San Fernando Val l ey S tate C o l lege
Epidemiology o f Acc idents Among Hospital
•I
Nur s ing S ervice Personnel
A the s i s s ubmi tted in parti a l sati s f action o f the
requiremen t s for the degree of Master of S c i ence
in Health S c i ence
by
Myron Aaron Li eberman
June , 1 9 6 8
·· ···-<·-·
·--···· ·- -·-·-
·····-···-· ···-··------·-·
""""···-····----····-'
The the s i s of Myron Aaron Li eberman i s approved :
San Fernando Va l ley State C o l l ege
June , 1 9 6 8
ii
DEDI CATION
For the l ove and f a i th which
has helped me through the
t ime , and the p at i ence
and deep unders tanding ,
I s incere ly dedicate
thi s thes i s to
my wife ,
ARLENE F . LIEBERMAN
iii
TABLE OF CONTENTS
PAGE
LIST OF CHART S .
vi
.
L I ST OF TABLE S
ACKNOWLEDGMENTS .
AB STRACT .
.
.
.
. viii
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ix
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X
CHAPTER
I.
INTRODUCT ION .
l
The Problem and Definitions o f T erms .
4
Purpo s e of the S tudy .
4
The Problem .
4
Importance o f the Problem and Need
. . .
for Re s earch . .
5
D e f in i t ion o f Terms .
7
•
Training Programs
.,
,.
II .
•
•
.
12
•
REVIEW OF THE LITERATURE .
14
Table I u.s. Bureau o f Labor Stati s t i c s
18
.
Table I I u.s. Bureau o f Labor Stati s ti c s .
.
.
19
Tab le I I I C a l i forni a Depar tment o f
I ndustr i a l Re lations
20
Tab le IV Argonaut Insurance C ompany
22
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.
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•
Table V Argonaut Insurance C ompany .
.
Table VI Mount Auburn Ho spita l , Cambr idge ,
. .
Ma s sachu s etts . . . . . . . . .
Tab le V I I C a l i fornia Hosp ital s .
iv
23
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24
25
PAGE
CHAPTER
III .
DE S I GN OF THE S TUDY
•
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29
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29 .
Statement o f the Hypothe s i s .
The S tudy S ampl e .
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E s tab l i shmen t of Criteria .
31
Methodology .
32
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Teaching Ho spital .
.
32
Non- Prof i t Hospital .
33
Procedure
.
35
•
Measurement .
.
36
Var i ab l e s .
Limi tations .
IV.
36
.
37
ANALYS I S AND D I S CU S S ION OF DATA .
39
Reported I n j ur i e s and Emp loyment .
44
I n j ur i e s by Cau s e s
60
.
I n j ur i e s by Body Are a
Work- T ime Lo s s
v.
29
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•
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68
72
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SUMMARY AND CONCLU S I ON S .
B IBLIOGRAPHY
•
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•
v
77
81
L I S T OF CHARTS
PAGE
CHART
1.
lA .
2.
2A .
Compar ison o f Reported Acc idents Among
All Nurses by Age i n a Non- Pr o f i t Hosp i ta l .
40
Compar ison
Reg istered
Nurses and
Non- Pro f i t
41
o f Reported Acc idents Among
Nurses , Licensed Voc ational
Nurs ing Aides by Age in a
Hosp ital
.
•
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42
Comparison of Reported Acc idents Among
Registered Nurses , Licensed Voc ationa l
Nurses and Nurs i ng Aides by Age in a
Teaching Hospi t a l
43
•
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.
.
.
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.
Comparison of Reported Acc idents Among
Nurses Working Less Than 6 Months , 6
Months to 2 years , and Over 2 ye ars in
a Non- Pro f i t Hosp ital
.
4.
.
Comparison o f Repor ted Acc idents Among
All Nurses by Age in a Teaching Hosp i t a l .
.
3.
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•
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•
•
•
Comparison o f Reported Acc idents Among
Nurses Working Less Than 6 Months , 6
Months to 2 Years , and Over 2 Years
in a Teaching Hosp ital . . . . . . .
47
.
5.
Comparison o f Reported Acc idents Among
Registered Nurses , Licensed Voc ational
Nurses and Nurs ing Aides by Inj uries to
Nurs ing Personn e l by Hour of Day in a
Non- Pro f i t Hospi t a l . . . . . . . . .
48
Comparison o f Reported Accidents Among
Reg istered Nurses , Licensed Voc ationa l
Nurses and Nurs ing Aides by I n j uries to
Nurs ing P ersonne l by Hour o f Day in a
Teach ing Hospital
49
Comparison o f Reported Ac c idents Among
Registered Nurses , Licensed Vocational
Nurses and Nurs i ng Aides by Day o f Week
in a Non- Profit Hosp i t a l .
51
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6.
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7.
46
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vi
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PAGE
CHART
8.
9.
Comparison of Reported Accidents Among
Reg istered Nurses , Licensed Vocational
Nurses and Nursi ng Aides by Day o f Week
in a Teach ing Hosp i t a l . . . . . . . . . .
.
.
52
Comparison of Reported Ac c idents Among
Nursing P ersonne l by Month in a Non-Profit
Hospital .
. . . . . . .
54
Comparison o f Reported Ac c idents Among
Nurs ing P ersonne l by Month in a Teaching
Hospital . . . . . .
. .
. . . . .
55
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10 .
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•
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vii
L I S T OF TABLE S
TABLE
1.
PAGE
Inj uries to Nurs ing Personne l by Hospital
Work Area in a Non- P ro f i t Hospi t a l
.
.
.
.
2.
Inj uries t o Nurs ing Personnel by Hosp ital
Work Are a in a Teaching Hospital . .
. .
.
.
. 58
3.
Inj uries to Nurs ing Personne l by Cause
o f I n j ury in a Non- Pro f i t Hosp i t a l .
.
.
. 61
•
•
Inj ur i es to Nurs ing Personne l by Cause
of Inj ury in a Teaching Hospi t a l
.
5.
•
Inj ur ies to Nurs ing Personne l by Caus e
o f Inj ury in a Non-Pro f i t Hospital
•
6.
.
.
.
.
.
Inj uries to Nurs ing Personne l by Cause
of Inj ury in a Teaching Hospital .
Inj uri es to Nurs ing Personnel by Part
of Body I n j ured in a Teach ing Hosp i t a l .
9.
Frequency and Seriousness of Acc ident
Rates in a Non- P r o f i t Hospital .
.
Frequency and Seriousness o f Acc ident
Rates in a Teaching Hospital
.
.
vi i i
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62
66
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•
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. 67
•
•
Inj ur ies to Nursing Personne l by Part
of Body I n j ured in a Non-Prof i t Hosp ital .
8.
10 .
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.
7.
.
57
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4.
•
70
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. 71
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73
74
ACKNOWLEDGMENT S
The author w ishes to acknow ledge w i th s incere
apprec iation the advice and assistance o f P ro f essor
Thomas F . Torpy , Thes is Chairm an , who spent numerab le
hours o f his time and talent in consultation and guidance ;
and Professors C l aude T. Cook and Lennin H . Glass who
served on my C omm i ttee.
Further , I w ish to thank the Hospi t a l Adminis trator
of the Non-Pro f i t and Teaching Hospital in Los Ange les ,
C a l i forni a .
Appreci ation is a lso expressed to the Hospital
Administrators , Univers i ty Professors and Pub l i c Heal th
Department O f f i c i a ls who wrote personal c ommunications .
Acknow ledgment is a lso expressed to Mr . W i l l iam
We inlood who gave of h is t ime and talent and Mr . James
O ' Hanlon , Jr . o f Human F actor Research , S anta Barbara ,
C a l iforni a .
ix
ABSTRACT
Epidemio logy of Acc idents
Among Ho spital Nur s i ng S ervi c e P e r sonne l
By
Myron Aaron Lieberman
Master of S c i ence in He a l th S c ience
June , 1 9 6 8
The epidemiology o f nur s ing per sonnel acc idents
hait ;�, been a s s e s sed in two ho spital environments us ing
re lationship s among s ever a l s e lected factor s .
The
var iations of the contributing factors were inve s tigated
in thi s s tudy from indu s tr i a l inj ury report s .
In this s tudy , the factors contributing to acc idents
were analy z ed to compare the ir interre lationship s ; the s e
factor s demonstrated that the highe s t incidence o f
acc idents
is among nur s e s
in the age group twenty-one
through th irty ; for tho se employed l e s s than s ix months
or over two years acc idents remained the s ame ; the
greate s t number o f acc idents in thi s s tudy occurred
dur ing the late morning and early evening hour s ; among
days o f week , Monday was found to be the highe s t followed
by Tue sday and Friday .
S eptember and January were the
months in wh ich mo s t a c c idents occurred , and the highe s t
X
preva lence o f accidents was found among nurs ing personne l
in the Med i c a l Unit and Surgi c a l Theatre o f both
hospit a ls .
D i fferences between the popul at ions studied were
observed in several areas ; these d i f f e rences , however ,
were sma l l , and the p atterns showed that a c c idents are
caused by s everal f ac tors ; among these are in j ur i es
result ing from puncture wounds by need l es, hemol ets , or
glass 2 4 . 2 per cent ;
lacerat ions from ampules or g l ass
1 3 . 7 per cent and caught in or between doors, carts, or
bed s ide r a i ls accounted for 1 3 . 8 per c ent of the nurs ing
personne l ' s accidents in the non-prof it hospita l .
The
teaching hospit a l's nurs i ng personn e l incurred puncture
wounds from s im i lar ob j ec ts as above .
These ac counted
for 3 8 per cent o f the inj uries reported , wh i l e
lacerations from ampul es , g l ass o r cans 2 8 . 6 per cent
and caught in or between doors , carts or bed s ide r a i ls
1 1 . 8 per cent accounted for the sma l l est percent age o f
traumat i c inj ur i es .
xi
CHAPTER I
INTRODUCT ION
A ma j or hea l th prob l em among a l l occupati ons is
acc idents.
Accidents , unless they are breathtaking
disasters involving many peopl e at onc e , seem too
scattered to arous e interest and o f ten too unp leasant to
promote anything but a defens ive "It couldn't happen to
me" .
Yet the tol l mounts a larmingly as technical changes
increase .
(1)
In the Los Ange l es Metrop o l i tan area there are
2 7 , 6 9 2 emp loyed Registered Nurses and 1 6 , 3 2 8 of these work
in hospitals .
(2)
It has been es timated that nurses as
a group sustain 4 0 to 50 per cent o f the acc idents in the
hospital setting .
(3)
Hence 6 , 53 1 to 8 , 1 6 4 acc idents
occur e ach year in hospi t a ls to the Registered Nurses
throughout the Los Ange l es area .
At the t ime of this
study , s imilar information on the number , and employment
of Li censed Vocational Nurses or Nurses Aides was not
ava i l ab l e from the State , C i ty , or County agenc i es .
The safety of the pati ent has a lways been one of
the criteria by which nurses eva luate the e f f e c t iveness of
One may go so far as to say that this
nursi ng procedures .
criterion o f safe ty underlies a l l other yardsticks which
the nurs ing profess ion uses to eva luate techniques .
Nurses w i l l agree that no procedure can be therapeuti c a l ly
soun d ,
e:�?E�?"I!l�"C:::<:.J:�X
....
s :t:c:l?.�-�L�_<: nd cont ribute
1
2
o f the patient , unless i t i s carried out safely .
This
raises the important ques tion--how s a f e ly does the nurse
function?
(4)
F lorence Nightingale in· Notes on: Nu·rs· i ng ( 5 ) said ,
in 1 8 6 1 , "That every women makes a good nurs e .
I b e l i eve ,
on the contrary , that the very e l ements o f nurs ing are a l l
but unknown"
•
•
•
She then went o n to say:
How f ew men or even women , unders tand , e i ther in
gre at or i n l i t t l e things , what i t is the being
in charge- -r mean know how to carry out a charge
. . . From the most colossal ca l ami t i es , (sic ) down
to the most tri f li ng accidents , resul ts are often
traced to such want o f s ome one in charge or of
The vary (s i c )
h is know ing how t o be i n charge .
fact o f a n acc ident happening proves i ts own c as e .
There is nothing more to be s a id .
E ither they
did not know their bus iness or they did not know
how to perform i t .
A century later ,
in 1 9 6 7 Gohr
(6)
f ound employee
inj ury rates in hospitals to be about 1 5 per cent higher
than the overa l l i ndustry rate .
In comparing s ta f f
acc ident records in New York ' s 2 7 c i ty h ospitals w ith
those of 42 ma j or i ndus tr i es in the United States , Kesner
(4)
found that the hospi ta ls had the same number o f
d isab l ing i n j uries per mi l l i on work i ng hours as the 4 2
industri es comb ined .
Further analys is o f the accidents
mentioned showed that 7 0 per c ent were c aused by unsafe
acts o f the individual m embers of the nurs ing staffs .
Awareness o f these prob l ems led to the initiation
o f this i nvestigation , which is s o l e ly dire cted a t
studying nursing service personnel a c c idents and t o
3
supplem ent the meager inform a tion now avai l ab l e on nursing
servi c e occupational inj uries within a hospital environment , which is a growing concern to hospital administrator
throughout the Nation .
As an examp le,in 1 9 6 6 Z ero ( 7 )
,
indicated s everal reasons why administrators should be
interested in an employee safety program .
listed are :
Among those
( 1) better m or a l e among empl oyees and , as a
result , better j ob performance ;
l
( 2 ) replacing a t emporari lY:
inj ured empl oyee is a c os t ly item in terms of salaries ,
training , and ineptness on a new j ob , not to mention the
like lihood of recruiting a s emi adequate rep lacement .
Thus a safety education program for accident preven
tion could be initiated to help the nursing personnel
protect themselves from the physical and psychological
c onsequences o f a ccidents .
This might improve the
e f ficiency of the personn e l by removing the frequent
necessity for training new p ersonnel to replace the
in j ured members of the nursing staff .
The fin a l resul t
could w e l l b e a reduction i n cos t o f operating the
hospital , with subsequent reductions in patient fees .
�
I
4
THE P ROBLEM AND DEFINITIONS OF TERMS
The goal o f research in accident prevention is the
iden t i f i c�tion o f the b as i c c auses of a c c idents , in the
hop· e that their e l imination or modif i c a ti on may reduce
1
j
acc ident frequency or s everity w ith a resul t ant sav ing in
human l if e and productiv i ty .
