chapter 12 | Promoting a Healthy Workplace 175by the ANA Board of Directors, and represent
constituent member associations. Additionally,
state member associations often offer their own
workplace advocacy information. Issues such as
collective bargaining, workplace violence, mandatory
overtime, staffing ratios, conflict management, del-
egation, ethical issues, compensation, needlestick
safety, latex allergies, pollution prevention, and
ergonomics are addressed.
The ANA Web site (www.nursingworld.org)
keeps up-to-date information related to workplace
advocacy and safety available to all nurses.
Joint Commission
The Joint Commission ( JC) is an independent,
nonprofit organization. Established more than
50 years ago, it is governed by a board that includes
physicians, nurses, and consumers. The JC evalu-
ates the quality and safety of care for more than
15,000 health-care organizations. To earn and
maintain accreditation, organizations must have an
extensive on-site review by a team of JC health-
care professionals at least once every 3 years. Many
of the national patient safety goals discussed in
Chapter 10 were influenced by the safety of the
health-care worker. For example, fatigue due to
mandatory overtime has been identified as causing
increased medication errors.
Institute of Medicine
The Institute of Medicine (IOM) is a private, non-
governmental organization that carries out studies
at the request of many government agencies. The
mission of the IOM is to improve the health of peo-
ple everywhere; thus, the topics it studies are very
broad (iom.edu). In 1996 the IOM began a quality
initiative to assess the nation’s health. Part of this ini-
tiative was the 2004 report: Keeping Patients Safe:
Transforming the Work Environment of Nurses.
The report identified concerns and issues related to
organizational management, workforce deployment
practices, work design, and organizational culture
(Beyea, 2004). Each of these issues will be discussed
in the section of this chapter on enhancing the
quality of work life.
Programs
The primary objective of any workplace safety
program is to protect staff members from harm
and the organization from liability related to that
harm.
The first step in development of a workplace
safety program is to recognize a potential hazardand
then take steps to control it. Based on OSHA reg-
ulations (U.S. Department of Labor, 1995), the
employer must inform staff members of any poten-
tial health hazards and provide as much protection
from these hazards as possible. In many cases, ini-
tial warnings come from the CDC, NIOSH, and
other federal, state, and local agencies. For example,
employers must provide tuberculosis testing and
hepatitis B vaccine; protective equipment such as
gloves, gowns, and masks; and immediate treat-
ment after exposure for all staff members who may
have contact with blood-borne pathogens.
Employers are expected to remove hazards, educate
employees, and establish institution-wide policies
and procedures to protect their employees
(Herring, 1994; Roche, 1993). Nurses who are not
provided with latex gloves may refuse to participate
in any activities involving blood or blood products.
The employee cannot be subjected to discrimina-
tion in the workplace, and reasonable accommoda-
tions for safety against blood-borne pathogens
must be provided. This may mean that the nurse
with latex allergies is placed in an area where expo-
sure to blood-borne pathogens is not an issue
(Strader & Decker, 1995; U.S. Department of
Labor, 1995). The OSHA also has information
available on exposure to chemical or biological
agents related to terrorism. Terrorism response
exercises are conducted through OSHA to train
health-care workers on responding to terrorism
threats (http://www.osha.gov/). The second step in
a workplace safety program is a thorough assessment
of the amount of risk entailed.Staff members, for
example, may become very fearful in situations that
do not warrant such fear. For example:Nancy Wu is the nurse manager on a busy geriatric
unit. Most patients require total care: bathing, feed-
ing, and positioning. She observed that several of
the staff members working on the unit use poor body
mechanics when lifting and moving the patients. In
the last month, several of the staff members were
referred to Employee Health for back pain. This
week, she noticed that the patients seemed to remain
in the same position for long periods and were rarely
out of bed or in a chair for the entire day. When she
confronted the staff, the response was the same from
all of them: “I have to work for a living. I can’t
afford to risk a back injury for someone who may