Category Archives: Health Care Workers

Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study

Source: Orianne Dumas, Krislyn M. Boggs, Catherine Quinot, Raphaëlle Varraso, Jan‐Paul Zock, Paul K. Henneberger, Frank E. Speizer, Nicole Le Moual, Carlos A. Camargo Jr., American Journal of Industrial Medicine, Early View, November 6, 2019
(subscription required)

From the abstract:
Background:
Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross‐sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses.

Methods:
The Nurses’ Health Study II is a prospective cohort of 116 429 female nurses enrolled in 1989. Analyses included 61 539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277 744 person‐years of follow‐up (2009‐2015), 370 nurses reported incident physician‐diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job‐Task‐Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index.

Results:
Weekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87‐1.43]; for instruments, 1.13 [0.87‐1.48]). No association was observed between high‐level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence.

Conclusions:
In a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect.

The Constant Caregiver: Work–family Spillover among Men and Women in Nursing

Source: Marci D Cottingham, Jamie J Chapman, Rebecca J Erickson, Work, Employment and Society, OnlineFirst Published November 8, 2019
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From the abstract:
Work–family spillover is a central concept in the work and occupations literature, with prior research detailing its negative outcomes and gendered dimensions. With increased demands for careworkers and more men entering occupations such as nursing, we examine experiences and perceptions of spillover using qualitative data from a diverse sample of 48 US nurses. We find similarities across men and women in terms of exhaustion and stress as well as in anticipating spillover in their careers. Yet, we also find some differences, with men (but not women) highlighting the transfer of emotional capital between work and family. We extend work–family research by broadening the concept of spillover to include its anticipation and the transfer of emotional capital – both aspects that have been previously under-examined. These findings have implications for the retention and support of careworkers and refine the concept of spillover in ways that could apply to various employment sectors.

U.S. Nursing Assistants Employed in Nursing Homes: Key Facts (2019)

Source: PHI, September 3, 2019

From the abstract:
This research brief provides the latest annual snapshot of U.S. nursing assistants employed in nursing homes, including key demographics and a variety of wage and employment trends. This year’s research found that 581,000 nursing assistants support older people and people with disabilities in nursing homes. Nursing assistants are injured more than three times more frequently than the typical American worker, and earn a median hourly wage of $13.38 and a median annual income of $22,200.

Key Takeaways:
– The number of nursing assistants employed in nursing homes in the U.S. declined from just over 599,000 in 2008 to 581,000 in 2018.
– Nursing assistants earn a median hourly wage of $13.38 and a median annual income of $22,200.
– Nursing homes will need to fill nearly 680,000 nursing assistant job openings between 2016 and 2026.

Burnout and Satisfaction With Work–Life Integration Among Nurses

Source: Liselotte N. Dyrbye, Colin P. West, Pamela O. Johnson, Pamela F. Cipriano, Dale E. Beatty, Cheryl Peterson, Brittny Major-Elechi, Tait Shanafelt, Journal of Occupational and Environmental Medicine, Volume 61, Issue 8, August 2019
(subscription required)

From the abstract:
Objectives:
To evaluate characteristics associated with burnout and satisfaction with work–life integration (WLI) among nurses and compare their experience to other American workers.

Methods:
We used data from 8638 nurses and 5198 workers to evaluate factors associated with burnout and satisfaction with WLI, and compare nurses to workers in other fields.

Results:
In the multivariable analysis, demographics, work hours, and highest academic degree obtained related to nursing were independent predictors of burnout. Factors independently associated with satisfaction with WLI included work hours. In pooled multivariable analyses including nurses and other workers, nurses were not more likely to have symptoms of burnout but were more likely to have lower satisfaction with WLI.

Conclusions:
Work hours and professional development related to the risk of burnout among nurses. Nurses are at similar risk for burnout relative to other US workers but experience greater struggles with WLI.

Aggression Detectors: The Unproven, Invasive Surveillance Technology Schools Are Using to Monitor Students

Source: Jack Gillum and Jeff Kao, ProPublica and Wired June 25, 2019

…. The students were helping ProPublica test an aggression detector that’s used in hundreds of schools, health care facilities, banks, stores and prisons worldwide, including more than 100 in the U.S. Sound Intelligence, the Dutch company that makes the software for the device, plans to open an office this year in Chicago, where its chief executive will be based.

California-based Louroe Electronics, which has loaded the software on its microphones since 2015, advertises the devices in school safety magazines and at law enforcement conventions, and it said it has between 100 and 1,000 customers for them. Louroe’s marketing materials say the detection software enables security officers to “engage antagonistic individuals immediately, resolving the conflict before it turns into physical violence.” ….

