Workplace safety PIF 2012 Presentaton.ppt

Canadian Association of
Occupational Therapists
Professional Issue Forum
Workplace safety and injury prevention in occupational
therapy practice in Canada
Thursday June 7, 2012 8:30-11:30

Background
• What are PIFs?
• Today’s PIF on Workplace Health and Safety
– Issues
– Objectives

Who we are:
• Welcome: Karyne Lapensee, OT Student, Janet Craik,
OT Reg. (Ont.), CAOT
• Facilitator: Andrea Dyrkacz, OT Reg. (Ont.)
• Lonita Mak, OT Reg. (Ont.)
• Mike Brennan, CAOT
• Althea Stewart-Pyne, RNAO

Objectives
• explore and document current trends/issues
around workplace safety and injury
prevention with in occupational therapy
practice in Canada.
• raise awareness, and offer possible solutions
to enable a healthy, sustainable workforce.

Agenda
8:30 WELCOME & INTRODUCTION
8:35-9:45 PANELIST PRESENTATIONS
9:45 COFFEE
10- 10:45 ROUNDTABLE DISCUSSIONS
10:45-11:30 SUMMARY AND NEXT STEPS

Work-related injuries in
occupational therapy
– causes, prevalence and impact on practice
Lonita Y.M. Mak, BSc(OT)
Andrea P. Dyrkacz, BMR(OT), BA, MDiv
Carol S. Heck, BScPT, MSc, PhD

Definition
In 2007, Human Resources and Skills
Development Canada, defined an
occupational injury as,
“Any injury, disease or illness
incurred by an employee in the
performance of (or in connection
with) his or her work.”

Definition (continued)
Additionally, “Healthcare workers
are more likely to miss time due to
illness or injury than any other
worker in Canada.”
(Canadian Institute for Health Information, 2005)

Rationale
Although occupational therapists are
considered to be expert in the prevention
and treatment of work-related injuries –
little has been done to study the injuries
experienced by occupational therapists
themselves.

Rationale (continued)
Indeed, the bulk of the extant
literature extrapolates and infers this
information, and is generally taken
from physiotherapy and nursing
practice.

• Until recently, the only studies that examined
work-related injuries sustained by
occupational therapists focused on clinical
speciality-specific injuries, such as those
experienced by hand therapists.
(Stevens, 1994; Caragianis, 2002)
• However, because of the narrow focus of
these studies and small sample sizes, their
findings can not be generalized across
clinical practice settings.

• Only one published article systematically
reviewed the impacts of occupational injuries
on occupational therapy practitioners.
• However, it also used the literature of other
healthcare disciplines to posit the prevalence,
incidence and causes of work-related injuries
in occupational therapy practice.

• It strongly recommended that occupational
therapy-specific research be undertaken,
recognizing that occupational therapy is a
unique and distinct profession, and that it
occupational risks are similarly specific.
(Alnasar, 2007)
• A focus on work-related injuries experienced
by occupational therapists was long overdue.

Research question
What are the types and prevalence
of work-related injuries
experienced by Canadian
occupational therapists across
practice contexts?

Research objectives
1. To identify the types and location of work-related
injuries experienced by occupational therapists;
2. To determine how practice context affects type and
location of work-related injuries;
3. To determine how occupational therapists respond
to work-related injuries, and the cultural and
structural factors that modify and shape that
response; and
4. To identify strategies employed by occupational
therapists in managing their return to work
after experiencing an injury.

Methodology
• All English-speaking occupational
therapists with accessible email addresses
registered with the Canadian Association of
Occupational Therapists (CAOT) received
an electronic survey (n=2623) in June 2009.
• Non-responders received subsequent
follow-up reminders.
*

Methodology (continued)
• 260 survey participants were excluded for
various reasons, leaving 2363 eligible
survey respondents.
• Demographically, the occupational
therapists who submitted the 610 completed
questionnaires were generally representative
of Canadian occupational therapists, when
compared to CAOT membership statistics.
(February 2009)
*

Demographics: province/territory
*

Demographics: practice setting(s)
(Note: multiple responses were permitted for this question)
*

Demographics:area(s) of clinical practice
*

Experience of work-related injury
•Have you
ever been
injured in
your work
as an
occupational
therapist?
* 13.9% of survey participants indicated they had
experienced two or more episodes of work-related
injury.
*

