Healthcare and Social Assistance

Participating core and specialty programs: Center for Motor Vehicle Safety, National Center for Productive Aging and Work, Prevention through Design, Surveillance and Translation Research.

Employers, workers, professional and labor organizations, medical educators and accrediting bodies use NIOSH information to improve occupational safety and health through work design in the healthcare and social assistance sector.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker Population* Research Type
A Depression, Anxiety, Cognitive impairment, Suicide Fatigue and stress due to suboptimal work organization Healthcare workers, veterinary medicine/animal care (VM/AC) workers; vulnerable workers Intervention Translation
B Depression, Anxiety, Cognitive impairment, Suicide Improved surveillance on work practices, work factors (e.g., psychosocial and safety climate), and health outcomes Healthcare and VM/AC workers Surveillance research
C Fatal and non-fatal injuries Fatigue, stress, work organization as risk factors for motor vehicle crashes during commutes and shifts Residents, interns, and home healthcare workers; others with long hours / irregular schedules Intervention Translation
D Depression, Anxiety, Cognitive impairment, Suicide Stressful social, interpersonal, and situational aspects of work environment (esp. bullying, violence, interpersonal interactions, dealing with traumatic situations such as those involving death and dying, injury, illness, anger, grief, loss) Healthcare and social assistance workers who directly interact with patients/families, VM/AC workers, small businesses Intervention
E Infectious diseases, Blood borne pathogen infection Safety culture/safety climate/safety leadership Mid-to-small healthcare settings, nursing aides, home healthcare workers, management, VM/AC, other settings where poor adherence to safe practice has been documented Intervention Translation
F Depression, Anxiety, Cognitive impairment Non-standard work arrangements Healthcare workers Intervention

Surveillance

* See definitions of worker populations

Activity Goal 7.2.1 (Intervention Research): Conduct intervention studies to develop and assess the effectiveness of work design and well-being interventions to reduce injuries and illness among healthcare workers.

Activity Goal 7.2.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective work design and well-being interventions among healthcare workers.

Activity Goal 7.2.3 (Surveillance Research): Conduct surveillance research to better track work practices, work factors (psychosocial and safety climate), and health and safety outcomes among healthcare workers, including those in contingent work arrangements and VM/AC workers.

Burden

Work in healthcare (human and animal) and social assistance is often associated with high levels of stress resulting in multiple adverse health and safety outcomes and burnout. The American Nurses Association surveyed 4,614 nurses in 2011 and found that 74% had concerns about the effects of stress and overwork, 24% cited the risk of a fatigue-related crash after a shift as one of their top 3 safety and health concerns, and 53% worked some mandatory or unplanned overtime each month [ANA 2011]. In one survey of veterinary personnel, 35% consider their job dangerous, 34% reported adverse effects from workplace stress, and 42% of veterinarians experienced or witnessed workplace abuse [Fowler 2016]. Veterinarians are estimated to be at higher risk for suicide, compared with the suicide risk for the general population [Bartram and Baldwin 2010; Platt B 2012]. Suboptimal work organization issues have been associated with increased exposure to blood and body fluids and increased risk of needlestick injuries among healthcare workers [Clarke 2007; Hessels 2016]. Temporary, contract, as-needed (pro re nata or PRN), on-call and other non-standard job arrangements are common in healthcare. These work arrangements have been associated with adverse psychological outcomes and performance [Ferrie 2008; Martens 1999; Virtanen 2005].

Need

The relationship between suboptimal organization of work and resulting work-related fatigue and stress with depression, anxiety, cognitive impairment, suicide and other related health and safety outcomes among workers in the healthcare and social assistance sector is not fully understood. Research to better characterize how these organizational factors impact health, and interventions to address these organizational factors, is necessary. This may include surveillance on work practices, work factors (psychosocial and safety climate), and health outcomes among healthcare workers. Innovative surveillance approaches are especially needed for certain groups such as those in non-standard work arrangements. Work organization interventions from other healthcare settings such as hospitals and clinics could be translated to workers in nursing homes, homes, veterinary/animal care environments and non-standard work arrangements.

