Results of a new survey by The Harris Poll reveal that many patients receive too many needlesticks in hospital procedures, which amplifies misconceptions and lack of awareness from Americans on the risks of common medical procedures.
The “Accepted But Unacceptable” Practice of Repeated Needlesticks
Needlesticks are an often-overlooked challenge but can be one of the most traumatic aspects of a patient’s hospital stay. More than half of Americans (51%) report some fear of needles, and of that group, a top reason is fear of needing multiple needle insertions (31%).
The survey findings reflect that this concern isn’t unwarranted: a shocking 11% of survey participants with recent hospital experience needed 10 or more sticks to obtain a single blood sample – and more than half required multiple needlestick attempts for a single procedure (59% for IVs and 71% for blood draws). Moreover, 77% of patients are unaware that regardless of their conditions, patients should expect no more than two needlestick attempts from one clinician.
Nurses Agree That Repetitive Needlesticks Negatively Impact Patient Care Delivery and Workflow
Unsurprisingly, the survey highlights nurses’ strong concern about the impact of repeated needlesticks on the patient care experience. Most nurses agree that repeated needlesticks negatively impact the patient experience and say that alternatives are needed to reduce the number of needlesticks patients encounter (92% and 91%, respectively).
More than just providing a better experience, nurses agree that delays to patient treatment caused by difficult venous access or fear of needles are a problem (89% and 84%, respectively), and 67% agree that issues related to vessel access consume too much time and contribute to workflow inefficiencies.
Repeated needlestick attempts create additional work and add stress for the frontline clinician, many of whom are already feeling the impact of increased patient volume, labor shortages, and unprecedented staffing demands,” said Rachelle Landry, a registered nurse (RN) and vice president of Clinical Transformation at BD. “Additionally, repetitive sticks risk damaging a patient’s vessel health and future access for care needs.”
Interest in New solutions is High – But More Education and Advocacy are Needed to Drive Change
New technologies, such as ultrasound guidance systems, are available to drive first-stick insertion success for IVs and needle-free blood collection that uses an existing IV line to draw a blood sample without the additional stick.
However, while relatively few Americans know these technologies (25% for ultrasound guidance systems and 17% for needle-free blood draw), interest in these technologies is incredibly high (88% and 89%, respectively). Nurses are more aware of these solutions (91% and 62%, respectively), and their interest is near universal (97% and 100%, respectively).
After seeing the various risks associated with needlesticks, most Americans (85%) surveyed agree they will be better advocates for themselves in future hospital stays.
A Vision for a Better Future
BD has long been on the path toward creating a better and more compassionate standard of care for patients and providers through its “One-Stick Hospital Stay” vision that imagines a future where a needlestick could be a single occurrence during a hospital stay. This includes a three-pronged approach to advance the standard of care for IV therapy and blood draws:
Enable the right device to be placed successfully the first time.
Use that device as a single access point for required therapies and blood draws.
Help the device last throughout the patient’s hospital stay.
Survey Methodology
This survey was conducted online in the United States by The Harris Poll on behalf of BD among 2,006 adults age 18+ from December 11-28, 2023, including those who have received IV therapy or blood draws during a hospital stay lasting overnight or longer in the past 24 months. Harris online polls’ sampling precision is measured using a Bayesian credible interval. For this study, the total sample data is accurate to within +/- 2.8 percentage points using a 95% confidence level. In addition, the survey included 106 RNs working in hospitals in the United States, and for this sample, the data is accurate to within +/- 10.9 percentage points using a 95% confidence level.
During her second day on the job, the newly minted RN was tending to a febrile patient in the ICU and preparing to give him a shot of insulin. Because the patient was thin, she pinched a fold of flesh on his abdomen between her thumb and forefinger, as she’d been trained to do—but when she inserted the syringe it poked right through the patient into her own finger.
“He just looked at me and said, ‘oh, honey,’” the nurse recalled in an anonymous posting in an online discussion board for nurses. “That rang in my head the whole time as I was bleeding the puncture and washing my hands. Oh honey, indeed.”
She’s not alone. Nurses, not surprisingly, comprise the largest percentage of the estimated hundreds of thousands of U.S. health care workers who experience a needlestick injury on the job every year and run the risk of acquiring more than 20 diseases, including Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV).
“Without hesitation, nurses, by far, have the highest percentage of needlesticks and splashes and splatters of any other profession in health care, mostly because they’re at the patient’s bedside more than any other worker,” says Amber Mitchell, DrPH, MPH, CPH, executive director and president of the non-profit International Safety Center.
