Abstract
Nurses’ Well-Being: Burnout and Work-Related Factors
Aoyjai Montgomery and Patricia Patrician
Background: At least every one out of 10 nurses reported they were suffering from high burnout. Poor workforce health is costly to nurses themselves, their patients, and health care organizations. However, it is unclear what work-related factors are related to nurse burnout.
Methods: A cross-sectional study using an electronic survey was conducted from July 2018 through January 2019 using the Copenhagen Burnout Inventory, the Practice Environment Scale of the Nursing Work Index (PES-NWI) to measure work environment, and work characteristic questions. Nurses (N = 922) in Alabama hospitals (N = 43) were included in this study. Independent t-tests, analysis of variance, and multiple linear regressions were examined. Findings: The majority of nurses reported high Personal Burnout (60%), high Work-related Burnout (54%), and moderate to high Client-related Burnout (63%). All burnout dimensions were statistically significantly negatively related to years of nursing experience (r = −.11 to −.18), total personnel on a typical shift (r = −.08 to −.11), and all five subscales of the PES-NWI (r = −.24 to −.57). Burnout was significantly different based on work type, unit type, and shift length. The PES-NWI composite score and years as a registered nurse (RN) were significantly important predictors of Personal and Work-related Burnout. Unit type was also selected as a significant predictor of Work-related Burnout. Work environment, shift length, and RN skill mixed were selected as Client-related Burnout predictors.
Conclusions/Implications for Practice: The findings suggest that when nurses perceive that their work environment supports professional practice, they are less likely to experience burnout. Furthermore, nurse managers should take into account that recently hired full-time nurses working 12-hr shifts may be more prone to burnout, and they should be the primary targets for burnout prevention programs and for hospital initiatives to promote well-being at work.
Intensive Care Unit Nurses’ Experiences of Caring for COVID-19 Patients
Paula Levi and Jacqueline Moss
Background: Intensive care unit (ICU) nurses are enduring unprecedented burden caring for COVID-19 patients, leading to occupational stress, psychological trauma, and even suicide. This study investigated ICU nurses’ experiences caring for COVID-19 patients, assessed for symptoms of post-traumatic stress disorder (PTSD), job satisfaction, and whether the nurses considered leaving their job.
Methods: This mixed-methods study recruited ICU nurses working in an academic health science center’s designated COVID-19 ICU. Participants were recruited using flyers and emails and were interviewed for 1 hour using open-ended questions to explore their experiences caring for COVID-19 patients. Symptoms of PTSD were assessed using the PTSD Checklist (PCL-5), job satisfaction with a 5-point Likert-type scale, and intention to leave their job with a “yes or no” question. Semi-structured interviews were transcribed and analyzed using NVivo software; quantitative data were analyzed using frequencies and means with R 4.0.5.
Findings: The sample of 10 ICU nurses comprised nine females and one male, all Caucasian, with a mean age of 26.6 years. Analysis of interview transcripts revealed nine recurring themes: Knowledge, Emotion, Difference in Work, Patient’s Family, Isolation, Quality of Care, Futility, Job Satisfaction, and Public Reaction. Quantitative findings revealed most participants (7/10) were “somewhat satisfied” with their job. Five of the 10 considered leaving their job in the last 6 months. Seven of the 10 met the diagnostic criteria for PTSD.
Conclusions/Implications for Practice: Understanding the impact that stressful patient care has on ICU nurses will allow for new policies and design and deployment of interventions to reduce stress and the development of PTSD. Left unchecked, PTSD in ICU nurses can lead to psychological and physical consequences that affect nurses personally and professionally, including patient care and the institutions for which they work.
Surviving During COVID-19: Work Experiences and Concerns of Service Workers
Marie-Anne Rosemberg, Mackenzie Adams, Carri Polick, Hannah Ratliff, Wei Li, and Jenny Dang
Background: The coronavirus pandemic presents a unique burden specifically for workers in service industries. The purpose of this study was to understand the experiences and concerns of service industry workers during COVID-19.
Methods: This was a mixed-methods study with a congruent triangulation design. Participants were recruited through social media between May and June 2020. We collected survey data and conducted individual interviews. Integration for this mixed-methods approach began after analysis for joint interpretation. Divergence or convergence between the survey and interview data was explored.
