chapter 12 | Promoting a Healthy Workplace 185ergonomic hazards. Under this clause, employers
must keep their workplaces free from recognized
serious hazards, including ergonomic hazards. This
requirement exists whether or not there are voluntary
guidelines (osha.gov/ergonomics/FAQs-external).
The ANA, supported by the Johnson &
Johnson Foundation, has begun a campaign enti-
tled “Handle with Care.” This initiative is aimed at
preventing potentially career-ending back and
other musculoskeletal injuries among nurses.
Health-care facilities that have invested in these
assistive patient handling programs report cost sav-
ings in thousands of dollars both for direct costs of
back injuries and lost workdays (nursingworld.org/
handlewithcare/factsheet). In addition, assistive
patient handling equipment improves the quality
care of patients. Dr. de Castro, senior staff special-
ist for occupational health and safety at the ANA,
observes that such equipment:
■Improves the safety of the patient by decreasing
the potential for manual patient-handling mishaps
■Increases patient comfort by taking away the
human element of potentially awkward or force-
ful handlings
■Restores patient dignity, especially in situations
when difficult handling situations impede on a
person’s privacy or self-esteem (de Castro, 2004)
The investment in a safe patient-handling program
may seem daunting due to the cost of equipment
such as mechanical lifts, transfer aids, and ergonom-
ic beds and chairs. However, the cost savings in
time, reduction of injuries, and lost workdays—as
well as the improved quality of patient care—make
this a sound return on investment.
Repetitive Stress Injuries
Repetitive stress injuries (RSIs) have been called the
workplace epidemic of the modern age.RSIs usually
affect people who spend long hours at computers,
switchboards, and other worksites where repetitive
motions are performed. The most common RSIs
are carpal tunnel syndrome and mouse elbow. As
technology expands in health-care facilities, the use
of computers increases for all health-care personnel.
Badly designed computer workstations present the
highest risk of RSIs. Preventive measures (Krucoff,
2001) include the following:
■Keep the monitor screen straight ahead of you,
about an arm’s length away. Position the center
of the screen where your gaze naturally falls.
■Align the keyboard so that your forearms,
wrists, and hands are aligned parallel to the
floor. Do not bend the hands back.
■Position the mouse directly next to you and on
the same level as the keyboard.
■Keep thighs parallel to the floor as you sit on
the chair. Feet should touch the floor, and the
chair back should be ergonomically sound.
■Vary tasks. Avoid long sessions of sitting. Do
not use excessive force when typing or clicking
the mouse.
■Keep fingernails short, and use fingertips when
typing.Impaired Workers
Substance Abuse
Sue had been a nurse for 20 years. Current marital
and family problems were affecting her at work. To
ease the tension, she took a Xanax from a patient’s
medication drawer. This seemed to ease her tension.
She continued to take medications, working her way
up to narcotic analgesics.
Bill had begun weekend binge-drinking in col-
lege. Ten years later, he continues the habit several
times during the month. He does not believe he is an
alcoholic because he can “control ” his drinking. After
he begins showing up at work hung over and mak-
ing medication errors, he is f ired for the medication
errors. At the exit interview, no mention is made of
his drinking problem. The agency feared a lawsuit
for defamation of character.
Mr. P., the unit manager, has noticed that Ms. J.
has been late for work frequently. She arrives with
a wrinkled uniform, dirty shoes, unkempt hair, and
broken nails. Lately she has been overheard making
terse remarks to patients such as, “Who do you think
I am—your maid?,” and spends longer and longer
periods off the unit. The floor has a large number of
surgical patients who receive intramuscular and
oral medications for pain. Lately, Ms. J.’s patients
continue to complain of pain even after medication
administration has been charted. Ms. J. frequently
forgets to waste her intramuscular narcotics in front
of another nurse. Mr. P. is concerned that Ms. J. may
be an impaired nurse.
As nursing education moved from the untrained
nurse—embodied in the character of Sairey Gamp
in the Dickens novel Martin Chuzzlewit—to the
educated Florence Nightingale model, nurses were