While no one knows exactly how many needlestick injuries occur nationwide every year, data that the International Safety Center collects annually from about 30 U.S. hospitals and health systems provides a snapshot of the problem. In 2013, a total of 508 percutaneous injuries were reported by network facilities—a sharps injury rate of 21.37 per 100 occupied beds. More than 36% of the injured employees were nurses.
Although those figures represent a significant improvement in injury rates in the 15 years since President Clinton signed into law a federal needle safety bill, the reduction is of little consolation to the nurse who accidentally gets stuck.
Testing and re-testing for infection can last up to six months—and treatments can be grueling. The post-exposure prophylactic treatment sometimes given to prevent HIV infection, for instance, can cause nausea, vomiting, diarrhea, and fatigue. And while the risk of contracting a bloodborne pathogen from a contaminated needle is generally quite small, the mental anguish associated with a needlestick can be enormous. Weeks and months of waiting for test results can cause anxiety, depression, and other psychiatric disorders.
When it comes to needlesticks, there’s no denying that “an ounce of prevention is worth a pound of cure.” With that in mind, here are six strategies nurses can follow to better protect themselves.
1. Use safety devices.
Needlestick rates have declined precipitously since the enactment of the Needlestick Safety and Prevention Act, which requires hospitals and other employers to use safer needles. That said, not all safety devices are equal. Case in point: When Robert Wood Johnson University Hospital in New Jersey switched from using winged blood collection sets with a forward-shielding safety mechanism to one with a quick, in-vein retraction system, needlestick injuries dropped by 70%. Whenever possible, use a needle-free device, but if a syringe is your only option, choose one with a “passive” safety mechanism. Studies show that fewer accidental needlesticks occur with devices that deploy automatically, as compared to those that are manually activated. Whatever device you use, make sure you feel comfortable handling it, and request more training and practice if you don’t.
2. Never recap.
Once upon a time, the practice of recapping used needles was commonplace. While vigorous education campaigns about the dangers of the practice have helped reduce the incidence of recapping-related injuries, it’s still a problem. Recapping is dangerous in several ways: The needle can miss the cap and puncture one’s hand, it can pierce the cap and stab one’s finger, or an ill-fitting cap can slip off creating a hazard. In rare situations where recapping is absolutely necessary, the Occupational Safety and Health Administration (OSHA) recommends using a single-handed scooping method, where the cap is placed on a flat surface and scooping it onto the tip of the syringe. But safety experts say it’s best to avoid the practice entirely.
3. Plan ahead.
Before delivering an injection, envision how you will safely administer the shot and dispose of the contaminated needle. Locate the sharps disposal container—it should be within arm’s length, at eye level, and not overfilled—and explain to the patient everything that you will be doing. Patients are less likely to become startled and make a sudden movement if they are also prepared. If a patient is agitated, combative, or unpredictable, ask a colleague to assist you. Limit interruptions during procedures and dispose of used needles immediately after use only in the approved sharps container.
4. Get involved.
Under the law, hospitals and other health care facilities are required to solicit input from frontline workers like nurses to help evaluate and select safety devices. Your input is valuable and you’ll likely adapt better to technology you’ve had a hand in selecting.
5. Avoid fatigue.
Research shows that working excessively long hours can contribute to job-related injuries like needlesticks. According to one study, needlestick injuries in hospital nurses increased by 16% for every additional 10 hours they worked, and a 2015 study found a 32% increased risk of a needlesticks for newly licensed RNs working overtime. One of that study’s authors, Amy Witkoski Stimpfel, PhD, RN, an assistant professor and researcher at New York University’s Rory Meyers College of Nursing, says shift work contributes to chronic partial sleep deprivation, which can lead to performance impairments. “Our attention lapses – even briefly – and we make mistakes when we are sleep deprived. The slightest lapse of attention can lead to a needle being stuck in the wrong place.”
6. If you get stuck, report it.
Lack of time, embarrassment, and a perceived low infection risk are just some of the reasons nurses often don’t report needlesticks. But the potential consequences of an accidental exposure are simply too big to ignore—and time is of the essence. While the risk of contracting HIV from a contaminated needle is around 0.3% (1 in 300), according to the CDC, risk goes up with a deep injury or when a patient has a high viral load. Swift reporting of an accidental needlestick provides a better opportunity to get consent from a patient to test their blood for infectious diseases and for you to start on prophylactic therapy, if it’s warranted. PEP must be started within 72 hours after a possible exposure to HIV. If you are accidentally stuck, gently wash the puncture area with soap and water, report the incident to your supervisor, and follow your employer’s procedures.
It’s no secret that nurses and other healthcare professionals face the daily danger of infection, back injuries, falls, needlesticks, and other on-the-job hazards. During the height of the COVID-19 pandemic, healthcare workers put themselves at grave risk to care for critically ill patients, and some paid with their lives.
