NursIng EMPLOYMENT TRENDS AND ISSUES Topics: Collective Bargaining Union: Mandatory Overtime: STOP Mandatory Overtime.

Bad for Nurses, Worse for Patients Migration Problems: Nurses on the Move: Global Migration Nursing Shortage: The Anatomy of Nursing Shortage Sexual Harassment: Breaking the Silence Conflict in the Workplace: Conflict in the Workplace? Hospitals are Not Soap Ope ra Sets Workplace Violence: Nurses: How Safe Are You? Ergonomic Hazards: Use your brain, not your back. Fix the job, not the worker. W ork smarter, not harder. Bioterrorism: Are we ready to respond? Assessing Nursing's Bioterrorism Prepared ness Volunteerism: Mr. And Ms. Volunteer... and the Winner is...PHILIPPINES! Collective bargaining is a process of negotiating an agreement regarding the ter ms and conditions of employment through a system of shared responsibility and de cision-making between labor and management. WHAT ARE THE FOUR ESSENTIAL ELEMENTS OF COLLECTIVE BARGAINING? Legal: Collective bargaining is a process of negotiating an agreement. Economic: Its contents specify the terms and conditions of employment Political: The agreement is a product of a negotiation between labor and managem ent. Moral: It involves a system of shared responsibility and decision- making. WHY IS COLLECTIVE BARGAINING AN IMPORTANT ASPECT OF LABOR-MANAGEMENT RELATIONS? Collective bargaining is important because it promotes the rights and ideals of labor. Right to life. Right to work. Right to equity. Right to participate. Industrial peace. WHAT ISSUES ARE DISCUSSED IN COLLECTIVE BARGAINING? Two kinds of issues are generally discussed in collective bargaining: Economic Issues 1. Check-off 2. Working days and hours 3. Salary increases / allowances / bonuses / profit-sharing 4. Leaves 5. Overtime / holiday/ shift premiums 6. Employee welfare Non-Economic Issues 1. Union recognition / coverage 2. Definition of employees category 3. Union security 4. Rights and responsibilities of parties 5. Security of tenure 6. Seniority 7. Grievance machinery 8. Arbitration 9. Job evaluation and wage and salary administration

10. Employee services 11. No strike / no lockout Collective Bargaining Union was particularly useful for nurses because it provid ed a tool to demand a voice in decisions affecting them and their job security ( Phillips, 2003). Such demands continue to be relevant in today's health care env ironment (Forman & Davis, 2002). In todays health care environment, collective bargaining is proving to be one of the most effective ways to: Protect patients from inadequate and unsafe care. Ensure that nurses have fair pay, good benefits, and safe/satisfactory working c onditions. Establish effective channels of communication with those who make decisions that impact nursing practice. Advance nurses professional growth and development. Mandatory Overtime - Bad for Nurses, Worse for Patients REGULARLY SCHEDULED WORK HOURS" Including pre-scheduled on-call time and the time spent for the purpose of commu nicating shift reports regarding patient status necessary to ensure patient safe ty, shall mean those hours a nurse has agreed to work and is normally scheduled to work pursuant to the budgeted hours allocated to the nurses position by the he alth care employer. Overtime is defined as the hours worked in excess of an agreed upon, predetermin ed, regularly established work schedule, as identified by contract; usual schedu ling practices; policies or procedures. Mandatory overtime is identified as a workplace issue and a patient safety issue . Mandatory overtime is the practice of hospitals and health care institutions t o maintain adequate numbers of staff nurses through forced overtime, usually wit h a total of twelve to sixteen hours worked, with as little as one hour s notice . In the past, mandatory overtime in healthcare was used only in response to unfor eseen emergencies in acute care hospitals. Since the mid-1990 s, hospitals have used mandatory overtime as standard practice in an attempt to cut costs by not h iring additional nurses. Mandatory overtime puts patients at risk. The highly-regarded Institute of Medicine has reported that as many as 98,000 pa tients die from medical errors in hospitals every year. It is clear that exhaust ed workers will be more prone to errors in judgment or lack of attention to deta il. Medication Errors The Institute of Medicine s report To Err is Human: Building a Safer Health Syst em (1999) states the deaths from medication errors that take place both in and o ut of hospitals, more than 7000 annually. In a separate report, investigation by the Chicago-Tribune states that since 1995, at least 1,720 hospital patients ha ve died and 9,548 others have been injured because of mistakes made by RN s acro ss the country (Associated Press,2000). Quality Patient Care "Once a shift exceeds twelve consecutive hours, acute fatigue sets in. A worker may still be able to perform routine tasks, but his brain waves exhibit a patter n of stage one alpha sleep. Errors made in this stage are frequently major, sinc e the worker tends to perform the opposite of the correct action." (Journal of O ccupational Health and Safety, 1989) Legal Liability Nurses practice under each state s Nurse Practice Act, which govern nursing prac tice. Most nurse practice acts state that nurses are held accountable for the sa fety of their patients. Thus, if a nurse accepts a patient assignment and someth

ing untoward happens to that patient, the nurse is liable under her license. Onc e a nurse accepts an assignment, her license can be in jeopardy if she is unable to deliver safe patient care. Mandatory overtime forces nurses out of the profession. ANA s recent study, l Setting (3/2000), Increase in Decrease in Decrease in Increase in Increase in Decrease in Decrease in Increase in

