Nursing was the most common occupation and residential care facilities were the most common reported job setting for healthcare professionals (HCPs) with COVID-19, CDC researchers found.
In a subset of six jurisdictions reporting occupational type or job setting for HCPs with COVID-19, 30% of infected HCPs were nurses — twice the proportion of nurses in the healthcare workforce (15%) — and two-thirds of cases were in nursing and residential care settings, reported Michelle Hughes, PhD, of the CDC, and colleagues in Morbidity and Mortality Weekly Report.
Similar to previously reported U.S. data, HCPs with COVID-19 who were male, age 65 or older, or nonwhite, or had underlying medical conditions, were particularly likely to have died.
The researchers cited workers in long-term care facilities as those most in need of attention during the pandemic.
“During the COVID-19 pandemic, multiple challenges in long-term care settings have been identified, including inadequate staffing and PPE, and insufficient training in infection prevention and control,” Hughes and colleagues wrote. “As the pandemic continues, it is essential to meet the health and safety needs of HCPs serving populations requiring long-term care.”
Even HCPs who do not provide direct patient care, such as administrative staff members and environmental service workers, were at risk, Hughes and colleagues also emphasized. About 19% of cases among HCPs had such jobs.
They added that their count probably underestimated the number of healthcare professionals with COVID-19, especially among asymptomatic individuals, given that job status was only available for 22% of COVID-19 cases reported to CDC. It was added to the CDC case report form in May.
The data — which covered Feb. 12 to July 16, 2020 — included 641 deaths in healthcare professionals with COVID-19. More recent statistics from the CDC indicates 162,328 cases of COVID-19 and 710 deaths as of Sept. 23 among U.S. healthcare professionals.
In the MMWR analysis, which covered about 100,000 COVID-affected HCPs who met inclusion criteria, median age was 41, and 79% were women. Of those with race/ethnicity data available, 47% were non-Hispanic white, 26% were Black, 12% were Hispanics or Latinos of any race, and 9% were Asian.
Among HCPs with data on underlying medical conditions, 44% had at least one of 10 underlying medical conditions. Cardiovascular disease (18%) was the most common, followed by chronic lung disease (16%) and diabetes (13%). Cardiovascular disease and diabetes mellitus were most common in those who died.
Hospitalization and intensive care unit admission status were available for only a portion of HCP cases; however, 8% of those with known status were hospitalized and 5% were admitted to an ICU.
The statistics are shocking but not surprising. At least 60% of health care workers will experience workplace violence with nurses and doctors receiving the brunt. While 25% will experience physical violence, 45% non-physical violence: verbal abuse, threats, and sexual harassment. The effects may be minor. But experiencing workplace violence can lead to missed work, lost income, physical and mental injury, disability, and death.
The figures above are likely low due to underreporting. Workers are hesitant to report violence for several reasons:
Conditioned to believe it’s “part of the job”
Reporting processes are time-consuming, cumbersome, and re-traumatizing
Employer focus on profit and patient experience
Historic non-action
Fear of retaliation from perpetrator or employer
Vulnerable Nurses
Nurses’ dedication and compassion make them especially vulnerable to violence by patients or visitors. They are often in close contact with patients who have mental health or substance abuse challenges. They care for their patients despite warning signs and known violent history. Patients, in turn, are often stressed, scared, and can easily become agitated. Nurses have a reputation for sticking it out in the worst of times, Finally, they are compelled to “do no harm” and prioritize patient safety above their own.
Workplace Violence Prevention
Health care organizations are beginning to understand the scope of the problem and respond. But we have a long way to go before health care workers can feel safe and sound at work. Occupational Safety and Health Administration (OSHA) does not currently require employers to implement workplace violence prevention programs but encourages it. Its guidelines include 5 core elements:
Management commitment and employee participation
Worksite analysis and hazard identification
Hazard prevention and control
Safety and health training
Record keeping and program evaluation
Legislation
Under the proposed bill H.R. 1309, the Department of Labor would require health care employers to develop and implement a comprehensive plan for protecting their workers from workplace violence. On November 21, 2019, H.R. 1309 was passed in the US House of Representatives and received by the US Senate for review.
Nurses should not be afraid at work. If everyone works together, we can turn this tide. Nurses contact their state senator and urge them to pass H.R. 1309. They should encourage their employers to proactively develop workplace violence protection. Most all, nurses must support one another and encourage reporting to help end this crisis.