Beyond the hazards we recognize within American healthcare, did you know that social services and healthcare workers experience the highest injuries from workplace violence (WPV) in any industry?
Working in healthcare is dangerous on many levels, but suffering violence at the hands of others is certainly not something any of us willingly signed up for when we chose to enter the field.
“In 2018, the private ownership all-worker incidence rate for nonfatal occupational injuries and illnesses involving days away from work resulting from intentional injury by other persons in the private healthcare and social assistance industry was 10.4 per 10,000 full-time workers, compared to the all-worker incidence rate of 2.1. The health care and social service industries experience the highest rates of injuries caused by workplace violence and are five times as likely to suffer a workplace violence injury than workers overall.”
The BLS adds that “healthcare workers accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018. The industry’s number of total workplace violence has grown since 2011.”
In July of 2023, a Denver-area hospital security guard was killed by a visitor in July of 2023. In October of 2022, a man attending the birth of his child at a Dallas hospital shot and killed two facility staff members. A man killed his surgeon and three others in Tulsa in June of 2022 because he blamed his surgeon for his continued pain following back surgery. The U.S. Department of Justice Civil Rights Division has documented significant violence against those legally providing reproductive health services.
When it comes to healthcare workers’ dangers, the disturbing stories and statistics are real. If an average of 300 American physicians die by suicide each year, with nurses also at increased risk, we can conclude that the dangers of working in healthcare are unique and far beyond the general public’s imagination.
We Didn’t Sign Up for This
Imagine your first day in nursing school. You’re excited, trying to calm your nerves, and already fretting about surviving the program. As your education begins, you learn about pathophysiology, the nursing process, patient care, and leadership, and you also start your clinical rotations.
During your coursework, there may hopefully be a discussion about burnout prevention and self-care. However, it’s unlikely that your instructors will talk about nurse suicide, let alone the statistics regarding healthcare workplace violence. Nursing education does not include self-defense classes and active shooter scenarios, but perhaps it may in the future.
We all want to be safe and do the jobs we signed up for, namely taking care of patients or otherwise supporting the system that does so. However, the knowledge that WPV against healthcare workers is more significant than those employed in law enforcement is serious food for thought.
Solutions Must be Found
The Occupational Safety and Health Administration (OSHA), states the following:
“In most workplaces where risk factors can be identified, the risk of assault can be prevented or minimized if employers take appropriate precautions. One of the best protections healthcare employers can offer their workers is to establish a zero-tolerance policy toward workplace violence. The policy should cover all workers, patients, clients, visitors, contractors, and anyone else who may come in contact with workers of the facility.”
“By assessing their worksites, employers in the healthcare industry can identify methods for reducing the likelihood of incidents occurring. OSHA believes a well-written and implemented Workplace Violence Prevention Program, engineering controls, administrative controls, and training can reduce workplace violence. It is critical to ensure that all workers know the policy and understand that all claims of workplace violence will be investigated and remedied promptly.”
Recognizing the dangers, taking them seriously, and being proactive are critical. Healthcare professionals should be fully trained in identifying risk factors for violence and incident response.
Just as American students and their teachers are tragically in need of training for active shooter scenarios, healthcare workplaces sadly need the same. With some calling for arming school teachers, we may not be far from similar calls to arm healthcare workers.
While some states may have laws making assault or battery against healthcare workers a felony, we recognize that the threat of punishment does not necessarily deter those inclined to such behavior.
On a more philosophical, sociological, and anthropological level, the larger societal factors regarding why these violent acts occur in the first place are worthy of discussion. What about our culture makes these types of crimes so common? What is it about our shared humanity that drives us to violence? And how can we lower the risk of overall violence in our communities?
The reality of workplace violence remains a daily threat however we choose to address these grave issues. As a society and separate industries, we must address the scourge of violence enveloping our country and do our best to create a safer, saner, more civil society and workplace environment. How we get there remains a topic desperately open for discussion.
It has almost nothing to do with aromatherapy, candles, or even yoga.
As a nurse, you probably respond to the myriads of articles and social media posts on “self-care” with a dubious shrug. Authors of lifestyle content often imply that self-care is a specifically female pursuit—one that is synonymous with “self-pampering.” So, the 20th-century images of women lolling in bed nibbling on chocolates have been replaced with stock photos of women soaking in rose-petal baths, getting manicures, and serenely smiling through avocado facial masks.
It can be glorious to pamper oneself, but nurses struggling to combine 12-hour shifts with family obligations during a global pandemic—while paying off monstrous student loans—may feel they have more urgent priorities. Being urged to set aside some “me time” for journaling or dabbling in essential oils, though, is self-care through a marketer’s lens. Psychologists, nurse scientists, and other health practitioners have very different definitions of self-care, and studies that show it is no mere indulgence.
