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chapter 12 | Promoting a Healthy Workplace 185 CikguOnline
ergonomic hazards. Under this clause, employers ■ Align the keyboard so that your forearms,
must keep their workplaces free from recognized wrists, and hands are aligned parallel to the
serious hazards, including ergonomic hazards. This floor. Do not bend the hands back.
requirement exists whether or not there are voluntary ■ Position the mouse directly next to you and on
guidelines (osha.gov/ergonomics/FAQs-external). the same level as the keyboard.
The ANA, supported by the Johnson & ■ Keep thighs parallel to the floor as you sit on
Johnson Foundation, has begun a campaign enti- the chair. Feet should touch the floor, and the
tled “Handle with Care.”This initiative is aimed at chair back should be ergonomically sound.
preventing potentially career-ending back and ■ Vary tasks. Avoid long sessions of sitting. Do
other musculoskeletal injuries among nurses. not use excessive force when typing or clicking
Health-care facilities that have invested in these the mouse.
assistive patient handling programs report cost sav- ■ Keep fingernails short, and use fingertips when
ings in thousands of dollars both for direct costs of typing.
back injuries and lost workdays (nursingworld.org/
handlewithcare/factsheet). In addition, assistive Impaired Workers
patient handling equipment improves the quality
care of patients. Dr. de Castro, senior staff special- Substance Abuse
ist for occupational health and safety at the ANA,
Sue had been a nurse for 20 years. Current marital
observes that such equipment:
and family problems were affecting her at work. To
■ Improves the safety of the patient by decreasing ease the tension, she took a Xanax from a patient’s
the potential for manual patient-handling mishaps medication drawer. This seemed to ease her tension.
■ Increases patient comfort by taking away the She continued to take medications, working her way
human element of potentially awkward or force- up to narcotic analgesics.
ful handlings Bill had begun weekend binge-drinking in col-
■ Restores patient dignity, especially in situations lege. Ten years later, he continues the habit several
when difficult handling situations impede on a times during the month. He does not believe he is an
person’s privacy or self-esteem (de Castro, 2004) alcoholic because he can “control” his drinking. After
he begins showing up at work hung over and mak-
The investment in a safe patient-handling program
ing medication errors, he is fired for the medication
may seem daunting due to the cost of equipment
errors. At the exit interview, no mention is made of
such as mechanical lifts,transfer aids,and ergonom-
his drinking problem. The agency feared a lawsuit
ic beds and chairs. However, the cost savings in
for defamation of character.
time, reduction of injuries, and lost workdays—as
Mr. P., the unit manager, has noticed that Ms. J.
well as the improved quality of patient care—make
has been late for work frequently. She arrives with
this a sound return on investment.
a wrinkled uniform, dirty shoes, unkempt hair, and
Repetitive Stress Injuries broken nails. Lately she has been overheard making
Repetitive stress injuries (RSIs) have been called the terse remarks to patients such as, “Who do you think
workplace epidemic of the modern age. RSIs usually I am—your maid?,” and spends longer and longer
affect people who spend long hours at computers, periods off the unit. The floor has a large number of
switchboards, and other worksites where repetitive surgical patients who receive intramuscular and
motions are performed. The most common RSIs oral medications for pain. Lately, Ms. J.’s patients
are carpal tunnel syndrome and mouse elbow. As continue to complain of pain even after medication
technology expands in health-care facilities, the use administration has been charted. Ms. J. frequently
of computers increases for all health-care personnel. forgets to waste her intramuscular narcotics in front
Badly designed computer workstations present the of another nurse. Mr. P. is concerned that Ms. J. may
highest risk of RSIs. Preventive measures (Krucoff, be an impaired nurse.
2001) include the following:
As nursing education moved from the untrained
■ Keep the monitor screen straight ahead of you, nurse—embodied in the character of Sairey Gamp
about an arm’s length away. Position the center in the Dickens novel Martin Chuzzlewit—to the
of the screen where your gaze naturally falls. educated Florence Nightingale model, nurses were