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1. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ Theme 2 A Safe Workplace Michael M. Koroma RGN. Dip(Ghana, 2002) BSc(Hons)Nursing (USL, 2008) Vice President(SLNA)

2. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • INTRODUCTION It is a pressing reality. Health systems worldwide are increasingly challenged – faced with a growing range of health needs and financial constraints that limit services’ potential to strengthen health sector infrastructures and workforces. We are immersed in a global nursing workforce crisis – one marked by a critical shortage of nurses. The reasons for the shortage are varied and complex, but key among them are unhealthy work environments that weaken performance or alienate nurses and, too often, drive them away − from specific work settings or from the nursing profession itself.

3. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 As professionals, nurses need a practice environment that acknowledges the social and health mandate of their discipline and the scope of practice as defined by country/regulatory legislation (Rowell 2003).

4. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 In quality professional practice environments, the needs and goals of nurses are met and patients are assisted in meeting their individual health objectives. This takes place within the cost and quality framework mandated by the organisation in which the care is provided.

5. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 BACKGROUND • In almost every country nurses provide the majority of health services – up to 80 percent in some cases. • In Ghana, more than 500 nurses left the country in 2000 for higher-paying jobs in richer countries − three times the total recorded for 1999 and more than double the number of nursing graduates Ghana produced that year.

6. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • The current shortage is undermining the goals of health systems globally and challenging our ability to meet the needs of our citizens. • The reasons for the health care and nursing crisis are varied and complex, but evidence underlines that unhealthy work environments are key among them. • Unhealthy environments affect nurses’ physical and psychological health through the stress of heavy workloads, long hours, low professional status, difficult relations in the workplace, problems carrying out professional roles, and a variety of workplace hazards. • Evidence indicates that “long periods of job strain affect personal relationships and increase sick time, conflict, job dissatisfaction, turnover, and inefficiency“ (Baumann et al. 2001). • Nurses who are stressed because of heavy workloads, friction with colleagues, inappropriate tasks, insufficient skills and knowledge, poor management or unsafe working conditions are challenged to provide the highest standards of care.

7. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 DEFINITION • A healthy work environment is a practice setting that maximizes the health and wellbeing of nurses, quality patient outcomes and organisational performance (RNAO 2006d).

8. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 The focus is on the prevention of injuries and the fair and equitable treatment of nurses who are injured at work or develop a work- related illness. Nurses have the right to work in an environment that does not threaten their health, safety or welfare.

9. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • COMPONENT OF WORKPLACE HEALTH AND SAFETY • Safe work environments • Healthy work environments • Safe workplace design • Safe work processes and systems • Safe work procedures and practice • Safe patient care

10. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • 1. Safe Work Environments means the existence of: • Safe equipment • Hygienic conditions • Safe walking and working surfaces • Freedom from violence • Non-hazardous and toxic materials, and if they are present, provision for safe handling, storage and disposal of them

11. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • 2. Healthy work environments It means that: Safety measures are in place in relation to blood borne and body fluid pathogens to prevent contamination of nurses and patients

12. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • 3. Safe workplace design Good ergonomics in relation to: • Seating • Equipment use • Adequate lighting • Safe exits/egresses (clearly marked, open and well-lit)

13. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 4. Safe work processes and systems • Written and up-to date standards, protocols, policies, procedures • Adherence and compliance with these • Adequate staffing • Safe delegation of duties

14. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • 5. Safe Work Procedures and Practices • Lifting techniques • Prevention of needle stick and other injuries • Adequate break times for nurses to prevent tiredness and increase the risk of medication and other errors

15. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • 6. Safe patient care • Safe administration of medication and other skills • Competent staff (skilled and knowledgeable) • Adherence to proper work standards and ethics

16. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 CHARACTERISTICS OF A SAFE WORK PLACE (Kristensen, 1999) Theremustbe: • demands that fit the resources of the person (absence of work pressures); • a high level of predictability (job security and workplace safety); • good social support from colleagues and managers and access to education and professional development opportunities ((team work, study leave); • meaningful work (professional identity); • a high level of influence (autonomy, control over scheduling, leadership); and • a balance between effort and reward (remuneration, recognition, rewards).

17. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • OCCUPATIONAL HEALTH SAFETY ILO Convention No: 155 Concerning Occupational Safety and Health and the Working Environment. 22 June 1981 Workplace or occupational health and safety legislation can provide a framework, but what is required is the development of a culture of safety in health care.

18. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ISSUES OF OCCUPATIONAL HEALTH • Exposure to hazardous drugs and blood borne pathogens • On the job exposure to chemicals • Burning out • Heavy lifting and moving of patients and medical equipment, • Workplace violence and abuse (intruders, patients, relatives, other staff) • Needle stick injuries • Working on night shift: an emerging health risk • Excessively long working hours and heavy workloads

19. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 The ICN Guidelines on Occupational Health and Safety (2007) 1. “Exposure to biological hazards, such as HIV, Hepatitis B and C, is estimated to have a serious impact on nursing. In countries where the prevalence of HIV is the highest in the world, nurses suffer an average of two to four needlestick injuries per year, thereby increasing their chances of contracting HIV, Hepatitis B or C.

20. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 2. Working on night shift: an emerging health risk • Most people have routine work hours with time left for recreation and rest.  • At night the body usually turns its attention to growth, repair, rest and recovery.  • Today experts are recognising the significant stress and biological changes due to continuous night shift work.  • Other associated effects are sleep problems, fatigue, gastro intestinal complaints, depression, anxiety and heart disease. 

21. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • Studies have also reported social problems associated with shift work such as high alcohol consumption – drug use – divorce and spousal abuse. • Humans are biologically programmed as a day-oriented species.  • The human body contains genetic codes for critical life rhythms such as heart beat, breathing, blood pressure, temperature, hormones and digestion that rise and fall in predictable 24-hour cycles known as circadian rhythms.  Changes in its rhythms can lead to changes in hormonal levels which may result in disturbed sleep and fatigue. • In acute phases it may take days or weeks for the body to readjust.

22. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • We fall asleep as adrenal hormone levels and body temperature drop and we return to wakefulness as the levels rise again.  • Ability to concentrate, alertness and attentiveness decreases when this level is at its lowest point, typically occurring between 4-6 am. • This is the vulnerability hours for shift workers as surgeons, nurses and anaesthetists.  • Accidents and medical errors are more common on night shift.

23. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • Nurses may use the evidence to claim compensation. In certain countries, the additional stress and social disruption experienced by nurses working night shifts are compensated by “hardship” allowances (additional income). In others, access to longer rest periods or more frequent leave has been negotiated. In any case, nurses need to be aware of the higher incidence for accidents and adverse events during night shift hours. Source: Wellness Milestones – Article by Sandra Tanajak – Director, Council for Public interest in Anesthesia. AANA – News Bulletin – June 2007 – www.aana.com

24. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 3. On the job exposure to chemicals pose health risks for nurses A recent study suggests that occupational exposure to hazardous materials may put nurses at risk for adverse events such as cancer, asthma and miscarriages.    The survey examined nurses’ medical histories and job-related exposure to chemicals used in health care, including “cleaning products, radiation, mercury and latex.”

25. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 According to findings, • “nurses reporting high exposure to radiation had a 20 percent higher rate of breast cancer than nurses with low or no radiation exposure.  • High exposure to medications of any type, meanwhile, correlated with a 14 percent increase in cancer incidence relative to nurses reporting low or no exposure, and the data linked high exposure to ethylene oxide and antineoplastic drugs to a 20 percent rise in miscarriages.  • Respondents with high exposure to disinfectants, cleansers and latex had asthma rates as much as 50 percent higher than nurses with less exposure to those substances. Source:  Robert Wood Johnson Foundation (2007)Workplace Chemical Exposure May Increase Nurses’ Risk for Adverse Health Events, Survey Finds.

26. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ 4. NEEDLE STICK INJURIES • Persons providing routine nursing care (38%) and cleaning (15%)are the most common situations where needle stick injuries occur. • Invasive procedures such as injections and venipuncture are the most commonly reported causes of injury.

27. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 Risk of infection after needle stick injury • Source Risk HBV 6.0-30.0% 1:3 HCV 1.8% HIV 0.3% 1:300

28. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 Prevention of injury: • * Use instruments to retract • * Use safety needles and re-cappers • * Pass instruments correctly and safely • * Use sharps containers and replace before full

29. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010

30. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ • 5. Workplace violence. • Violence in the workplace is a reality for many nurses. • Potential perpetrators include: • fellow nurses, • other professionals, • patients, • or their families. • In the past, prevention measures have focused on training of the carers. However, there is growing recognition that organisational and • environmental factors (e.g. job design, patient flow, management style, ward structure, noise/heat levels) must also be addressed in order to stop the increasing spiral of workplace violence.

31. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 6. BURNING OUT • Overload of work. Constant dealing with illness and death. Rotating shifts, night shifts disturbing biological rhythms. • Fear of contagion or exposure due to poor occupational health and safety measures. • Frequent use of casual or temporary work contracts. • Stress dealing with family as well as professional responsibilities. • Unhealthy work climate, e.g. bureaucracy, lack of autonomy, rigid management hierarchy. • High technical competence while failing to provide training in psychosocial aspects of providing nursing care.

32. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ The patients’ rights are the nurses’ responsibilities (professional, ethical, legal) The nurses’ rights are the employers’ responsibilities (liability laws, ILO conventions, labour laws, occupational health and safety legislation) www.commonwealthnurses.org

33. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ A nurses’ right to safety is the employers’ responsibility The law mandates of the employer: Safe systems of work Safe Climate Safe equipment Competent colleagues

34. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ • 1. Safe systems of work • Written practice standards • Written policies, protocols and procedures • Appropriate documentation systems(NP) • Systems of accountability for care given, or • not given and actions taken(nursing process-NP) • Adequate staffing systems

35. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 2. SAFE CLIMATE Safety climate comprises: • Safety within the organisation and safety related to policies, procedures, and rewards (Brown & Leigh, 1996). Safety within the organisation is both physical and psychological. The physical aspects include: • the provision of adequate equipment, • Safe physical structures, • an appropriate practice environment.

36. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 The psychological component of safety includes • rewards for employees and • requires employees to feel comfortable asking questions without fear of reprisal. Griffin and Neal (2000) described safety climate as an antecedent of safety performance.

37. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ • 3. Safe equipment • It is: • Available • In good working order • Well maintained • Operational by staff who is well knowledgeable in its use

38. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ • 4. Competent colleagues • Continuing education • Fair system of appraisal • Supervisors and managers with the • necessary skills to manage • Requires: recruitment, training, • deployment, promotion and retention • strategies

39. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 Nurses, at all levels, need to embrace safety and consider it an integral part to the way work is planned, resourced, performed, monitored and evaluated

40. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 ____________________________________ SAFE STAFFING The environment in which health care is provided influences not only the quality of care delivered but also the safety and well being of the care provider.

41. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 The American Federation of Teachers (1995) defines Safe staffing as “an appropriate number of staff with a suitable mix of skill levels . . . available at all times to ensure that patient care needs are met and that hazard-free working conditions are maintained.”

42. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • NURSE -PATIENT RATIO Examples of the nurse patient ratios applied on day shifts are: Medical/surgical wards:   Group A hospitals 1:4+In Charge Group B 1:5+In charge Accident/Emergency 1:3+In Charge+Triage Labour Wards 1:1 Ante/Post natal 1:5+In Charge Operating Rooms: General cases 3 nurses per theatre, Complex cases 4 High Dependency Unit 1:2+In Charge Palliative Care 1:4+In Charge

43. Nurses need their sleep and they need their breaks at work Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 • The effects of fatigue on the brain from sleep deficiency are similar to those of alcohol • Fatigue appears more rapidly with irregular work schedules • Risk of accidents is 7 times higher between midnight and 8 am

44. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 Measures that promote a safe work environment • Ongoing employee education • Adequate staff so there are reasonable shift lengths and workloads • Supervision and support for inexperienced staff • Measures to prevent stress, isolation and burnout • Adherence to universal precautions • Provision of personal protective equipment

45. Commonwealth Nurses Federation in Conjunction with the Sierra Leone Nurses Association Freetown 4 Safety Workshop - April, 2010 The challenge for us nurses is to further improve work practices to ensure we do not risk our life making a living.

46. THANK YOU FOR YOUR ATTENTION