172 unit 3 | Professional Issues
Almost half our waking hours are spent in the
workplace. For this reason alone, the quality of the
workplace environment is a major concern. Yet, it is
neglected to a surprising extent in many health-care
organizations. It is neglected by administrators who
would never allow peeling paint or poorly main-
tained equipment but who leave their staff, their
most costly and valuable resource, unmaintained
and unrefreshed. The “do more with less” thinking
that has predominated many organizations places
considerable pressure on staff and management
alike (Chisholm, 1992). Improvement of the work-
place environment is more difficult to accomplish
under these circumstances, but it is more important
than ever.
Much of the responsibility for enhancing the
workplace rests with upper-level management,
people who have the authority and resources to
encourage organization-wide growth and change.
Nurses, however, have begun to take more respon-
sibility for identification of and problem solving for
workplace issues. This chapter focuses on these
issues, in addition to sexual harassment, impaired
workers, enhancement of work-life quality, diversity,
and disabled workers.
Workplace Safety
Safety is not a new concept in the workplace. The
modern movement began during the Industrial
Revolution. In 1913, the National Council for
Industrial Safety (now the National Safety
Council) was formed. The Occupational Safety and
Health Act of 1970 created both the National
Institute of Occupational Safety and Health
(NIOSH) and the Occupational Safety and Health
Administration (OSHA). The OSHA, part of the
U.S. Department of Labor, is responsible for devel-
oping and enforcing workplace safety and health
regulations. The NIOSH, part of the U.S.
Department of Health and Human Services, pro-
vides research, information, education, and training
in occupational safety and health. The National
Safety Council (NSC) partners with the OSHA to
provide training in a variety of safety initiatives.
The NSC maintains that safety in the workplace is
the responsibility of both the employer and the
employee. The employer must ensure a safe, health-
ful work environment, and employees are account-
able for knowing and following safety guidelines
and standards (National Safety Council, 1992).
Threats to Safety
Working in a health-care facility is reported to be
one of the most dangerous jobs in the United
States. The Department of Labor reports that a
health-care worker in a nursing facility is more likely
to be injured on the job than a coal miner. Health
and safety threats in the nursing workplace include
infectious diseases, physical violence, ergonomic
injuries related to the movement and repositioning
of patients, exposure to hazardous chemicals and
radiation, and sharps injuries (ANA, 2007).
Health care is the second-fastest-growing sector
of the U.S. economy, employing more than 12 million
workers. Women represent nearly 80% of the
health-care workforce. Health-care workers face a
wide range of hazards on the job, including needle-
stick injuries, back injuries, latex allergy, violence,
and stress. Although it is possible to prevent or
reduce health-care worker exposure to these haz-
ards, health-care workers are experiencing increas-
ing numbers of occupational injuries and illnesses;
rates of occupational injury have risen over the past
decade. By contrast, two of the most hazardous
industries, agriculture and construction, are safer
today than they were a decade ago. NIOSH-TIC-2
is a searchable bibliographical database of occupa-
tional safety and health publications, documents,
grant reports, and journal articles supported in
whole or in part by the NIOSH (cdc.gov/niosh/
topics/healthcare/).
In spring 2001, a Florida nurse with 20 years’
psychiatric nursing experience died of head and
face trauma. Her assailant, a former wrestler, had
been admitted involuntarily in the early morning to
the private mental health–care facility. An investi-
gation found that the facility did not have a policy
on workplace violence and no method of summon-
ing help in an emergency (Arbury, 2002).
Six hundred thousand to one million needlestick
injuries occur annually to U.S. health-care workers.
Percutaneous exposure is the principal route for
human immunodeficiency virus (HIV ) and hepatitis
B and C virus transmission. Additionally, infections
such as tuberculosis, syphilis, malaria, and herpes
can be transmitted through needlesticks.
Threats to safety in the workplace vary from one
setting to another and from one individual to
another. A pregnant staff member may be more
vulnerable to risks from radiation; staff members
working in the emergency room of a large urban