Category Archives: Health Care Workers

Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid

Source: Brie Hawley, Megan Casey, Mohammed Abbas Virji, Kristin J Cummings, Alyson Johnson, Jean Cox-Ganser, Annals of Work Exposures and Health, Early View, Published: 25 October 2017
(subscription required)

From the abstract:
Cleaning and disinfecting products consisting of a mixture of hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are widely used as sporicidal agents in health care, childcare, agricultural, food service, and food production industries. HP and PAA are strong oxidants and their mixture is a recognized asthmagen. However, few exposure assessment studies to date have measured HP, PAA, and AA in a health care setting. In 2015, we performed a health and exposure assessment at a hospital where a new sporicidal product, consisting of HP, PAA, and AA was introduced 16 months prior. We collected 49 full-shift time-weighted average (TWA) air samples and analyzed samples for HP, AA, and PAA content. Study participants were observed while they performed cleaning duties, and duration and frequency of cleaning product use was recorded. Acute upper airway, eye, and lower airway symptoms were recorded in a post-shift survey (n = 50). A subset of 35 cleaning staff also completed an extended questionnaire that assessed symptoms reported by workers as regularly occurring or as having occurred in the previous 12 months. Air samples for HP (range: 5.5 to 511.4 ppb) and AA (range: 6.7 to 530.3 ppb) were all below established US occupational exposure limits (OEL). To date, no full-shift TWA OEL for PAA has been established in the United States, however an OEL of 0.2 ppm has been suggested by several research groups. Air samples for PAA ranged from 1.1 to 48.0 ppb and were well below the suggested OEL of 0.2 ppm. Hospital cleaning staff using a sporicidal product containing HP, PAA, and AA reported work-shift eye (44%), upper airway (58%), and lower airway (34%) symptoms. Acute nasal and eye irritation were significantly positively associated with increased exposure to the mixture of the two oxidants: HP and PAA, as well as the total mixture (TM)of HP, PAA, and AA. Shortness of breath when hurrying on level ground or walking up a slight hill was significantly associated with increased exposure to the oxidant mixture (P = 0.017), as well as the TM (P = 0.026). Our results suggest that exposure to a product containing HP, PAA, and AA contributed to eye and respiratory symptoms reported by hospital cleaning staff at low levels of measured exposure.

‘Whatever it takes’: Hospitals get creative in hiring nurses amid a national shortage

Source: Max Blau, STAT, September 13, 2017

It’s hard to find a nurse who’ll move to West Virginia.

That’s what Doug Mitchell realized after becoming the chief nursing officer of WVU Medicine in late 2015. Early on, he had to hire 200 nurses to staff the nonprofit health system’s new $200 million expansion of its Heart and Vascular Institute. Traditional incentives — signing bonuses, overtime pay, flex scheduling — were all on offer. But they weren’t cutting it. ….

….Hospital administrators, long accustomed to the world of hiring incentives, are making more enticing offers to nurses than ever before. Five-figure signing bonuses have replaced four-figure ones. One Texas health system dangles the prospect of free nursing degrees to train existing staff or volunteers as nurses, while a Missouri health system offers an enticing loan forgiveness program. A Kentucky hospital even gave new nurses who came aboard a chance to win a 2017 Ford Mustang convertible…..

How 1,000 Nurses in Northern Michigan Went Union

Source: James Walker, Labor Notes, September 20, 2017

Nurses in rural northern Michigan made history August 9-10 when we won labor’s biggest organizing victory since “right to work” took effect in the state in 2013. By a vote of 489–439, more than 1,000 RNs at Traverse City’s Munson Medical Center, the area’s largest employer, will be represented by the Michigan Nurses Association.

Munson nurses tried to organize years earlier, unsuccessfully. “I was involved in the effort to organize 15 years ago,” said critical care pool RN Dagmar Cunningham. “Since then benefits have decreased and the workload due to sicker patients has increased. Something had to change.”

This time around, we succeeded. How did we do it?. ….

Organizational Restructuring in US Healthcare Systems: Implications for Jobs, Wages, and Inequality

Source: Eileen Appelbaum and Rosemary Batt, Center for Economic and Policy Research (CEPR), September 2017

From the summary:
The healthcare sector is one of the most important sources of jobs in the economy. Healthcare spending reached $3.2 trillion in 2015 or 17.8 percent of GDP and accounted for 12.8 percent of private sector jobs. It was the only industry that consistently added jobs during the Great Recession. In 2016, the private sector healthcare industry, which is the focus of this report, added 381,000 private sector jobs, the most of any industry. It is a particularly important source of employment for workers without a college degree, most of whom, as we document in this report, earn low wages.

