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Nurses in Pain

Nurses in Pain. Susan Letvak PhD, RN, FAAN saletvak@uncg.edu UNC Greensboro School of Nursing. Objectives. Discuss the prevalence of pain and depression in nurses Describe the impact nurse health has on nurses and the healthcare system

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Nurses in Pain

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  1. Nurses in Pain Susan Letvak PhD, RN, FAAN saletvak@uncg.edu UNC Greensboro School of Nursing

  2. Objectives • Discuss the prevalence of pain and depression in nurses • Describe the impact nurse health has on nurses and the healthcare system • Discuss strategies to improve nurse health and assist nurses who work while in pain and/or depressed

  3. Nurse Health “To help a million sick, you must kill a few nurses”

  4. Nursing IS Demanding

  5. Pain • International research demonstrates that the 12-month prevalence of low back pain in nurses ranges from 45-76% with neck pain at 28-60%, shoulder pain at 35% and knee pain at 22% of nurses. • The lifetime prevalence for a musculoskeletal symptom/pain in nurses is 85%.

  6. Pain in Canadian Nurses • 2005 National Survey of the Work and Health of Nurses (2005): 38% stated they have pain that prevents them from carrying out normal activities (most was from back, neck, shoulder, hips) -11% moderate pain, 3% severe -37% felt pain from work factors; 38% from work/non-work factors

  7. Depression • Healthcare workers have high rates of depression in large population studies • Depression and pain frequently appear together

  8. Depression in Canadian Nurses National Survey of the Work and Health of Nurses (2005): • 11% responded they suffer from depression (2,044 of 18,676 respondents) (Canadian research finds 7.9-8.6% depression rates in the population- rate is 10% in U.S.)

  9. The Experience of Being a Nurse with Pain and/or Depression 1. A daily struggle … “Some days you feel you just can’t get to work. It was, you were in too much pain. Too down. No. I can’t. If you make me go I’m going to stab myself in the head with scissors you know. But I went in…”

  10. The Experience of… 2. My practice of nursing has changed 3. A lack of administrative support 4. Patient safety concerns “I’m slower. And I guess that could be a real big thing if, like, a baby was choking in the room. I couldn’t get there as fast as someone who didn’t have my problems. I don’t run.”

  11. Large RWJF Study Mixed Methods Approach Aim 1: Determine the prevalence/extent of presenteeism due to pain and/or depression in RNs and its impact on job productivity. Aim 2: Examine the relationships among individual characteristics, workplace characteristics, presenteeism, and perceived quality of care in RNs. Aim 3: Estimate the cost of presenteeism due to musculoskeletal pain and or depression in RNs.

  12. Nurses with pain/depression impact everyone • Nurses who work with pain and depression struggle every day… • Nurses who work with them want management to recognize/do something about it. They are sick of being dumped on. • Nursing administration thinks nurses “stick together and help each other” and don’t know what they can do about it…

  13. Pain and Depression are Significantly Associated with Presenteeism in Nurses

  14. Findings 1. The number of patient falls go up by 18.3% with each increased unit of the presenteeism score (Based on a Poisson regression model) 2. The number of medication errors go up by 18.0% with each increased unit of the presenteeism score. (Based on a Poisson regression model) 3. Quality of Care score goes down 0.15 points for each increased unit of the presenteeism score. (Based on a normal regression model)

  15. Costs

  16. A Typical Year in BC WorkSafeBCOverview: May 2010 • Facts about the RN Workforce : • Over 1,200 RNs sustained injuries requiring WorkSafeBC time‐loss compensation • Over $6.5 million in claim costs paid • Over 45,000 lost days of work (average duration for a claim is 38 days) • 51% of lost days from MS injury/pain!

  17. Why aren’t we doing more?

  18. Florida BON Application • A. In the last five years, have you been enrolled in, required to enter into, or participated in any drug or alcohol recovery program or impaired practitioner program for treatment of drug or alcohol abuse that occurred within the past five years? • B. In the last five years, have you been admitted or referred to a hospital, facility or impaired practitioner program for treatment of a diagnosed mental disorder or impairment?   • C.During the last five years, have you been treated for or had a recurrence of a diagnosed mental disorder that has impaired your ability to practice nursing within the past five years? 

  19. More nurses are working with pain/depression • Increased life stress • Increased job stress: higher acuity of patients, less staffing (minimum staffing is maximum staffing), longer shifts, lack of breaks… • No time to grieve… • An aging workforce = more health problems

  20. Is Your Work Killing You?Dr. David Posen’s • “Work stress is killing family life and personal life. It's killing the spirit, and in some cases, it's causing very serious health problems.” • The workplace is a good part of the problem… increased job demands/pressures/less staffing

  21. Pain • The majority of PHYSICAL pain in nurses is occupationally related • Hard to “prove” injuries that have occurred over time ARE occupationally related • Not reporting injuries…

  22. Early Recognition of Occupational Illness/Injury

  23. Injury Prevention • Eliminate Risk Factors • Engineering Controls • Administrative Controls • Training and Education • “

  24. Workplace Design

  25. Stress Reduction

  26. Prosen’s Suggestions…. • Identify small things that can make a difference. Ie: taking breaks throughout the day. There should be a mid-morning break, a break at lunch, and a mid-afternoon break –PACE YOURSELF to prevent stress from building.. • Get enough sleep! • EXERCISE regularly

  27. Pain Facts • We will all suffer pain at some point- acute v. chronic • Doctors and scientists really don’t understand pain/how to fully manage • Pain and depression are highly linked • Women feel more pain than men (women have 34 nerve fibers per square centimeter of facial skin, while men average just 17)

  28. REPORT! • Don’t keep your health issues to yourself- if you aren’t comfortable talking to a manager, go to human resources or contact your BCNU representative for where to turn for help. • REPORT injuries and SEEK medical care immediately to document. • SPEAK UP for workplace change

  29. Assess your ability to work with pain • Make a list of your job tasks. Which tasks do you need to restrict because of continuous symptoms? Which tasks make your condition worse, rather than just making you feel different at the moment you are doing the task? • Look to modify your tasks- what you can’t/have trouble doing- GET SUPPORT TO DO!

  30. How to work with pain • Advocate for PAID holistic treatments: Tai Chi, Accu-puncture, massage, biofeedback… • Learn relaxation and meditation techniques • Keep moving…

  31. Depression help

  32. Depression Help • Increase awareness/sensitivity toward depression in both staff nurses and managers • Ensure policies/benefits are in place that support good mental health and treatment availability • Make reasonable job accommodations for nurses whose depression is impacting their work performance

  33. Depression help • Hold depression recognition screenings: placing confidential self-rating sheets in cafeterias, break rooms, or bulletin boards • Provide confidential treatment options

  34. If YOU are depressed… • Seek help… don’t fear medication therapy • Consider CBT (on site or online): • MoodGym(FREE): • https://moodgym.anu.edu.au/welcome

  35. What is the Role of the RN? • What are the essential functions of a RN’s job? • Should physical strength/stamina be a requirement to be a nurse in today’s healthcare environment?

  36. Age: 65 What is YOUR future ?? Age: 65

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