The American Nurses Association (ANA) has taken the position that regardless of the number of hours worked, each registered nurse has an ethical responsibility to carefully consider his/her level of fatigue when deciding to accept any assig nment extending beyond the regularly scheduled work day or week, including manda tory or voluntary overtime assignment. Nurses on the Move: Global Migration Ravenstein ( 1885) father figure of migration defined a migrant as a person who came as a settler not as a tourist or visitor in to another country. Typology of Nurse Migrant (Kingma 2006) Economic Migrant Quality-of-Life Migrant Career-Move Migrant Survival Migrant Partner Migrant Adventurer Migrant a) Holiday Worker b) Contract Worker

Migration Flows Traditionally, international nurse migration tended to be a NorthNorth or SouthSo th phenomenon (Dugger 2006; WHO 2006). The directional flow of nurses may change over time. Established flows in SouthNo rth migration are also subject to change as more source countries enter the inte rnational labor market. It is estimated that 30,000 nurses and midwives educated in sub-Saharan Africa a re now employed in seven OECD countries, specifically, Canada, Denmark, Finland, Ireland, Portugal, UK, and US (WHO, 2006). Some nurses take an indirect route to their final destination, using stops along the way to build up their skills and credentials. For example, forty percent of the surveyed Filipino nurses employed in the UK ha d previously worked in Southeast Asia and the Middle East (Opiniano, 2002). Forty-three percent of working international nurses surveyed in London were cons idering relocating to another country, in many cases to the US (Buchan et al., 2 005). This nurse migration has occurred primarily as a result of push/pull factors. Push factors are those things that push or drive a nurse to want to leave their country to go to another. Push factors identified by Awases, Gbary, & Chatora ( 2003) include economic factors (unsatisfactory remuneration), institutional fact ors (lack of proper work facilities and equipment), professional factors (lack o f career development options) and political factors (socio-political instability ). Pull factors are those things that draw the nurse toward a different country. Pu

Nurse Staffing and Patient Outcomes in the Inpatient Hospita medication errors safe, quality patient care patient satisfaction hospital length of stay mortality and morbidity recruitment of new nurses retention of nurses legal liability issues against nurses

ll factors encouraging nurse migration include opportunities for professional de velopment, aspirations for a better quality of life, personal safety, improved p ay and learning opportunities (Kingma, 2001; Buchan, 2001). Most of countries are dependent on foreign nurses

The emigration of qualified employees puts the health care system at risk in the home countries

Pros and Cons of International Nurse Migration INTERNATIONAL NURSE MIGRATION PROS Educational opportunities Professional practice opportunities Personal and occupational safety Better working conditions Improved quality of life Trans-cultural nursing workforce (e.g. racial and ethnic diversity) Cultural sensitivity/competence in care Stimulation of nurse-friendly recruitment and contract conditions Personal development Global economic development Improved knowledge base and brain gain Sustained maintenance and development of family members in the country of origin CONS Brain and/or skills drain Closure of health facilities due to nursing shortages in a given area Overwork of nurses practising in depleted areas Potentially abusive recruitment and employment practices Vulnerable status of migrants Loss of national economic investment in human resource development The growing number of unemployed Filipino nurses, estimated at more than 200,000 by the Department of Health as of March 31. Philippine Nurses Association estimates that about 287,000 nurses are unemployed or underemployed in the country as of July 2011. In South Africa, there are 32,000 nurse vacancies in the public sector and 35,00 0 registered nurses are either inactive or unemployed (OECD 2004). In general, migration is increasingly seen as a means for development and a bett er distribution of global wealth (IOM 2003).