Injury rates
• While there was no significant difference
between rates of injury and age, females (55%)
were significantly more likely more likely to
experience a work-related injury than males
(31%). (p=0.006)
• This is perhaps explained by the finding that
female (20.4 + 9.4) survey participants reported
working as occupational therapists significantly
longer than male (15.2 + 8.2) respondents. (p=0.003)
*

Number of reported occurrences
*

Practice settings
Survey participants
were significantly more
likely to be injured if
they worked in General
or Rehabilitation
Hospital settings.
(p=0.05)
*

Injury location: occupational therapists
Head/Face
6.71%
Spine
30.97%
Torso
10.82%
Upper
Extremity
33.39%
Lower
Extremity
18.09%
n=536
*

Injury location by profession
*

Limitations of the study
• Surveys were sent only to members of
CAOT who expressed a willingness to
participate in studies – a subset of all
Canadian occupational therapists
• It is possible that occupational therapists
that have had a work-related injury might be
more likely to complete a survey dealing
with injuries in clinical practice –
influencing the data obtained.
*

Limitations of the study (continued)
• This study asked occupational therapists to
self-report their experience(s) of injury.
Because of this, there is no way to
absolutely verify that any injury is directly
attributable to a work-related incident.
• This is particularly true of reported
Repetitive Strain Injuries (RSI), soft tissue
injuries and degenerative conditions, such
as osteoarthritis.
*

Patient handling education
• Physiotherapy and nursing literature
indicate that work-related musculoskeletal
injuries are often attributed to patient-
handling activities.
• Survey participants were asked to recall if
they had participated in formal pre- and
post-professional patient handling
education.
*

Patient handling education (continued)
Have you had formal patient handling education as
part of your pre- or post-professional education?
Pre-professional n=577
Post-professional n=586

Patient handling injuries
• It is not surprising that occupational
therapists also reported that patient handling
incidents caused the majority of work-
related injuries.
• 20.82% (n=127) of survey respondents
reported being injured in a patient handling
incident.
*

Causative factors
What do you think contributed to your
patient handling injury?
*

How are occupational therapists different?
• Occupational therapists are similar to
their physiotherapy and nursing
colleagues in the predominance of
patient handling injuries.
• The locations of physical injuries
experienced in the workplace are also
similar to those of their comparator
professions.

How are occupational therapists
different? (continued)
• However, there are also differences in the
causative factors described by survey
respondents.
• These differences maybe specific to the
practice of occupational therapy, and where
Canadian occupational therapists find
themselves interacting with their
patients/clients.

Equipment-related injuries
• The first difference is in the
equipment used by occupational
therapists in their workplaces.

Equipment-related injuries (continued)
Five general areas of equipment-related
injuries were noted by survey respondents:
1. Lifting/carrying and setting up equipment for clinical
interventions (33.1%)
2. Computer use (23.5%)
3. Splinting activities (17.1%)
4. Cuts and lacerations not specific to splinting (13.5%)
5. Wheelchair-related (11.9%)

Equipment-related injuries:
lifting/carrying and setting up equipment for clinical interventions
• 33.1 % attributed their equipment-related
injuries to setting up equipment for
treatment sessions, and lifting and carrying
equipment and reports.
• These injuries were attributed to both
single-episodes of lifting, and repetitively
carrying/lifting equipment and reports while
travelling to provide services.

lifting/carrying and setting up equipment for clinical interventions
What were the most significant factors that contributed
to your lifting/carrying and setting up-related injury?

Equipment-related injuries: computer use
• 23.5% attributed the injury to computer
use:
• Hours spent writing reports (in an office
or in client homes/workplaces)
• Computer stations set-up for multiple
users
• Old/poorly functioning computer
peripherals and desks/chairs

Equipment-related injuries: splinting
• 17.1% attributed their equipment-
related injuries to splinting activities.
• Lacerations due to cutting splinting
materials
• Repetitive strain injuries due to dull
scissors or cutting blades
• Burns due to heat gun and heating pan
use

cuts and lacerations not specific to splinting
• 13.5% reported cuts or lacerations
while using sharps or cutting tools not
related to splinting.

Equipment-related injuries: wheelchair-related
• 11.9% reported a wheelchair-related
equipment injury, most often due to
• Unanticipated patient action
• Being hit or run over by a wheelchair
• Through body parts being caught in
wheelchair components

Transportation or mobility-related injuries
• Occupational therapists also reported a
significant number of transportation or mobility
related injuries (15.1%)
• This may be related to the significant number of
occupational therapists who are community,
rather than institutionally based.
• As well, the vast expanse of our country, and our
challenging Canadian climate contribute to the
injuries reported in this grouping.

