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Losing patience

By Michelle Morra
| www.cos-mag.com

Canada’s health care sector is always struggling to makeends meet. Whenever they do have money to invest, health executives tend todevote spending on new hospitals, better medical equipment or surgical suites,to help improve patient care.

What that means, says Cameron Mustard, President of theInstitute for Work & Health (IWH), is that “over the last 15 years therehasn’t been a lot to spare for investments in efforts to protect the health ofworkers in the sector.” 

Canada’s health care sector is always struggling to makeends meet. Whenever they do have money to invest, health executives tend todevote spending on new hospitals, better medical equipment or surgical suites,to help improve patient care.

What that means, says Cameron Mustard, President of theInstitute for Work & Health (IWH), is that “over the last 15 years therehasn’t been a lot to spare for investments in efforts to protect the health ofworkers in the sector.”

Health care workers have higher-than-average rates of workinjuries and illnesses, absences from work and related costs. One estimate, ascited in the IWH’s 2005 Annual Report, suggests that more than 16 millionnursing hours are lost to injury and illness yearly in Canada. The report alsosays that in 2002, the absentee rate for full-time registered nurses in Canadawas 83 per cent higher than that of the general labour force.

“Traditionally, the emphasis has been on ‘the patient comesfirst,’” says Joseline Sikorski, CEO of the Ontario Safety Association forCommunity & Healthcare

(OSACH). “In fact, that’s part of one’s healthcare education — puttingthe patient first. The thought of protecting the staff has traditionally beensecondary.”

The sector is starting to see things differently. Studiesshow that healthier staff who are less tired are better able to effectivelycare for patients. The well-being of patients and staff, while once consideredmutually exclusive, are undeniably linked.

“People enter into the profession of caregiving with a greatdeal of commitment to the role, but they do get tired,” says Mustard. “They gethurt, too.”

Getting to the sore spots

Health care staff in acute care, long-term care, communityservices and group homes are at high risk of experiencing musculoskeletaldisorders (MSDs), a condition that tops the list of occupational risks in thesector. Slips and falls are also responsible for a significant number ofinjuries.

Among the other priority concerns are needlestick injuries,which can expose a healthcare worker to a transmissible disease. Violentbehaviour from angry or upset patients and their family members, or aggressionfrom patients with dementia, is another real threat to nurses and other staff.Mental stress and fatigue are also rampant among health care workers, which notonly compromises the quality of their lives but increases their risk of injury.

The health care sector’s lack of resources is a challengethat labour, government, and the research community are aggressively tackling.Finding answers isn’t the problem. It’s funding them. There are examples,however, of facilities that have found a way, through research studies andother means, to justify investing in safer equipment and processes. The resultsare encouraging.

  

Ceiling-mounted lifts

Musculoskeletal disorders are the most common type of workerinjury in healthcare. Whether it’s back pain, shoulder or neck pain or otherpain of varying degrees, MSDs are very often the result of client handling.When a health care worker (these days, it’s usually an aging healthcare worker)attempts to move or lift a human being, aches and pains can easily follow.

In 2001, in a move toward safer practices, an extended careunit at Queen’s Park Care Centre in New Westminster, B.C., replaced its older,floor-based patient lifts with ceiling-mounted equipment. The floor-basedlifts, while an improvement over manual lifting, had their shortcomings.

A report from the Workers’ Compensation Board of BritishColumbia says that before installing the ceiling-mounted lifts, MSDs at thefacility averaged eight lost-time patient handling injuries a year. No suchinjuries have occurred since installation. The facility went from $39,874.96 inpatient handling claims costs to zero. Based on the project’s success, effortsare under way to design and implement similar comprehensive ceiling-liftprograms across the region as resources become available.

The work done in B.C. was very influential, says Mustard, insubsequent discussions in Ontario about implementing ceiling-mounted lifts.“There has been good evidence accumulating now for 10 years that thistechnology works,” says Mustard. He says that while ceiling lifts were beingused in other countries most Canadian provinces have been slow to adopt them.

