AORN Position Statement on
Workplace Safety
PREAMBLE
Perioperative nurses, along with others in the health care environment, are routinely faced with a wide array of occupational hazards that create a risk of personal injury in the workplace. A survey of registered nurses revealed that stress/overwork, disabling back injuries, and contracting a bloodborne disease were the top three health and safety concerns.1,2 The National Institute for Occupational Safety and Health (NIOSH) reported that an estimated 600,000 to 800,000 percutaneous injuries occur annually to health care workers.3 Reported information on needle sticks shows that nurses sustain the majority of these injuries.3 Nurses practicing in the perioperative environment are at distinct risk for percutaneous injury due to prolonged exposure to open surgical sites, frequent handling of sharp instruments, and the presence of large quantities of blood and other potentially infectious body fluids.4
Back injuries pose a significant risk to perioperative nurses and are the most prevalent occupational injury in the health care industry.5 Direct costs associated with occupational back injuries of health care providers average $37,000. Indirect costs associated with back injuries can range from $147,000 to $300,000.5
Key indicators to an organization's culture and commitment to ensure a safe workplace include maintaining safe equipment, providing adequate nurse staffing levels, and fostering safe work practices.6 An unsafe workplace contributes to work-related injuries and diseases that often result in physical, emotional, and financial difficulties for perioperative nurses. Occupational injuries resulting from an unsafe workplace impact the health care organization by increased costs and a reduced ability to provide services. Occupational hazards in the workplace have been identified as a major contributor to nurses leaving the profession, contributing to the growing nursing shortage.1
BACKGROUND
The shortage of skilled registered nurses and other health care personnel has a major impact on the delivery of safe, quality patient care. The current shortage has become an area of grave concern for health care organizations and providers, the government, and consumers. Workplace safety is a primary concern of nurses and impacts their decision to continue working in the nursing profession. A safe workplace will have a positive impact on the retention and recruitment of qualified nurses to provide safe patient care.
The health care organization's commitment to workplace safety is an important factor influencing employee compliance with safe work practices. The workplace safety culture is of increasing importance as workloads increase, due to the effects of the nursing shortage, increased patient acuity, and emphasis on higher productivity.7 One study demonstrated that strong support from senior management resulted in a reduced rate of occupational exposure to blood and body fluids.7
The multiple occupational hazards that create a risk of personal injury that perioperative nurses face in the workplace are both physical and psychosocial. Some of the workplace safety exposure issues identified in the perioperative setting include, but are not limited to, the following.8
AORN suggests the following strategies for developing and maintaining a safe workplace:
The Association is committed to the creation and maintenance of a safe perioperative work environment to protect all of those present in the workplace and provide safe patient care. AORN supports research that is directed toward creating and maintaining safe work environments. AORN further supports the Environmental Protection Agency, NIOSH, Occupational Safety and Health Association, and state and local regulations that promote workplace safety in the perioperative environment.
References
1. "Working conditions are major factor in retaining current nurse workforce," Legislative Network for Nurses 18 (Sept 10, 2001) 137.
2. "On-line health and safety survey, September 2001, Key finding," American Nurses Association/NursingWorld.org, http://nursingworld.org/surveys/keyfind.pdf (accessed 8 Oct 2002).
3. "NIOSH alert: Preventing needlestick injuries in health care settings," US Department of Health and Human Services, National Institute for Occupational Safety and Health (November 1999) http://www.cdc.gov/niosh/2000-108.html (accessed 7 Oct 2002).
4. J Jagger, M Bentley, P Tereskerz, "Study of patterns and prevention of blood exposures in OR personnel," AORN Journal 67 (May 1998) 979-996.
5. D Blackmon, "Back injury prevention," Surgical Services Management 5 (July 1999) 43-46.
6. S Clarke et al, "Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses," American Journal of Infection Control 30 (June 2002) 207-216.
7. R Gershon, et al, "Hospital safety climate and its relationship with safe work practices and workplace exposure incidents," American Journal of Infection Control 28 (July 2001) 211-221.
8. "Health care workers," US Department of Health and Human Services, National Institute for Occupational Safety and Health, http://www.cdc.gov/niosh/healthpg.html#tb (accessed 9 March 2003).
