Category Archives: Health Care Workers

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.

Robotic health care is coming to a hospital near you

Source: Mattie Milner, Stephen Rice, The Conversation, May 7, 2019

Medical robots are helping doctors and other professionals save time, lower costs and shorten patient recovery times, but patients may not be ready. Our research into human perceptions of automated health care finds that people are wary of getting their health care from an automated system, but that they can adjust to the idea – especially if it saves them money.

Hospitals and medical practices are already using a fair amount of automation. For instance, in one San Francisco hospital and other places, delivery robots – about the size of a mini-fridge – zip through the hallways delivering pills, bringing lunch to patients and ferrying specimens and medical equipment to different labs. Some hospitals are set up for delivery robots to open remote-control doors and even use elevators to get around the building.

Lower Nurse-to-Patient Ratio: Higher Patient Satisfaction

Source: Teresa Dousay, Bailey Childers, Madison Cole, Tara Hill and Charles Rogers, Morehead State University, (undated)

Objectives
• Determine if lower nurse to patient ratio improved patient satisfaction
• To assess how nurse-to patient ratios and nurse work hours affect the patients hospital stay.
• To determine whether nurse staffing in California hospitals, where state mandated minimum nurse to patient ratios are in effect, differs from Kentucky with no mandated ratio

Abstract:
The issue of nursing care and patient staffing ratios is not new to medical-surgical nurses. It took national importance in 1996 with the release of an Institute of Medicine (IOM) report that evaluated nursing and patient safety. Patient’s conditions have become complex and require more nursing attention than before, yet, hospitals have become more economically focused and business oriented. Hospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care. Nursing-sensitive outcomes are one indicator of quality of care and may be defined as “variable patient or family caregiver state, condition, or perception responsive to nursing intervention”. Most research has focused on adverse rather than positive patient outcomes for the simple reason that adverse outcomes are more likely documented in the medical record (Stanton, 2004, p. 2). This project focuses on positive nursing sensitive outcomes such as patient satisfaction, shortened inpatient length of stay and decreased hospital readmissions. The purpose of this paper is to reinforce the hypothesis that lower nurse-to-patient ratio results to higher patient satisfaction…..

Related:
Mandated Nurse-to-Patient Staffing Ratios: Benefits at the Bedside and Beyond
Source: Advanced Medical Reviews, February 28, 2019
….Adequate nurse staffing can reduce medical errors, patient mortality, length of stay, preventable events such as patient falls, healthcare-associated infections (HAIs), pressure ulcers and central line infections. It also may reduce patient care costs by avoiding readmissions. ….

Sex and Gender Role Differences in Occupational Exposures and Work Outcomes Among Registered Nurses in Correctional Settings

Source: Mazen El Ghaziri, Alicia G Dugan, Yuan Zhang, Rebecca Gore, Mary Ellen Castro, Annals of Work Exposures and Health, Advance Articles, March 30, 2019

From the abstract:
Background and context:
The correctional environment exposes registered nurses to unique occupational health hazards including, but not limited to, an increased risk for workplace violence. Gender role expectations regarding femininity and masculinity may influence occupational exposures and outcomes differently. Risk comparisons between male and female registered nurses working in correctional settings, have been minimally examined. With the proportion of male registered nurses working in corrections higher than that of nurses working in other healthcare sectors, and with the increasing number of males entering the nursing workforce in general, it is important to characterize and understand occupational exposures and outcomes of male and female registered nurses, especially those working in correctional settings.

Purpose/objectives:
This paper aims to describe and compare sex and gender role differences in occupational exposures and work outcomes among correctional registered nurses.

Methods:
A cross-sectional web-based survey using Qualtrics was administered to registered nurses working in a northeastern correctional healthcare system between June and October 2016. The survey was composed of 71 items from the CPH-NEW Healthy Workplace All Employee Survey, Assessing Risk of Exposure to Blood and Airborne Pathogens and General Health Survey, Bem Sex Role Inventory-Short Form (BSRI-SF), and the Negative Acts Questionnaire-Revised.