A subsequent, systematic review by the IWH of several otherstudies in this area confirmed that lifts, in combination with training andpolicy changes, prevented injury.

New funds available

In December, 2005, the Ontario Ministry of Health andLong-Term Care took advantage of a federal funding program that gave provincialministries funds to support the acquisition of medical technology.

 

“Ontarians have been fortunate,” says Mustard. “The way theobjectives of this fund were described in the media were things like purchasingmore MRIs, and CATs, again, for the patients. But what the Ministry of Healthand Long-Term Care did, which I think was very clever, was to say, we see atechnology need that will benefit patient care but will be primarily beneficialto the health of the health care workforce.” That was patient liftingequipment.

Safer needles

Every day, an estimated 190 needlestick injuries happen inCanadian health care facilities. On January 1, 2006, Manitoba became the firstprovince in Canada to mandate the use of safety-engineered needles in thehealth care sector. Changes to the Workplace Safety and Health Act required,among other things, that workers use safety-designed needles, such asretractable or safety-shielded devices, to prevent injuries, where reasonablypractical.

Shortly thereafter, similar legislation came into effect inSaskatchewan that the province calls “the most rigorous occupational health andsafety regulations in the country for protecting health care and other workersfrom sharps-related injuries.” More than 130 groups representing both employersand employees participated in the consultation process that led to theseregulations, which went into effect July, 2006.

“There was a very strong message given to us, that theworkers thought this was very important,” says Rita Coshan, Manager, RiskManagement and Toxicology for Saskatchewan Labour.

What’s different about Saskatchewan’s regulations is thatthey do not use the “reasonably practical” qualifier. Referring to the Manitobaregulations, Coshan says, “If it’s a high risk procedure, and it doesn’t costmuch to switch [to safer needles], it would be required,” says Coshan. “But ifthe risk is somewhat lower and it’s expensive to switch, you could argue thatit’s not required.

“Ours is an absolute requirement,” she says. “If a needlecan get blood or body fluids, then you have to use the needle safealternative.”

The difficulty is that the safer needles “can be anywherefrom one and a half times to more than eight times as expensive,” says Coshan.“That’s why the ‘reasonably practicable’ qualifier was problematic. If youdon’t make it an absolute requirement, it’s very difficult to get people toswitch to more costly devices.”

The sector is seeing that when it comes to protecting healthcare workers from sharps. Training and procedures alone might not be enough.“Covering a sharp actually removes the hazard,” says Coshan. “You don’t have torely on workers using good practices. You just take it out of the equation.”

Labour groups in other provinces have been urging their ownministries of labour to implement regulations similar to those in Saskatchewanand Manitoba.

Ontario followed suit in August 2007 by amending itsOccupational Health and Safety Act to make safety-engineered or needle-lesssystems mandatory as of September 1, 2008. This followed a strong push forsafer needles by the Service Employees International Union and the OntarioNurses Association.

Ontario has also announced its commitment to purchase up to55 million new N-95 respirators to protect members from contracting SARS,influenza, or other infectious disease.

The various players in health care are aggressively workingon addressing these and other health and safety problems. Mustard says theseefforts are to improve the quality of work and increase the number of peoplewho are training for health professional careers — because without addressingthe issue of staff shortages, progress will be limited.

“It takes a long time to change the direction of a boat likethat,” says Mustard. “You can much faster get 25,000 lifting devices into thelong-term care facilities than you can prepare 10,000 people to be nurses. Itjust takes longer.”

Sikorski agrees, calling these current improvements “thebeginning of a journey.”

“If you look at the aging workforce and the body and thewear and tear,” she says, “and the accommodation around special safetyrequirements so people can continue to work longer in a healthy work life,there’s a great need to focus on retention. And safety is a big piece of this.”

  

Freelance writer Michelle Morra is a former COS editor andan award-winning journalist. You can reach her at:

writemorr@yahoo.ca

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