WHAT'S THE RUSH? Can you keep up the pace and keep employees safe?

Speed kills. It's true in sports as it is in surgery. "Everyone's always in a hurry, and that's how accidents happen," says Lori Simonetti, RN, nurse manager at Urologic Specialists of New England in West Warwick, R.I. The constant frenetic pace, she says, is her biggest challenge when it comes to keeping her staff safe. She's not alone. It's an everyday conundrum in health care, especially in the ambulatory surgery model built on speed and efficiency. But where do you draw the line between fast and reckless, between responsible and risky?

"Staff are constantly pushed by surgeons and anesthesia to go faster, and that's when they're most at risk," says Lynne Pinkham, RN, BSN, CAPA, of Mid Coast Hospital in Brunswick, Maine.

But there's a way to keep from being overwhelmed by the insatiable need for speed, says Ms. Pinkham. "You empower nurses to have a voice, to be able to speak up and say, stop, or let's slow down," she says. "We've really promoted that here over the years, and we now have the support of all of our OR leadership, including the chief of surgery and the chief of anesthesia. It has become our norm, our culture."

Clearly, however, not everyone is getting the message. Though the numbers have improved in recent years, there were still 360,000 reported injuries and illnesses among healthcare workers in hospitals and surgery centers in 2015, according to the Bureau of Labor Statistics.

The potential hazards are many and obvious. Every day, healthcare workers trip over cords, get splashed by blood and bodily fluids, are cut and punctured by scalpels and syringes, are exposed to radiation, and pull muscles or strain tendons while trying to lift or move heavy objects and patients. All while constantly aware that time is money, So let's go, go, go.

"There's a lot of pressure on staff by physicians for quick turnover and this can cause staff to rush," says Nicolette Williams, RN, CNOR, OR director of the Lakeland (Fla.) Surgical and Diagnostic Center. "With all the equipment in the OR, there are a lot of electrical cords on the floor that are a trip hazard. Some of our falls have come from staff rushing around and tripping."

Sharps top the list
In a recent Outpatient Surgery survey, readers pointed to several old standbys as the culprits in their most recent employee injuries. Sharps were No. 1, followed by trips and falls, and lifting or repetitive injuries.

The challenges related to sharps in particular are underlined by the sheer number of devices and systems designed to eliminate them. No-pass zones, needleless systems, safety blades and covers, additional sharps containers, retractable needles, double-gloving and rules against recapping are all being implemented, with varying degrees of success.

"We're always looking for a safer sharps shield that is easily used by all," says a clinical director from Indiana. "We use as many safety devices as possible," says Tracy Rhodes, BSN, director of nursing at the Eye Center of North Florida in Panama City.

So how does an ambitious facility get to zero sharps injuries? Clearly, the best bet is a combination: the right equipment and the right attitude. "When there's a needlestick, it's because someone felt pressured or rushed," says Jackie Crowder, RN, chief nursing officer at St. Joseph's Outpatient Surgery Center in Phoenix, Ariz. At St. Joseph's, "scalpels are passed in basins and our needles are not recapped," says Ms. Crowder. "If you think you're going to load up 3 syringes of local, you open 3 syringes and 3 needles."

Empowerment is key, too, she adds: "I explain to our staff that we don't come to work to hurt people or to hurt ourselves. In those moments when you need to stop the line and figure things out, you'll always get management's backing." That approach, she points out, is emblematic of the all-important shift away from the "I'm-the-doctor, you're-the-nurse, you-do-what-I-say" attitude of the past.

WORKPLACE VIOLENCE
Security a Growing Concern

RECOGNIZED HAZARD Workplace violence against healthcare workers is rampant.

The most violent industry in the United States outside of law enforcement? Health care. Studies show that almost 75% of all workplace assaults between 2011 and 2013 happened in healthcare settings.

Adding to the list of staff safety concerns, many surgical facilities have dramatically increased their efforts to keep employees safe from potentially dangerous intruders. They've installed panic buttons, conducted "code silver" active shooter training, installed bullet-proof glass, hired 24-hour security, mounted security cameras, designated safe rooms, installed key card systems, invited Homeland Security agents in for consulting, stepped up enforcement of badging with vendors and reps, brought in local police and conducted "ALICE" (alert, lockdown, inform, counter, evacuate) training.

"We haven't always had a huge level of concern, but in recent years we have seen the increase nationwide of workplace violence — especially in medical facilities," says Nicolette Williams, RN, CNOR, OR director of the Lakeland (Fla.) Surgical and Diagnostic Center, whose facility has ramped up its approach with regular drills, planned escape routes and the addition of security guards.

Keep in mind, says Ms. Williams, that when a crisis arises, the empathetic and caring nature of healthcare workers can actually be counterproductive. "Recently we did a drill where the scenario was that a family member threatened to get their gun from the car and come back into the facility," she says. "We called the code and all the staff ran toward the 'angry family member' when they should have immediately called security to the area and let them handle the situation. The general attitude of our staff here is to run and help without thinking of their safety first. You need to make sure staff know that it's OK to move away from danger and not run toward it."

— Jim Burger

Hand in hand
"Attitude," says Skeet Todd, RN, BSN, CNOR, CPAN, RNFA, director of perioperative services at Texas Spine & Joint in Tyler, "is more important than any piece of equipment you have. You can get the right stuff, but people get complacent. And when they do, mistakes happen. You think you've pulled the sheath over the blade, but you haven't, and somebody goes to pick it up and they get cut."

At Ms. Todd's facility, the close relationship between physicians and staff is a key safety element, she says: "We're physician-owned and they see us in a little bit of a different light. There's a little more concern. Most of my employees have been here a number of years, so there's also a personal component.

"I've worked in places where physicians literally threw sharps on the Mayo," she says. "That doesn't happen here. They don't just flip it toward you or throw it down. They either hand it back or say, 'Hey, I'm putting this down.' There's an essence of care."

But caring and efficiency don't have to be mutually exclusive. "We have rapid turnover, but everybody has the ability to stop everything if they need to," says Ms. Todd. "There are areas where you can speed up, and there are some where you just cannot. You cannot speed up at the cost of safety. If you speed up to the point where somebody gets stuck, you just delayed that case 30 minutes while that gets taken care of."

And when you're trying to handle the daily hustle of health care, you also need to make sure staff know that no matter how intense the pressure feels to keep the line moving, it's OK to blow the whistle and stop running when personal safety is at stake. OSM