This report describes how organizational restructuring is affecting the job opportunities and wages of healthcare workers. We focus on changing employment and wages in hospitals and outpatient clinics, where the most profound restructuring is occurring. Over the last decade or more, hospitals have restructured the organization of care delivery in response to major technological advances, regulatory changes, and financial pressures. This restructuring has occurred at two levels: the consolidation of hospitals and providers into larger healthcare systems on the one hand; and the decentralization of services and the movement of jobs to outpatient facilities on the other. Outpatient care facilities include a wide range of services — from primary care centers to specialized units such as urgent care centers, ambulatory surgery centers, free-standing emergency rooms, dialysis facilities, trauma and burn units, and other specialty clinics. These organizational changes began before the 2010 passage of the Patient Protection and Affordable Care Act (ACA), but have accelerated considerably since then, and are likely to continue even as the ACA is revamped in the future.

This shift to outpatient care centers offers benefits to patients — convenience as well as opportunities for preventative care — and most healthcare providers and unions have supported the move to more community-based care. But in this report, we show that workers are bearing the costs of this organizational restructuring.

Related:
Supplement
Press release

Growth in Health Hiring and Hospital Spending Decline

Source: Altarum Institute Center for Sustainable Health Spending, Press Release, September 8, 2017

Hiring in the health sector moderated in August after rising over the last few months, while July spending growth slowed, according to analysis of health economic indicators released today by Altarum’s Center for Sustainable Health Spending. Driving low overall spending growth is historically low hospital spending, which, at a revised .8% June growth rate, is the lowest year-over-year monthly growth rate recorded in more than 25 years. After 2 months of unexpectedly robust growth (41,000 in July and 36,000 in June), the health sector only added 20,000 jobs in August, consistent with the slower level of growth seen in the first 5 months of the year. … Hospital hiring is continuing to grow at about two-thirds the 2015 and 2016 pace (6,000 versus 10,000-11,000 new jobs per month). With indications of declining hospital utilization and reports of potential job losses at individual hospitals, further declines in hospital job growth are expected in coming months. …

Related:
Health Sector Trend Report
Source: Altarum Institute Center for Sustainable Health Spending

A Prescription For Good Jobs In The Industrial Midwest: Labor Standards And Unions In The Booming Hospital Industry

Source: National Employment Law Project (NELP), Data Brief, August 29, 2017

…..In many major cities in the Industrial Midwest, hospitals (or health care systems) are among the largest private-sector employers. See Appendix A. Hospitals are often the economic anchors of their communities, generating millions of jobs, directly or indirectly. As a result, hospitals and the wages they pay have an outsized role on the impact of the economic health of communities.

But today, the vast majority of hospital service jobs are not objectively “good jobs.” For every high-paid doctor in the hospital industry in the Industrial Midwest and indeed nationwide, there are more than six workers providing vital supportive services that a strong health care system needs: workers who sterilize surgical instruments, clean hospital rooms, maintain patient files, prepare and deliver food, keep patients clean and comfortable, and transport patients within the hospital. Today, too many of these jobs fail to pay a living wage, to the detriment of the more than 300,000 workers who hold these jobs in the Industrial Midwest alone, many of whom are women and people of color.

We have the opportunity as a nation to improve these jobs by applying key principles from manufacturing jobs—specifically, by improving labor standards and ensuring that workers have voice in the workplace. Raising the minimum wage to $15 per hour and respecting hospital workers’ right to join a union would significantly improve the jobs in the growing hospital industry and the health care sector more broadly…..

Dirty Laundry: An Investigation

Source: Annie Hylton, Dissent, Summer 2017

…..While most New Yorkers recognize the thousands of storefront laundromats scattered across the city that offer drop-off washing or dry-cleaning services as well as coin-operated machines, few may be familiar with larger corporate-owned commercial laundromats, to whom these services are increasingly being contracted. Many of us have likely used a sheet or table cloth cleaned in a commercial laundry, which typically provides services for hotels, hospitals, restaurants, and neighborhood laundromats that outsource their laundry. The commercial laundry industry is growing: in the New York metropolitan area alone, the number of laundry and dry cleaning workers grew from about 9,480 in 2011 to 12,680 in 2016, according to the Department of Labor.