Results:
Of 95 registered nurse participants, 75% were female with the highest percentage identified as belonging to the feminine group (37%), while the highest percentage of male participants were identified as belonging to the androgynous group (33%). Females worked primarily on the first shift, while males tended to work the second and third shifts (P < 0.05). Over one third of all participants (37%) reported having experienced a sharps-related injury and having been exposed to blood-borne pathogens and body fluids within the previous 2–5 years. The majority of the participants (>95%) reported being at risk for workplace violence and having been victims of workplace violence perpetrated by an inmate. Significant gender differences (P < 0.0001) were noted in the bullying exposure with androgynous nurses having higher occasional bullying. There was a marginal difference in burnout for females (M = 6.8, SD = 2.1) and males (M = 5.8, SD = 1.9, P = 0.05). Implications: Effective interventions are needed to address the sex and gender role-based differences in bullying exposure and burnout in order to promote the overall health and well-being of correctional registered nurses.

The Union That Roars

Source: Graham Vyse, Governing, February 2019

In an anti-union era, nurses are proving that organized labor can still be powerful. ….

…. NNU isn’t new to this fight. Breaking up the for-profit health-care system has been a defining mission of the union since its founding a decade ago. But now the group faces a new challenge. NNU is embarking on a revamped Medicare for All campaign not only at the federal level — where the prospects of success are bleak, at least in the short term — but in states across the country, especially those with Democratic governors, most notably California, Minnesota and New York. ….

What every healthcare facility should do NOW to reduce the potential for workplace violence

Source: Thomas A. Smith, Journal of Healthcare Protection Management, Volume 34 Number 2, 2018
(subscription required)

The increase in workplace violence in healthcare facilities is now recognized by OSHA and other regulatory bodies as well as IAHSS, major nursing organizations, and the Joint Commission according to the author. In this article he reports on the causes and effects of such violence and presents security guidelines for taking action to reduce it as well as how COOs can be convinced to support such action.

Proportion of Non–US-Born and Noncitizen Health Care Professionals in the United States in 2016

Source: Yash M. Patel, Dan P. Ly, Tanner Hicks, et al, JAMA: Journal of the American Medical Association, Research Letter, Vol. 320 no. 21, December 4, 2018
(subscription required)

From the abstract:
National estimates of the proportion of current health care professionals, including physicians, who are non–US-born or noncitizens are unknown. These proportions may be significant. For example, non–US-born medical graduates comprise approximately one-fifth of practicing US physicians, and among non–US-born medical graduates who match into residency positions in the United States, approximately 60% are not US citizens. Using data from the US Census, this study estimated the proportion of non–US-born and noncitizen health care professionals in the United States in 2016.

Workers’ compensation injury claims among workers in the private ambulance services industry—Ohio, 2001–2011

Source: Audrey A. Reichard, Ibraheem S. Al‐Tarawneh, Srinivas Konda, Chia Wei, Steven J. Wurzelbacher, Alysha R. Meyers, Stephen J. Bertke, P. Timothy Bushnell, Chih‐Yu Tseng, Michael P. Lampl, David C. Robins, American Journal of Industrial Medicine, Volume 61 Issue 12, December 2018

From the abstract:
Background:
Ambulance service workers frequently transfer and transport patients. These tasks involve occupational injury risks such as heavy lifting, awkward postures, and frequent motor vehicle travel.

Methods:
We examined Ohio workers’ compensation injury claims among state‐insured ambulance service workers working for private employers from 2001 to 2011. Injury claim counts and rates are presented by claim types, diagnoses, and injury events; only counts are available by worker characteristics.

Results:
We analyzed a total of 5882 claims. The majority were medical‐only (<8 days away from work). The overall injury claim rate for medical‐only and lost‐time cases was 12.1 per 100 full‐time equivalents. Sprains and strains accounted for 60% of all injury claims. Overexertion from patient handling was the leading injury event, followed by motor vehicle roadway incidents. Conclusions: Study results can guide the development or improvement of injury prevention strategies. Focused efforts related to patient handling and vehicle incidents are needed.