Transportation or mobility-related injuries
(continued)
• It is interesting to
note that many of the
walking/climbing
(falls) injuries, and
the majority of the
motor vehicle
accidents were
attributed to
inclement weather
conditions,
particularly ice and
snow.

Threats and acts of violence
• Studies show that workplace
violence in the health sector is often
considered part of the job, and has
therefore been frequently
overlooked.
• It is simply considered part of
healthcare culture.

Threats and acts of violence (continued)
• However, what is unique to the
practice of occupational therapy is
our focus on mental health practice
and the extent to which we provide
care in the community, often alone
and vulnerable.

Threats and acts of violence (continued)
• Occupational therapists also
experience threats and acts of
violence because of their
involvement in assessments tied to
the provision of benefits and
services.

Threats
• It is both interesting and troubling that
30.3% of respondents reported
receiving credible threats of violence
in their work lives as occupational
therapists.
• These threats were prevalent across
clinical contexts and practice settings.

Threats: practice setting
n=62

Threats: client type
n=157
9.55% of patients who made a threat were identified as
having a history of violence or aggression.

Threats: reasons
*Health care system barrier 4/11;
Non-specific 4/11;
Funding issue 2/11;
Motor vehicle license revocation 1/11.
Note: many of
the assessments
are related to the
provision or
continuation of
benefits or
services.

Acts of violence
• 4.26 % of occupational therapists who responded to
the survey reported being injured due to an act of
violence.
• It is striking to note that while 26 occupational
therapists reported being injured through an act of
violence, 47 reported a form of physical assault.
• This discrepancy is puzzling, as many survey
respondents do not appear to consider a physical
assault to be an act of violence.

Sexual assault
• While only one occupational therapist
reported being sexually assaulted
while at work, 14 reported episodes
that could meet the legal definition of
sexual assault.
• These occupational therapists reported
incidents of sexual touching and serious
threats of sexual assault.

Injury reporting
Did you report your workplace injury to....

Medical care
Did you require medical care as a result of
your workplace injury?

Medical care (continued)
76
68
55
25
19 18 16 9 8 7 2 1
0
10
20
30
40
50
60
70
80
n=304

Work continuation
Did you continue to work even though you were injured?

Work continuation (continued)
Why did you continue to work even though
you were injured?

Work discontinuation
What happened after you had your injury?

Work limitations
Has your workplace injury limited you in your
employment/life?

Work modifications
What changed in order for you to continue to work?

What can be done?
• Both occupational therapists who reported work-
related injuries and those who were injury-free had
many recommendations to reduce the frequency of
injuries in occupational therapy practice.
• These recommendations were made to assist
occupational therapists as a professional group, their
employers and universities that prepare students for
future clinical practice.
• However, there are striking differences in the
recommendations made by the two groups.

What can be done? occupational therapists
* Training in injury prevention,
crisis intervention, and safety
initiation.

What can be done? universities
n=408

Conclusions
1. Although occupational therapy work-
related injuries at first appear similar to
those experienced by physiotherapists and
nurses, their causes are often specific to
occupational therapy practice and settings.
If the specific contexts of many
occupational therapy injuries are not
recognized, effective management
strategies cannot be developed.

Conclusions (continued)
2. Both injured and non-injured
occupational therapists strongly
advocated for more patient-handling
education at the pre-professional level
– quantitatively and qualitatively.

3.Occupational therapists need to
become better advocates for
themselves – we must recognize the
value of proper and functional
equipment, and adequate workspace in
minimizing repetitive strain injuries
and other career-limiting injuries.

4.Occupational therapists minimize their
work-related injuries and continue to work
– not wanting to burden their colleagues and
abandon their patients.
By not attending to their own needs when
injured, occupational therapists contribute
to the development of chronic, disabling
conditions that limit their ability to provide
care in the long term.

5.Like other health care professionals,
occupational therapists do not
adequately recognize that we are also
victims of workplace violence.
Threats and physical assaults are not an
inherent and acceptable part of our
professional lives.