Unlocking Access to Health Care: A Federalist Approach to Reforming Occupational Licensing

Source: Gabriel Scheffler, Health Matrix: Journal of Law-Medicine, Vol. 29, No. 1, 2019

From the abstract:
Several features of the existing occupational licensing system impede access to health care without providing appreciable protections for patients. Licensing restrictions prevent health care providers from offering services to the full extent of their competency, obstruct the adoption of telehealth, and deter foreign-trained providers from practicing in the United States. Scholars and policymakers have proposed a number of reforms to this system over the years, but these proposals have had a limited impact for political and institutional reasons.

Still, there are grounds for optimism. In recent years, the federal government has taken a range of initial steps to reform licensing requirements for health care providers, and these steps have the potential to improve access to health care. Together, they illustrate a federalist approach to licensing reform, in which the federal government encourages the states to reform their licensing regimes, while largely preserving states’ control over the system. These steps include: (1) easing federal licensing restrictions for health care providers in certain areas where the federal government possesses regulatory authority; (2) creating incentives for states and professional bodies to experiment with reforms; (3) intensifying the Federal Trade Commission’s focus on licensing boards’ anti-competitive conduct; and (4) generating additional pressure for state-level reforms through expanding health insurance and promoting delivery system reforms under the Affordable Care Act.

This article argues that a federalist approach represents the most promising path toward reforming occupational licensing in health care. Federal intervention in licensing is necessary, due to states’ lack of incentives to experiment with licensing reforms, the externalities of their licensing regimes, and their inability to resolve their own collective action problems. Nevertheless, large-scale federal preemption of state licensing laws is unlikely, due to a combination of interest group politics, Congress’s tendency toward incrementalism, and its reliance on the states to administer federal policies. A federalist approach also has functional advantages over outright federal preemption: it allows for more experimentation in constructing new licensing regimes, and it enables the federal government to take advantage of states’ institutional expertise in regulating occupations. Finally, this approach presents a model for how the federal government can play a constructive role in occupational licensing in other fields besides health care, and in other areas of state regulatory policy.

Environmental and Personal Protective Equipment Contamination during Simulated Healthcare Activities

Source: Rachel T Weber, Linh T Phan, Charissa Fritzen-Pedicini, Rachael M Jones, Annals of Work Exposures and Health, Advance Articles, June 4, 2019
(subscription required)

From the abstract:
Providing care to patients with an infectious disease can result in the exposure of healthcare workers (HCWs) to pathogen-containing bodily fluids. We performed a series of experiments to characterize the magnitude of environmental contamination—in air, on surfaces and on participants—associated with seven common healthcare activities. The seven activities studied were bathing, central venous access, intravenous access, intubation, physical examination, suctioning and vital signs assessment. HCWs with experience in one or more activities were recruited to participate and performed one to two activities in the laboratory using task trainers that contained or were contaminated with fluorescein-containing simulated bodily fluid. Fluorescein was quantitatively measured in the air and on seven environmental surfaces. Fluorescein was quantitatively and qualitatively measured on the personal protective equipment (PPE) worn by participants. A total of 39 participants performed 74 experiments, involving 10–12 experimental trials for each healthcare activity. Healthcare activities resulted in diverse patterns and levels of contamination in the environment and on PPE that are consistent with the nature of the activity. Glove and gown contamination were ubiquitous, affirming the value of wearing these pieces of PPE to protect HCW’s clothing and skin. Though intubation and suctioning are considered aerosol-generating procedures, fluorescein was detected less frequently in air and at lower levels on face shields and facemasks than other activities, which suggests that the definition of aerosol-generating procedure may need to be revised. Face shields may protect the face and facemask from splashes and sprays of bodily fluids and should be used for more healthcare activities.

Peaks, Means, and Determinants of Real-Time TVOC Exposures Associated with Cleaning and Disinfecting Tasks in Healthcare Settings

Source: M Abbas Virji Xiaoming Liang Feng-Chiao Su Ryan F LeBouf Aleksandr B Stefaniak Marcia L Stanton Paul K Henneberger E Andres Houseman, Annals of Work Exposures and Health, Advance Articles, June 4, 2019
(subscription required)