Commercial laundries can range from massive industrial operations employing hundreds or even thousands of workers to more modest “sweatshop” laundries, with anything from a dozen employees to fifty or more, like Suffolk, where Marlyn Gonzalez worked. It is in such commercial laundries, most of which are housed in large factory-like buildings in Queens, Long Island, and the Bronx, that thousands of laundry workers—largely African-American or immigrant women—labor in hot, crowded, and often dangerous or toxic conditions to clean the linens used by millions of New Yorkers. And it is these workers who endure the consequences of an industry plagued by poor working conditions, exploitation, and abuse…..

Prevention Is Key (Er…Required): Will Your State Soon Mandate Workplace Violence Prevention Programs?

Source: Sean Kingston, JDSupra, August 4, 2017

It is no secret to hospital and other healthcare employees that their workplace is no longer a guaranteed safe zone. In fact, recent statistics released by the Occupational Safety and Health Administration (OSHA) indicate that workplace violence is four times more prevalent in the healthcare and social services industries than in other private industries. Violence may come from many sources, including patients or those accompanying them, employees and those who have relationships with employees, and third parties with no business at the facility.

Responding to an outcry from nurses’ unions and patients’ rights groups, and following the lead of seven other states, the California Occupational Safety and Health Administration (CalOSHA) recently enacted a new law (effective April 1, 2017) creating a standard for workplace violence prevention in the healthcare industry. While the breadth of coverage and depth of action required of employers in California now exceeds what can be found in any other state, it could be a sign of things to come for other states.

Because the national tide is turning to legislation that mandates workplace violence prevention programs, particularly in the healthcare context, all healthcare employers would be wise to emulate the practices required by CalOSHA. The federal OSHA and numerous state counterparts are working to assemble similar legislation. …

State Health Agency and Local Health Department Workforce: Identifying Top Development Needs

Source: Angela J. Beck, Jonathon P. Leider, Fatima Coronado, and Elizabeth Harper, American Journal of Public Health (AJPH), Vol. 107 no. 9, September 2017
(subscription required)

From the abstract:
Objectives.
To identify occupations with high-priority workforce development needs at public health departments in the United States.

Methods.
We surveyed 46 state health agencies (SHAs) and 112 local health departments (LHDs). We asked respondents to prioritize workforce needs for 29 occupations and identify whether more positions, more qualified candidates, more competitive salaries for recruitment or retention, or new or different staff skills were needed.

Results.
Forty-one SHAs (89%) and 36 LHDs (32%) participated. The SHAs reported having high-priority workforce needs for epidemiologists and laboratory workers; LHDs for disease intervention specialists, nurses, and administrative support, management, and leadership positions. Overall, the most frequently reported SHA workforce needs were more qualified candidates and more competitive salaries. The LHDs most frequently reported a need for more positions across occupations and more competitive salaries. Workforce priorities for respondents included strengthening epidemiology workforce capacity, adding administrative positions, and improving compensation to recruit and retain qualified employees.

Conclusions.
Strategies for addressing workforce development concerns of health agencies include providing additional training and workforce development resources, and identifying best practices for recruitment and retention of qualified candidates.

Industry Payments to Physicians for Opioid Products, 2013–2015

Source: Scott E Hadland, Maxwell S. Krieger, and Brandon D. L. Marshall, American Journal of Public Health (AJPH), Vol. 107 no. 9, September 2017
(subscription required)

From the abstract:
Objectives.
To identify payments that involved opioid products from the pharmaceutical industry to physicians.

Methods.
We used the Open Payments program database from the Centers for Medicare and Medicaid Services to identify payments involving an opioid to physicians between August 2013 and December 2015. We used medians, interquartile ranges, and ranges as a result of heavily skewed distributions to examine payments according to opioid product, abuse-deterrent formulation, nature of payment, state, and physician specialty.

Results.
During the study, 375 266 nonresearch opioid-related payments were made to 68 177 physicians, totaling $46 158 388. The top 1% of physicians received 82.5% of total payments in dollars. Abuse-deterrent formulations constituted 20.3% of total payments, and buprenorphine marketed for addiction treatment constituted 9.9%. Most payments were for speaking fees or honoraria (63.2% of all dollars), whereas food and beverage payments were the most frequent (93.9% of all payments). Physicians specializing in anesthesiology received the most in total annual payments (median = $50; interquartile range = $16–$151).

Conclusions.
Approximately 1 in 12 US physicians received a payment involving an opioid during the 29-month study. These findings should prompt an examination of industry influences on opioid prescribing.