In London, more than 50 percent of the surveyed international nurses (75 percent from the Philippines, 70 percent from South Africa) reported that they regularl y send remittances to their home country. Fifty percent of Filipino and South Af rican nurses remit 26 percent or more of their income (Buchan et al. 2005). In major nurse exporting countries, total recorded remittances constitute a sign ificant proportion of the gross domestic product (GDP), e.g., 10 percent for the Philippines, 14 percent for Jamaica, and 8.5 percent for Uganda (IMF 2003). Brain drain, brain gain, brain waste and brain circulation are all possible scen arios that result from nurse mobility. Nursing shortage refers to a situation where the demand for nursing professional s, such as Registered Nurses (RN), exceeds the supply, either locally (e.g. with in a given health care facility), nationally or globally. It can be measured, fo r instance, when the nurse-to-patient ratio, the nurse-to-population ratio, or t he number of job openings necessitates a higher number of nurses working in heal th care than currently available. almost 4.3 million nurses, physicians and other health human resources worldwide - reported to be the result of decades of underinvestment in health worker educ ation, training, wages, working environment and management. Jobless Nursing Grads, No Nurses in Govt Hospitals Spell Criminal Neglect - Drilon BY INQUIRER.NET ON August 10, 2011 Senator Franklin Drilon professed surprise about Onas revelation, and noted that the DOH has a P1 billion allocation for unfilled positions. We were told that there are 287,000 who are not employed in the nursing professio n, meaning that there are nurses who end up in call centers, in doctors clinics and while employed, they are not employed in their profession, and some are just plainly unemployed, he said at a press conference.

According to the International Council of Nurses (2009), Germany and the Netherl ands lack about 13,000 nurses while about 18,000 nurses in France leave the hosp itals every year (Oulton, 2009). In Jamaica, as stated by Lowell, Findlay, & Stewart (2009), more than twenty per cent of specially trained nurses are lost each year (as cited in Oulton, 2009). In Africa, there is a shortage of about 600,000 nurses (Oulton, 2009). Dugger (2008) states that Uganda has one to two nurses per 100 patients, a situ ation that is not uncommon in many African countries (Oulton, 2009). A nurse from the main referral hospital in Lesotho reports that 70 nurses tend t o almost 3,400 patients, an average of close to 50 patients per nurse (Associate d Press 2006). In Malawi, a major hospital reported that half of its nursing posts were vacant

, and only two nurses were available to staff a maternity ward with 40 births a day (ICN 2004). In Zimbabwe, the Minister of Health Care and Welfare estimates the nurse to pati ent ratio to be 1:700 but researchers found that nurses working in provincial ho spitals may work with a nurse to patient ratio of 1:522 while in district hospit als the ratio may be as high as 1:3,023 (Chikanda 2005). Such ratios cannot supp ort excellence in health care. Nursing shortages have been linked to the following effects: Increased nurses patient workloads Increased risk for error, thereby compromising patient safety Increased risk of spreading infection to patients and staffs Increased risk for occupational injury Increase in nursing turnover, thereby leading to greater costs for the employer and the health care system Increase in nurses perception of unsafe working conditions, contributing to inc reased shortage and hindering local or national recruitment efforts Generational Issues in Nursing: Impact on Image Current Generation in Nursing Traditional Born 1930-1940 Baby Boomers Born 1940-1960 Generation X Born 1960- 1980 Generation Y Born 1980- Present The Traditional, silent or mature generation, born 1930-1940. This generation is important now because of its historical impact on nursing but is not currently in practice. This group of nurses was hard working, loyal and family-focused and felt that the duty to work was important. Many served in the military during Wo rld War II. This period was prior to the womens liberation movement. Baby Boomers, born 1940-1960. This generation is currently the largest in the wo rk arena, is also the group moving toward retirement. This is the generation tha t grew up in the time of major changes:womens liberation, civil rights movement and the V Generation X (Gen X), born 1960-1980. The presence of Generation X, along with G eneration Y, is growing in nursing. They are more accomplished in technology and very much involved with computers and other advances in communication and infor mation; they have experienced much change in these areas in their lifetimes to d ate. These nurses want to be led, not managed and they have not yet developed hi gh levels of self-confidence and empowerment. Generation Y(Nexters, Millennials) born 1980-present: This generation primarily entering nursing now, though second-career students and older students are enter ing the profession. Millenials characteristics are optimism, civic duty, confiden ce, achievement, social ability, morality and diversity. Current and Projected Shortage Indicators On April 1, 2011, the U.S. Bureau of Labor Statistics (BLS) reported that the he althcare sector of the economy is continuing to grow, despite significant job lo sses in recent months in nearly all major industries. Hospitals, long-term care facilities, and other ambulatory care settings added 37,000 new jobs in March 20 11, the biggest monthly increase recorded by any employment sector In October 2010, the Institute of Medicine released its landmark report on The F uture of Nursing, initiated by the Robert Wood Johnson Foundation, which called for increasing the number of baccalaureate-prepared nurses in the workforce to 8 0% and doubling the population of nurses with doctoral degree.