From the abstract:
Cleaning and disinfecting tasks and product use are associated with elevated prevalence of asthma and respiratory symptoms among healthcare workers; however, the levels of exposure that pose a health risk remain unclear. The objective of this study was to estimate the peak, average, and determinants of real-time total volatile organic compound (TVOC) exposure associated with cleaning tasks and product-use. TVOC exposures were measured using monitors equipped with a photoionization detector (PID). A simple correction factor was applied to the real-time measurements, calculated as a ratio of the full-shift average TVOC concentrations from a time-integrated canister and the PID sample, for each sample pair. During sampling, auxiliary information, e.g. tasks, products used, engineering controls, was recorded on standardized data collection forms at 5-min intervals. Five-minute averaged air measurements (n = 10 276) from 129 time-series comprising 92 workers and four hospitals were used to model the determinants of exposures. The statistical model simultaneously accounted for censored data and non-stationary autocorrelation and was fit using Markov-Chain Monte Carlo within a Bayesian context. Log-transformed corrected concentrations (cTVOC) were modeled, with the fixed-effects of tasks and covariates, that were systematically gathered during sampling, and random effect of person-day. The model-predicted geometric mean (GM) cTVOC concentrations ranged from 387 parts per billion (ppb) for the task of using a product containing formaldehyde in laboratories to 2091 ppb for the task of using skin wipes containing quaternary ammonium compounds, with a GM of 925 ppb when no products were used. Peak exposures quantified as the 95th percentile of 15-min averages for these tasks ranged from 3172 to 17 360 ppb. Peak and GM task exposures varied by occupation and hospital unit. In the multiple regression model, use of sprays was associated with increasing exposures, while presence of local exhaust ventilation, large room volume, and automatic sterilizer use were associated with decreasing exposures. A detailed understanding of factors affecting TVOC exposure can inform targeted interventions to reduce exposures and can be used in epidemiologic studies as metrics of short-duration peak exposures.

Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission

Source: California Future Health Workforce Commission, February 2019

From the summary:

California’s health system is facing a crisis, with rising costs and millions of Californians struggling to access the care they need. This growing challenge has many causes and will require bold action by the new governor, legislators, and a broad spectrum of stakeholders in the public and private sectors. At the core of this challenge is the simple fact that California does not have enough of the right types of health workers in the right places to meet the needs of its growing, aging, and increasingly diverse population.The California Future Health Workforce Commission has spent nearly two years focused on meeting this challenge, issuing a new report with recommendations for closing California’s growing workforce gaps by 2030…..

…..The Commission’s final report includes a set of 27 detailed recommendations within three key strategies that will be necessary for: (1) increasing opportunities for all Californians to advance in the health professions, (2) aligning and expanding education and training, and (3) strengthening the capacity, retention, and effectiveness of health workers. Throughout its deliberations, the Commission has focused on the need to increase the diversity of the state’s health workforce, enable the workforce to better address health disparities, and incorporate new and emerging technologies.

While advancing all 27 recommendations over the next decade will be important, the Commission has high-lighted 10 priority actions that its members have agreed would be among the most urgent and most impactful first step toward building the health workforce that California needs.

To make these proposals a reality, the Commission also recommended establishing statewide infrastructure, starting in 2019, to implement the recommendations in partnership with stakeholders, to monitor progress, and to make adjustments as needs and resources change. This statewide effort will need to be paired with strong regional partnerships to advance local workforce and education solutions.

The Commission’s 10 priorities for immediate action and implementation are:
1. Expand and scale pipeline programs to recruit and prepare students from underrepresented and low-income backgrounds for health careers….
2. Recruit and support college students, including community college students, from underrepresented regions and backgrounds to pursue health careers….
3. Support scholarships for qualified students who pursue priority health professions and serve in underserved communities….
4. Sustain and expand the Programs in Medical Education (PRIME) program across UC campuses….
5. Expand the number of primary care physician and psychiatry residency positions….
6. Recruit and train students from rural areas and other underresourced communities to practice in community health centers in their home regions….
7. Maximize the role of nurse practitioners as part of the care team to help fill gaps in primary care….
8. Establish and scale a universal home care worker family of jobs with career ladders and associated training….
9. Develop a psychiatric nurse practitioner program that recruits from and trains providers to serve in underserved rural and urban communities….
10. Scale the engagement of community health workers, promotores, and peer providers through certification, training, and reimbursement….

Together, the Commission’s prioritized recommendations will:
● Grow, support, and sustain California’s health work-force pipeline by reaching over 60,000 students and cultivating careers in the health professions.
● Increase the number of health workers by over47,000.
● Improve diversity in the health professions, producing approximately 30,000 workers from under-represented communities.
● Increase the supply of health professionals who come from and train in rural and other underserved communities.
● Train over 14,500 providers (physicians, nurse practitioners, and physician assistants), including over 3,000 underrepresented minority providers.
● Eliminate the shortage of primary care providers and nearly eliminate the shortage of psychiatrists.
● Train more frontline health workers who provide care where people live…..

Improving Job Quality for Direct Care Workers

Source: Paul Osterman, Economic Development Quarterly, Volume 33 Issue 2, May 2019
(subscription required)

From the abstract:
The prevalence of low wage work is a major challenge for American labor markets and health care is an industry in which many of these low wage workers are found. This paper provides data documenting these facts and then discusses strategies for upgrading job quality for long-term care workers who constitute the majority of low wage employees in health care occupations. In addition the paper briefly discusses approaches for upgrading the employment opportunities of low wage employees who are in the health industry but in jobs that are not health care specific.