Results: Twenty-seven individuals completed audio-recorded phone interviews and 28 completed the survey. Participants worked in food retail (n = 23), restaurant (n = 25), and hospitality (n = 7) industries. Length of time on the job ranged from 2 months to 17 years. There was discordance in the perceived level of threat of COVID-19. Most participants reported that their workplace complied with state mandates for protection measures, whereas others reported lacking basic supplies such as soap, hand sanitizer, and masks. Job insecurity, change of job tasks, and work hours were the most common ways that COVID-19 affected the workers. Participants noted concerns about customer attitudes and demands, paid time off, ability to pay bills, and level of authority to enforce work policies. The majority of the participants reported being anxious, concerned, worried, stressed, exhausted, and lonely.
Conclusions/Implications for Practice: Future studies are needed to understand how workers’ experiences have changed during the prolongation of the pandemic. Despite the uncertainties associated with this pandemic, multiple approaches can be taken to better protect these workers. Occupational health nurses can coordinate with organization to (a) ensure that employers adhere to state and local mandates, (b) identify resources to meet workers’ needs, (c) empower workers by helping them understand their rights, and (d) facilitate clear communication processes within organizations for both customers and workers.
Feasibility and Acceptability of Motivational Interviewing as an Approach to Reducing the Negative Health Effects of Noise Exposure Among Agricultural Producers
Marjorie McCullagh, Nathan Stefanovshy, Laura Ridge, and Keane Trautner
Background: Noise exposure is an especially severe issue for those working in production agriculture, as workers are frequently exposed to high noise and underserved by systems designed to protect them. Traditional educational approaches have had limited effectiveness, and motivational interviewing has not been tested. The purpose of this study was to develop and test the feasibility and acceptability of a motivational interviewing intervention aimed at reducing noise exposure among agricultural producers.
Methods: In a one-group pretest/posttest design, we provided a series of two to three short telephone-based motivational interviewing sessions for agricultural producers. Measures of noise exposure, use of hearing protection devices, and related attitudes and beliefs were collected by quantitative survey items at pretest and several weeks after intervention. Data were analyzed using descriptive methods.
Findings: The motivational interviewing intervention was developed using motivational interviewing principles and strategies targeted at farming. Plans for implementing the intervention were realistic given the resources and expertise of coaches; recruitment was protracted. Preliminary review of posttests (n = 6) reflected very high acceptability, with participants rating the program as >6 (out of 7) in 14 of 15 measures (e.g., length, frequency, phone-based, timing, number of sessions, quality of coach, new ideas, interesting, helpful). (“I found the program to be designed for me personally” was rated as 5.83.) Results will be used to determine the feasibility of a large-scale effectiveness test of this new approach designed to prevent noise-induced hearing loss and other negative health effects associated with high noise exposure. Ultimately, this work is expected to improve the hearing health and quality of life among members of this high-risk, hard-to-reach, and underserved group.
Conclusions/Implications for Practice: Agricultural producers are frequently exposed to hazardous noise and can benefit from services designed to mitigate their exposure. Motivational interviewing is both a feasible and acceptable intervention among agricultural producers.
Time-Trend Analysis of OSHA Noise Standard Violations by Region and Industry in the United States: 1972–2019
Sungwon Park, Chang Park, Hong Gi, and Saeng Oi
Background: About 25% of U.S. workers have been exposed to hazardous noise, and noise-induced hearing loss (NIHL) is a major occupational health problem. Since the Occupational Health and Safety Administration (OSHA) began enforcing Noise Standards nearly 50 years ago, no studies have explored the trends of OSHA Noise Standard violation cases over time by industry and region. There is a need to examine how industrial or regional differences affect the frequency and nature of violations over time.
Methods: This study analyzed OSHA data from 112,867 inspections of facilities with violations between 1972 and 2019. The inspection cases were aggregated by region, industry, and year, and 2,451 cases were used for analysis. Time-trends over 48 years, two industrial types (manufacturing and non-manufacturing), and 10 OSHA regions were inspected. To model reported violations case count data, a panel negative binomial regression was applied.