(8)
Purpose o f the Study
The purpos e of this study is to i nvestigate the
relationships among s e lected f ac tors suspected o f
c ontributing to accidents among nurs i ng personne l.
These factors are:
( 3 ) work shi f t ;
area .
(1 )
age ;
( 4 ) day o f w e ek ;
( 2 ) work experience ,
( 5 ) month ; and
( 6 ) work
I t is a lso proposed that these factors be studied
in two d i f ferent hospital env i ronments .
The Prob l em
This s tudy accepts as i ts prem is e that g iven the
It further accep ts the premis e that work i n j uries of the
nurs i ng personn e l m ay be caused by
uns a f e a c ts of the
ind iv idua l members of the nursing s t a f f; unsafe conditions
i
i
J
5
which may be both mechan i c a l and physic a l or any
combination of them .
(1 0 )
Importa· n c· e o· f ·the Pr' ob l em ·at1d N e' ed Fo· r· Re·s ear· ch
Although i t has been general ly r e cognized by
occupationa l saf e ty authorities that nursing personne l
d o have a large number of acc idents , there has b e e n no
attempt to document this fact in ob j e c t ive terms , and a
dearth of publ ished information exists.
Thus , the f i rst
task o f the pro j ec t w as to determ ine the magni tude o f the
problem of nurs ing personne l acciden't:s i n two hospital
environments .
Existence o f this problem o f nurs ing personnel
acc idents has been indicated mai nly by authori tative
opinion and among anecdotal reports o f m any hospitals '
experiences .
(10 )
Granting that nurs ing personne l do have a l arge
number o f accidents , and that this fact requires no
documentation ; . the more important questions rem a i n un­
answered : · Is there a re lationship between the seri ousness
of inj ury , body parts i n j ured , and acc idents reported by
Registered Nurses , L i censed Vocational Nurses , and Nurses'
Aides in a hosp ital environment?
Also what e f fect do the
factors previous ly mentioned have on the above?
Researchers
\
(11 )
have attempted to demonstrate
aspects of work - t ime los t o f nurs ing personn e l and
6
cause-cost to combat this decrement , but this approach
has led to l imited solut ions since:
(1)
these fac tors
cannot show caus a l relationship to acc ident rate .
Acc i -
dents t o nurses sti l l occur a f ter a l l factors have been
optimi zed ;
( 2) changes which have no bene f i t for nurs ing
personnel , i . e . , worktime loss and caus e - cost sometimes
have no e f fect , or even the oppos i te e f f ect in hosp ital
environments .
For example , Gordon ( 1 2 ) has reported that
data c o l lected in her study were not detailed enough to
a l low extens ive ana lysis and in the Argonaut Insurance
Company S tudy ( 3 ) the only inj ury breakdown was cause- cost
for total hospital personne l in the categories o f
l i f ting pati ents ;
( 2)
l i fting ( o ther ) ; and
(1)
( 3 ) s l ips and
f a l ls .
Other solutions to the nurs ing personne l acc ident
problem have been proposed .
Some authors
(Norwood
[13]
and Gohr [ 1 0] ) have suggested look ing a t the distribution
of a l l hospital staff emp loyees by occupation
( in per cent )
and compar ing this w i th the number o f accidents occurr ing
to each occupationa l group .
These reports indic ated that
nurs ing , and other occupations in the hosp itals have a
greater than the ir percentage share o f i n j uries .
Others
have suggested that nurs ing personne l i n j uries be
prevented by education .
( 4 , 14 ,
15)
But , it w i l l be
recal led that mos t hospitals have some type o f safety
programs and acc idents to nurs ing personn e l are sti l l
7
I!
D e f in ition o f Terms
��������----��
,.
(
In order to insure common unders tanding o f
!
! terminology ,
the fol l ow ing def initions indi cate the
meaning of certain terms as they are used in this s tudy .
Acc ident : .
us ed in th is study w i l l be reso lved
into three components :
F irst , a sudden occurrence ,
second , producing a qu ick resu l t , and thirdly ,
coming from w i thout .
I n this way a d istinc tion
is made between acc idental i n j u r i es and occupational
diseases , the latter are presumed to have an
insidious onset .
(16 )
a wound made by a pointed instrument .
Puncture :
(17 )
Laceration :
a wound made by tearing .
(17)
S truck by external objects or c aught in or b e tween
are s tandard i ndustr i a l acc ident reporting
criter i a .
(18)
Incidenc e :
the degree , or range o f occurrence .
(19)
Prevalenc e :
w idespre ad existence .
(19)
Acc idental I n j urx Rate :
Number of D isab l ing Inj uries X 1 , 0 0 0 , 0 0 0
Number o f Emp loyee-Hours Worked
(20)
8
Seriousness o f Acc identa l I njury:
number o f days
miss ed from work by c ause o f i ndus t r i a l inj ury.
Seve rity Rate:
Total Days Charged X 1, 000, 000
Emp loyee - Hours o f Exposure
Work Injury:
( 20 )
is any i n j ury suffered by a person
wh ich arises out of any acc ident in the course of
h is emp loyment.
( 20 )
Lost T ime Injury:
a work inj ury wh ich resu lts in
death, permanent total disab i l ity, permanent
part i a l disab i l it y, or temporary total disab i l ity.
( 20 )
Temporary Total Disab i lity:
any i n j ury wh i ch does
not resu lt in death or permanent impairment, but
wh ich renders the i n j ured person unab l e to per form
a regu larly estab l ished j ob.
Permanent Total Dis ab i l ity:
( 20 )
any injury other th an
death wh ich permanently and tot a l ly incapac itat es
an emp loyee from fol lowing any gainfu l occupation.
{20 )
9
Permanent Part i a l D isab i l i ty:
any i n j ury o the r
than death or permanent total dis ab i l i ty which
resul ts in the comp l e te l oss or l oss of use of
any member of the body , or any permanent impairment
of functions o f the body or part thereof , regard­
less o f any pre - existing disab i l i ty o f the i n j ured
member or impaired body function .
Exper ience :
(1)
number o f months or years worked ;
l ess than 6 months ;
years ; and
Work Shif t :
(20)
(3)
( 2 ) six months to two
over two ye ars .
Day :
begins no e ar l ier than six a . m .
and no l ater than nine a . m . and which ends no
later than s ix p . m .
Evening:
beg i ns no earl i er than two
p . m . and ends be fore midnight .
N ight:
begins after ten- th irty and
ends be fore nine a . m .
Employment :
F u l l t ime :
Part-time :
forty hours per week
less than forty hours
per week .
Work Area :
The Nurs i ng Unit is real ly a traf f i c
highway ; the main streams o f work are end l ess ly
repeated throughout the day and n ight .
The nurs i ng
station is roughly in the center o f the group o f
10
patients , and i t is genera l ly assumed that the
maximum travel distance should be about 8 0 fee t .
This a lmost automati c a l ly p laces a reasonab l e l imit
o f 25 to 3 0 patients in one nurs ing unit , though
practice var ies in th is respect .
A nurses' station
is a centr a l location where nurses' patient c are
duties are most read i ly and most quickly per formed .
Around the nurses' station are uti l ity rooms , baths ,
pantri es , drug c ab inets , and a tre atment room .
Hosp i ta l:
(21)
The word hosp ital as herein emp l oyed ,
means any institution whi ch ma intains and operates
organized f ac i l ities for the d iagnos is , treatment
of human i l l ness , c are , inc luding convalescence ,
c are during and a f ter pregnancy , where persons may
be admitted for an overnigh t s tay or longer .
Non-Pro f i t Hospital :
(22)
The ownersh ip of th e
institution is vested in a group o f pub l i c spiri ted
c i t izens who assume the f i nan c i a l respons ib i l i ty
for bui lding and ma intenance through th e
organizat i on o f a j oint stock c ompany , and me e t
that obligation b y the sale o f s tock wh ich i s not
interes t bearing and , therefore , . has the same
va lue as a g i f t .
(23)
11
Teachin·g Ho·s· p i·tal:
P r imary respons i b i l i ty is for
education of the phys i cian , but the hospital is
cal led upon to partic ipate.
I t s erves not only
immed iate needs o f the s i ck , but prepares the
phys i c i an of the future .
I t is essential that
adequate f ac i l it i es and high qua l i ty comprehens ive
services be used .
The prescribed standards spec i fy
that this hospital have a suf f i c i en t number o f
pati ents s o as t o guarantee an adequate c l i n i c a l
experienc e .
Nurse :
( 23 )
A person who has success fu l ly comp l eted
educational requirements in a hospital or
col legiate program and has passed State Board
Examinati on for registration , or has completed
requirements for experi enc e and has passed S tate
Board Examination L i cens ing .
This def inition
inc ludes both the register ed nurse
l i cens ed vocational nurse
Nurses A ide :
( R . N . ) and the
(L . V . N . ) .
One who has been trained through an
on-the- j ob tra in ing program to ass ist w ith patient
care and unit activit i es .
12
TRAIN ING P ROGRAM S AVA ILABLE FOR NURSE S ,
LICEN SED VOCATIONAL NURS E S ,
AND NURSE S ' AIDES
Regi s · t e· r ed Nurs e
Dip l·orn:a Pr"og·r·am :
Requ i r e s at l e a s t three c a lendar
years or academic year s to c omp le te .
Empha s i s is placed
on learning nur s i ng through practical use o f knowledge .
(24)
Ba·cc a l aUYe at e Degree Program :
f ive years to comp l ete.
Requires f our or
The degree program in nurs i ng i s
expected t o meet the admi s s ion requirements that the
c o l lege or univers i ty has e s tabl i shed for a l l its
bacca l aureate degree s tudents.
Nur s i ng cour s e s are
taught by members o f the C o l lege ' s faculty in nurs ing
regard l e s s o f where the teaching takes place- - in the
c l a s sroom or in the hospital or communi ty agency .
In a
f ive year program in nur s ing leading to a baccalaureate
degree , the s tudent spends two year s in col lege f o l l owed
by three years in a hospital a f f i l i ated with a c o l lege o f
medic ine .
{2 4 )
A s sociate in: Arts De·g r·e·e· Program :
U s ua l ly offere-d
in a j un i or c o l lege Department of Nur s ing with s elected
c l inical exper i en c e s arranged for in one or more hospital s
The program i s c ompleted i n two years .
{2 4 )
13
Lice·n: s ed Voc· ational· Nur· s e s
Compri s e three general groups:
(1 )
tho s e who s e
only teacher has b e e n experience and who are n o t l icensed
, .
to practi ce ;
( 2 ) thos e with experience but nor: f ormal
education who have taken board examinati o n s and become
l i c en s ed ; and
( 3 ) thos e who have graduated from approved
s chool s o f practical nurs ing and hav e become l i censed
in the s tate or s tate s in whi ch they practice .
S chool s o f
practical nur s ing a r e conduc ted under the aus p i c e s o f a
hospital vocational s chool , or other community agency .
The program require s one calendar year to complete .
( 24 )
Nurs e s A ide s
The b a s i c cour s e o f i n s truction f o r nurs ing aides
i s s ix months .
To inc lude 1 3 0 c l a s s hour s of individual
c l inical i n s truction and 3 7 0 hours o f superv i s ed practice
for a tota l o f 5 0 0 hour s .
A t the end o f the c our s e they
receive a diploma as a graduate of a Nurs ing A. s s i s tants
Program .
There i s no certi f i cation for nur s ing aide s in
the S tate of C a l if ornia at thi s t ime .
(25)
CHAPTER I I
REVIEW OF THE LITERATURE
A survey o f a l l Nur s ing Arts , and Re s e arch
Period i c a l s was carr i ed out , beginning wi th thos e
pub l i shed in 1 8 6 1 and end i ng with tho se pub l i shed in
1966 .
To date only one s tudy entirely d irected at the
s tudy of nur s ing per s onne l acc idents has been publ i shed .
(12)
In personal communications with re spon s ible
admini s tr ator s or s af e ty o f f i cers in unive r s i ti e s and
ho spitals the f o l lowing respon s e s are repre s entative :
Kirson wrote " I have not rev iewed any materi a l
concerning i n j uri e s to nur s e s in our hospi tals" .
(2 6 )
Douglas ( 1 9 6 8 ) " I regret very much to have to
report that we have done no such s tudy , nor are
we aware o f any f igur e s bearing on th i s problem" .
(27)
Kraus noted " I am f orced to agree with your
f indings on the ava i labi l i ty of qua l i ty pub l i shed
materi a l on inj uri e s to nur s e s" . ( 2 8 )
Hendrix held "The l i terature i s lacking in thi s
one r e spect o f hospital operations" . ( 2 9 )
The e ar l i e st relations o f nur s ing and acc idents
are from II S amue l , Chapter 4 , Verse 4 of the Old
Tes tament .
I n the K ing James Ver s i on ( 3 0 )
i t was s a i d that
Jonathan , S au l ' s s on had a son that was l ame on
his feet .
He wa s f ive years old when the tidings
came o f S au l and Jonathan out of J e z re l l , and h i s
nur s e took him up , and f l ed :
and i t came t o pas s ,
a s s he made ha s te to f le e , that he fe l l , and became
lame .
14
15
The firs t mention o f accidents to nur s e s wa s made
by F lorence Nightinga le in' N o·t·e· s· ' o n· Nu· r· s'ing .
She
di s cu s sed the accidents to nur s e s in hos pital s in the s e
words :
I t i s impo s sible in a book to teach a per s on
in charge of sick how to manage , a s it i s to
teach her how to nurs e
But i t i s pos sible
to pre s s upon her to think o f her s e lf
( 5:41 )
•
•
•
•
.
•
Of another incident she wrote :
A man received an inj ury to the spine
he was
de sperate to see once more out of the window .
Hi s nur s e actu a l l y got him on her back and
managed to perch him up at the window for an
The cons equence to the
instant, to s ee out .
nurs e was a s erious i l ln e s s , which nearly
proved f atal . ( 5 : 6 1 )
.
•
•
The arti c l e s outlined the duti e s performed by the
nur se s , and gave us the fir s t insight into accidents o f
nur sing personne l .
From the era o f F lorence Nightinga l e
through the beginning o f 1 9 0 0 e s s enti a l ly nothing wa s
written about accidents to nur sing per sonn e l in the
ho spital literature.