The average age of the Registered Nurse is climbing According to the 2008 National Sample Survey of Registered Nurses released in Se ptember 2010 by the federal Division of Nursing, the average age of the RN popul ation in 2008 was 46 years of age, up from 45.2 in 2000. With the average age of RNs projected to 44.5 years by 2012, nurses in their 50s are expected to become the largest segment of the nursing workforce, accounting for almost one quarter of the RN Changing demographics signal a need for more nurses to care for our aging popula tion. According to the July 2005 report, Nursing Workforce: Emerging Nurse Shortages D ue to Multiple Factors , a serious shortage of nurses is expected in the future as demographic pressures influence both supply and demand. The future demand for nurses is expected to increase dramatically as the baby boomers reach their 60s and beyond. According to a May 2004 report, Who Will Care for Each of Us?: America s Coming Health Care Crisis, released by the Nursing Institute at the University of Illin ois College of Nursing, the ratio of potential caregivers to the people most lik ely to need care, the elderly population, will decrease by 40% between 2010 and 2030. Demographic changes may limit access to health care unless the number of n urses and other caregivers grows in proportion to the rising elderly population. Impact of Nurse Staffing on Patient Care In a study publishing in the April 2011 issue of Medical Care, Dr. Mary Blegen a nd her colleagues from the University of California, San Francisco found that hi gher nurse staffing levels were associated with fewer deaths, lower failure-to-r escue incidents, lower rates of infection, and shorter hospital stay. Insufficient staffing is raising the stress level of nurses, impacting job satis faction, and driving many nurses to leave the profession. In the March-April 2010 issue of Nursing Economics, Dr. Peter Buerhaus and colle agues found that more than 75% of RNs believe the nursing shortage presents a ma jor problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patient. Almost all surveyed nurses se e the shortage in the future as a catalyst for increasing stress on nurses (98%) , lowering patient care quality (93%) and causing nurses to leave the profession (93%). In an article published in the June 2009 issue of Health Affairs titled Hospitals Responses to Nurse Staffing Shortages, the authors found that 97% of surveyed hos pitals were using educational strategies to address the shortage of nurses. Spec ific strategies include partnering with schools of nursing, subsidizing nurse fa culty salaries, reimbursing nurses for advancing their education in exchange for a work commitment, and providing scheduling flexibility to enable staff to atte nd classes. The paper ends with a call for more public financing support for the nursing educational system to expand student capacity. In February 2008, Johnson & Johnson launched the Campaign for Nursing s Future, a multimedia initiative to promote careers in nursing and polish the image of nu rsing. This multimillion dollar effort includes television commercials, a recrui tment video, a Web site, brochures, and other visuals.

There is a nursing recruitment initiative and nursing workforce development prog ram for residents of the United States originally from foreign countries, who we re professional nurses in their countries but are no longer in that profession i n the United States. This initiative helps these nurses get back into the nursin g profession, especially getting through credentialing and the nursing board exa ms. The original model was developed in 2001 at San Francisco State University i n cooperation with City College of San Francisco and there are centers in many cities, such as Los Angeles, San Diego, and Boston, Massachusetts. Breaking the Silence Defined as unwelcomed sexual advances, request for sexual favours and verbal or physical conduct of a sexual nature. Harassing behaviour include but are not limited to the following: Verbal sexual advance determined by the recipient as unwelcome. Sexually oriented comments about someones body, appearance and/or lifestyle. Offensive behaviour such as, leering, ridicule or innuendo. Display of offensive visual materials. Deliberate unwanted physical contact (Gardner & Johnson, 2001). Sexual harassment in the workplace is an unlawful exercise of power. The harasse r uses his or her authority, or power to belittle, humiliate, refuse to promote, or demote someone (Hamlin & Hoffman, 2002). Quid pro quo -- something in exchange for something else (Garner, 1999): Unwelcome sexual advances, request for sexual favors, and other verbal or physical conduc t of a sexual nature constitute harassment when a submission to or rejection of such conduct is used as the basis for employment decisions (Gardner & Johnson, 2 001). Sexual harassment is a major problem in healthcare; it is a pervasive, disparagi ng, social, legal and ethical problem. It is a form of sex discrimination that a ffects both sexes, although, the majority of sexual harassment is perpetuated by men against women, and few working women have not experienced sexual harassment . Only ten percent of the sexual harassment complaints are filed by men and resear chers theorize that this may reflect that fewer women hold powerful positions or men may be embarrassed and fear humiliation if they file (Fiedler & Hamby, 2000 ). The detriment to the victim involves both short- and long-term psychological, ps ychosocial, and occupational consequences. Emotional distress may be manifested by anxiety, depression, post traumatic stress disorder (PTSD), and substance abu se. Many victims experience increased absenteeism, burnout, job change, interper sonal conflict, and/or impaired intimacy and sexual functioning. An unsafe work environment leads to compromises in patient care; for instance, w hen the harasser is a colleague, valuable patient care information may not be co mmunicated. Also, a distressed individual may have difficulty concentrating, in turn, missing important patient information (Valente & Bullough, 2004) The New York State Nurses Association recommends that:

Every institution have a written policy statement (zero tolerance), which includes the following elements: Purpose, who is covered, legal definition and guidelines, responsibilities of em ployees and management, implementation procedure, and the grievance procedure to be followed by the employee and employer. Non-retaliation statement. Specifics on how complaints should be made and how confidentiality will be ensur ed. Employers provide initial and annual educational programs that define sexual har assment and communicate the institutions position, policy, and procedure for repo rting. Registered nurses develop skills to identify and prevent sexual harassment by: Taking immediate verbal and/or physical action to reject sexual harassment behav iors. Reporting instances of sexual harassment promptly. The ANA Web site offers this advice to nurses subjected to sexual harassment: Confront the harasser, and make it clear the attention is unwanted. Report the harassment to your supervisor or to a higher authority if your superv isor is the harasser. Go to a government agency or the courts if necessary. Document the harassment promptly in writing. Seek support from friends, relatives, colleagues or your state nurses associatio n Conflict in the Workplace? Hospitals are Not Soap Opera Sets Everyone has to deal with conflict: both in the workplace and personal lives. Nu rses are unique in that they experience workplace conflict not just among collea gues and professionals in the workplace, but also as a regular component of prov iding patient care. The potential for conflict within the workplace is practically unlimited, when o ne considers the variety of different personality types and communication styles , cultural backgrounds, gender, age, personal experiences and beliefs that each member of the team contributes. Ignoring workplace conflict sets destructive forces in motion that decrease produ ctivity, spread the conflict to others, and lead to lessened morale (Wilmot & Hoc ker, 2007). Workplace Conflict Is Expensive Although workplace conflict is the largest reducible employer cost, it remains l argely unaddressed. Workplace conflict is a decisive factor in more than 50% of employee departures. Employee turnover results in costs related to recruiting training, lower product ivity of new hire, and secondary morale effects on managers, peers and subordina tes. Unresolved workplace conflict can end up in litigation. Workplace conflict significantly increases personal stress levels. The total value of lost work time due to stress is estimated to be over $1.5 bil lion annually. Bullyingin Nursing Nursing and Bullies Tell Tale Signs of Workplace Bullying The following examples will help nurses determine if they are being bullied (Fel

blinger, 2008;Longo & Sherman, 2007; Murray,2008a;): Despite a nurses attempt to learn a new procedure or complete a task, the supervi sor is never pleased. A nurse is called to unplanned meetings with the supervisor (and perhaps others who are witness or participants) where only further degradation occurs. The workplace bully continually undermines and torments a nurse who is trying si mply to do his or her job. Despite having expertise and a history of excellence in the area of practice, a nurse is accused of being incompetent. No matter how many times a nurse asks for help, and the senior leader tells the nurse action will be taken, the bully continues to interfere with the nurses job performance. The bully screams or yells at the nurse in front of others to make him or her lo ok bad. Colleagues are told to stop interacting with a nurse at work and in social setti ngs. A nurse constantly feels stressed and fearful waiting for additional negative ev ents. When a nurse asks an organizational leader for help, he or she is told to get a t ougher skin or work out your differences. Co-workers and senior leaders share the nurses concern that the bully is a proble m but they take no action to address the concern in the workplace. Nurses Bullying Nurses Nurses, at times, can be no different than schoolgirls on the playground; they l ike to gossip. This can lead to the outcasting of a nurse. The main form of nursing bullying is the gossiping that takes place between nurs es about another nurse. For whatever reason, nurses feel the need to gossip. Eve ryone gossips, it s human nature. But the problem is, when nurses do it in the w ork place, it can affect the way a nurse performs under pressure and a patient s life may be at stake. Berating and belittling other nurses affects the way thos e nurses perform their day-today tasks. Without getting too specific, some common forms of nurse-to-nurse bullying inclu de: Harsh words and back-stabbing -This is talking bad or negatively about one nurse behind his or her back. Accusations -This is accusing a nurse of not administering a treatment for whate ver reason. Being mean, in general- This can be anything from making fun of the particular n urse s hospital scrubs or just belittling the nurse. Doctors Bullying Nurses Doctors and managers have always been bullies, this is how they stay in charge a nd make sure everything gets done; sometimes it gets taken too far. Belittling a nurse in front of coworkers, patients and even family members can have dire eff ects. This can lead to treatments not being administered properly and/or the neg lect of day-to-day activities as well as lowered job satisfaction which can lead to not wanting to come to work. Remedial action: Some health organizations are seeking to educate staff and health care team memb ers on how to improve social interactions, proper business etiquette, and foster positive people skills in the work environment.

