Hospital work environments, nurse characteristics, and sharps injuries

Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-6096, USA.
American Journal of Infection Control (Impact Factor: 2.21). 07/2007; 35(5):302-9. DOI: 10.1016/j.ajic.2006.07.014
Source: PubMed


A growing body of research links working conditions, such as staffing levels and work environment characteristics, with safety for both patients and workers in health care settings, including sharps injuries in hospital staff nurses.
Surveys of 11,516 staff nurses from 188 Pennsylvania general acute care hospitals in 1999 were analyzed. Hospital work environments, measured using the Practice Environment Scales of the Nursing Work Index--Revised, and staffing were tested as predictors of experiencing at least one sharps injury in the preceding year, both before and after controlling for nurse risk factors, use of safety-engineered devices, and hospital structural characteristics.
Nurses with less than 5 years of experience, perioperative nurses, and those performing routine venipuncture for blood draws were more likely to be injured. Nurses working in hospitals with the most favorable working environments were one-third less likely to be injured. Staffing levels were not associated with sharps injuries.
Across a large state, nurses working in acute care hospitals with better practice environments had fewer sharps injuries. Work environment conditions and specialty- and setting-specific risk factors deserve continued attention in sharps injury research.

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Available from: Sean P Clarke, Oct 07, 2014
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    • "Working non-day shifts and overtime were also reported to be associated with increased sharps injuries (Trinkoff et al., 2007). These findings suggest that the health of nurses has been impacted by unhealthy work environments and nurses' QOWL (Aiken et al., 2011b; Clarke, 2007; Kelly et al., 2011; Shields & Wilkins, 2006a; Trinkoff et al., 2007). "
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    ABSTRACT: This article discusses evaluating and improving the health and quality of work life (QOWL) of nurses. Nurses are reported to have higher illness, disability, and absenteeism rates than all other health care workers. Research suggests that QOWL impacts nurses' health and the provision of quality health care, particularly patient safety. Occupational health nurses have a pivotal role in evaluating and improving nurses' QOWL and health. This will ensure quality health outcomes for nurses and patients and reduce costs for the health care system. [Workplace Health Saf 2013;61(4):173-181.].
    Full-text · Article · Apr 2013 · Workplace health & safety
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    • "Van Bogaert demonstrated that the ward practice environment is central to the provision of high quality care and suggested that nurses working in more positive ward environments are better placed to provide better care. The nurse work environment in this study has been measured using the Nursing Work Index-Practice Environment Scale (PES-NWI) (Lake, 2002; Clarke, 2007; Aiken et al., 2008). This PES-NWI measures organisational behaviours such as managerial support, teamwork, nurse participation in hospital affairs, all of which can be adjusted or improved. "
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    ABSTRACT: BACKGROUND: Patient safety is a priority for health services in all countries. The importance of the nurse's role in patient safety has been established. Effective nurse staffing levels, nurse education levels, and a positive work environment for nurses are factors which are known to impact on patient safety outcomes. OBJECTIVES: This study sought to explore the relationship between the ward environment in which nurses practice and specific patient safety outcomes, using ward level variables as well as nurse level variables. The outcomes were nurse-reported patient safety levels in the wards in which they work, and numbers of formal adverse events reports submitted by nurses in the last year. DESIGN: This cross-sectional quantitative study was carried out within a European FP7 project: Nurse Forecasting: Human Resources Planning in Nursing (RN4CAST) project. SETTINGS: 108 general medical and surgical wards in 30 hospitals throughout Ireland. PARTICIPANTS: All nurses in direct patient care in the study wards were invited to participate. Data from 1397 of these nurses were used in this analysis. METHODS: A nurse survey was carried out using a questionnaire incorporating the Practice Environment Scale of the Nursing Work Index (PES-NWI). Ethical approval was obtained from the authors' institution and all ethics committees representing the 30 study hospitals. Multilevel modelling was carried out to examine the impact of ward level factors on patient safety. These included proportions of nurses on the ward educated to degree level, and aggregated ward-level mean for PES-NWI scores. RESULTS: The study results support other research findings indicating that a positive practice environment enhances patient safety outcomes. Specifically at ward level, factors such as the ward practice environment and the proportion of nurses with degrees were found to significantly impact safety outcomes. The models developed for this study predicted 76% and 51% of the between-ward variance of these outcomes. The results can be used to enhance patient safety within hospitals by demonstrating factors at ward-level which enable nurses to effectively carry out this aspect of their role. CONCLUSIONS: The importance of ward-level nurse factors such as nurse education level and the work environment should be recognised and manipulated as important influences on patient safety.
    Full-text · Article · Oct 2012 · International journal of nursing studies
    • "In a national study of more than 2,000 nurses, working 12 or more hours per shift or any shift other than day shift was associated with a 68% increased likelihood of a needlestick (Trinkoff et al., 2007). In a larger study of more than 11,000 nurses in Pennsylvania, Clarke (2007) found a smaller yet significant increase in the odds of a needlestick with longer work hours (OR = 1.16 [confidence interval, 1.10, 1.23], p = .001). In addition to the emotional cost of needlesticks, the direct cost associated with this injury is considerable. "
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    ABSTRACT: Registered nurses are the largest group of health care providers in the United States. To provide 24-hour care, hospital staff nurses often work long hours and consecutive shifts, without adequate meal or rest breaks. Serious declines in functioning related to provider fatigue can lead to safety issues for patients and nurses alike. The occupational health nurse can assess the effects of nurses' work hours and break periods on employee health, educate staff on the importance of sleep and deleterious effects of fatigue, and implement programs to improve the work environment. This article examines nurses' work hours, break and meal period laws and regulations, and the role of the occupational health nurse in caring for this group of employees. Overall findings suggest that the expertise of an occupational health nurse in the hospital setting could significantly improve the health and safety of staff nurses.
    No preview · Article · Nov 2010 · AAOHN Journal
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