In 1 9 3 8 the National S afety Counci l
( 31 ) indi cated
that even though the s a fety movement in indus try wa s
we l l under way , there were about 3 5 , 0 0 0 workers ki l led
yearly in occupational acciden t s , a l though in 1 913 there
were f ewer persons working than in 1 9 3 7.
The arti c l e
a l s o indicated that no s a ti s f ac tory e s timates have been
made for the individua l years between 1 913 and 1 9 2 8.
16
1 93 7 , Kruger writing in Ho·sp·i· t als
( 3 2 ) and Anna Wolf in· · T:he· Mo'd ' e·r n· Ho' s'p'i' t' a l
( 3 3 ) mentioned
that nur s e s hav e occupational accidents.
Kruger' s
(32)
s tudy of total hospital emp l oyee acc idents showed nur s e s
had , o r were inv o lv e d in , 1 8 per cent o f the i n j u r i e s .
He went on to s ay that thi s was 5 0 per c ent higher than
for the entire emp loyee group .
Accidental i n j u r i e s to
nurs e s in thi s s tudy were of the fol lowing type s :
burn s ,
( 2 ) cuts ,
Anna Wol f
(3)
sprain s , and
(1 )
( 4 ) punctured f inger s .
(33 ) analyz ing rep orted i n j ur i e s , found that
34 per cent r e su lted f rom cuts , 17 per c ent from f a l l s�
14 per cent from various causes resulting in contus ions ;
1 2 per cent from burn s ;
9 per cent f rom pricks of pins
and needle s , and 14 per cent from m i s c e l laneous cau s e s .
She then continued :
The day' s work in nur s i ng inc ludes i nnumerable
chances for acc idents unle s s s k i l l fu l , con s c i entious
and careful serv ic e is g iven .
Nur s ing is u sually
rendered under constant phy s i c a l and mental s tra i n ,
pres sur e , haste and tens ion .
S e l t z er
( 34 )
in 1 9 4 0 and Buck
(35)
in 1 94 1 wrote
that hospital employee s s hould be encouraged to rea l i z e
the ir own respons i b i l i ty for the reduct ion of acc idents .
Then ten year s l ater , Kesner
(4 ) out l i ned the components
o f Acc ident Control For Nur s ing.
He drew from the results
o f the National S a fety Counc i l S tudy in 27 N ew York C i ty
Ho spital s;.· th e s e s tati s t i c s;
Of 3 9 2 reported acc idents
276 or 70 per c ent were c au s ed by u n s af e acts of the
indiv iq1J� l member s of the nur s.:i.?g team .
17
In 1 9 5 2 , Carnex
(3 6} ob s erved that employees o f
the nur s ing s ta f f have a higher accident rate than
workers in manu f a c tur ing , ship bui lding , a ircraf t , sheet
metal or steel p l ants .
He d i s cu s s ed the f act that each
year thou s and s o f nur s e s ' hands , f inger s , eye s , and toe s
are ,
in that order , acc identa lly i n jured .
The Un i ted
S tates Department o f Labor , Bureau o f Labor Stat i s t i c s
undertook a n extens ive and detailed s tudy o f the work
i n j ury experience of hospital employees , based upon
records for the year 1 9 5 3 .
Prior to thi s repor t ,
i s sued in 1 9 5 4 there were no national i n j ury rate data
re lating spec i f i ca l ly to hospital employee s .
( 18 )
Thi s
s tudy wa s a cooperative venture in which the Amer ican
Ho spita l A s sociation partic ipated exten s ively .
The
r e sponse rate wa s high , over 80 per cent o f the ho s p i ta l s
contacted returned u s able report s .
From the 4 , 68 0
re sponding hos p i t a l s data c overing 1 , 688 m i l l ion emp loyee
hour s o f on-duty expo sure wa s given
( s ee T ab l e 1 ) .
Thi s
i s equivalent to a year ' s work o f 8 3 7 , 5 0 0 ful l-time
employe e s .
( 18 )
In The Bureau o f Labor Stati s t i c s report there wa s
a s tr iking r e l at i onship between ho s p i ta l s i z e , a s
me asured b y total employment , and the leve l o f i n j ury
oc currenee . F indings ind i cated that the i n j ury frequency
rate s for ho spit a l s tend to vary directly with the s i z e
o f the hospital s .
( 18 )
18
TABLE I
RE SULTS OF JOINT S TUDY BY UNI TE D S TATES
BUREAU OF LABOR S TAT I ST I C S AND AMERICAN
HOSP I TAL ASSOC IATI ON , 1 9 53
( 18: 51 )
HOS P I TALS REPORT ING*
GENERAL HOSP I TAL * *
SPECIAL HOS P I TAL* *
No . o f
I n j uri e s
Days
Lo s t
No . o f
I n j ur i e s
Reg i s tered
Nur se
1, 169
51, 293
107
2 , 493
Licensed
Vocational
Nur se
261
11 , 164
55
1 , 953
8 3 , 58 2
88
3 , 263
OCCUPATI ON
Nur s e s
Aides
1 , 0 57
Day s
Lo s t
*Number of Nur s ing Serv i c e Per sonn e l not indicated in
Jo int S tudy Report
* *D e:f,j,:p�(i�}:)y
1:h�
§l:l�J::":i CC1n Ho spi.t:al A s so ciation
�
19
TABLE I I
RESULTS OF JOINT S TUDY BY UNITED S TATE S
BUREAU OF LABOR S TAT I S T I C S AND AMERICAN
HOSP I TAL ASSOCIATION , 1 9 53
(1 8: 4 2 )
COMPARI S ON S BY OPERATING DEPARTMENTS
IN COOPERATING HOSP I TALS
Emp l oyee s
Worked
1 , 00 0 hrs .
per Year
All
Di s ­
ab l ing
Inj u r i e s
Reported
Acc idents
Emp loyee s
at Ri sk
Regi s tered
Nur s e
404
8 , 43 5
17 ,744
6.9
Licensed
Vocational
Nur s e
243
4 ,724
9 ,806
8 .1
Nur s e s
Aides
783
25 , 590
47 , 5 4 4
7.5
Temp.
Avg .
Total
D i s ab.
Days
Lost
D i s ab .
I n j ury
Temp .
S ever .
Total Rate
D i s ab . Exper .
Nur s ing
S ervi c e
Nur s ing
S ervi c e
Reg i s tered
Nur s e
Perm
D eaths
or Perm. Part.
D i s ab .
D i s ab .
0
0.4
6. 5
84
20
0.6
Licen sed
Vocational
Nur s e
0
0.3
7.8
46
13
0.4
Nurs e s
A ides
0
0.2
7. 3
. 47
18
0.3
20
The data su�ge s t that nur sing personne l s u s ta i n
a large number o f accidents .
·Fu r ther that the days
l o s t due to i n j ury were le s s than for more dangerou s
s k i l l s s u c h a s logging and s awm i ll opera t i on s , but
was higher than the average f or the exp l o s iv e s
manufacturing indus try or t h e manufa c ture o f synthetic
f ibers
.
(1 8 )
I t i s worthwh i l e to review br i e f ly some o f the
f indings of the National S a f e ty Counci l' s s tudy in 1 9 5 5
(37)
that a s a group , the nur s ing profe s s i on had a
higher frequency rate than a l l of the other pro f e s s ional
p ersonnel among the 2 4 6 United States ho sp i ta l s s tudi ed .
The C a l i fornia D epartment o f I ndustrial Re lations
(38)
found , in 1 9 5 5 , 1 , 2 0 0 nur s e s suf fered l o s t - t ime
accidental inj ur i e s in private hosp ital s .
The i n j ur i e s
mos t commonly reported were :
TABLE I I I
MOST COMMONLY REPORTED INJURIES OF
NURS ING SERV ICE PERSONNEL
Per cent*
S trains , sprains , d i slocations
Fracture s .
.
.
Cuts , l ac eration s , puncture s
( excep t infections )
Occupational di s ea s e s
Brui s e s , contu s i on s . . . . . . . . . . . . . . . . . . . . . . . . .
Infected cuts , punctur e s
Eye i n j ur i e s
. .
. , . . . . . . . . . .. . . . . . . . . .
Other i n j urie s
. .
. . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
•
•
•
.
•
.
.
.
.
.
.
.
.
.
.
.
.
.
• •
.
.
.
.
•
.
•
•
•
.
•
•
.
• • • • •
.
• • • • •
.
• • •
.
.
.
.
.
.
•
.
•
• • •
.
.
• • •
•
•
.
•
.
.
.
.
.
.
.
• •
• • • • •
.
.
.
.
.
.
•
.
•
.
.
.
.
.
•
• •
•
.
.
.
•
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
TOTAL
48
11
ll
lO
. 9
5
. 3
3
• • •
.
.
.
100
*Actual numbers o f i n j ur i e s were not ava i lable
through the C a l i fornia Department o f Indu s tr i a l Re lat ions
21
Sche f fler
(39 )
i nd i ca ted that ha z ards such a s
spi l l s o n f loor s , and f lower petal s on f loors , o n
occas ion , have c au s ed broken hips to s everal nur s e s .
He
a l s o indi cated that many o f the nur s e s needed continu a l
education in moving and handl ing o f patient s .
Hi s report
indicate s the s e l a s t named , and frequent ly u s ed nur s ing
procedure s i nvolve preventab le i n j u r i e s to nur s ing s ta f f
member s inc luding reg i s tered nur s e s , and nur s ing aide s
within a teaching hospital .
I n another s igni f ic ant
more recent r e s e arch repor t , McDonald (40) has described
the mos t common cau s e s o f acc idents among ho spital
per sonne l to be care l e s s ne s s and short cuts taken by a
person , who when rushed and anxious to f i nish her task ,
skips over important l i tt l e procedures that are nec e s s ary
for her own protection .
He d e s cribed nur s e s a s e spec i a l ly
prone to cut f ingers on ampu le s , and back i n j u r i e s due to
poor body mechan i c s that may result in chronic troub le
and interfere with future work .
I t i s worthwh i le to review b r i e f ly s ome o f the
main f indi ng s of the Argonaut I nsurance Company
inve s t igator s
( 3 ) who concluded that in 2 3 2 part i c i pating
hospital s there were 5 , 41 5 reported i n j ur i e s , each
identi f i ed by department , part of body , and c au s e of
i n j ury in an e ffort to e s tabl i sh or identify area s or
conditions that w i l l a s s i st admini s tration s to deve lop
corrective procedure s .
22
I n the Nurs ing Department the f o l l owing was
observed:
TABLE IV
INJURY BREAKDOWN BY DEPARTMENT F ROM JANUA.RY 1 , 1 9 6 3
TO JANUA RY 1 , 19 6 4
Department
General
Nur s ing
Total No .
of
Employe e s
1 8 , 41 9
(3 : 1 0 )
P er cent
of total
Employe e s
33 . 6
No . o f
Cases
2 ,14 6
Per cent
o f Total
Number
39.6
INJURY BREAKDOWN BY DEPARTMENT F ROM JANUARY 1 , 1 9 6 3
TO JANUARY 1 , 1 9 6 4
SEVERITY
Total c o s t
of Inj ury
General
Nur s ing
51 0 , 1 5 8
(3 :15)
FREQUENCY
No . o f
Employee s
1 8 , 41 9
Frequeticy and S everit;t :
No. o f
Cases
2 ,146
1 I n j ury
out o f
•
•
.
8.5
To accurately s umma ri z e
and evaluate the problem o f frequency o f i n j ury by
department , cons ideration s hould be given to the number
o f emp loyee s within each department and the re spon s i bi l i t i e s and/or type o f work that mus t b e performed.
thi s analy s i s, i t was a s sumed that each emp loyee has
For
23
been tra i ned to perform h i s or. her work to the degree
that work or environmental haz ards are equal in each
department .
For the other reported problem areas ; part o f
body and cau s e , there wa s no indi cation a s to department ,
hence , they were not r ev i ewed in thi s current s tudy .
Argonaut' s report wa s updated in 1 9 6 6 to demo n s trate the
following results
(11:11 ) :
TABLE V
INJURY BREAKDOWN BY CAUSE AND COST
1 9 6 2-1 9 6 6
(11:1 5 )
Cause of Inj ury
No . o f
Cases
Per cent
o f Total
Lifting P atients
2 , 629
11
Cost
Per cent o f
Total Cost
$1 , 8 6 4 , 11 6
27
I njury data u s ed i n the Argonaut report are
composites of employee inj ur i e s obta ined from 2 6 0 member
ho spitals parti c ipating in the Cali fornia Hos p i t a l
Assoc iation .
However , the report did n o t have individu a l s
l i s ted b y department s , b u t s ince the nur s e would be the
only one l i fting pat i ent s , l iberty was taken to ab s tract
i t from thi s report .
24
Kowal and Bau st
(41)
conducted
a
f ive year study
in Mount Auburn Ho spital , Cambr idge , M a s sachu s ett s .
They f ound :
TABLE VI
Job Category
Per cent of
I n j urie s
Per cent of
Workforce
Regi stered
Nur s e
10 . 0
29 . 0
Licensed
Vocat ional
Nur s e
.1
.1
15 . 0
9.0
Nur s e s
Aid e s
S igni f i cant f indings on this survey were that
while Nur s i ng Aide s repr e s ent 9 per cent o f the tot a l
work force they incurred 1 5 per cent o f t h e acc ident s .
The study f urther indicated that the most s erious
acc ident s in the f iv e year period were a s s o c iated with
the Regi stered Nur s e group , and s e condly Nur s ing Aide s.
Back inj ur i e s and lacerat ions were the mo st c ommon type
o f acc ident s to thi s group o f employee s .
Norwood ( 1 3 )
inv e st i gated a London Ho spita l ' s
staf f acc ident exper i enc e , and f ound that nur s e s , a s a
group , sust ained the high e st number o f accident s.
Bus h
( 4 2 ) a s c ertained that nur s e s a s a group sustain large
number s of i n j ur i e s in New York ho spita l s .
25
St i ll another theory o£ po s s ible cause and e f fect
of acc ident s is advanced by Gohr
(1 0 ) .
I n a 196 5 study
he considered the nur s ing s ervi c e employee s to be a
high r i s k occupat i on within the hospit a l environments
and s howed that among the nur s ing group , Regi stered Nur s e s
had a n i n j ury r ate o f 1 6 per cent and a t ime l o s s rate
o f one per cent.
