Table Of ContentNurses at Risk
Nurses at Risk
A Guide to Health and
Safety at Work
Second Edition
Rosemary Rogers
Jane Salvage
and
Roger Cowell
Foreword by Harriet Harman, MP
Cartoons by Kipper Williams
~
MACMillAN
© Rosemary Rogers and Jane Salvage 1988
© Rosemary Rogers, Jane Salvage and Roger Cowell 1999
Foreword© Harriet Harman MP 1999
Canoons © Kipper Williams 1999
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Any person who does any unauthorised act in relation to this
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The authors have assened their rights to be identified
as the authors of this work in accordance with the
Copyright, Designs and Patents Act 1988.
First edition published 1988 by Butterworth-Heinemann Ltd
Halley Coun, Jordan Hill, Oxford OX2 8EJ
This edition published 1999 by
MACMillAN PRESS LTD
Houndmills, Basingstoke, Hampshire RG21 6XS
and London
Companies and representatives
throughout the world
ISBN 978-0-333-73185-7 ISBN 978-1-349-14803-5 (eBook)
DOI 10.1007/978-1-349-14803-5
A catalogue record for this book is available from the British Library.
This book is printed on paper suitable for recycling and made from
fully managed and sustained forest sources.
10 9 8 7 6 5 4 3 2 1
08 07 06 05 04 03 02 01 00 99
Copy-edited and typeset by Povey-Edmondson
Tavistock and Rochdale, England
Contents
Foreword by Harriet Hannan MP ix
Introduction xi
1 Health services: bad for your health? 1
Contexts 3
The politics of occupational health 6
Occupational health in the NHS 10
2 Health and safety: the legal framework 23
Employers' duties 25
Employees' duties 29
Duties of manufacturers and suppliers 31
Safety representatives 31
The legislation 33
Enforcement of the health and safety regulations 38
The role of the European Union 38
Financial awards and injury benefits 39
3 The working environment 44
Buildings 44
Asbestos 50
Fire 51
Security 58
Staff facilities 59
Lighting 63
Temperature and ventilation 66
Noise 68
Conclusion 69
4 Stress 70
How stress is defined 72
Societal stressors 74
Employer-induced stressors 79
Professional stressors 84
Action on stress 87
Conclusion 93
v
vi Contents
s
Violence and bullying 95
Violence 95
Bullying 104
Whistle blowing 107
Conclusion 111
6 Toxic substances and agents 112
Toxic chemicals 112
Waste anaesthetic gases 123
Drugs 126
Cytotoxic drugs 128
Radiation 133
Mercury 140
7 Infection and infection risks 142
Microbiological hazards 143
Protection 144
Enteric infections 150
Methicillin-resistant Staphylococcus aureus (MRSA) 156
Hepatitis 159
HIV and AIDS 164
Legionnaire's Disease 172
Tuberculosis 174
8 Technological hazards 177
Equipment safety 177
Sharps 182
Electrical hazards 186
Lasers 187
Computers 189
9 Reproductive hazards 192
Anaesthetic gases 194
Biological risks 195
Radiation 197
Workload and stress 198
Employees' rights 198
10 Manual handling: time to stop? 204
The costs of manual handling 204
The regulations 207
Guidance on manual handling 210
Safer patient handling policies 212
Contents vii
11 Injury at work and work-related illness 218
Accidents 218
Supporting the work-injured nurse 220
Conclusion 232
12 The healthy nurse 235
Personalconrurrritrnent 235
Working conditions and the working environment 239
Occupational health services 243
Conclusion 249
Appendix 1 lnfonnation 255
Appendix 2 Organisations 263
Appendix 3 An A to Z of hazards 268
Index 271
The authors and publishers are grateful to the Editor-in-Chief of
Nursing Times, Emap Healthcare Ltd, for permission to reproduce
copyright material from that journal.
