Researchers at the School of Nursing’s first Center of Excellence, the Work and Health Research Center, are examining the impact of the work environment on the health and well being of nurses and other care providers. Researchers at the Center have received nine million dollars in federal research funding to study the impact of a variety of work environment exposures on care providers in a number of diverse settings including acute care and psychiatric hospitals, social service workplaces, and community and home care settings. During the past year the Center has been engaged in field research in Maryland, California, Idaho, New York, Illinois, Wisconsin, and Washington State -- collecting data from nurses, home care assistants, social workers, and alcohol and drug treatment workers. Center researchers are particularly interested in how changes in the health care work environment are affecting the health and well being of nurses.
According to Center Director Professor Jane Lipscomb, Ph.D., RN, FAAN:
Nurses can face impossible working conditions, with problems that involve patient care, recruitment, retention, and general health and error rate. A nurse might be at risk of making errors on the job because they simply don’t have enough down time between shifts.
For over ten years Center researcher Professor Alison Trinkoff, Sc.D., RN, FAAN, the Principle Investigator of the Nurses Worklife and Health Study, together with other center researchers, has performed ground breaking research on the impact of long working hours, shift schedules, staffing levels, and physical and psychological work factors on the health of nurses. She notes that “dramatic changes have occurred in the health care industry in the past decade, largely because of an increased emphasis on reducing costs. Nurses, the largest segment of the health care workforce, are greatly affected by these changes. For many nurses, these adverse working conditions don’t occur singly but in combination, including frequent shift rotation, returning to work after insufficient time off, and working overtime on short notice or on scheduled days off.” Summarizing the results of these studies, Trinkoff suggests that “Health care providers and legislators need to recognize the limits within which nurses can practice safely.”
Increasingly health care is moving outside the hospital and into the home and Center researchers have taking on the challenge of performing research in this new setting. Center researcher Jeanne Geiger Brown, Ph.D., RN, Assistant Professor, is studying the unique properties of the home work environment among the growing population of often poorly paid nursing aides and assistants. She and Carles Muntaner, M.D., Ph.D., a Professor and previous Center member, have studied more than 1600 home care workers using an innovative telephone interviewing protocol developed by Dr. Geiger Brown. Their research shows, she says, that
Home care workers do not have the normal supports that workers in traditional health care environments enjoy. Their work is physically and emotionally demanding, and they are at risk for musculoskeletal disorders and depression; all for a median income of $12,000 per year.
Center researchers are actively involved in developing new research tools to measure the unique risks that emerge in the home care environment as part of a 1.7 million dollar study funded by the National Institute of Occupational Safety and Health to examine the risk of needle sticks and blood borne pathogen exposures among nurses and other workers who provide care in the home. Dr. Jane Lipscomb, the principal investigator of this study, points out that “little is known about the risk of blood exposure in those care-givers who work in the home. As an environment, activities performed in the home are much less structured compared to what we find in a hospital. This means they are much more challenging to understand, measure and control.” But taking on new challenges like this is the bread and butter of the Center. “Measuring complex work exposures, evaluating the risks they pose to care providers, and designing protective interventions are the core activities of the Center,” says Professor Jeffrey Johnson, Ph.D., the Center’s associate director. “We often find ourselves in the situation where we are evaluating occupational risk factors that have never been adequately measured before. This means we have to create new instruments by first using qualitative measurement methods such as workplace observations, in-depth interviews, and focus groups of workers.”
According to Center researcher Dr. Karen Kaufman, RN, Ph.D., an Associate Professor at the School of Nursing and an expert in the analysis and interpretation of qualitative data:
Only after a careful review of the data from many focus groups can we began to see the deeper patterns of what care givers are experiencing. Listening to these voices also provides us with a sense of the changes that need to be made to protect workers from harm.
This kind of painstaking research is vitally important in the development of preventive interventions. Center member Kate McPhaul, RN, MPH, Ph.D., an Assistant Professor at the School, is one of the first nurse researchers in the country to have identified the home as a critically important arena for violence research and intervention:
Increasingly, healthcare, long term care, and social services are delivered in the home and community rather than institutions, thus the traditional safety paradigm for workers and patients must be completely reconsidered.We have conducted over twenty five focus groups of home visiting workers in five states which illuminate the unique safety risks and organizational barriers faced by these workers. It’s become clear to us that a new violence prevention paradigm is needed for this workforce.
The Center is deeply committed to developing an understanding of how to improve the work environment. According to Lipscomb: “Nearly all of our studies involve interventions. We have found that only by engaging workers, their union representatives, along with management, in all aspects of the intervention can we hope to accomplish any real change.” According to Johnson:
We see this as another scientific challenge: What are the most effective ways to make change? How can we learn from our experiences and contribute to the emerging science of workplace intervention.