Employers, workers, professional and labor organizations, medical educators and accrediting bodies use NIOSH information to improve occupational safety and health through work design in the healthcare and social assistance sector.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker Population Research Type
A Illnesses, non-fatal injuries and suicide Work and non-work factors that contribute to worker safety, health, and well-being (i.e. Total Worker Health [TWH] approach) (e.g., musculoskeletal health, shift scheduling and control, well-being) Healthcare workers, especially low-wage healthcare support occupations (e.g., home health aides, dental assistants, pharmacy aides, veterinary assistants and laboratory animal caretakers). Intervention
B Illnesses, non-fatal injuries and suicide Indicators for use of TWH approaches and adverse outcomes that might be improved by TWH Healthcare workers, especially low-wage healthcare support occupations (e.g., home health aides, dental assistants, pharmacy aides, veterinary assistants and laboratory animal caretakers). Surveillance research
C Illnesses, non-fatal injuries and suicide Barriers and facilitators to implementing TWH research findings Healthcare workers, especially low-wage healthcare support occupations (e.g., home health aides, dental assistants, pharmacy aides, veterinary assistants and laboratory animal caretakers). Translation
D Illnesses, non-fatal injuries and suicide Evaluate effectiveness and adoption TWH polices, practices and programs Healthcare workers, especially low-wage healthcare support occupations (e.g., home health aides, dental assistants, pharmacy aides, veterinary assistants and laboratory animal caretakers). Intervention Translation

 

Activity Goal 7.12.1 (Intervention Research): Conduct intervention studies to develop and assess the effectiveness of work design and well-being interventions that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being in Healthcare and Social Assistance.

Activity Goal 7.12.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts in Healthcare and Social Assistance.

Activity Goal 7.12.3 (Surveillance Research): Conduct surveillance research to better track risks to worker safety, health and well-being in Healthcare and Social Assistance.

Burden

In 2017, the healthcare and social assistance sector experienced the highest number of nonfatal occupational injuries and illnesses (583,000 cases) and the fourth highest incidence rate (4.1 per 100 full-time equivalent workers) of any private industry sector [BLS 2018a]. The highest incidence rate of nonfatal injuries and illnesses was in state-operated nursing and residential care facilities (10.9 per 100 FTE workers). Other industries covered by the HCSA program with high incidence rates include veterinary services (9.8), psychiatric and substance abuse hospitals (7.8) and state-operated hospitals (7.7) [BLS 2019]. In 2017, healthcare support occupations accounted for over 4.1 million jobs in the HCSA sector [BLS 2018b]. Of these, home health aides and personal care aides accounted for nearly 6 of every 10 jobs [BLS 2018b]. Low wage healthcare support occupations are at risk of injury due to overexertion, falls, suboptimal work organization and violence. Over a fifth of home care aides reported at least one incident of verbal abuse by clients and client’s family members in the past 12 months [Karlsson et al 2019]. For veterinarians, suicide is of particular concern. Male veterinarians are 1.6 times more likely and female veterinarians are 2.4 times more likely to commit suicide than the general population [Witte et al. 2019].

Systemic changes to our economy and socio-demographic workforce factors are ren­dering some past approaches to protecting workers ineffective. Increasingly, employ­ers face tighter profit margins, demanding timelines and global completion. Workers and employers must navigate new types of work arrangements, the aging of the workforce, high levels of work-related stress, and the growing challenges of both work and home life. Many enterprises continue to confront the legacy hazards of the traditional workplace, such as traumatic injury associated with manual lifting and falls, chemical exposures, and shift work. At the same time, scientific evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected—that risk factors in the workplace can contribute to common health problems previously considered unrelated to work.

Need

Total Worker Health promotes the integration of occupational safety and health (OSH) protection with workplace policies, programs, and practices to prevent injury and illness and advance overall health and well-being through research, interventions, partnerships, and capacity-building to meet the needs of the 21st century workforce. The healthcare and social assistance industry sector faces unique challenges and opportunities in promoting worker health as it relates to patient safety.   For healthcare workers, patient-care issues often take precedence over personal safety [DeJoy, Murphy, & Gershon, 1995]. However, many opportunities exist where both worker safety and patient safety can be improved.[The Joint Commission, 2012]Evidence suggests that integrating occupational safety and health protection program activities with health promotion program activities may be more effective for safeguarding worker safety, health, and well-being than either of these programmatic activities on their own (Sorensen et al. 2013; NIOSH 2012; DeJoy 1993; Sauter 2013). Despite these developments, there is need for continued research to better understand the benefits of integrated approaches to prevention and to promote more comprehensive intervention, especially among certain occupations and industries.