It was a l s o found that the i n j ury rate
for Nur s e s Aides was 2 6 per cent with a t im e los s rate
of 5 per cent.
Then in 1 9 6 7 he stated that the hospital
i s not a safe place to work , and showed the following
as ev idence.
TABLE V I I
ACC IDENTS IN 2 3 2 CALIFORNIA HOS P ITALS ANALYZED
FOR PERCENTAGE OF TOTAL AND OF COST
Department
General
Nur s ing
P er c ent o f
Tot a l
Emp loyment
34
Per cent o f
Total No.
of C a s e s
40
(6 : 289)
P er Cent o f
Total
Cost
48
H i s data showed Nur s ing accident exper ience four
to f ive t im e s higher than D i etary or e ight to ten tim e s
higher than Ma intenance and Engineer ing.
The Cali fornia D iv i s ion of Labor Stat i st i c s and
Re search on injur i e s to worker s in private and pub l i c
26
hospit a l s
I
in California in 19 6 6 s tated that five out of
�very ten injurie s to hospital worker s con s i s ts o f s trai n s ,
I
.
.
.
f pra1n s , d 1 s1 oca t.1ons , or hern1a s.
I
They sugges t th e nee d
! for training workers in safe technique s of li f ting , moving ,
�r
I
I
1
I
a s si s ting patients .
( 43 )
· a 'In
I n a repor t of· wo·r k Tn: jur·ie s I n C'aT ifo·r·ni
. I .Nu·r·s·l··n_.._
g· Hom e s and co·nvaTe s·c·e nt Ho·s·p·it·a·l s the ri s k o f
·
I
___
!in j ury to emp loyee s of nur sing home s and c onval e s cent
/ho spitals
[
i s greate s t when they are handling the invalid ,
I
!and often helple s s , patients.
Near ly h a l f o f the 516
i
! lost-time
!
inj uri e s to emp loye e s o f nur sing home s and
c onva le scent hospi ta l s reported in California during
! the fir s t six months of 1 9 6 6
! moving , or bathinq patients ,
/ involving
I
! occurred
-
physical contac t .
were sustained in lif ting ,
or in performing other tasks
Mos t o f the other in j uries
with employe e s hand ling hospital equipment or
-·
I
-
I
! supplies , or when they walked through corridor s or
! patients '
I
I
! Her shey
rooms whi le performing their dutie s.
(44)
(43)
stated in a recent arti c l e in the JoUrnal
l of
Nur sing , that nur s e s are not immune to inj ury , and
l in
the cour s e o f their work .
!
!
i
J often enough they have been inj ured , in one way or another ,
i
!i
From the s e survey s , one s e e s there is li ttle mention
i
iof nur sing per sonne l accidents and vir tu a l ly no mention
I1 so l e ly
I
o f nursing s taff member s .
27
r·-�
l
1
bI
,--..
Gordon (1 2 )
in 19 6 7 has focused upon the general
roblem of nurs i ng i n j ur i e s .
!p rivate ,
jthe
I
I
land
I
iof
non-prof i t community teaching ho s p i t a l , observ ing
highe st i n j ury inc idence among nur s e s in the 4 6- 5 0
5 1- 5 5 age group s .
She next cons idered the inc idence
injuries to nur s ing personne l by month and day .
/greate s t
!
She s tudied a 4 6 2 bed
The
number o f i n j uri e s in any one month wa s 1 4 i n
March ; the l owe s t w a s 4 i n November .
The highe s t d a i ly
1 inc idence oc curred on Sundays and Thur sday s , wh i le the
I
l lowe s t
wa s reported on Friday s .
/ showed that the lowe s t
! when mo s t patien t s are
l
/
Analy s i s o f inj ury reports
inc idence wa s dur i ng the night hours
a s leep and s t a f fing i s minima l .
Inj ur i e s were obs erved to increase through the day
( concurrent with
j highe s t
I
the increase in staff and activ ity .
The
prev alence o f i n j ur i e s occurred on a multidi s c i -
i
/pl inary nurs ing uni t where nursing per sonnel are required
I
I to carry out varying duti e s in caring for medi c a l and
! surgi cal
I
l
I
a s wel l a s neurolog i c a l patient s .
More than
one-ha l f o f the nur s ing per sonne l were handl i ng equipment
I
/of
or supp l i e s at the t ime of i n j ury .
The mos t common cause
inj ury was obs erv e d to be puncture wounds by needle s
and lacerations by ampu le s .
From the rev i ew of nur s ing per s onne l injur ie s , and
others related to total hospital pers onne l i n j u r i e s i t
appears that nur s e s , a s a group , hav e a large number of
acc idents .
28
i
!
The background research data have left many
!questions unanswered although they have prepared the way
I
if or this study.
I
I
I
I
CHAPTER III
DESIGN OF THE STUDY
I.
STATEMENT OF THE HYPOTHESIS
Considering the large grouping of accidents in and
around the hospital,
causative factors include the number
of agents as well as work groups involved.
Hence the
following hypothesis was developed for testing:
Each one of the independent variables are causal
factors of accident rates.*
II.
THE STUDY SAMPLE
The study sample consisted of the industria l injury
reports of all nursing personnel during the year September
1 9 6 6 to September 1 9 6 7 in (1 ) a nonprofit and ( 2 ) a
teaching hospital in the Los Angeles Metropolitan area.
These hospitals were selected on the bases of size of
the sample available in each hospital and the wil lingness
of the hospital administration to make available their
industrial injury reports.
The study was initiated at a 4 4 9 bed,
5 5 bassinet
non-profit private hospital in Metropolitan Los Angeles,
California,
which was built in 1 9 53 and enlarged in 1 9 6 7.
This hospita l offers facilities to meet the needs of all
. �13:�:E> 1.?9.�
4 -Selected Factors
29
30
patients;
therapy,
including cLinical Laboratory,
dietary,
physical
and special departments such as a medica
coronary care unit,
care unit,
x-ray,
medical special nursing unit,
surgical recovery rooms,
intensiv �
cardiac nursing unit,
and a surgical cardiac nursing unit.
The mnnber of employees in all hospital departments
on September 3 0,
1 96 6 was 5 4 7 .
The number of nursing
service employees on this date was ( J l l,',
represe�ting
5 7 per cent of the total hospital employees.
150
nursing service employees,
Registered Nurses,
72
Vocational Nurses,
and 8 9
Of the 311
( 4 9 per cent) were
( 2 3 per cent) were Licensed
( 2 9 per cent) were Nursing Aides
The non-profit private hospital was compared to a
3 6 8 bed, 3 0 bassinet teaching hospital in Los Angeles,
California.
This hospital offers the following services;
clinical laboratory, x-ray,
physical therapy,
dietary and
specialty departments such as a cardiopulmonary laboratory
inhalation
therapy laboratory,
an intensive care unit
for surgical and cardiac patients,
physical medicine-rehabilitation,
hemodialysis unit,
and a research center.
The number of employees in all hospital departments
on September 3 0 ,
1 9 6 6 was 1 7 7 0.
The number of nursing
service employees on this date was 2 6 2,
representing
1 4 . 8 per cent of the total hospital employees.
�
Of the
i
31
2 6 2 nursing service employees, 15 4 ( 5 9 per cent) were
Registered Nurses,
75
( 2 8 per cent) were Licensed
Vocational Nurses,
and 33
(13 per cent) were Nursing
Aides.
III.
ESTABLiq-HMENT OF CRITERIA
The theory advanced in this study is
formulations by Norwood
However,
a
composite of
(13 ) , Gohr ( 6 ) , and Gordon (1 2 ) .
the reorganization of these theories as presented
here is unique.
Gordon
(1 2 ) , in 1 9 6 7 , indicated the highest incidence
of injuries to nursing service personnel was among the
21- 2 5 age group with a slight decrease among; the 4 0- 6 0
age group.
She went on to say that there is a degree of
correlation between accident rate,
If this is correct,
month,
day and shift.
then this might be an indicator for
other hospital environments.
Norwood
( 1 3 ) , in 1 9 6 4 ,
stated that the results of an investigation in one hospita
�
\
!
can never be said to be typical for hospitals in general,
but they may be useful in indicating some improvements
which can be made in any hospita l service.
It has further been noted that the epidemiologic
approach to accidents has received much emphasis in some
literature.
(45 , 46)
Hence,
the theory of this study
will utilize the methods of epidemiology.
!
Further, one may!
imply that accidents are a health problem,
and they may be I
I
j
32
approached in the same way,
with the same methods that
are used in the epidemiologic approach to other health
problems.
Essentially this would involve;
and analysis of data,
(b)
(a)
'
collection:
examination of apparent relation i
:
ships for other causative factors,
(c)
establishment of
hypotheses regarding causation and testing them under
controlled conditions.
(8)
METHODOLOGY
IV.
For the purpose of this study data were obtained
from industrial injury report forms on file in each
The report forms were completed differently
hospital.
in each hospital,
therefore the information in this
section may be useful in indicating some improvements
which can be made in the hospital service.
Teaching Hospital
The general incident report form is filled
duplicate by the injured employee or supervisor of the
department.
are:
name,
incident,
The sections completed on this report form
address,
age,
sex,
work area,
account of
and signed by a witness if there is one.
One
copy remains in the department and the other is taken
with the employee to the Emergency Room.
The physician
in the. Emergency Room renders treatment as necessary and
advises the employee to see a physician if further
treatment is warranted,
or when to report back to work.
\
33
The physician fills out the section of the incident report
form called "Doctor's Report of lnjuries and Recommen­
dations".
The physician's secretary fills out in duplicatl$
the "Doctor's First Report of Work Injury".
One copy is
sent to the hospital!s Department of Environmental Health
and the other is sent to the employee's department.
The incident report is returned to the employee's
department within 2 4 hours from the time of injury.
The
department within this time period completes five copies
of the Employer's Report of Industrial Injury.
copies are distributed as follows:
(1)
These
3 copies to the
hospital's Environmental Health Department�
of these,
1
copy is forwarded to the State Department of Industrial
Relations,
(3)
(2)
1 copy to the employee's department, and
1 copy to the hospital administrator's office.
The
data for this study were collected from the copy retained
in the office of the hospital administrator.
Non-Profit Ho·spital
The general incident report form is completed as in
the teaching hospital,
but in triplicate.
sent to the employee's department;
One copy is
one to the insurance
department and one remains with the injured employee and
is taken to the Surgical-Walk-in Clinic.
Before going
to Surgical-Walk-In-Clinic, the injured employee must
see the cashier,
obtain a fee registry form,
(although no
__
!
34
fees are charged to the employee) ,
then sees the
secretary of the Clinic to obtain an Accident Injury
and Industria l Report form.
employee.
given,
The physician then sees the
A diagnosis is established and treatment
if needed,
and is noted on both the general
incident report and Accidental Injury and Industrial
Report.
The physician then advises the employee to see
a physician for further treatment if warranted or when
to report back to work.
One copy of the incident report
form is taken back to the employee's department.
This
report is then signed by the director of nursing and also
by the assistant director of nursing;
following which it
is sent to the hospital administrator's office.
!
The Surg1cal-Walk-In-Clinic sends the incident repor�
form and the Industrial report form to the Insurance
Department where one copy is put into the employee's
medical folder.
The insurance department fills out the
Doctor's First Report of Work Injury.
distributed as fol lows:
department;
Company;
(3)
(2)
(1)
This report is
2 copies to the insurance
1 copy to the Industrial Injury Insurance
1 copy to the employees medical chart;
(4)
copy to the State Department of Industrial Relations;
(5)
1 copy to the hospital personnel department.
1
and
After
all the reports are seen by the hospital administrators
office they are sent to the hospita l personnel officer.
The secretary types from these forms an Employer's Report
35
of an Industrial Injury.
This is filed in the hospital
personnel office where data for this study was collected
from the above copy.
In this study reports of accidents incurred by
nursing personnel from September 196 6 to September 19 6 7
were selected from the total number of accident reports
of all hospital personnel.
The above dates were selected
owing to the availability of data.
The private non-profit
hospital had moved to new quarters and began filing injury
reports as of September 1 96 6.
Prior to this time injury
reports were filed with the personnel department.
In the
teaching hospital reports are on file in the hospital
administrator's office and were more accessible.
V.
PROCEDURE
Industrial Injury Reports of nursing personnel were
selected and examined from the total hospital Industrial
Injury reports.
The reports were reviewed to obtain the
following data:
1.
Age
2.
Marital Status
3.
Hours worked per day and week
4.
Date of accident and date of report
5.
Number of days disabled
6.
Department
36
j
7.
Time and Shift
8.
Years employed
9.
Type of accident
10 .
Nature of injury
11 .
How accident occurred.
Accident reports were analyzed for the purpose of
!identifying the circumstance (s)
I
under which nursing
)personnel accidents has disastrous consequences.
!
i
Ito
i
I
I
I
The following types of graphic forms were utilized
illustrate the data from injury reports.
1.
Bar charts
2.
Frequency charts
3.
Tables
! Variables
l
I
!
I
I'l
I
The variables were utilized to compare their
interrelationships.
Dependent variable:
Accident rate
Contingent dependent variables:
accident
(number of days missed from work) ;
of body injured.
Independent variables:
i
I
Seriousness of
1.
Age
2.
Work experience
3.
Work shift
Part
37
r
-
I
4.
Day of week
5.
Month
6.
Work area
The effects of the independent variables on the
�ependent variable will be analyzed both separately and in
!I
interaction.
jobserved
In this study independent variables were
J
I
to s ee which one singly or in combination have
/
!
This is a study using existing data-the industrial
I
s ignificant effect on the accident rate.
i
VI.
LIMITATIONS
injury reports of the nursing personnel .
As such it has
the same advantages and disadvantages as other studies
! using
I
these types of records.
An advantage using this type of methodology is
i
I
!availability of data.
It is possible to go back over a
!
certain period of time and obtain a larger sample or a
l
e an return to the original investigation and determine the
i
The disadvantages include the fact that records are
I
I
J measure of previous accomplishment.
I
! reliability
I
l
Also other researchers
of the study on the basis of the same cases.
not in the form or terminology desired by the researcher.
I The desired information may not be available and it may
I! be
I
I
I
L
impossible to obtain it.
The researcher cannot impose
38
r :� : �::-::�:d -�::
l
·
- ·-
-
a
records.