Nurses: How Safe Are You? Violence has been a constant threat to nursing in the workplace. Incidents have rarely been reported because of the poor public image it would create for the he alth care facility. Violence in the workplace is best described as existing on a continuum from verb al/ emotional abuse to physical assault and homicide. In health care settings, w orkplace violence can be perpetrated by patients, families, friends, visitors, c o-workers, physicians, supervisors and managers Myths that nurses believe about Workplace Violence in healthcare settings: The nurse must have done something to provoke the attack. It cant happen here, or it wont happen to me. Its part of the job. Patients arent responsible for their behavior. According to ANA, as violence in health care escalates, nurses are the workers a t greatest risk because: a high percentage of nurses are women the nature of the work involves close physical contact and people under stress work is in shifts the worksite is highly accessible and may not be secure A comprehensive review of the literature identified the following factors to be associated with assault in the health care workplace: Inexperienced health care workers are at increased risk of assault. The largest number of injuries occur while attempting to contain patient violenc e. Short staffing and temporary staffing have been associated with increased assaul ts. Assaults seem to occur during times of high activity and high emotion on patient units.

Actions Following An Assault Steps to follow: While there is no clearly defined process for the victims of violence, the Task Force has identified certain steps that should take place. The sequence of these steps depends on the individual situation. Report any impending and actual acts of violence at work to your supervisor imme diately, regardless of who is the victim and whether or not there are injuries. Reports must be written as well as verbal. Call the police immediately. If necessary, file a police report as soon as possi ble. Take someone with you when you file the police report, preferably co-worker s who are familiar with the event. If the assault is from a patient, document the patients behavior in the nursing n otes. This is the most essential legal documentation. Seek medical attention even if there are no obvious injuries. Be sure to document any physical injuries and your emotional state. Follow the health care providers recommendations for treatment and work restrictions.

ERGONOMIC HAZARDS Use your brain, not your back. Fix the job, not the worker. Work smarter, not ha rder. Though less dramatic, are job and process design problems that are common and ha rmful. Examples are improper work methods and inadequate work and rest patterns or repe

titive tasks that result in musculoskeletal damage such as back injuries and car pal tunnel syndrome General ergonomic hazards or risk factors Awkward postures Forceful exertions Repetitive motions Prolonged activities Contact stress Vibration Temperature Psychosocial stressors Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal D isorders - 6/21/03 In order to establish a safe environment of care for nurses and patients, the Am erican Nurses Association (ANA) supports actions and policies that result in the elimination of manual patient handling. Patient handling, such as lifting, repo sitioning, and transferring, has conventionally been performed by nurses. The pe rformance of these tasks exposes nurses to increased risk for work-related muscu loskeletal disorders. With the development of assistive equipment, such as lift and transfer devices, the risk of musculoskeletal injury can be significantly re duced. Effective use of assistive equipment and devices for patient handling cre ates a safe healthcare environment by separating the physical burden from the nu rse and ensuring the safety, comfort, and dignity of the patient. Ergonomics and Nursing Injuries Currently, women make up 46% of the workforce and suffer 33% of all work-related injuries. In 1996, about 100,000 women suffered back injuries that resulted in 500,000 days off of work. Nursing remains a female-dominated profession, with 92 .5% of all nurses being women. Reasons for Risk: This is largely due to the fact that 98% of the time, nurses lift patients manua lly. Inadequate staffing is another risk factor that increases the potential for MSD injuries for nurses. Are we ready to respond? Assessing Nursing s Bioterrorism Preparedness Bioterrorism is a unique form of terrorism which entails the use of biological o rganisms for the sole purpose of spreading potentially deadly diseases. What to look for: a rapidly increasing disease incidence in a normally healthy population an epidemic curve that rises and falls during a short time an unusual increase in the number of people seeking care, especially those with fever or respiratory or gastrointestinal complaints an endemic disease that rapidly emerges at an uncharacteristic time or in an unu sual pattern an increased incident of illness among people who frequently go outdoors as comp ared with those who typically remain indoors clusters of patients arriving from a single locale large numbers of rapidly fatal cases. History Early use Biological terrorism dates as far back as Ancient Rome, when feces were thrown i nto faces of enemies. This early version of biological terrorism continued on in to the 14th century where the bubonic plague was used to infiltrate enemy citie American biological weapon development began in 1942. President Franklin D. Roos evelt laced George W. Merck in charge of the effort to create a development prog ram. In 1972 police in Chicago arrested two college students, Allen Schwander and Ste