Findings: As to the 48-year time-trends, we found a small annual decrease. After 1972, the overall violations decreased steadily until 2014, increased in 2014–2016, and decreased again after 2016. OSHA Region 4 had the greatest number of violations, followed by Regions 5, 3, and 6. Most violations occurred in manufacturing industries, which decreased in a similar fashion over time. The 10 OSHA regions and two industries were jointly significant in the number of violations among regions and among industries (p < .05).
Conclusions: By identifying time-trends of violations by industry and region, we found an overall decrease in violation cases from 1972 to 2019. However, the fact that one quarter of U.S. workers still experience NIHL poses a significant concern. Further studies are needed to determine whether the time-trends align with changes in OSHA noise reduction policies and initiatives.
The Hypertensive Employee: Conundrums for the Occupational Health Nurse
Donna Ferreira and Sedonia Smith
Background: The Centers for Disease Control and Prevention (CDC) reports one in three American adults have hypertension. The Occupational Health Nurse (OHN) faces challenges when determining the best practice interventions and work capability for the hypertensive employee. OHN’s needs to accurately assess blood pressures (BP) and the severity of the clinical presentation and take evidence-based and safe actions. This presentation focused on best practices for BP assessment, determination of the employee’s work capacity, and recommendations for when to refer the employee to a higher level of care, including the safest modes of transportation.
Methods: Review of literature, publications, online resources, and empirical knowledge from occupational health experiences were utilized to provide the OHN with best practice tools for delivering excellence in care for the hypertensive employee.
Findings: Assessing BP with a manual device using the correct cuff size is most accurate. Having the employee remain seated and quiet and refraining from exercise, caffeine, and smoking before the assessment is the best practice for evaluating BP. Determining an employee’s ability to work full duty, work with restrictions, or inability to work is based on the BP findings, regulations, policies, and job requirements. Clinical guidance for hypertensive urgency (>180/120) and hypertensive emergency (>180/120) was defined with recommendations for actions illustrated in an algorithm. Symptomatic hypertensive emergencies require a 911 call. Analysis of liability and risks for transportation methods such as ambulance, taxi, family member, or when to drive self were compared in a matrix.
Conclusions/Implications for Practice: OHNs were provided tools to determine when to refer a hypertensive employee to their primary physician or an emergency room, determine work capacity, and choose the safest transportation mode using an algorithm. The OHN will gain knowledge and confidence when faced with the hypertensive employee at the workplace.
Implementing and Sustaining a Safe Early Mobility Program by Managing Leading and Lagging Outcome Indicators: The Role of the Occupational Health Nurse in Worker Safety
Danielle Gabele, Melanie Barone, Judi Manwell, and Susan Gallagher
Background: Early mobility can improve economic and clinical outcomes with a high Return on Investment (ROI). This project explored the frequency of use of safe patient handling and mobility (SPHM) equipment. The rate of occupational injury associated with patient mobility tasks served as a measure of lagging indicators (frequency, severity, and economic costs of injury).
Method: This two-phase project was conducted at an 886-bed medical center in the heart of Los Angeles (n = 21). The first phase of the project was conducted between November and December 2015 (baseline date were collected over the 12 months preceding December 2015). The second phase was January 2016 to December 2018, when worker injury data were collected. As part of the first phase, the planning team identified members of the mobility team as the target study group. From November to December 2015, a needs assessment was conducted to determine the mobility team’s classroom and hands-on learning needs. Lift-Tracker, the data collection software, was put in place to record training as a leading indicator. The second phase of the project incorporated worker injury data, which were reviewed for patient handling injuries only.
Findings: Lagging indicators demonstrated a significant reduction in worker injury associated with patient mobility tasks when compared over time, with profound economic outcomes. In fiscal year 2014, there were 51 back injuries and in fiscal year 2015, 70. After dedicated interventions, there were only 37 back injuries in fiscal year 2016. In fiscal year 2017, there was a further 37% decrease in back injuries. From fiscal years 2014 to 2017, there was a 62% decrease in lost work days, which translated to a savings of US$18 million, compared to the three fiscal years prior.
Conclusion/Application to the Occupational Health Professional: This project featured a model for the OHN to manage risk associated with an early mobility program by better understanding foundational elements (leading indicators) and long-term frequency and severity of patient handling injuries (lagging indicators).