In the fall of 2017, the #MeToo and TIME’S UP movements began in Hollywood. While lots of organizations were advocating to protect women in a number of fields, they weren’t solely based in health care. On March 1, 2019 that all changed when Time’s Up Healthcare launched.
According to Tiffany A. Love, PhD, FACHE, GNP, ANP-BC, CCA, CRLC, Regional Chief Nursing Officer with Coastal Healthcare Alliance as well as one of the organization’s founders, Time’s Up Healthcare was “established in response to the common experience of power inequity, unsafe work environments, and a lack of inclusion at every level of health care leadership. The aim is to drive new policies and decisions that result in more balanced, diverse, and accountable leadership; address workplace harassment and other types of discrimination; and create equitable and safe work cultures within all facets of the health care industry.”
She took the time to answer our questions about the organization. What follows is an edited version of the interview.
You’re a founding member of the initiative. Why did
you get involved?
I have worked in health care since the age of fifteen. I’ve experienced a lot of harassment and other types of discrimination over the years, and I had accepted it as a normal aspect of working in the health care environment. In more recent years, I decided that I would take a stand to create the change I wanted to see, and Time’s Up Healthcare offered me that opportunity.
What is the mission for Time’s Up Healthcare? What
does the group hope to accomplish?
Our mission is to unify national efforts to bring safety,
equity, and dignity to our workplace. We want to engage and support health care
professionals and organizations from all disciplines to change policy and
practices to support safe, equitable, and inclusive work environments. We want
to raise awareness about the issues that health care professionals face. We
also want to provide support for survivors through the Time’s Up Healthcare Legal
Defense Fund.
Why is it important for this group to exist? How do
you hope to change healthcare?
Time’s Up Healthcare is important because health care professionals need a group who will advocate for them without expecting anything in return. Time’s Up Healthcare is a 501(c)(3) foundation. Most of the work is done by volunteer health care professionals who donate their time and money to this important initiative.
As health care professionals, we are aware of the
research that has proven patient safety is at risk when health care workers are
forced to work in an environment that is not safe, equitable, or inclusive. The
health of the employees as well as the patients is impacted by these
conditions.
What do most health care workers not realize about
harassment in the workplace? Or assault?
Many health care workers have been desensitized to harassment because it is so common. Harassment can be in the form of verbal aggression, exclusion, bullying behaviors, and the threat of physical violence. It can also take the form of assault through unwanted touching and even physical violence.
If nurses want to get involved with the group, what
can they do?
We welcome you to join us at https://www.timesuphealthcare.org. You can sign up for our newsletter or purchase a pair of Time’s Up Healthcare scrubs under the shop tab. A portion of the proceeds will assist survivors through the Time’s Up Healthcare Foundation and Legal Defense Fund. You can also become a sponsor or encourage your organization to become a signatory who pledges commitment to align with Time’s Up Healthcare’s core statements.
You can also follow us on social media. We are on Twitter:
@TIMESUPHC, Facebook: Time’s Up Healthcare, and Instagram: timesuphc. Look for
Time’s Up Healthcare. You can also search the hashtags: #TimesUpHealthcare
#TIMESUPHC and #TUHHERO.
This is the first time nursing contract negotiations are being
held since 2016, when Allina hospital nurses went on strike for health
insurance benefits. These current negotiations have been in talks, with
contracts set to expire May 31. But it appears that no deal will be happening
by then, and the MNA is planning to strike again.
One nurse, Mary McGibbon, shared with the Star Tribune that she wore a sling for her elbow injury (brought about accidentally by a patient) to a contract negotiation meeting. Accidents with patients are common enough, but there is more concern as hospitals have seen an increase of patients with mental health issues. Sometimes the patients will deliberately attack their nurses, which can be so traumatic it affects their ability to work.
Workers compensation claims increased by nearly 40 percent
between 2013 and 2014, up to 70 percent, and have remained at 65 percent or
higher since then. These numbers reported by the Minnesota Department of Labor
and Industry only count the most severe cases reported, including those where
nurses missed three or more days of work due to injury.
Talks for nurse protection have been gaining speed since a
2014 incident, where a patient attacked and injured four nurses with a metal
bar. Minnesota passed a law in 2015, making hospital staff training on
de-escalating and preventing violence mandatory.
Another nurse, Michelle Smith, is back to work in surgical recovery but still going through recovery from a concussion she got roughly two years ago. She similarly is pushing for more support in negotiations to prevent these incidents from happening.
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.
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.