phen Pera, who had planned to poison the city s water supply with typhoid and ot her bacteria Critical Biological Agents Categories for Public Health Preparedness Category Biological Agent Disease A: Higher immediate risk Variola major Bacillus anthracis Yersinia pestis Clostridium botulinum Francisella tularensis Filoviruses and arenaviruses (Ebola and Lassa Virus) Smallpox Anthrax Plague Botulism Tularaemia Viral hemorrhagic fevers B: Next-highest risk Coxiella burnetii Brucella species Burkholderia mallei Burkholderia pseudomallei Aplhavirus Rickettsia prowazekii Toxins (e.g., ricin, staphylococcal enterotoxin B) Chlamydia psittaci Food-safety threats (e.g., Salmonella species, E.coli) Water-safety threats(e.g., Vibrio cholera, Cryptosporidium parvum) Q fever Brucellosis Glanders Melioidosis Encephalitis Typhus Fever Toxic syndromes Psittacosis Salmonellosis Diarrheal illness, sepsis haemolytic uremic syndromes Cholera cryptosporidiosis C: Potential, but not an immediate risk Emerging-threat agents (e.g., Nipha viru s, hantavirus) Category A These high-priority agents include organisms or toxins that pose the highest ris k to the public and national security because: They can be easily spread or transmitted from person to person They result in high death rates and have the potential for major public health i mpact They might cause public panic and social disruption They require special action for public health preparedness. Category B These agents are the second highest priority because: They are moderately easy to spread They result in moderate illness rates and low death rates They require specific enhancements of CDC s laboratory capacity and enhanced dis ease monitoring. Category C These third highest priority agents include emerging pathogens that could be eng ineered for mass spread in the future because They are easily available They are easily produced and spread

 ct.

They have potential for high morbidity and mortality rates and major health impa

Mr. And Ms. Volunteer... and the Winner is...PHILIPPINES! History Plans to develop a school of nursing in England were interrupted in 1854 by a ch olera epidemic. Nightingale volunteered her services and learned a great deal ab out how to prevent the spread of disease. When Crimean War broke out that same year, she obtained permission to take a gro up of 37 volunteer nurses into the battlefield area. British medical officers in itially refused their assistance but as conditions worsened they were admitted t o the barracks. Since the days of its beginnings, nursing has developed its contributions to soc iety which include a service-to-society mission, delivering services that are vi tal to human welfare and a well defined code of ethics (Creasia & Parker, 2001). Volunteering can help you get back in touch with what is important to you. What are your passions? What drives you to want to help? Use these passions and motiv ations to guide you in your search for volunteer opportunities. The following are some ideas to help you get started in your search for a volunt eer opportunity: Policy Development. Parish Nursing. Camp Nurses. Hospice Volunteer. Sexual Assault Nurse Volunteers. Caring for the Elderly. Community Health Volunteers. Medical Reserve Corps. Licensure As A Retired Volunteer Nurse. American Red Cross. School Nurse. Over 400,000 of our countrys Registered Nurses are EXPLOITED by many healthcare i nstitutions through FALSE Volunteerism Practices and Non-Accredited Training Pro grams (BON-CPE Council Accreditation), where they are made to work with the full responsibilities of an employed staff Nurse, without any form of compensation, benefits, and employer protection. Most are even required to pay while rendering Nursing Care services. Because these Nurses have obtained the Bachelor of Science in Nursing and have p assed the Nurses Licensure Examination, they are fully qualified to practice saf e Nursing Care to patients, families, and communities, as per RA 9173, the Nursi ng Act of 2002. However, these young Professionals are charged exorbitant fees f or these so-called trainings, and are left to submit to this blatant form of explo itation. These practices prevent new Nurses from being hired, because all available Nurse Plantilla positions are filled up by these unpaid Volunteers or Trainees. These hea lthcare institutions have no need to hire anymore, as they can get Nursing servi ces for FREE through the EXPLOITATION of our Nurses. Furthermore, they are deceived with empty promises of employment and the misinfo rmed belief of improving their resumes though Volunteer or Training Certificates. Lastly, as per the International Council of Nurses (ICN) November 2010 Asia Nursi ng Workforce Forum, Training and Volunteer certificates are NOT recognized abroa d as work experience. These exploitative practices have existed for more than 15 years. It was tempora rily halted in 2008, through the efforts of the PNA. In January 2011, the issue broke out again in the media, but the exploitation stopped only for ONE WEEK. Th e effect is always short-lived, as government support in this issue is not conti nuous. Today, there are many Private and Government hospitals still engaging in this EX PLOITATION. They now go by different names, masquerading as Specialty Programs suc

h as Nurse Residency, Basic Skills Training, Clinical Advancement, and Post-Grad uate Trainings. Uphold the respect for the dignity of Nurses and the right of the Filipino People to quality healthcare! Nurses take care of the health of our countrymen, but who takes care of our dear Nurses? Nursing science is a new productis open-minded; constantly evolving; never finish edTo actively and creatively participate in realizing the future, whatever it may hold, demands unparalleled vision, a greatly expanded human compassion, the cap acity to enjoy uncertainty, and the courage to stand up and be counted; to initi ate; to set direction that mankind may benefit. There is vast promise for those of wisdom, imagination and daring whose social concerns transcends personal gain and whose integrity does not vacillate- Martha Rogers