·
:���-��� �:�.-�:-��-�:��:��--::-- ��-�- - ---- ---- - - I
- --
-
of v
-
The records may be a s accurate as the eff iciency
w ith which they were collected.
�
!
1
-
Other factors which may
influence the rel i ab ility and val idity of data i s the
collect ion and incentive to record some mi s information.
I
S ince most of the information used came from
indu strial injury report forms ,
it may be a s sumed that
!
of f icial report forms ,
ments to reinforce th i s
they interpreted employee s '
stature of
I
I
state-
I
innocence.
Another problem was that the reports were frequently
incomplete or of que stionable accuracy i f the ho s pi tal
I pers onnel
secretary or department secretary d id not
receive copies of
all reports . *
Hence ,
to exclude reports on incomplete data
as
i t w a s neces s ary
I
I
I
it might cau se
b i a s in the study.
It was a s s umed that there was probably the s ame
degree o f error a s far a s the reports were concerned in
both the non-prof i t ho s pital and the teaching ho spital.
.
* See page 3 2 - Methodology
<'-�>�= <�<L��--�-�---� ��-..-..--> ��� Y�•�···-�-�---·�·-�<�·•··�n>��� "' •�o�•� --�-- ·--�-· --�--. •-•�-·-·���• - ---•M•--·-•d-•
·-· -•�--·.---•·�•·-• ,-.--�· -�-·•·---�· r.-••'-"'•••�•·-�- �-••• �
,, . ,,_. ,_, -
"J
CHAPTER IV
ANALYSIS AND DISCUSSION OF DATA
I
Industrial Injury Reports were selected to determine
I
!the inc1dence and prevalence of injuries to nursing service
!
personnel in
!
examine the hypothesis that the independent variables are
I
! teaching
I
( 1 ) a non-profit private hospital and ( 2 ) a
hospital.
The purpose of this analysis was to
!causal factors of accident rates .
Ii
!
Charts 1- 2 demonstrate the distribution of nursing
service employees according to their age classification.
l in
I
)
!
the Hospital N* the largest employee group was among the
1 2 6 - 3 0 age group and in Hospital T* the largest single age
l
I
l
1
group was the 2 1- 2 5 year population.
of injuries found among the Registered Nurses in Hospital
N were in the ages 2 6 - 3 0 ;
of the age groups 2 6 -3 0 ,
ages 2 6 -3 0 ,
! incidence
i
1
I
The highest incidence
among Licensed Vocational Nurses
5 1- 5 5 ; and, among Nursing Aides,
3 6 - 4 0 and 4 6 - 5 0 .
In Hospital T,
the highest
was in the Registered Nurses of ages 2 1- 2 5 ,
2 6 - 3 0 ; Licensed Vocational Nurses, 2 1- 2 5 , 5 6 - 6 0 ; Nursing
Aides 2 1- 2 5 ,
and 3 6 - 4 0 .
The lowest incidence was among the staff members
under 2 0 years ,
between 4 1- 4 5 years and over 6 1 years of
*In this section the non-profit hospital will be
referred to as Hospital N and the teaching hospital will
be refer-��<:i_ _ :to §1� �<.:>s_p � tal T.
39
6 1 and
ove r
I
56-60
I
I
51-55
�
r.:1
::::>
1-)
z
H
""'
0
I
46-50
I
41 -45
I
36-40
tl.l
r,il
�
I
31-35
J
26-30
I
2 1-25
2 0 and
I
und e r
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
NUMBER OF REPORTED INJURIES
CHART 1 - NUMBER OF REPORTED INJURIES AMONG NURSING PERS ONNEL
BY AGE IN A NON- PROFIT HOSPITAL 1 9 6 6 - 1 9 67
�
0
,----- ---
�
Cf.l
w
H
p::
11
z
H
10
�
H
9
::;:J
"
z
w
�
H
u
u
<G
�
5
r:<.!
4
p::
w
3
0
�
z
RN
LVN
AIDE
7
6
f:'a
- --,
8
�
w
�
0
a
�
fTFFi
13::1
12
KEY
2
1
0
Y L.-J 1 1 I Y Y 1
2 0 and
under
2 1- 2 5
2 6-30
3 1 - 35
36-40
I
4 1 - 45
1 L.-J Y Y Y
46-50
51-55
5 6- 60
6 1 and
over
AGE GROUPS OF RN ' S , LVN ' S AND NURSING AIDES
CHART lA - COMPARI S ON OF REPORTED ACC IDENTAL INJURIE S AMONG RN ' S , LVN ' S
AND NURSING AIDES BY AGE IN A NON - PROFIT HOS PITAL 1 9 6 6 - 1 9 67
"""
I-'
6 1 and
over
=:J
I
56-60
Q
�
::::>
"
z
H
Ji.l
0
Cf.l
li1
�
46- 5 0
I
41-45
I
I
36-40
I
31-35
I
25-30
I
2 1-25
2 0 and
und e r
�
0
2
1
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38 ;
NUMBER OF REPORTED INJURIES
CHART 2 - NUMBER OF REPORTED INJURIES AMONG NURSING PERSONNEL
BY AGE IN A TEACHING HOS PITAL 1 9 6 6 - 1 9 6 7
.::..
N
KEY
�----
�
26
Cl.l
r::.::t
�
::;::J
IJ
z
H
�
z
r::.::t
0
H
u
u
<t1
0
r::.::t
22
10
z
AIDE
14
ga
�
�
LVN
18
12
�
RN
20
�
0
P-1
�
�
ITtSl
�
24
- ------�
8
6
4
2
0
I
p 71 1•-�"J
I?I J\ 1 :�···1
2 0 and
under
2 1 - 25
I '-oJ•;.:• I
' ' ' [' )....:":."(
t 7 1 1 '>
I
!:.<r"" j..:' q
I , .p..· .·J
r'J' I � · --1
ll'l
� � � � � � � � � � Y L,-J
2 6- 3 0
3 1- 35
3 6 -40
4 1 -45
46-50
5 1-55
56-60
AGE GROUPS OF RN 1 S , LVN r·s AND NURSING AIDES
6 1 and
over
CHART 2A - COMPARI S ON OF REPORTED ACCIDENTAL INJURIE S AMONG RN ' S , LVN ' S
AND NURSING AIDES BY AGE IN A TEACHING HOSPITAL 1 9 6 6 - 1 9 67
-----·�--��·-----·-��--···-·--
�
w
44
'
!
!age
I
for a l l nurs ing. g:roup s in Hospital N .
I ere
r
�
found i n Hospital T .
(See Chart 2 }
Similar r e s u l t s
There i s a
e c l ine in injuri e s in both ho spital s among nur s i ng s ervic e
I
;empl oyees in the age groups o f 4 5 and over , but a s l ight
[
i ncrea s e is ob s e�ed in Ho spital N among the Regi s tered
I
�urs e s and Nur s ing Aides in the age group s 3 6 - 4 0 , 4 6 - 5 0 ;
I
�hi l e in Hospital T this wa s noted within the 3 6 - 4 0 age
!group
I
o f Reg i s tered Nur s e s and Nur s e s Aide s .
! incidence
i
.i
The inj ury
to nur s ing servi c e employee s is b imodal in
!Hospital T a t age 2 1 - 2 5 , and 2 6 - 3 0 among Regi s tered Nur s e s ,
! tor Nur s e s
/vocational
I
i
!
I
Aides o f age 2 1- 2 5 , and 3 6 - 4 0 , whi l e Licensed
Nur s e s peak only at age 2 1 - 2 5 .
Ho spita l N
shows h ighe s t accident experi ences at age s 2 1 - 2 5 , 2 6 - 3 0 ,
l and 3 1 - 3 5 for Reg i s tered Nur s e s ; 2 6 -3 0 , 3 6 - 4 0 , 4 6 - 5 0 for
i
!!
I
Nur s e s Aide s and large a c c ident expo sure for Licensed
voc at ional Nur s e s at age s 2 6 - 3 0 , and 5 1 - 5 5 .
The s e data are
I shown in Chart s lA- 2A .
I
Thes e f indings agreed with tho s e o f Gordon ( 1 2 )
!
i
and
! Norwood ( 13 ) who u s ed s im i l ar data c o l le c ti on and testing
)
techn ique s .
!
REPORTED INJURIES AND EMPLOYMENT
!I
I
The s urvey next cons idered the incidence o f
/ in j ur i e s to nur s ing per sonne l by work experience .
i
I
1 3-4 )
·I ·
I
( Charts
In Hospital N the highe s t acc i dent inc i denc e * for
. �See .pa.g.e.?.
45
!Re g i s tered Nur s e s was among tho s e employed over two years
! .
I
\or l e s s than s ix -month s .
jt o
I
I
Among thos e employed s ix -months
two year s , Regi stered Nur s e s in Ho s p i t a l T had the
!h ighe s t acc ident inc idence . Here it s eems that neither
!newne s s or extended s ervi c e protec ted nur s in g personne l .
�any acc idents were reported in both group s . Licensed
!
jVocational
I
l ( se e
i
Chart 4 ) .
!Nur s e s
I
[group
Nurs e s and Nur s e s Aides showed s imi lar results
2
I n Ho spital s N and T , Licensed Vocational
sustained mo s t of the inj ur i e s with i n the employment
year s and over .
Nur s ing Aides i n both hos p i ta l s
!
!
lhad s imilar f inding s , i . e . incre a s e s in acc idents coincidin�
lw ith e i ther newne s s or long experienc e .
The data were examined to determine injury by s h i f t
/
l.tworked ( s ee pg . 9 for hour s o f shift ) . I n Ho spital N the
i
!
.l
l
[greate s t number of injuries oc curred duri ng the hour s o f
!10
l in
12
a .m. ,
2
p .m. ,
of
2
6 p . m . , and
a . m . , and
! ava i lable
11
p .m .
I n Hospital N , dur ing the
p . m . , there are f ewer s t a f f members
s ince thi s is the u sual coffee break period .
I
2
1 8 p . m . , nur s e s s tart to prepare the patient s for bed .
I
[Ho spital T the high e s t incidenc e s were at 8 a .m . ,
I! 6
p . m . , and
! thi s
!
i
i
I
11
p .m .
I
a . m . ,j
hour J
p . m . , 4 p . m . , 8 p . m . , and 9 p . m . ; whi l e
Hospital T the highe s t number o f inj uries were at 8
! 10
I
11
a .m . ,
I
At
In
p .m . ,
The s e t ime s were of intere s t s ince a t
hospital thi s i s the beginning or end o f each shift .
T he s amp l e s differed s igni f ic antly a s to the hours o f
j increased
1..
.
.. ...
i n j ur i e s
·· · · · . ...
.. ...,
.
( s ee Chart s 5 - 6 ) .
This m a y have been
1
[
_j
TOTAL
(/)
lJ:l
�
;::J
over
two
years
IJ
z
H
�
z
lJ:l
0
H
C,)
C,)
<t:
6 months
to
2 ye ars
lJ:l
C,)
�
�
re
fJ
�
�
KEY
�
ITJ
r----- I
less
than
6 months
RN
LVN
�
�
2
4
6
8
10
12
14
16
18
I
20
I
22
24
26
AIDE
I
28
I
30
32
NUMBER OF ACCIDENT - INJURY - RE PORTS
CHART 3 - NUMBER OF REPORTED ACCIDENTAL INJURI E S BY WORK EXPERIENCE
IN A NON- PROFIT HOS PITAL 1 9 6 6 - 1 9 67
>1::0"1
Cl.l
�
r:<::
:::.>
over
two
years
:'· H
�
�
z
J:;i1
Q
H
C,)
C,)
. <X::
TOTAL
6 months
to
2 years
J:;i1
C,)
z
J:;i1
·
1
�
P-1
fJ
: iii
o
·
!3:
TOTAL
less
than
6 months
2
4
6
T
8
�
�
·--
KEY
RN
f7J
li:.J
LVN
rsrsJ
�
AIDE
1
--
10
12
14
16
18
20
22
24
26
28
30
32
NUMBER OF ACCIDENT - INJURY - REPORTS
CHART 4 - NUMBER OF REPORTED ACC IDENTAL INJURIES BY WORK EXPERIENCE
IN A TEACHING HOS PITAL 1 9 6 6 - 1 9 6 7
,j:::,.
-.....]
NURSE S AIDES'
3
2
1
4
:
:
Cf.l
j:£1
�
§
�
E-1
�
e::::l
H
u
u
<I::
�
�
j:£1
�z
3
2
1
8
7
6
5
4
3
2
�
��m
�
r:m�
b\11
l'i'"'l
'·!til
I�I
j;TsJ
,•
l><rl
lim
lm1
l�.i'l
l.s'P,I
l'ri
�s
ru.1
1� .rl
LICENSED VOCATIONAL
NURSE
- •,'
s�.;r::
m R
�
A �
.. • .
· ··•
0 �
If " •
··-
•
�
#.
R�GJSTE,RED
NURSES
1
11
10
9
8
7
6
5
4
3
2
1
I I I
I
12
A
I
I
1
M.
2
3
4
5
6
7
8
9
10
11
12
A
p
. M
1
2
3
4
5
6
7
8
9
M Oll(
T IME OF DAY
11
p
No
T ime
� M
CHART 5 - REPORTED ACCIDENTAL INJURIES AMONG NURSING PERSONNEL BY HOUR OF DAY
IN A NON- PROFIT HOSPITAL 1 9 6 6 - 1 9 6 7
"""'
00
NURSES AIDE S
3
2
·�
sJ
1
tr.)
�
�
:.::::>
�
H
�
E-1
�
Q
H
u
�
�
�
�
�z
��i
'S:�
s�:
-
�;�}
"�-:.""
:-:=
�
�
.
81
7
6
5
��,
t'c
�'
��r ��:�� �
=:�-.:,·(
�
m
���
ED VOCATI ONAL
'-� ,
�
�--=
����:
REGI STERED NURSES
i? o
m
:.:�
4
3
2
1
11
10
9
8
7
6
5
4
3
2
M �
A
... M
p
p
M oC
TIME OF DAY
CHART 6 - RE PORTED ACC IDENTAL INJURIE S AMONG NURSING PERS ONNEL BY HOUR OF DAY
"'""-
' ,_,._____
., .,
IN A . TEACHING
HOSPITAL 1 9 6 6 - 1 9 67
, ...,..