Future directions
1. A review of the national websites of the
Canadian (CAOT), American (AOTA) and
Australian (OTA) failed to locate any
information regarding initiatives to reduce
work-related injuries in occupational therapy
practice.
– Their focus was wholly related to the
prevention and treatment of work-related injuries
in the populations served by their members.
*

Future directions (continued)
• Only the British Association of Occupational
Therapists had resources to reduce work-related
injuries in its members.
• Their focus was primarily on workplace violence –
a mandated initiative of the National Health Service.
• The NHS began an aggressive program to eliminate
workplace violence in all health professions as a
recruitment and retention strategy.
*

• Canadian Provinces have enacted legislation
to protect workers from being injured on the
job.
• In many cases, this includes special
legislation that focuses on workplace
violence, i.e., Ontario Bill 168, an
amendment of the Occupational Health and
Safety Act.
• This takes the law one step further…
*

• It specifically prohibits workplace
violence and harassment.
• This legislation makes a statement
that workplace violence and
harassment are occupational health
and safety issues simply by their
inclusion in the Act.
*

• As of June 15, 2010 all Ontario
employers became required to put in
place a Workplace Violence Prevention
Program including a policy, risk
assessment, education/training and a
reporting/evaluation process dealing with
workplace violence and harassment.
*

• This survey asks us to consider:
• How are we responding as
occupational therapists, educators and
employers?
• How are our professional
organizations supporting us in ensuring
we are safe from injury, violence and
harassment in our workplaces?
*

Thank-you…
• The University Health Network Allied
Health Research Fund for providing the
funding to undertake this study.
• Our Allied Health and Nursing colleagues
for encouraging and supporting us in this
endeavour.
• The Canadian Association of Occupational
Therapists for their facilitation of this
Professional Issue Forum

Canadian Association
of
Occupational Therapists
Presents:

Michael Brennan, MBA
Chief Operating Officer
DUE DILIGENCE,
Workplace Safety
2012

History of the Act
 The O.H.S.A. (Occupational Health and Safety
Act) came into force on October 1, 1979
 Its purpose is to protect workers against health
and safety hazards on the job
 The Occupational Health and Safety Act is the
basic legal authority across Canada

History of the Act cont’d…
 It sets out rights and duties for all workplace
parties
 It provides for the enforcement of the law
 It is based on the principle of the Internal
Responsibility System (IRS)

Internal Responsibility
System (IRS)
Under the Act, workers and employers must share
the responsibility for occupational health and
safety.
Workplace parties are in the best position to
identify health and safety problems and to develop
solutions.
How well the system works depends on a complete,
unbroken chain of responsibility and accountability
for health and safety.

Internal Responsibility
System (IRS) cont’d…
Section 2 of the Nova Scotia O.H.S.A.
The foundation of the Act is the Internal
Responsibility System (IRS), which is based on the
principle that;
employers, constructors and employees at a workplace
share the responsibility for the health and safety of
workers in the workplace

Other Legislation
 W.H.M.I.S.
 Smoking in the Workplace Act
 Ontario Building Code
 Transportation of Dangerous Goods
 Workplace Safety & Insurance Board Act
 Accessibility – In progress
 Relevant Acts, Regulations, Codes, etc.

Definitions
Employer – a person who employs one or more
workers or contracts for the services of one or
more workers, and includes a sub-contractor or
contractor who performs work or supplies services

Definitions cont’d…
Supervisor - a person who has charge of a
workplace or authority over a worker
Worker - a person who performs work or supplies
service for monetary compensation

Employer’s Responsibilities
Occupational Health and Safety Act
Section 25 (1), (2)

O.H.S.A. Section 25
25.(1) An employer shall ensure that,
a) the equipment, materials and protective devices
as prescribed are provided;
b) the equipment, materials and protective devices
provided by the employer are maintained in good
condition;
c) the measures and procedures are carried out in
the workplace;
d) the equipment, materials and protective devices
provided by the employer are used;

O.H.S.A. Section 25, cont’d…
2) an employer shall,
(a) provide information, instruction and
supervision to a worker to protect the health or
safety of the worker;

b) in a medical emergency for the purpose of
diagnosis or treatment, provide, upon request,
information in the possession of the employer,
including confidential business information, to a
legally qualified medical practitioner