References: Bureau of Justice Statistics, Special Report: National Crime Victimization Surve y, Workplace Violence, 1992-96, Revised 7/28/98 - www.ojp.usdoj.gov Illinois Nurses Association Position Statement on Workplace Violence, Illinois N urses Association, 1995 Guidelines for Preventing Workplace Violence in Healthcare and Social Service Se tting, U.S. Department of Labor, OSHA, available at www.osha.gov Western Massachusetts CISD Team, c/o WMEMS, 168 Industrial Park Drive, Northampt on, MA 01060 Sandberg, D. A., McNiel, D. E., & Binder, R. I. (2002). Stalking, threatening, a nd harassing behavior by psychiatric patients toward clinicians. Journal of the American Academy of Psychiatry Law, 30, 221-229. Valente, S. M., Bullough, V. (2004). Sexual harassment of nurses in the workplac e, Journal of Nursing Care Quality, 19(3), 234-241. American Red Cross a. Understanding professional liability. Retrieved from http: //redcross.org/nov/nurse/howto96.html American Red Cross b . Nurses volunteer options. Retrieved fromhttp://www.redcr oss.org on November 21, 2003. Board of Nurse Examiners for the State of Texas. (2000). Nursing practice act & nursing peer review act. Chally, P.S., & Loriz, L. (1998). Ethics in the trenches: Decision making in pra ctice. American Journal of Nursing, 98(6), 17-20. Creasia, J.L., & Parker, B. (2001). Conceptual foundations: The bridge to profes sional nursing practice(3rd ed.). St. Louis: Mosby. Ehrlich, P. (2005). "Handmaidens No More: The History of the Nursing Shortage." Working Nurse, issue #21, pages 23-26. American Association of Colleges of Nursing. (2005). Nursing Shortage. Retrieved October 16, 2006. http://www.aacn.nche.edu/Media/FactSheets/NursingSho rtage.htm Anderson, Charlie. (2004). Registered Nurse. Retrieved November 21, 2006. http://www.medicalcareerinfo.com/registered_nurse.htm

About Appropriate Staffing. Date of Retrieval November 30, 2006, From World Wide Web at: http://www.nursingworld.org/staffing/ Carrington,J., Detragiache,E. How Extensive Is the Brian Drain. October 16, 2006 , From World Wide Web at:http://www/img.org/external/pibs/ft/fandd/1999/06/carri ngt.htm DeMoro, Rose Ann. (2004, March). Regulating Health Care Patient-ratio law ends nursing shortage . Date of Retrieval November 30, 2006, From World Wide Web at: http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/03/18/EDG B95M71K1.DTL Domrose, C. The Future of Nursing. December 1, 2006, From the World Wide Web at: http://www.nurseweek.com/news/features/02-04/future.asp http://www.ehow.com/how_6511940_train-nurses-bioterrorism-natural-disasters.html #ixzz1RsWrcIIp http://www.who.int/countries/qat/en/ http://healthmad.com/healthcare-industry/conflict-in-the-workplace-hospitals-are -not-soap-opera-sets/#ixzz1RsFOEPd7 http://www.medicaltourismmag.com/ http://www.nursesource.org/facts_shortage.html http://www.bls.gov/oco/ocos083.htm http://www.poea.gov.ph/stats/2006Stats.pdf http://www.atimes.com/atimes/Southeast_Asia/HF20Ae04.html http://www.who.int/whosis/database/core/core_select.cfm http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm http://content.nejm.org/cgi/content/full/353/17/1761 http://bhpr.hrsa.gov/nursing/

Our Lady of Fatima University Graduate School

Nursing Employment Trends and Issues

By: Katrina M. Gonzalez, RN, CRN

General Objective: To be able to present clearly the current trends and issues a ffecting the Nursing Employment Specific Objectives: After the lecture-discussion, students will be able to: A. Determine the risks of encountering workplace hazards affecting the nurs es of today. B. Examine the current issues that are shaping the face of nursing. C. Identify trends in employment that is influencing the nursing profession Introduction Registered nurses constitute the largest group of health care providers in the P hilippines. As technology continues to advance and the status of hospitalized pa tients becomes increasingly complex, nurses are challenged to adapt to a changin g environment. With this challenge come opportunities to find employment that is professionally enriching and personally satisfying. The current nursing shortag e gives nurses the advantage of a broad selection of career choices Nursing employment today is a vast experience that affects millions of nurses in the Philippines. Using the topics cited in this paper, we can study and examine the experiences of nurses and how we can learn from each one of them. Every nur se whether a Baby boomer nurse, the generation X and the Generation Y have its o wn unique experience in their chosen area of specialization. Each of us went thr ough hardships and difficult circumstances that became what we are today. Using these topics we can be able to help and share information that can equip us more to become the best nurse.