·�-·---·--�-�"·• _• ., _________ -·-�• •-��""- -"'··�··--•-· ··-·•-·• ,_.,._._,..
·--·�- ·•-·
__
•�--�··-·•·•-"'"•--"''' ---·�·-�- "
••-�"-"'"'' �·w-·•-•-•••-----"·••--•··•-· •···-•-·--
,., M
- "'" '"'"""��·-_.,_,.,,�·•
�
\.0
so
I
!
i
... ...
�ue to different shi f t a s s igrunents and with c oncurrent
�ncre a s ed
I
i
hos p i ta l s .
I
s taffing and activ i ty through the day in both
The low valu e s occurred dur ing the night hou r s
MThen most patients are a s leep and staf f ing i s minimal at
I
� o th
I
�he s e
hospital s .
f indings agree with tho s e o f Gordon
i
I ( 13 )
!
I
/b oth
The s e data are pre s ented i n Char t s 5 � 6 .
( 1 2 ) , and Norwood
•
Re lationships o f days o f week were apprec i ab l e i n
hog;pital s .
( Charts 7 - 8 )
Hospital N had the highe s t
! reported daily incidence o n Tue sday s and Friday s ; o n the s e
I
! days
Regi
s tered Nur s e s had the highe s t incidence with s ix
.
! acc idents
I
l
,'! Nur s e s
had the h ighe s t inc idence on Tuesdays with four
! acc idents
!I
on Tuesday and f our on Fr iday ; Licensed Vocational
but only one on Friday s ; Nur s e s Aide s had two
acc idents on Tuesdays and f ive on Friday s .
! inc ident days were Mondays and Wednesday s .
[
Other high
On two days ,
wedne s day and S aturday , only Reg i s tered Nur s e s had acc i -
1
Po s s ibly on thes e days there are f ewer Licensed
! dents .
!
Vocational Nur s e s or Aides i n service .
I n Ho spital T
!
Ia
high daily incidence occurred on Monday and Thur sday ;
I
I in which Reg i s tered Nur s e s s u s ta ined e ight acc idents on
Monday , and n in e on Thur sday ; Licensed Vocational Nur s e s
sustained three acc idents Monday , and one o n Thu r sday ;
Aide s sus tained f iv e acc idents on Monday and f ive on
Thursday .
Annu a l ly o ther h igh acc ident experience days
were Tue sday , Wedne sday and Friday .
Regi stered Nur s e s
�-
IJ:d
, '�
ro::1
�
;::J
1-)
z
H
1-=l
�
z
ro::1
A
H
u
�
"""
0
�
ro::1
�z
�
ffi]
.
15
Cf.l
KEY
13
------
I
RN
LVN
AIDE
12
11
10
9
8
7
6
5
�J
H
IJ
t$
3
If
f'?
2
1'\.".lhh-':l'�f
H
1
I
I
S un .
I
I
I
Mon .
I
I
I
Tue s .
I
I
I
Wed .
I
I
1
Thur .
I
I
I.
Fn . .
I
I
I
S at .
I
DAY OF WEEK
CHART 7 - REPORTED ACC IDENTAL INJURI E S AMONG NURSING PERS ONNEL
BY DAY OF WEEK IN A NON- PROFIT HOS PITAL 1 9 6 6 - 1 9 6 7
Ul
1-'
KEY
� RN
�
[ill
I
18
-
17
-
16
-
.
(/)
f;l::l
H
�
;::J
IJ
z
H
15
14
13
12
�
z
11
-
10
-
H
u
u
<:t:
9
f;l::l
�
�
8
�
6
-
5
-
4
-
3
-
-
"'
"'
"�
"- � �
"- � �
1:-:-:
"- ��
H
"- lt>
1f
"- ! :' Ji
.
r-
�
-
-
I
���
�ITroil
:• ·.'•.• 'iff
U
7 I
I
S un .
I
":;::;:
��:·:
· ·..
::=
·. �
Mon .
I
I
Tue s .
I
..
. ,
..
.._ ;
� ...
'
_
I
�/·
.
.
.- .
.
I
Wed .
I
"'
"'
"'
"'
"' 75
"' j7
"' f�57
"- jf
"l�
"-�
.. . 1
.,,
I
1
Thu r .
I
-
"
;- :
· ·.
I
"
"
,...-
"
_ ; .
:O '·
"'
"'
"'
"'
I-"' : ...
"'
"' �..=��.
"' .;. :
"' ·�:·.. VJ1
..
:. · ·
�-�·
.· :
·-·
"
� 1.;."- ."":·
"' >.= �
�1
"' � �
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[".,
"
"
'""
7
1
-
-
�
f;l::l
2
.---
-
0
�z
�
-
-
LVN
AIDE
r-
-
-
!-=!
r-
I
I
"'
"'
"'
"'
"'
"' �
,�
"' ��
"' �1�
I
Fr i .
I
"
. ..
1�
"' . $ �
"' �. ·!·. $t
"' .. i t
·
·. .
.
.
.
. ..
.
I
1
Sat .
I
DAY OF WEEK
CHART 8 - RE PORTED ACCIDENTAL INJURIES AMONG NURS ING PERSONNEL
BY DAY OF WEEK IN A TEACHING HOSPITAL 1 9 6 6 - 1 9 67
-�<-··--··· -·�·>-·�-- --·-···-- -.·--��"-··-----..---···--··--�-�------·
----�----- ..·-·--·--· · -- - · --··----·-···· ·-···· - · · · "
._.....-·----· ·--------·--·--·-·-···· ·--.----� '""··-··
V1
['V
53
sus tained 11 accident s on :Friday whi le Licensed Vocational
Nurs e s did no.t report any .
The s e f indings were o f intere s t s ince indu s try
repor t s the highes t incidence on Friday s , the end of the
usual work week
(12 : 70 ) .
In thi s s tudy , F ridays were
high r i s k days but not the highe s t for the week .
Monday ,
the f ir s t day back to work for many empl oye e s , showed
incre a s ed acc idents in both hospital s .
This may be
expl ained on the ba s e s o f patient admi s s ions for surgica l ,
or medical c are with conc omm i tant incre a s e in s t a f f
act iv i ty .
The l ow reported acc ident rate for both Saturda
and Sunday may be expl ained in l i ght o f reduced patient
I
r
'
!
cens i , and a decr e a s e in nur s ing s ta f f for the s e days .
Gordon
(12 )
found that the h ighe s t daily inc idence
occurred on Sundays and Thur sdays , with 2 1 i n j u r i e s
reported on e a c h o f thos e days .
Her data further showed
a b iweekly peak , which the pre s en t inve s t igati on a l s o
demons trated .
I n j ur i e s to nur s ing per sonnel by month are shown
in Chart s 9 - 10 .
Hospital N had the greate s t number o f
in j ur i e s in the month o f S eptember with 13 ; the lowe s t
number i n February with one i n jury r eported .
Reg i s tered
Nur s e s susta i ned i n j u r ie s i n every month except February ;
Licensed Voc at iona l Nur s e s sus tained i n j u r i e s in only
f our months and Nur s ing Aides had inj ur i e s in e i ght o f
the twelve month s .
I n S eptember o f 1 9 6 7 , Hospital N
;
;--- -:r-
NURSES AIDES
2
i
4
3
2
1
Cf.l
li:J
H
p::j
:::>
1-)
z
H
H
<11
E-1
z
li:J
0
H
u
u
<11
lil
0
p::j
li:J
1=0
s
z
8
0::5-.
La
LICENSED VOCATI ONAL
NURSES
�!{. . . .
. . ..
:-
----
--
El
-----
-------···
7
·fLl
--
REGI STERED NURSES
6
5
4
3
2
1
15.
14
13
12
TOTAL ACCIDENTS
11
10
9
8
7.
6
5
4
3
2
1
J an .
F eb . Mar .
Ap r .
May
Jun .
Jul .
Aug .
S ep t .
Oct .
Nov .
Dec .
MONTH
CHART 9 - COMPARI S ON OF REPORTED ACCIDENTAL INJURIES
�--�-�--··-·-"�------·�- '"""'-'"
AMONG RN ' S , LVN ' S
AND NURSING AIDES BY MONTH IN A NON- PROFIT HOSPITAL ..1 9 6 6 - 1-;; 9 67
"'�"·�-�-•�r'""-�· ----·-----·-·•-o._�
, ·---·�------·-·--·--·�-�-•·•-"•----··--·--·----·--·••--- •----·--------··••P•'•••> ••·•�-·-··�·�•·-•·--_.-
._
,_,,,,_.,_,___
'•'''•'-'""'''''-"
'''•'''•-"'''''--·�--·•-··-�··-••-�•-•••••••-•''"''''-
Ul
�
5f
H
I'
>'J
Cfl
�
1;2
:;::J
2
H
�
z
�
t=:l
H
u
u
<tl
�
p::j
�
�z
��
2
1
8
,,
<
LICENSED VOCATIONAL
Gl..
NURS E S
I]:·::;:
��
... .
1'01
f0 fill
:�:
•::..
�
i
m;
:-.
.. · '
�l
. .
m
Pill
PB
REGISTERED NURSES
7
6
5
4
3
2
1
12
11
10
9
8
7
6
5
4
3
2
1
TOTAL ACCIDENTS
- - - - -- - - -
-
r--
-
-
r---
r---
-
r---
-
-
r---
-
r---
-
-
-
-
-
:
J an .
Feb .
Mar .
Ap r .
May
Jun .
Jul .
Aug .
S ep t .
Oct .
Nov.
Dec .
MONTH
CHART 1 0
-
COMPARI S ON OF REPORTED ACCIDENTAL INJURIES AMONG RN ' S , LVN ' S
AND NURSING AIDES BY MONTH IN A TE�CHING HOS PITAL 1 9 6 6- 1 9 6 7
--�-��-�----·�---···--------�--·--�-���--"-�'-""________ ,_� -----�-----�------ --------- --···---·-·····-·-
U1
U1
56
increased i t s nur s i ng staff , and bed cap a c i ty ( see p ;
29)
During thi s year S eptember 1 9 6 6 - 1 9 6 7 , construction wa s
under way which re sulted in cramped quarters and haz ardous
conditions in work are a s .
Ho spital T reported the greate s t
number of inj ur i e s in January and February with ten in
each month .
Reg i s tered Nur s e s sus ta ined s ix accidents
in January , and four in September ; Licens ed Voc ational
Nur s e s sustained two acc ident s in both month s ; Nur s e s
Aides su stained two accidents i n January and f our i n
September .
Regi s tered Nur s e s reported no acc idents in
November , Licensed Vocation a l Nur s e s reported no acc idents
in February , and no Aides reported a c c idents in May .
In
Ho spital N , cons truction o f new are a s began in S ep tember
of 1 9 6 6 and continued during the s tudy .
I n January 1 9 6 6
one phas e o f the cons truction wa s c omp l e ted and a move
from cramped quarter s to the new wing wa s accomp l ished .
The se were time s o f confus ion and contention .
Construc tion
and moving may have been a deterrent to i n j ury s ince both
ho spitals during the month o f S eptembe r had the highe s t
rates o f i n j ury .
Hospital T had the l e a s t number o f
inj ur i e s i n November and December .
P o s s ibly at thi s time
of year f ewer patients are s cheduled for surgery , or
total pati ent load i s decrea s ed due to the hol idays o f
Thank sgiving and Chr i s tma s .
Inj ur i e s in the work area are pre sented in Tab l e s
l- 2 .
The highest preval ence o f inj uri e s occurred o n the
TABLE 1
Non- Profit Ho spital Ac c ident Experience 1 9 6 6 - 1 9 6 7
INJURIES TO NURS ING PERSONNEL BY HOS P I TAL WORK AREA
kospital
,
-
Area
1
Per cent
Reg i s tered o f Total
Nur se
Cases
Lie .
Voc .
Nur se
Per cent
o f Total
Cases
Nur s e s
Aide
Per cent
Per c ent
o f Total Total o f Total
Inj uri e s
Cases
_ I!lj
•
14
0
37 . 8
0.0
5
0
62 . 5
0.0
3
1
23 . 0
7.7
22
1
38 . 0
1.7
2
6
5.3
16 . 1
1
0
12 . 5
0.0
1
0
7.7
4
6
6 .9
10 . 4
Obs
te tr ic s :
I
Labor Room
D e l ivery Room
P . Partum Care
Nur sery
2
3
2
0
5.3
8.0
5.3
0.0
0
0
0
0
0.0
0.0
0.0
0.0
1
0
0
0
7.7
o.o
o.o
o.o
3
3
2
0
5.2
5.2
3.4
0.0
� enecology
0
0.0
1
12 . 5
2
15 . 4
3
5.2
2
5.3
0
0.0
1
7.7
3
5.2
1
3.6
1
12 . 5
2
15 . 4
4
6.9
0
0.0
0
0.0
0
o.o
0
0.0
3
2
37
8.0
5.3
100 . 0
0
0
8
0.0
0.0
100 . 0
2
0
13
5.3
5
2
58
8.5
3.4
100 . 0
Medical Unit
Med . Treatment Rm .
i
i
� urgi cal
Unit
Surgical Theatre
i
o.o
'
!
Unit
:
Pediatr i c s
k ntens ive
i
i
Care Un .
� - Ray
� eneral Nur s ing Ser .
Not Reported Cases
TOTAL
o.o
100 . 0
U1
-...]
TABLE 2
Teaching Hospital Acc ident Experience 1 9 6 6 - 1 9 6 7
INJURIE S TO NURS ING PERSONNEL BY HOS P ITAL WORK AREA
i
Hospital Area
Reg i s tered
Nur s e
.h.edical
Per cent
o f Total
Cases
Lie .
Voc .
Nur se
Per cent
of Total
Cases
Nur s e s
Aide
P er cent
o f Total
Cases
Total
Inj .
Per cent
of Total
Inj ur i e s
3
0
6.5
o.o
4
0
23 . 6
0.0
3
2
14 . 3
9.5
10
2
11 . 9
2.4
Surgical Unit
purgical Theatre
4
11
8.6
24 . 0
1
0
5.8
0.0
1
2
4.8
9.5
6
13
7.1
15 . 5
Labor Room
D e l ivery Rm .
