Nurse Health & Safety

Working RNs know it deep in their bones: nursing may be gratifying to the spirit but it’s tough on the body.

As the latest health and safety survey from the American Nurses Association (ANA) makes clear, the national effort to protect nurses from occupational injuries remains a crusade-in-progress.

It’s certainly true that hospitals are safer workplaces today than 10 years ago, when the ANA last surveyed RNs about their health concerns. Safe needle devices, patient-lifting equipment and other conveniences are more available today than a decade ago.

“We are seeing progress in a number of areas,” ANA President Karen A. Daley, PhD, MPH, RN, FAAN, told ADVANCE. “The willingness of employers to do more is encouraging. But there is still work to do.”

That becomes apparent when you consider the 4,614 RNs who participated in the ANA’s 2011 Health and Safety Survey repeated the same top three concerns as 2001’s participants, and in slightly higher percentages:

  • 74 percent cited the effects of stress and overwork (versus 70 percent in 2001), 

  • 62 percent cited disabling musculoskeletal injury (versus 59 percent in 2001), and 

  • 43 percent cited contracting an infectious disease (versus 37 percent in 2001). 

“For many years, injuries of one sort or another were shrugged off as the cost of doing business,” Daley said. “We don’t believe employers should shrug it off. They have an obligation to mitigate the health and safety concerns of nurses and other healthcare workers.”

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‘Healthier’ Work Schedules

Drilling down to the details of the survey reveals many positive changes made since 2001.

For example, while RNs still identify stress and overwork as their single greatest concern, work hours have decreased.

“Working schedules for RNs are perhaps a bit healthier today,” offered Jaime Murphy Dawson, MPH, senior policy analyst with ANA’s Center for Occupational and Environmental Health.

“In 2001, 64 percent of RNs worked more than 40 hours a week. That dropped to 55 percent in 2011. Mandatory overtime dropped as well.”

As for lifting patients, the decade also saw progress. In 2001, more than half of ANA respondents worked in hospitals that didn’t provide patient lifting and transfer devices. Ten years later, the tide had turned: 64 percent now work for hospitals so equipped.

Even so, 56 percent of 2011 respondents said they experienced musculoskeletal pain either caused or made worse by their jobs in the past year, while 80 percent said they frequently work despite musculoskeletal pain.

Moreover, a striking 13 percent reported suffering job-related injuries three or more times within a year – up from just 7 percent in 2001. Keep in mind, though, that RNs report injuries more readily today.

“In 2011, 81 percent of nurses who suffered an injury reported it,” Dawson said. “That’s a big change from 2001, when just 24 percent reported injuries.”

Small wonder the U.S. Bureau of Labor Statistics in 2010 ranked nursing the fifth highest profession in work days missed due to occupational injuries and illnesses.

“Nurses are still very concerned about developing musculoskeletal disorders,” Dawson noted. “ANA believes steps should be taken to completely eliminate patient handling.”

Sharps Injuries Down

More good news: safe use of needles has become routine.

Only 21 percent of respondents in 2011 listed fear of contracting HIV or hepatitis from a needle-stick as a concern, down from nearly half of 2001’s respondents (who numbered 7,299).

Passage of the federal Needle-stick Safety and Prevention Act of 2000 appears instrumental here: In 2001, 18 percent of RNs said their facilities didn’t provide safe needle devices; in 2011, only 4 percent said so.

“The ANA has a program called Safe Needles Save Lives that has helped reduce the number of sharps injuries nurses suffer,” Dawson said.

“Injuries still happen much more than they should. But we’ve seen great progress.”

Latex allergies are another concern that has diminished with time. Only 6 percent of 2011’s respondents worried about it versus 21 percent of their counterparts a decade ago.

“Latex allergy was an emerging issue in the 1990s but now we have lots of alternatives to latex available,” Dawson said. “In 2001, 61 percent of nurses said they worked in hospitals where powdered latex gloves were used. In 2011, only 25 percent said the same thing. Some hospitals have banned them.”

However, 10 percent of 2011’s respondents voiced concern about their exposure to chemotherapy and other toxic chemicals, up from 5 percent in 2001.

“While that’s a small margin of increase, it shows increased awareness of the issue over the past 10 years, partly due to clearer labeling of toxic chemicals,” Dawson said.

Assaults Down But.

In an intriguing finding, fewer RNs in 2011 reported suffering assaults in the workplace than in 2001 – yet concern over assault rose.

Eleven percent reported a physical assault within the past year (down from 17 percent in 2001), and 52 percent reported threats or verbal assault (down from 57 percent). Nevertheless, a higher percentage of respondents in 2011 ranked assault as a top-three safety concern (34 percent versus 25 percent).

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Do nurses view the world as more dangerous today?

“There is definitely increased awareness of workplace assault among healthcare workers and in the media,” Dawson observed. “Some states have responded with legislation to make assault on healthcare professionals a felony. That is definitely a positive step.”

Overall, 6 in 10 nurses told ANA surveyors health and safety concerns influence their decision to continue practicing or to leave the field.

That’s why surveying RNs is so important, Dawson concluded.

“We hope our survey will lead to further changes in the workplace and help nursing’s leaders identify and prioritize their efforts accordingly,” she said.

Added ANA President Daley: “Quality of the workplace is a key factor nurses consider when they talk about job satisfaction. It’s a key factor for employers in retaining and recruiting nurses. It’s a huge issue. And our commitment doesn’t waver on it.”

Michael Gibbons is an editor at

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