Weve all heard about violence in the workplace and up until recently we were reluctant to acknowledge that workplace safety is an issue that health care workers should take seriously and address with their employers. But how much of an issue is it really?
The Bureau of Labor Statistics (BLS) reports that its data shows that in 2000, 48% of all non-fatal injuries from occupational assaults and violent acts occurred in health care and social services. Most of these occurred in hospitals, nursing and personal care facilities, and residential care services.
Injury rates also reveal that health care and social service workers are at high risk of violent assault at work. BLS rates measure the number of events per 10,000 full-time workers in this case, assaults resulting in injury. In 2000, health service workers overall had an incidence rate of 9.3 for injuries resulting from assaults and violent acts. The rate for social service workers was 15, and for nursing and personal care facility workers, 25. This compares to an overall private sector injury rate of 2 (www.osha.gov/Publications /OSHA3148/osha3148.html).
So how safe is your workplace? This is a question that we posed to one group of nurses who work in what many might consider to be a high-risk atmosphere for workplace violence home care nursing. What we found out was that contrary to what many might think: home care nurses and other home care workers believe that their work environment the community at large can be one of the safest in the healthcare industry.
The Visiting Nurse Service of New Yorks (VNSNY) Bronx office performs more than 265,000 professional visits and logs more than 1.5 million home health aide hours each year. The 300 plus nurses employed by their acute care division (full time and per diem) are in the community seven days a week, 52 weeks a year, driving to and from patients throughout the Bronx.
Needless to say, healthcare worker safety is a subject taken seriously by the management at the VNSNY, and its nurses.
We have approximately 2,500 patients in service in the Bronx on any given day. Our nurses are in the community, are highly visible, and are valued by those we serve. [They] are seen by the community as family and are treated as such, says Ellen Murphy, RN, BSN, MSN, clinical director, Bronx Acute Care, VNSNY. They look out for our staff.Fanny Quinones, RN, VNSNY home care nurse, has serviced the same community for 10 years and feels right at home there. They know me in the neighborhood and the community has accepted me.
Ive been in my service area for 10 years now, says Fanny Quinones, RN. They know me in the neighborhood and the community has accepted me.
Fanny says she is frequently stopped by people not on service to ask her about the care the agency provides and to inquire about how they might get a family member seen by them. It helps that she is bilingual because many in her service area are Hispanic and they feel comfortable when she is able to discuss their concerns without having to go through an interpreter. Besides her familiar face, Fannys jacket or blouse identifies her as an employee of VNSNY and her home care bag, which she wheels to her patients, is another clue to the community that she is there in a professional capacity.
Being safe in the community requires that one follow established safety procedures, use common sense, and occasionally rely on ones own intuition. In many ways this parallels the safety precautions you and I might take when visiting the mall or walking the streets in our own neighborhoods.
Workplace safety is part of the orientation program, says Julie Rivera, RN, BSN, MSN, field manager for VNSNY Bronx Acute Care. We have a detailed policy on working safely in the community. Every new nurse is also assigned a nurse buddy who goes with him or her into the community and orients the nurse to the area, showing him or her what works best in that setting where to park, when to visit, and areas where they might request an escort.
Most of the policies address common sense issues dont carry more than $25, be observant, keep your car in good working order, visit during early morning hours when possible, be aware of persons lingering in doorways, use well-traveled streets, etc All nurses are assigned a cell phone and are encouraged to dial 911 if there is an emergency. This rarely happens. More often they call the office and ask advice on how to handle a new and unique situation. The nurses carry a laptop computer that is stowed away in their travel bag. They are encouraged to complete their documentation while in patients homes and not to linger in the car typing away on their laptops.
In addition to the basic safety precautions, the agency also provides escort services in areas where the nurse may be uncomfortable visiting alone. Security guards hired from outside agencies are also available to conduct joint visits in apartment buildings that show signs of drug activity. All of this is coordinated by VNSNYs Safety and Security Department that is headed by a retired police officer. Nurses also get to know the police officers assigned to their communities and the officers are aware when the nurses are in the area.
Given the level of personal security that is available to nurses, one might think that the visiting nurses job is dangerous.
To the contrary, says Fanny. I know every nook and cranny of my area and I know how to navigate the streets. Im more concerned about getting a parking ticket than having my car broken into, she says. In the 10 years that Ive been in the community, Ive only had to reschedule visits two or three times because my inner sense told me that something was not right.
Our nurses do more than just make home visits, says Murphy. VNSNY is not just a home care agency. We provide a full array of outreach services, which includes health and wellness screenings at community care sites, a mental health mobile van service, social services, and prescription drugs to those who cannot afford them, just to name a few.
Our nurses become invested in their communities, says Rivera. She tells of one nurse who has a birthday close to the birthday of a prior patient who is a paraplegic. She still stops by and celebrates their birthdays together even though he is no longer on service.
Another nurse bought a chair for her patient with her own money because the chair her patient had was too uncomfortable to sit in. The patient needed to sit up out of bed every day and she made that happen. Its this type of commitment that home care nurses have to the patients they serve, says Rivera. We view it as a privilege that these patients let us into their homes and their lives and we honor that.