P . P art . Care
Nursery
0
4
0
0
0.0
8.6
0.0
0.0
0
0
0
0
0.0
0.0
0.0
0.0
0
2
0
0
9.5
0.0
0.0
o.o
0
6
0
0
0.0
7.1
0.0
0.0
1
2.2
1
5.8
3
14 . 3
5
6.0
2
4.4
2
11 . 8
3
14 . 3
7
8.2
1
2.2
0
0.0
0
0.0
1
1.2
3
6.5
0
0.0
0
0.0
3
3.6
17
37 . 0
8
53 . 0
5
32 . 8
31
37 . 0
46
100 . 0
17
100 . 0
21
100 . 0
84
100 . 0
Unit
Med . Treatment Rm .
pb s te tr i c s :
�yneco logy Unit
� ediatr i c s
� ntens ive Care Un .
'
X- Ray
\
Gen . Nur s ing S er .
L----��
TOTAL
-�--------�----�--- -----------�·N
-�------�-----·--------·-·,.----------------------·-·-------,--�---------�----------�--------------
U1
co
59
the Medic a l Units in Ho spital N , where nur s ing per sonnel
are requ ired to carry out a var i e ty of dut i e s invo lving
patient contac t .
The s econd h ighe s t prevalence of i n j ur i e
$
occurred t o nur s ing pers onnel in the Surg i c a l Theatre ;
probably due to the nature o f the equipment and tasks
be ing performed .
D e l ivery Rooms .
The third highe s t was in the Labor and
Both o f the s e areas requ ire nurs ing
per sonnel with var i ed s k i l l s who are abl e to mee t
emergency s ituation s .
The l owe s t preval ence o f i n j ur i e s
among Reg i st ered Nur s e s were in t h e Surgical patient care
uni t s , P o s t Partum Care , and P ediatr i c s S ervi c e s .
This
may be due to f ewer demands f or patient care in the s e
areas .
I n Ho spital T the highe s t prevalence o f i n j ury wa s
in the Surgical Theatre where Reg i s tered Nurs e s accounted
for 11 accident s and Nurs ing Aides two accidents .
Thi s i s
1
probably due to s ituations such a s s tre s s , demand s o f
phy s ic i an s , and manipu l ation o f i n s truments under which
nurs ing p er s onnel mus t operate when in this work area .
The s e cond high e s t preva l ence o f i n j ur i e s wa s among
nur s ing personnel working i n a multidi s c ip l inary area o f
the Medical Uni t .
in D e l ivery Room s .
The third high e s t prevalence occurred
Thi s might prev a i l s ince there are a
multitude of s ituations and tasks to perform .
The lowe s t
preval ence o f i n j u r i e s wa s in the Intens ive Care Unit ,
I
I
)
60
due probably to a large number o f nur s i ng per sonne l with
advanced training and avai lab le equipmen t which i s e i ther
f ixed in pos i ti on or placed for monitoring patient s '
vital s igns in emergency s ituations .
INJURIE S BY CAUSES
The mo s t common causes of inj ury are l i s ted in
Tab l e s 3 - 4 .
In Hospital N 2 4 per cent o f the inj ur i e s
were puncture s * ;
cent ,
(2)
( 1 ) Reg i s tered Nur s e s s u s t ained 3 2 . 5 per
Licensed Voc a tional Nur s e s 1 2 . 5 per cent , and
( 3 ) Nur s e s Aides 7 . 7 per cent .
Laceration s * accounted for
a total o f 1 3 . 7 per cent of the inj urie s ; being s truck by
externa l ob j ec t s * were 1 2 . 1 per cent , caught in or between
1 3 . 8 per cent and s truck against an ob j e ct accounted f or
1 3 . 8 per cent of the in j ur ie s .
The lowe s t number o f
acc idents were reported among l i f ti ng
( no t patient s )
1.7
per cent , and pushing , pul l ing , bending , twi sting 1 . 7 per
cent .
In Ho spital T s imi lar results were found ; i . e . ,
3 8 per c ent o f the total inj ur i e s were punctures .
For
Reg i s tered Nur s e s , puncture wound s accounted for 4 7 . 8 per
cent o f a l l reported inj ur i e s ; Licensed Voc ational Nur s e s
incurred 2 9 . 3 p e r cent , and Nur s e s Aide s sustained 2 3 . 8
per cent o f the inj urie s .
* S ee page 7
Lacerations accounted f or
.
TABLE 3
Non-Profit Ho spital Acc ident Experience 1 9 6 6 - 1 9 6 7
INJURIES TO NURS ING PERSONNEL BY CAUSE OF INJURY
l
i
Total
In j ur i e s
14
7.7
8
13 . 7
1
7.7
2
3.5
37 . 5
1
7.7
7
12 . 1
0
0.0
1
7.7
1
1.7
5.4
0
0.0
6
46 . 1
8
13 . 8
3
8.1
1
12 . 5
1
7.7
5
8 .6
2
5.4
1
12 . 5
0
0.0
3
5.2
7
18 . 9
0
0.0
1
7.7
8
13 . 8
0
0.0
1
12 . 5
0
0.0
1
1.7
Stat . 1
37
TOTAL
2.7
100 . 0
0
8
0.0
100 . 0
0
13
0.0
100 . 0
1
58
1.7
100 . 0
Per cent
o f total
C a se s
12 . 5
Reg .
Nur se
12
Per cent
Total Cases
32 . 5
7
18 . 9
0
0.0
1
0
0.0
1
12 . 5
� truck by Ob j ect
3
8.1
3
Pushing , Pul ling
?end ing , Twi s ting
0
0.0
�aught in or
Between Ob j ects
I
S l i p s and F a l l s
2
Burns
.
�ause o f InJ ury
:func ture
i
I
Lacerations
i
i
� i f ting Patient
i
I
'·
i
i
$truck Against
� i f ting ( not
� i s c . or not
�
I
I
Per cenil:
o f Tota l
I n j ur i e $
24 . 2 ;
Lie .
Voc .
Nur s e
1
pt . )
Nur s e s
Aide s
1
-------·---------·-·-·------·-�·-------L.��·� , ·-··-·--··-"·--·�--·�-·-------------
Per cent
o f Total
Cases
7.7
I
l
···-··-----------·-·-·-------··-�----
0"1
f-'
TABLE 4
Teaching Ho spital Accident Experience 1 9 6 6 - 1 9 6 7
INJURIES TO NURS ING PERSONNEL BY CAUSE OF INJURY
Per cent
o f Total
In j uries
Per cent
of Total
Cases
Lie .
Voc .
Nur se
Per cent
o f Total
Cases
Nur s e s
Aide s
Per cent
of Total
Cases
22
47 . 8
5
29 . 3
5
23 . 8
32
38 . 0
Lacerations
8
17 . 3
5
29 . 3
4
19 . 0
17
28 . 6
S truck by Ob j ect
0
0.0
1
5.9
2
;9 . 5
3
3.4
Lif ting Patient
1
2.2
2
11 . 8
3
14 . 4
6
7.1
Pushing , Pul l ing
Bending , Twi s ting
1
2.2
1
5.9
0
0.0
2
2.2
C aught in or
Between Ob j ects
6
13 . 0
2
11 . 8
2
9.5
10
11 . 8
S l ips and Fa l l s
3
6.5
0
0.0
2
9.5
5
8.2
Burns
1
2.2
0
0.0
0
0.0
1
1.8
S truck Agai n s t
1
2.2
0
0.0
1
4.8
2
2.2
L i fting ( not pt . )
0
0.0
0
0.0
2
9.5
2
2.2
M i s c e l laneous or
not s tated
3
6.5
1
5.9
0
0.0
4
4.6
46
IOO . O
Cause o f Inj ur:t
Reg .
Nur s e
Puncture
TOTAL
·--·-·,---��--�·�-�----·----
l]�
_lQ_Q_�D.- �--- - 2-L
_____
_J_Q_Q Q__
___ ___
__
Tota l
Inj .
.
8-4--------1-0-0-.-0----------
____________
j
1
m
N
63
2 8 . 6 per c en t o f the total injurie s ; caught in or between
ob j ects were 1 1 . 8 per cent of a l l inj ur ie s ; whi le the
sma l l e s t number were reported as burns , 1 . 8 per cent of
the total i n j urie s .
I n l i fting o f patient s , Nur s e s in
Ho spital T exper ienced twice a s many inj u r i e s a s did
Nur s e s in Hos p i ta l N , 7 . 0 per cent , a s agai n s t 3 . 5 per
cent .
The h igh rate o f punctures wa s pos s ib ly due to the
lack of c ar e taken in di spo s a l of needl e s and syringe s .
Mo s t of the injur i e s from needle punc ture s happened when
the nur s e completed an inj e ction and attempted to replace
the needle holder on the syringe .
Nordqu i s t
(47)
i
in a per s onal communication exp laine 4
that :
The mo s t important point to keep in mind are the
I t i s the one
handling of needl e s and syringe s .
mo s t f requent acc ident to nur s e s , punctured
f ingers and hand s .
She then went on to s ay :
I f the pati ent i s too large or heavy don ' t he s i tate
to get help , b e l i eve me , I speak from experience , I
had once spinal fus ion and that ' s a l l you need or
ever want .
I don ' t know i f you k now how d i f f i cu l t
i t i s t o g e t a nur s i ng p o s i tion a fter once you had
back inj ury .
Emp loyers are very skepti cal o f
nurs ing personnel that have b a d back s .
In per s on a l interviews with nur s ing per s onnel with
the ir consent the f o l lowing was found :
I would report any puncture o f a needle becau s e
o f the pos s ib i l ity o f Hepati t i s , but would not
report l aceration s , or back injurie s .
Nurs e s
are pro f e s s ional people and should n o t have
CiCd.�d��!lt.§_, _ ��<:1 if t}·1�y do , ... should not repgrt them .
64
I would only report an inj ury that would keep
me from the j ob , such a s a back or s pine inj ury .
Both Gohr
(6)
and The Argonaut Ins urance Company
{3)1
reported that in 2 3 2 par t i c i pating ho spital s ; l i f ting
patients accounted for 1 0 . 5 per cent , s l ip s and fa l l s 1 5 . 7
per cent , lacerations 1 4 . l per cent and punctures 9 . 6 per
cent o f all repor ted inj uri e s incurred by nur s e s .
In a personal communication Gohr
(48)
in 1 9 6 8
reported that in a S an Franci s c o teaching hospital , 2 7 per
cent o f all injuries to nur s ing per s onne l were puncture s ,
l
1 6 per cent were lacerations and 5 per cent of the inj uri e s!
involved being c aught in or between s ome ob j e ct .
I
!
Gordon ( 1 2 ) reported that puncture s accounted for
2 1 per cent of a l l accidents whi le being s truck by an
ob j e c t accounted for 12 per cent , and l i f ting patients
involved 10 per cent .
In Ho spital N mo s t o f the inj ur i e s incurred by
Reg i s tered Nur s e s were from needle s
glass
( 1 0 . 8 per cent ) .
( 2 9 . 8 per cent ) or
They were due to puncture by
need les a fter inj ections or whi l e opening an ampule
containing an inj ectab l e sub s tance .
Other prob lems
inc luded 8 . 1 per cent due to be ing burned by autoc l ave s ,
or being i n j ured by patients who are confus ed .
S ome 1 2 . 5
\
i
per cent o f Licen s ed Vocational Nur s e s were inj ured through
s l ip s and f a l l s on wet f loor s and 1 2 . 5 per cent were
inj ured by confused patient s .
Nur s i ng Aide s incurred
I
65
3 0 . 7 per cent of their inj ur i e s resul t i ng from bed s ide
r a i l s , 2 3 per cent by confus ed patients , and 2 3 per cent
invo lved door s .
It i s s igni f i cant that patients accounted for 1 4 . 5
per cent of the in j ur i e s to nur s ing personne l in the s e
General Non- p sychiatric Ho spita l s .
The s e inj uries were
infli cted by uncooperat ive or s edated pati ents .
In Hospital T inj uri e s incurred by Reg i s tered
Nur s e s were caused by needl e s
( 1 1 p e r cent ) , and doors
( 3 9 per cent ) , ampul e s
( 1 3 p e r cent ) .
I n j ur i e s incurred
by Licen s ed Voc ational Nur s e s were caused by needl e s
( 2 9 per cent ) , and broken g l a s s
confused patients
( 1 2 per cent) .
( 2 4 p e r c en t ) , and by
Nur s e s Aides incurred
19 per cent of the ir i n j ur i e s by needle s , 1 4 per cent by
broken glas s , and 14 per cent by confused patient s .
It i s
s igni f icant that 9 . 3 per cent o f the total in j ur i e s to
nur s e s within both ho spitals were i n f l icted by patients .
The se data are pre s ented in Tab l e s 5 - 6
In 1 9 6 8 D egan
.•
( 4 9 ) reported the mo s t preva lent
inj urie s in the Mas sachu s e tt s General Ho spital to be
perforations due to needle s , and cuts due to gla s s . In
another per sonal c ommuni cation to the author in 1 9 6 8 ,
Helen S a lmon
( 5 0 ) reported the ma j or c aus e s o f acc i dents
to nur ses in ho spital s to be from sharp ob j ec t s , such as
needle s , broken gla s s , ampul e s , s l ips and f a l l s on wet
or poli shed f loor s .
TABLE 5
Non-Profit Ho spital Accident Experience 1 9 6 6 - 1 9 6 7
INJURIES TO NURS ING PERSONNEL BY CAUSE OF INJURY
Cau s e of I n j ury
Reg i s tered
Nur se
Per cent
Total
Cases
Licensed
Vocational
Nurs e
11
1
3
2
0
3
2
4
3
0
2
1
0
1
1
0
0
3
29 . 8
2.7
8.1
5.4
0.0
8.1
5.4
10 . 8
8.1
0.0
5.4
2.7
0.0
2.7
2.7
0.0
0.0
8.1
1
0
0
0
0
1
0
0
1
0
0
0
0
0
0
1
1
3
37
100 . 0
8
Need le
Ampule
Autoclave
Beds
Wheel Chair
F loor
Hemo let or s cape l
Gla s s
Patients
Stairs
Carts
Oxygen tanks
Doors
Trac tion equip .
Cupboard s
Addre s s -Mach .