Original approved by the House of Delegates, Chicago, March 2003
Sunset review: March 2008
Perioperative nurses, along with others in the health care environment, are routinely faced with a wide array of occupational hazards that create a risk of personal injury in the workplace. A survey of registered nurses revealed that stress/overwork, disabling back injuries, and contracting a bloodborne disease were the top three health and safety concerns.1,2 The National Institute for Occupational Safety and Health (NIOSH) reported that an estimated 600,000 to 800,000 percutaneous injuries occur annually to health care workers.3 Reported information on needle sticks shows that nurses sustain the majority of these injuries.3 Nurses practicing in the perioperative environment are at distinct risk for percutaneous injury due to prolonged exposure to open surgical sites, frequent handling of sharp instruments, and the presence of large quantities of blood and other potentially infectious body fluids.4
Back injuries pose a significant risk to perioperative nurses and are the most prevalent occupational injury in the health care industry.5 Direct costs associated with occupational back injuries of health care providers average $37,000. Indirect costs associated with back injuries can range from $147,000 to $300,000.5
Key indicators to an organization's culture and commitment to ensure a safe workplace include maintaining safe equipment, providing adequate nurse staffing levels, and fostering safe work practices.6 An unsafe workplace contributes to work-related injuries and diseases that often result in physical, emotional, and financial difficulties for perioperative nurses. Occupational injuries resulting from an unsafe workplace impact the health care organization by increased costs and a reduced ability to provide services. Occupational hazards in the workplace have been identified as a major contributor to nurses leaving the profession, contributing to the growing nursing shortage.1
BACKGROUND
The shortage of skilled registered nurses and other health care personnel has a major impact on the delivery of safe, quality patient care. The current shortage has become an area of grave concern for health care organizations and providers, the government, and consumers. Workplace safety is a primary concern of nurses and impacts their decision to continue working in the nursing profession. A safe workplace will have a positive impact on the retention and recruitment of qualified nurses to provide safe patient care.
The health care organization's commitment to workplace safety is an important factor influencing employee compliance with safe work practices. The workplace safety culture is of increasing importance as workloads increase, due to the effects of the nursing shortage, increased patient acuity, and emphasis on higher productivity.7 One study demonstrated that strong support from senior management resulted in a reduced rate of occupational exposure to blood and body fluids.7
The multiple occupational hazards that create a risk of personal injury that perioperative nurses face in the workplace are both physical and psychosocial. Some of the workplace safety exposure issues identified in the perioperative setting include, but are not limited to, the following.8
- Biological
- Exposure to bloodborne pathogens from percutaneous injuries, splashes, and other contact
- Exposure to infectious microorganisms
- Exposure to biological components of surgical smoke from use of lasers and electrosurgical units
- Exposure to the chemical and protein allergens in latex gloves
- Ergonomic
- Static or awkward posture
- Standing for long periods of time in one position
- Back injuries
- Repetitive motion
- Moving patients or carrying heavy instruments and equipment
- Chemicals
- Anesthesia gases
- Disinfecting/sterilizing agents
- Cleaning agents
- Specimen preservatives
- Physical hazards
- Fire
- Electrical
- Radiation
- Lasers
- Smoke plume
- Compressed gases
- Psychosocial
- Long hours
- Mandatory overtime
- Demographic diversity
- Nursing shortage
- Call
- Trauma
- Burnout
- Abuse-verbal and physical
- Violence from staff, patients, patients' families, or nurses' families
- Cultural
- Tolerance of abuse from physicians
- Lack of commitment by management to adhere to an optimal workplace safety program
- Absence of respect from peers and other health care professionals
- Absence of a code of conduct for all team members
AORN suggests the following strategies for developing and maintaining a safe workplace:
- The facility has the responsibility to establish and promote a safe work environment and strive to use best practice models (eg, magnet hospital status criteria, workplace of choice).
- Each facility should develop a comprehensive workplace safety program that includes a written plan for each topic covered in the program, a written plan to provide education on safety initiatives, and monitoring of compliance for employees and other health care providers.
- Every perioperative nurse is responsible for following safety policies and participating in the safety programs.
- The perioperative nurse has a responsibility to identify safety hazards, take appropriate action, and report them through the appropriate channels.
The Association is committed to the creation and maintenance of a safe perioperative work environment to protect all of those present in the workplace and provide safe patient care. AORN supports research that is directed toward creating and maintaining safe work environments. AORN further supports the Environmental Protection Agency, NIOSH, Occupational Safety and Health Association, and state and local regulations that promote workplace safety in the perioperative environment.
References
1. "Working conditions are major factor in retaining current nurse workforce," Legislative Network for Nurses 18 (Sept 10, 2001) 137.
2. "On-line health and safety survey, September 2001, Key finding," American Nurses Association/NursingWorld.org, http://nursingworld.org/surveys/keyfind.pdf (accessed 8 Oct 2002).
3. "NIOSH alert: Preventing needlestick injuries in health care settings," US Department of Health and Human Services, National Institute for Occupational Safety and Health (November 1999) http://www.cdc.gov/niosh/2000-108.html (accessed 7 Oct 2002).
4. J Jagger, M Bentley, P Tereskerz, "Study of patterns and prevention of blood exposures in OR personnel," AORN Journal 67 (May 1998) 979-996.
5. D Blackmon, "Back injury prevention," Surgical Services Management 5 (July 1999) 43-46.
6. S Clarke et al, "Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses," American Journal of Infection Control 30 (June 2002) 207-216.
7. R Gershon, et al, "Hospital safety climate and its relationship with safe work practices and workplace exposure incidents," American Journal of Infection Control 28 (July 2001) 211-221.
8. "Health care workers," US Department of Health and Human Services, National Institute for Occupational Safety and Health, http://www.cdc.gov/niosh/healthpg.html#tb (accessed 9 March 2003).
Original approved by the House of Delegates, Chicago, March 2003
Sunset review: March 2008