(c) when appointing a supervisor, appoint a
competent person;
Competent person - means a person who,
(a) is qualified because of knowledge, training
and experience to organize the work and its
performance,
(b) is familiar with this Act and the regulations
that apply to the work, and
(c) has knowledge of any potential or actual
danger to health or safety in the workplace

d) acquaint a worker or a person in authority over a
worker with any hazard in the work and in the
handling, storage, use, disposal and transport of any
article, device, equipment or a biological, chemical
or physical agent;
e) afford assistance and co-operation to a committee
and a health and safety representative in the
carrying out by the committee and the health and
safety representative of any of their functions;

f) only employ in or about a workplace a person
over such age as may be prescribed;
g) not knowingly permit a person who is under such
age to be in or about a workplace;
h) take every precaution reasonable in the
circumstances for the protection of a worker;

i) post, in the workplace, a copy of this Act.
j) prepare and review at least annually a written
occupational health and safety policy and
develop and maintain a program to implement
that policy;
k) post at a conspicuous location in the
workplace a copy of the occupational health and
safety policy;

Supervisors’ Responsibilities
Section 27 (1), (2)

Section 27 (1)
27.(1) A supervisor shall ensure that a worker,
(a) works in the manner and with the protective
devices, measures and procedures required by
this Act and the regulations; and
(b) uses or wears the equipment, protective
devices or clothing that the worker's employer
requires to be used or worn.

Section 27 (2)
A supervisor shall,
(a) advise a worker of the existence of any potential
or actual danger to the health or safety of the
worker of which the supervisor is aware;
(b) provide a worker with written instructions as to
the measures and procedures to be taken for the
protection of the worker; and
(c) take every precaution reasonable in the
circumstances for the protection of a worker.

Worker’s Responsibilities
Section 28 (1), (2), (3)

Section 28 (1), (2), (3)
A worker shall,
(a) work in compliance with the provisions of this
Act and the regulations;
(b) use or wear the equipment, protective devices or
clothing that the worker's employer requires to be
used or worn;
(c) report to his or her employer or supervisor the
absence of or defect in any equipment or protective
device of which the worker is aware and which may
endanger himself, herself or another worker; and

Section 28 (1), (2), (3), cont’d…
(d) report to his or her employer or supervisor any
contravention of this Act or the regulations or the
existence of any hazard of which he or she knows.
(2) No worker shall,
(a) remove or make ineffective any protective device
required by the regulations or by his or her employer

Section 28 (1), (2), (3), cont’d…
(b) use or operate any equipment, machine, device or
thing or work in a manner that may endanger himself,
herself or any other worker; or
(c) engage in any prank, contest, feat of strength,
unnecessary running or rough and boisterous
conduct.
(3) A worker is not required to participate in a
prescribed medical surveillance program unless the
worker consents to do so.

Section 51 Notices
51.(1) Where a person is killed or critically injured
from any cause at a workplace, the employer shall
notify an inspector, and the committee, health and
safety representative and trade union, if any,
immediately of the occurrence by telephone, telegram
or other direct means and the employer shall, within
forty-eight hours after the occurrence, send to a
Director a written report of the circumstances of the
occurrence containing such information and
particulars as the regulations prescribe.
..ConferenceSAFETY_PresentationWork_Refusals.docx

Critical Injury
Critically injured: an injury of a serious nature that,
a) places life in jeopardy;
b) produces unconsciousness;
c) results in substantial loss of blood;
d) involves fracture of a leg/arm but not a finger or a toe;
e) involves the amputation of a leg, arm, hand, or foot
but not a finger or toe;
f) consists of burns to a major portion of the body; or
g) causes the loss of sight in an eye

Offences & Penalties
66.(1) Every person who contravenes or fails to
comply with,
a provision of this Act or the regulations;
an order or requirement of an inspector or a
Director; or an order of the Minister,
is guilty of an offence and on conviction is liable to
a fine of not more than $25,000 or to imprisonment
for a term of not more than twelve months, or to
both.

Offences & Penalties, Cont’d…
66 (2) - If a corporation is convicted of an offence
under subsection (1), the maximum fine that may
be imposed upon the corporation is $500,000

Defense of Due Diligence
(3) On a prosecution for a failure to comply
with,
(a) subsection 23 (1);
(b) clause 25 (1) (b), (c) or (d); or
(c) subsection 27 (1),
It shall be a defense for the accused to prove that
every precaution reasonable in the circumstances
was taken.

 Take every precaution reasonable
 Have a basic written standard
 Provide the main defense available
 Is used as a proactive management tool
 Must be present in the workplace before an
accident takes place
 Includes written policies, practices and procedures
 Ensures that training and instructions are given
 Observations and monitoring are conducted
regularly
 Fair and consistent enforcement is applied
 Record keeping is maintained current
What Is Due Diligence?