S tove
M i s c e l laneous or
Unknown
TOTAL
Nur s e s
Aide s
Per cent
o f Total
Cases
12 . 5
0.0
0.0
0.0
0.0
12 . 5
0.0
0.0
12 . 5
0.0
0.0
0.0
0.0
0.0
0.0
12 . 5
12 . 5
37 . 5
1
0
0
4
0
1
0
0
3
0
0
0
3
0
0
0
0
1
7.7
0.0
0.0
30 . 7
0.0
7.7
0.0
0.0
23 . 1
0.0
0·. 0
0.0
23 . 1
0.0
0.0
0.0
0.0
7.7
100 . 0
13
100 . 0
Per cent
o f Total
Cases
0'1
0'1
TABLE 6
Teaching Ho spital Acc ident Exper ience 1 9 6 6 - 1 9 6 7
INJURIES TO NURS ING PERSONNEL BY CAUSE OF INJURY
Reg i s tered
Cau s e o f Inj ury
Nur se
18
Need l e
5
Ampule
1
Autoc lave
1
Beds
0
Whee l Chair
F loor
2
3
Hemo let or Scapel
1
Glas s
2
Patients
1
Stairs
0
Carts
0
Cans
6
Door s
0
Cupboard s
0
Addre s s Mach .
6
M i s c e l l aneous or
Unknown
TOTAL
46
Per cent
Total
Cases
39 . 2
10 . 9
2.2
2.2
0.0
4.3
6.5
2.2
4.3
2.2
0.0
0.0
13 . 0
0.0
0.0
13 . 0
100 . 0
Licensed
Vocational
Nur s e s
5
0
0
0
1
0
0
4
2
0
1
0
1
0
1
2
17
Per cent
o f Total
Cases
29 . 4
0.0
0.0
0.0
5.9
0.0
0.0
23 . 6
11 . 7
0.0
5.9
o.o
5.9
0.0
5.9
11 . 7
100 . 0
Nur s e s
Aides
4
0
0
1
0
2
0
3
3
0
1
1
1
0
0
5
21
Per cent
of Total
Cases
19 . 0
0.0
0.0
4.8
0.0
9.4
0.0
14 . 3
14 . 3
0.0
4.8
4.8
4.8
0.0
0.0
23 . 8
100 . 0
0'\
-...)
68
INJURIES BY BODY AREA
The mo s t frequently inj ured body part s were hand s
and f i nger s .
I n Hospital N , 5 5 per c ent o f inj ur i e s
sus tained b y Reg i s tered Nur s e s were i n j ur i e s t o hands and
f inger s ; 7 5 per cent to Licensed Voc at ional Nur s e s , and
6 9 per cent to Nur s e s Aide s .
F i f ty per cent o f a l l
inj ur i e s t o nur s ing per sonnel involved i n j ur i e s t o hand s
and f i nger s .
Inj ur i e s to the trunk o f the body
( except
back ) accounted for 9 . 8 per cent of the inj uri e s .
The
back or sp ine i s f requently mentioned in many ho s p i tal s '
acc ident reports
( 6 , 1 1 , 1 8 ) but in thi s s tudy such
in j ur i e s were found to repre s ent only 6 . 6 per cent of the
total acc idents .
The s e inj ur i e s resulted from l i fting
patients or s lips and f a l l s on f loor s .
Hence , inj ur i e s
t o upper extremit i e s ac counted f o r 9 2 p e r c e n t o f a l l
inj ur i e s t o nur s ing per sonne l .
In Ho spital T , 7 4 per cent o f the inj ur i e s sustained
by nur s ing s ervic e per sonne l involved inj uri e s to hands
and f i nger s ; of the s e Regi s tered Nur s e s incurred 7 9 per
c ent , Licens ed Vocational Nur s e s 8 3 per cent and Nur s e s
Aides 5 2 p e r cent .
S houlders and arms accounted for 6 . 3
per cent o f a l l i n j ur i e s to Regi s tered Nur s e s and 4 . 8 per
cent for Nur s e s Aide s .
Inj uri e s o f the back and sp ine
comp r i s ed 7 per cent o f a l l i n j ur i e s to nur s ing servi ce
personnel .
Thi s did not agree with data from other
69
s tud ies
( 6 , 12 ) .
Poss ibly the s e c a s e s were r e ferred t o
Workman ' s Compens at ion Boards f o r determinations a n d thus
were not avai lab l e to the r e s e archer .
These data are
pres ented in Tab l e s 7 - 8 .
Gohr
( 6 ) h a s reported i n 1 9 6 7 , that body parts
most frequently inj ured among a l l hospital per sonn e l were
h and s and f inger s 3 6 . 6 per cen t , back and spine 1 7 . 6 per
c ent .
Gordon ( 1 2 ) found that hands and f ingers we re
i nvolved in 4 1 per cent of the reported inj ur i e s o f a l l
nurs ing personne l while the back and spine accounted for
2 2 per cent o f the inj uri e s .
74
I
! inj ury .
I
1
( See tab le on preceeding page )
In Hospital T there are a total o f 2 6 2 nurs ing
I
! s ervic e employees ; among the s e 1 5 4 are Regi s tered Nur s e s ,
7 5 are Licen s ed Vocational Nurs e s , and 3 3 are Nur s e s '
! Aide s .
Aga i n using the Frequency Formula the following
i
! re sults
were obtained :
TABLE 1 0
FREQUENCY AND SERIOUSNE S S OF ACC IDENT RATE S
IN A TEACHING HOSP ITAL
I
! Employee
No . of D i s ab l ing
Inj ur i e s
II
'1
Frequency
Rate
Ser iousne s s o f
Acc ident Days ,
Charged a s Los il:
I
Reg i stered
Nur s e
3
9.0
3
L icensed
Vocational
Nur se
3
19 . 2
22
Nur s e s '
Aide
5
72 . 8
6
11
20 . 3
31
Total
I n thi s report there wa s no s triking relationship
between ho spital s i z e , a s mea s ured by total nur s i ng
s ervice employment , nor the leve l of inj ury occurrence .
Genera l ly ,
the f indings support the view that the inj ury
I
I
I
I
i
!
75
frequency rate s for ho spital nur s ing s t a f f members tend
to vary dire c tly with the s i z e of the ho spital , as
mentioned by the Uni ted S tate s Department of Labor , Bureau
of Labor S tatistic s .
(18)
The pres ent data when compared to the 1 9 6 6 i n j ury
rates pub l i shed by the National Safety Counc i l
(51)
indicate that Ho spital N with its f requency rate o f 6 . 2
i s l e s s than the national average for indus try , but higher
than the automob i l e , texti le , chemi cal , or shipbui lding
i ndustrie s .
Hospita l T ' s frequency rate o f 2 0 . 3 wa s
higher than the national ave rage o f 6 . 9 for a l l indu stry ,
and further i s higher than a i r transport ' s 2 0 . 2 rate which
is considered one o f the highe st , Hospital T is s t i l l one
tenth higher .
Thi s might an swer the que stion how s a fe ly
doe s the nur se func tion and how safe i s i t to work in a
hospita l . *
However it i s more l ike ly a function of the
smal l groups invo lved .
Gohr ' s
(6)
( 52 )
s tudy of 3 2 6 ho spita l s in 1 9 6 0 showed
the average hospital i n j ury frequency rate wa s 7 . 3 4/ 1 , 0 0 0
workers whi le the a l l - indus try average f or that ye ar was
6 . 0 4/1 , 0 0 0 worker s .
May ( 5 3 ) reported that in Maimonid e s Ho spital in
Brook lyn the frequency rate wa s 1 6 . 9 in 1 9 6 0 ;
1 9 6 1 and 3 . 3 in 1 9 6 2 .
* See P � · 1
2 0 . 0 in
He stated thi s reduction wa s
76
accomp l i shed by actions of a s a fety c ommittee and through
health education .
Further s tudy o f the work load and s t a f f ing o f
emp loye e s might show a better relationship to the activity
at the time o f inj ury and work load o f emp loye e s .
Better
reporting procedure s would permit accurate a s s e s sments
o f both frequency and s ever i ty rate s for employe e s , whi ch
I
I
I
,!I
wi l l corre ctly identify haz ardous activi t i e s and procedure s !
whi ch might show a need for health education , or rede s ign
o f work are a s , or a b a s i c reevaluation i n terms o f
engineering , or human f actor s analy s i s .
Another pos s ib i l i -
ty i s app l i c ation o f sys tems analy s i s to thi s continuing
problem o f nur s ing s ervi ce acc idents and i n j ur i e s .
S tudies of more than one year may a l s o be valuable .
i
i
I
/
I
77
CHAPTER V
SUMMARY AND CONCLUS I ONS
, .
The research d e s cr ibed in thi s s tudy wa s a
des criptive ep idemiological inve s t igation o f nur s ing
personne l acc idents in a non-profit and teaching ho spital
in Los Ange les , C a l i f ornia ; whi ch have received l i ttle
The prob lem
attention from the s c i enti f i c c ommuni ty .
concerned the relationships among s e lected factors
su spected o f contr ibuting to accidents among nur s i ng
per sonne l i n a ho spital environment .
To determine the cau s e and e f f e c t o f acc idents in
a hospital environment , the inve stigator analyzed approx­
imately two hundred indu s tr i a l inj ury repor t s that were
f i led by the nur s ing personne l of both hospital s .
thi s s tudy report i ng o f acc idents wa s
In
f ound to be in­
comple te , and much o f the data c o l l e c ted _ had to be
de le ted .
Re sults s howed that 1 4 2 a c c idents occurred
because o f care l e s sne s s , or short cuts taken by a per son
who skips over important l i ttle procedure s that are
nece s s ary for her own prote cti on .
The data were examined to s ee i f any o f the
var i ables could identify c au s e and e f fe c t relationship s
o f hospital acc idents among nur s ing s ervi c e personne l .
The inve s ti gator found that acc idents to nur s i ng personne l
are caus ed
}::)y
J:1o t
___
__ _
�:t"l:� _ ::>_i.:t"l:��-� !_�<:: :t:.?E_, �1:1:!
..
...
� comb i n a t:�'?l:_l
_
78
o f s igni f i c ant one s ;
such a s age , t ime o f day , days o f
week , month , work are a , and patient load .
Analys i s o f the above data c o l l e c ted dur ing the
, .
inve s tigation showed the f o l l owing r e s u l t s :
1.
Both ho spita l s employed mos t o f the nur s e s
among ages 2 1 - 3 5 ; therefore more acc idents
occur among the se individua l s .
2.
Accidents oc cur throughout the day , but
there is an incre a s e in accidents during
the morning hour s which has i t s highe s t
periods at 1 0 to 1 1 a . m . and at t h e end
of each shift in both ho spita l s .
Further,
high inc idence o f acc idents were reported
in the early morning and mid-evening .
No
acc idents were reported at 4 a . m . in e i ther
hospita l .
3.
In j ur i e s were reported each day o f the week ,
but Tue s day and Fr idays were the highe s t
incident days in Hospital N wh i l e Monday and
Thur sday were the days the large s t number o f
acc idents occurred i n Ho spital T .
4.
Data from thi s s tudy showed that January and
September had the greate s t number of inj ur i e s
whi l e D ecember h a d the fewe s t number reported .
79
5.
Repor t s on work area indicated that the
Surgi c a l Theatre and Medi c a l Unit accounted
for the large s t percentage of acc idents .
Data in Table s 3 - 4 and 7 - 8 indicate d i f ferenti a l s
in inj ury r i sk among Regi s tered Nur s e s , Licensed
Vocational Nur s e s and Nur s e s Aide s .
The Regi s tered Nur s e
i s more l ik e ly t o sustain inj uri e s t o hands and f inger s
f rom needle puncture s , and lacerations f rom ampule s ;
while the L icensed Voc ational Nur s e and Nur s e s Aide are
more l ikely to sustain i n j ur i e s to the ir back or spine
from l if ti ng patients ,
shoulders and arms from ob j ec t s or
being punctured or cut when clean ing equipment .
The s e
d i f feren c e s may re f l e c t the occupational t a s k s per formed
by the nur s ing s t a f f in a ho spital environment .
There appe ars to be very l i tt l e d i f ference between
nur s e s working l e s s than 6 month s , or 2 months to 2 year s ,
or 2 years and over a s to accident rate s in Hospi tal T ,
but in Hos p i ta l N there was an incre a s e o f a c c ident s among
nur s e s working 2 years or more .
The s e data and the spec i f i c r e s earch requirements
are des cribed in detai l in the ma in body o f thi s s tudy .
I t i s imprac tical to review a l l the maj or prob lem area s ,
a s indicated by the cau s e and e ff e c t r e l ationships o f
acc ident s , b u t the f o ll owing condition s may a l s o b e
caus e s :
80
1.
Punc ture s by needle s , hemo l e t s , and s cape l s .
2.
Lacerations from ampule s , and gla s s .
3.
S l ips and fal l s on floor s .
4.
S pra ins and d i s l oc ations from l i fting patient s .
Reports o f nur s ing per sonnel acc idents s howed that
dur ing the years 1 9 5 8 to 1 9 6 7 in ho s p i t a l environments
nur s ing per s onne l s u s tained thou sands o f accident s , and
that inj ury frequency rates for hospi tal s tend to vary
directly with the s i z e of the ho s p i ta l .
(18)
The acc ident
frequency rate s of the two ho s p i t a l s in thi s s tudy varied
f rom 6 . 2 to 2 0 . 3 during the period of September 1 9 6 6 to
S eptember 1 9 6 7 .
A s tudy o f 4 , 6 8 0 ho s p i t a l s part i c ipating
in a s tudy acro s s the country with s t a f f s of the s ame
average number s a s the two ho s p i ta l s in th i s s tudy showed
an average frequency rate o f 8 . 6 for the year 1 9 5 3 .
(18)
The s e acc ident stat i s t i c s des cribe only a minor aspect o f
the prob l em , however , b e c a u s e the va s t maj ority o f nurs ing
per sonne l who were i n j ured experi enced only a few minute s
to an hour o f f the j ob .
Be s ides the forego ing , a more detai led epidemi clogical s tudy o f the re lation ship s o f several s e lected
factors may indicate that the inf luence of other factors
such a s , emoti onal , no i s e , and he alth s tatus may inf luence
the occupational acc ident experi ence of nur s ing per sonne l .
The i s sue s e ems to be a comp lex i nteraction among
s everal fac tors and further s tudy to determine other means
of cau s e and e f fect are i nd i cated .
B IBLIOGRAPHY
81
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85