Foreword
A decade ago, in the foreword to the first edition of this book, I said that
nurses were one of the most valuable resources of the National Health
Service. They are hard-working and dedicated people who deserve the best
possible conditions in which to carry out their vital work. Ten years on these
words still apply. The health and well-being of staff are integral to the well
being of the NHS. If they are off sick or injured, they cannot treat patients at
all.
This book raises nurses' own concerns about the hazards they face and
suggests ways of tackling them.
The most frequently reported type of injury is caused by lifting and
handling. Research in one trust has shown that as the result of a safer
handling policy, time off for injuries sustained by handling patients was
reduced by 84 per cent. This saved £400,000 a year in replacement nursing
costs alone.
Research also shows that stress at work is a widespread problem in the
NHS and this rightly falls within the remit of health and safety. Current
research will lead to the issuing of guidance to the service on ways of coping
with organisational stress.
Fourteen per cent of recorded accidents to staff involve physical assault,
making it the third most common type of accident to staff. Violence can
cause pain, suffering and disability, and verbal abuse and threats can damage
health through anxiety or stress. The issue of violence to staff must be
managed as a health and safety risk.
These problems are difficult ones, but the fact that so much work-related
illness - mental and physical - can be prevented should give us hope. This
book offers valuable guidance to nurses and to their employers and managers
on how to improve matters. The authors' research into the problems is
backed by sound practical advice on how to tackle them.
The NHS is taking action on a number of issues relating to staff. The
framework for human resources currently being developed will raise the
profile of staff health and welfare as core management issues. The Health at
Work in the NHS project has been disseminating guidance and good practice
information; 80 per cent of NHS employers are participating, and NHS
Estates have been working on benchmarking and risk management tools.
The NHS is determined to tackle these areas to ensure that nurses are able
to work properly, safely and happily, thus helping them to give better care
while enjoying greater job satisfaction and better morale.
RIGHT HoNOURABLE HAluuET HARMAN MP
ix
Introduction
It is a decade or so since the first edition of Nurses at Risk - a decade which
has seen many changes in health care and nursing. Yet much of what we
wrote in that first edition is, sadly, still relevant today. In revising this book,
we found that all the issues researched then remain topical now - indeed
there appear to be more rather than fewer hazards, while the failure of the
Conservative government to tackle the key issues concerning the well-being
of the NHS workforce has taken an even greater toll, especially on nurses -
its front-line workers.
Rarely a week passes without new evidence of old and new hazards.
Improving the Health of the NHS Workforce, published by the Nuffield Trust
and the biggest ever report on the health of NHS staff, was issued just after
our manuscript was completed in March 1998. It provides compelling
research-based evidence of how little has changed in the last decade and
points out the appalling human and financial consequences of this systematic
and shameful neglect.
There have of course been some positive developments. New Labour has
yet to prove its Bevanite credentials as the saviour of the health service, but it
has more card-carrying credibility in this area than its Tory predecessors and
a lot more to lose in public credibility should it let the NHS down. Initiatives
such as the Health at Work in the NHS project, described in Chapter 12,
may eventually prove to have no teeth but at least on the surface promise a
greater commitment to the health and welfare of the NHS workforce.
Meanwhile a raft of much tougher European legislation affecting health
and safety at work, covering the whole spectrum of workplaces where health
care is delivered, has come into effect in the UK since 1988.
Despite these hopeful signs, however, we found the persistence of many
familiar hazards to health and well-being - such as back injuries caused by
staff shortages, poor training and lack of equipment - as well as the
emergence or escalation of new ones: glutaraldehyde, latex allergy and
methicillin-resistant Staphylococcus aureus (MRSA), to name just a few.
Some of these problems are attributable to new evidence or to changes in
clinical practice. Use of the sterilising solution glutaraldehyde, for example,
has risen in the past decade because of the increasing use of endoscopes for
diagnostic and therapeutic surgical procedures; at the same time, evidence
based awareness of the risks it poses has risen dramatically. Latex allergy is a
massively more significant health and safety problem than it was ten years
ago, thanks to the introduction of universal precautions and the consequent
increase in glove use. The effects of widespread and often indiscriminate
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