 Identifies all risks that are foreseeable
 Implements a health and safety system
 Takes proactive measures
Due Diligence Requires That
an Employer:

 Written policy and program
 Compliance
 A documented system
 Practices, procedures and controls
 Instruction and training
 Communication
 Time and resources
 Monitoring
Key Components of
Due Diligence

Summary
Due diligence requires that employers,
supervisors and others understand and carry
out their legal duties, assess the risks and
hazards in the workplace on an ongoing basis
and take all reasonable precautions with
respect to those risks.

Recommendations
 Control of injury and loss is a team effort.
 Loss control objectives are a recognized method
for continuous improvement.
 The management team should ensure that the
following are part of their culture:
 Integration of health and safety into all aspects of
the organization
 Creation of a system that recognizes positive
health and safety performance
 Maintenance of statistical measurement for
health and safety performance

Recommendations cont’d…
The program must be regularly updated to reflect
current legislative and industry standards.
Effective implementation of the Internal
Responsibility System (IRS) needs to be
monitored. Every employee must exercise Due
Diligence.
REMEMBER!
Due Diligence cannot be introduced to the courts
after the fact. It must be seen as an integral part of
the behavior, attitudes and culture in your
workplace.

Healthy |Work Environment, Workplace Health,
Safety and Well-being
Althea Stewart-Pyne RN, MHSc
Program Manager, International Affairs and Best Practices

Objectives
• Overview of RNAO Healthy Work Environment best
practice guidelines : Workplace safety and Well-being
of the Nurse and Preventing and Managing Violence in
the Workplace
• Best Practice Guideline Background
• Present recommendations for workplace safety

RNAO’s Vision for Healthy Work
Environments
Initially developed 6 HWE BPGs with the following
objectives:
 To provide the best available evidence to support
the creation of healthy work environments
 To support excellence in service
 To create an evidence-based practice culture
 To build learning communities

Purpose of workplace Safety BPG
• For the purposes of the BPG the concept of workplace health
and safety includes:
• Occupational health and safety initiatives that focus on
prevention of injuries and illnesses and
• Elimination or control of hazards.
• Health promotion/wellness activities.
• Supportive organizational culture and leadership practices.
• Employee assistance programs to assist employees with
personal issues.
• Ability management programs including early intervention and
return to work initiatives.
12
1

Background Context

 Violence in the workplace may:
 take the forms of physical, psychological, or sexual
abuse, harassment, mobbing, bullying, or aggression
 involve action or withholding action
 be unintentional or intentional
(Campbell & Landenburger, 1996)

Consequences of Violence
In Ontario, health/community care sector have highest
rate (34%) of lost time injuries due to violence in the
workplace compared with any other sector
Negative individual health effects: burnout diminished
self-esteem), increased sickness physical injury including
death
Organizational costs: increased absenteeism, lower
productivity, high turnover decreased capacity to offer
effective nursing care increased costs for recruitment and
retention

System Influences Affecting Safety
• Shorter hospital stays
• Sicker patients/clients requiring care at
home/community
• Increase in obese patient population
• Greater physical demand on the care provider
• Increase patient complexity that create additional risk
for musculoskeletal injuries, violence, and a higher
exposure to infectious diseases

Patients/Client
Environment
Co-workers
Contributors to Violence
Organization,Co
mmunity,
Society

Clouded Vision
• Perception that assaults/injuries are part of the job in
healthcare
• Worker beliefs that reporting incidents will reflect
poorly on them
• Lack of reporting policies & access
• Incident reports may not represent the overall issue

Contributors of Violence
Patients/clients
– vulnerability,
– feeling
powerlessness,
– frustration
– History of violent
behaviour
– Side effect of
medications
– Alcohol abuse

Co-workers
• Span of Control
• Stress
• Heavy workload
• Fatigue and/or
Burnout
• Emotional
• Exhaustion
• Abuse of power
12
8

Environment
• Lack of support from organization
• Lack of organizational policies to address violence
• Culture
• Remote locations and Home settings
• Working alone
• Lighting
• Presence of alcohol, drugs
• Presence of distraught family members, and/or
visitors
• Time of day
• Visibility of security personnel 12
9

Environment cont’d
• Isolated work with clients during treatment
• Insufficient or lack of staff training around managing
hostile behaviour
• Acute and chronic mentally ill patients released from
hospital without adequate support
13
0

