those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients, shocks from electrical equipment, and hazards posed by compressed gases. RNs who work with critically ill patients also may suffer emotional strain from observing patient suffering and from close personal contact with patients' families.

The Canadian Centre for Occupational Safety (CCOHS) says pretty much the same thing, listing the risks as biological, chemical, ergonomic, physical, safety, and psychological. Indeed, as recently as February 13, 2007, an article in the Canadian Medical Association Journal reported that some 29% of 18,348 Canadian nurses responding to a survey indicated that they'd been physically assaulted by a patient in the year 2005, while 44% said they'd been subjected to emotional abuse by patients or families of patients, 25% suffered from chronic back problems, and 9% suffered from depression.

However, the CCOHS also warns against other kinds of hazards, ranging from the dangers of frequent hand washing to lasers. In Goldfinger, James Bond was at risk of being bisected by a laser, but what spy ever had to worry about the hazards of hand washing?

Normally, government agencies are quick to take credit for their accomplishments, however small, but for some reason, the agencies responsible for occupational safety haven't chosen to mention their successes. Over the years, stricter regulations, better training, improvements in product safety, and changes in work assignments have made nursing a safer profession, physically. Although traditionally nurses have a 50-80% lifetime likelihood of lower back injury, hospitals have made dramatic improvements both by developing ergonomics training programs and installing mechanical devices for moving patients. In France, between 1990 and 2007, the use of safety devices cut needlestick injuries by 75%. Although the old hazards haven't gone away, and the modern nurse, and particularly the modern nurse anesthetist, also has to worry about repetitive stress injury and carpal tunnel syndrome.

But today, it appears that the most common occupational hazards experienced by nurses are caused by the bean counters in the office suites, and it's a worldwide epidemic. In 2005, the Institut für Pflegewissenschaft (Institute of Nursing Science), at the University of Basel examined the effects of cost-saving strategies on both nurses and their patients. They found, in every nation studied, a clear relationship between lower nurse-patient ratios and lower nursing job satisfaction, and higher patient mortality and higher nurse on-the-job emotional and physical injury. (Among other centers that considered the subject, the Korea Institute for Health and Social Affairs found that cuts in nurse staffing levels led to more episodes of pressure ulcers, adverse drug events, pneumonia, urinary tract infections, wound infections, and sepsis, which wiped out any savings made by cutting staff.

Burnout & Beyond

From Denmark comes the question: How often do you think: "I can't take it anymore"? That's one of the questions on the Copenhagen Burnout Inventory, a simple 19-question instrument designed to measure fed-upness. Burnout has been linked to increased use of sick days, but these have been mostly musculoskeletal complaints that, fortunately, don't turn into chronic problems.

There have been studies which link medical problems with nurses' working conditions. The increased frequency type 2 diabetes in the United States has been associated with overweight, but there's another factor – overtime. A paper in the January 15, 2007 American Journal of Epidemiology reported that while most cases of diabetes were associated with traditional risk factors, working overtime was an independent risk factor for type 2 diabetes among young and middle-aged nurses.

With increased hospital closings and staff cutbacks, nurses, who once had the sort of job security that a hereditary monarch would envy, have had to confront the prospects of job loss, and that can be unhealthy. A review published in the January 2004 Annals of Epidemiology of the Nurses' Health Study, a prospective cohort of female registered nurses residing in 11 US states, shows that job insecurity increases the risk of heart attacks.

These problems are bad, but maybe the turn of the millennium has some advantages. In its August 1998 issue, the journal Intensive & Critical Care Nursing published an article about several UK nurses accused of killing patients, entitled "Is A Murder Charge An Occupational Hazard Of Intensive Care Nursing?"

Some days, driving a taxi seems like a good career choice after all.

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