What is self-care?
This is awesome, but it is not self-care.
The World Health Organization’s definition might surprise some wellness influencers: “Self-care is a broad concept which also encompasses hygiene (general and personal); nutrition (type and quality of food eaten); lifestyle (sporting activities, leisure, etc.); environmental factors (living conditions, social habits, etc.); socioeconomic factors (income level, cultural beliefs, etc.); and self-medication.”
In its most minimal form, you advise patients to engage in self-care when you tell them why they need to take medications as prescribed, eat more vegetables, exercise, and floss their teeth. Nothing indulgent here, because at bottom self-care is simply an essential component of preventive care. So, as a starting point, at the very least you should practice what you preach. Not only for the sake of credibility; when you practice self-care, you function better.
And as a nurse, you will find that self-care can speed your recovery—or even help you avert—the most common occupational hazards that afflict nurses. Basic self-care practices can make you a less attractive target for the most common nursing woes.
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Stress: The APA offers some useful advice on handling workplace stress, but this year, almost any health worker should consider therapy as well. A good therapist is much more than a nonjudgemental sounding board; s/he can teach you to heed and acknowledge your emotions as you navigate both workplace and personal relationships. Therapy won’t prevent you from experiencing stress, of course, but it can give you some formidable tools to increase your resilience and ability to cope.
Musculoskeletal injuries from lifting and maneuvering heavy burdens: Studies conducted over the past 10 years suggest that stretching exercises and moderate resistance training can reduce the likelihood of injuries. Regular exercise and proper orthopedic shoes will help your feet and the rest of your body when you have to stand for endless periods. However, if you are trying to avoid injuries, yoga mightnot be an ideal choice of exercise program.
Needlesticks and other sharps injuries: No amount of self-care will give you Luke Cage-like super-durability, but super-spy Jason Bourne has some helpful advice: “sleep is a weapon.” One excellent way to prevent accidents of all types is to practice decent sleep hygiene. When you are well-rested, you are more alert, your response time is faster, you’ll be better coordinated, and at much less risk of making dangerous mistakes.
Self-care helps you to function at your best, under all conditions
The approach to self-care for nurses has changed dramatically since Covid-19 hit. And, the mounting staffing crisis makes it clear that self-care practices should be part of every nurse’s toolbox. The ANA positions self-care as a means of attaining and sustaining nursing excellence:
Promote health and safety
Preserve wholeness of character and integrity
Maintain competence
Continue personal and professional growth
Avocado slices might possibly help reduce undereye puffiness, but bona fide self-care can ward off compassion fatigue, help you manage your resources when “crisis standards of care” are the order of the day, perform your tasks with accuracy, and make it easier to communicate and connect with co-workers and patients. Which makes the job more satisfying—especially as it can improve health outcomes. In a caring profession, following a proper self-care routine can make a world of difference.
Baby steps are fine!
Don’t try to do everything at once—even taking aim at one health goal is better than nothing, and it’s much more doable. Pick an area for improvement, like sleep hygiene, diet, exercise, regular physicals, podiatric care, or mental health support. In setting priorities, identify the greatest stresses you face from your job. Consider the issues that afflict you most on a daily basis, long-term problems that wear you down, resentments, anything that makes it harder to keep your head in the game.
Making changes usually is more effective when done incrementally, so don’t drive yourself crazy with New Year Resolutions. If lack of sleep is your greatest foe, try to start by taking 15-minute breaks a few times a week to shut your eyes and relax. Feet killing you? Make an appointment with a podiatrist now—and follow their advice. If your bugbear is workplace and/or family stress, take advantage of one of the few positive effects of the pandemic: you don’t even have to leave home now to see a therapist, so what’s stopping you?.
Once you begin, play it by ear. Self-care is both a professional and personal investment. And after a month of healthy eating, better rest, or CBT, go ahead and reward yourself with some actual pampering. Find time to stand in a meditative pose or joyfully leap on a picturesque beach, play computer games, or nibble chocolates while reading celebrity gossip; a little silliness might be a healthy prescription after two years in a non-stop pandemic.
Testing and re-testing for infection can last up to six months—and treatments can be grueling. The post-exposure prophylactic treatment sometimes given to prevent HIV infection, for instance, can cause nausea, vomiting, diarrhea, and fatigue. And while the risk of contracting a bloodborne pathogen from a contaminated needle is generally quite small, the mental anguish associated with a needlestick can be enormous. Weeks and months of waiting for test results can cause anxiety, depression, and other psychiatric disorders.