American Nurses Association [2011]. Health & safety survey report. American Nurses Association, http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/Work-Environment/2011-HealthSafetySurvey.htmlexternal icon

Bartram DJ, Baldwin DS [2010]. Veterinary surgeons and suicide: a structured review of possible influences on increased risk. Vet Rec 166:388–397.

BLS [2018a]. 2017 survey of occupational injuries and illnesses. Washing­ton, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/soii-chart-data-2017.htmexternal icon

BLS [2018b]. Occupation employment and wages, May 2017. 31-0000 healthcare support occupations Washing­ton, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/oes/2017/may/oes310000.htmexternal icon

BLS [2019]. Supplemental news release tables. Table SNR01. Highest rates for total cases – injuries and illnesses. Washing­ton, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/soii-data.htmexternal icon

Clarke SP [2007]. Hospital work environments, nurse characteristics, and sharps injuries. Am J Infect Control 35:302-309.

DeJoy D, Southern D [1993]. An integrative perspective on work-site health promotion. J Occup Med 35:1221–1230.

DeJoy D M, Murphy LR, Gershon R [1995]. Safety climate in health care settings. In: Bitter A, ed, Advances in industrial ergonomics and safety VII). New York: Taylor & Francis.

Ferrie JE, Westerlund H, Virtanen M, Vahtera J, Kivimäki M [2008]. Flexible labor markets and employee health. SJWEH Suppl 6:98–110.

Fowler HN, Holzbauer SM, Smith KE, Scheftel JM [2016]. Survey of occupational hazards in Minnesota veterinary practices in 2012. JAVMA 248:207-218.

Hessels AJ, Larson EL [2016]. Relationship between patient safety climate and standard precaution adherence: a systematic review of the literature. J Hosp Infect 92(4):349-62.

Karlsson ND, Markkanen PK, Kriebel D, Gore RJ, Galligan CJ Sama SR, Quinn MM [2019]. Home care aides’ experiences of verbal abuse: a survey of characteristics and risk factors. Occup Envir Med 76:448-454.

Martens MJ, Nijhuis FN, Van Boxtel MJ, Knottnerus JA [1999]. Flexible work schedules and mental and physical health. A study of a working population with non-traditional working hours. J Organiz Behav 20: 35–46.

NIOSH [2012]. The research compendium: the NIOSH Total Worker Health™ Program: seminal research papers 2012. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2012-146, https://www.cdc.gov/niosh/docs/2012-146/default.html

Platt B, Hawton K, Simkin S, Mellanby RJ [2012]. Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review. Soc Psychiatry Psychiatr Epidemiol 47:223–240.

Sauter SL [2013]. Integrative approaches to safeguarding the health and safety of workers. Ind Health 51: 559–561

Sorensen G, McLellan D, Dennerlein JT, Pronk NP, Allen JD, Boden LI, Okechukwu CA, Hashimoto D, Stoddard A, Wagner GR [2013] Integration of health protection and health promotion: Rationale, indicators, and metrics. J Occup Environ Med 55(12 Suppl.): S12–S18..

The Joint Commission [2012]. Improving patient and worker safety: opportunities for synergy, collaboration and innovation. Oakbrook Terrace, IL: The Joint Commission

Virtanen M, Kivimäki M, Joensuu M, Virtanen P, Elovainio M, Vahtera J [2005]. Temporary employment and health: a review. Int J Epidemiol 34(3):610-22.

Witte TK, Spitzer EG, Edwards N, Fowler KA, Nett RJ [2019]. Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014. J Am Vet Med Assoc 255(5):595-608

Note: Goal 7.12 was added in October 2019.

Page last reviewed: April 24, 2018