External Policy
Factors
Organizational Physical
Factors
Physical
Work Demand Factors
Individual
Nurse
Factors
Organizational
Professional/
Occupational
Factors
External
Professional/
Occupational
Factors
External
Socio-Cultural
Factors
Organizational
Social
Factors
Individual
Cognitive/Psycho /
Social Work Demand
Factors
Physical / Structural
Policy Components
Professional/
Occupational
Components
Cognitive
Psycho/Socio/
Cultural
Components
Individual Work Context
Micro Level
Organizational Context
Meso Level
External Context
Macro Level
Nurse
Patient
Organizational
Societal
Outcomes
Organizing
Framework
for Healthy
Work
Environments
Best Practice
Guideline
Project

Target Group
 Nurses in all roles and settings:
 Interdisciplinary team members
 Students
 Administrators/leaders at all levels of the organization and system
 Policy makers, regulatory bodies and governments
 Professional organizations, employers and labour groups
 Educators
 Researchers
 Other stakeholders including to patients/clients, family advisory
groups, law enforcement/security personnel and the public

Purpose:
• Provides organizational systems and
supports required
• Promotes the importance of fostering a
climate and culture which supports the
promotion of health, well-being and safety of
nurses
• Describes impacts→ patient safety and
satisfaction
Workplace Health, Safety and
Well-being of the Nurse
134

Organization Practice Recommendations
1.0 Organizations / nursing employers foster a climate and
culture encompassing supportive practices, which ensure
the promotion of health, well-being, and safety of nurses.
1.1 Organizations / nursing employers create and design
environments and systems that promote safe and healthy
workplaces including strategies such as:
 Creating a culture, climate and practices that support
and promote staff health, well-being and safety.
 Organization’s annual budget includes adequate
resources (human and fiscal) to implement health and
safety initiatives.
 Organizational practices that foster mutual
responsibility and accountability by individual nurses
and organizational leaders to ensure a safe work
environment.

Organizational Recommendations
• 1.2 Organizations / nursing employers create
work environments where human and fiscal
resources match the demands of the work
environment.
• 1.3 Organizations / nursing employers
implement a comprehensive Occupational Health
and Safety Management System, which includes
initiatives related to emergency preparedness
and the management of infectious diseases.

Org Recommendations cont’d
• 2.0 Organizations should consider and accommodate the impact
that organizational changes, such as restructuring and
downsizing, may have on the health, safety and well- being of
nurses.
• 2.1 Organizations are responsible and accountable for
recognizing the stressors within the workplace during
organizational change and implementing appropriate supportive
measures.
• 2.2 Organizations form partnerships and work with
researchers to conduct evaluations of specific interventions
aimed at improving nurses’ health and well-being.

Org Recommendations cont’d
• 3.0 Organizations should implement and maintain
education and training programs aimed at increasing
awareness of health and safety issues for nurses. (e.g. safe-
lift initiative; self-responsibility)
• 3.1 Organizations promote and support initiatives relating
to the physical health and well-being of the nurse. This may
include but is not limited to fitness programs, health
promotion and wellness activities, and return to work
initiatives.
• 3.2 Organizations provide ongoing training programs and
education to ensure staff possess the knowledge to
recognize, evaluate and manage hazardous work situations.

Org Recommendations Cont’d
• 3.3 Organizations employ qualified individuals
with the knowledge and expertise in health and
safety, policy and legislative requirements to lead
these programs.
• 3.4 Organizations provide nurses with
opportunities for personal and professional
development with regards to healthy work
environments, professional competencies, and
work / life balance.

• 4.0 Workplace health and safety best practices
be embedded/integrated across all sectors of the
health care system.
• 4.1 Healthcare organizations / nursing employers
develop and share workplace health and safety
best practices at local, provincial, national and
international levels.

• 4.2 Organizations support and contribute to the
development of health and safety indicators at
the local, provincial and national level to assist in
data collection and comparable analysis across
the health care sector.
• 4.3 Organizations develop and utilize
standardized databases for sharing best
practices in nurse health, safety and wellness.

Research Recommendations
• 5.0 In collaboration with healthcare organization partners,
researchers should demonstrate the effectiveness of workplace
interventions aimed at improving nurse health, safety and well-
being using rigorous well-controlled research and evaluation
methodologies.
• 6.0 Researchers should make full use of existing databases on
nurse health, including outstanding resources such as the new
National Survey on the Work and Health of Nurses, in order to
improve our understanding of the key factors contributing to
healthy work environments for nurses and to help develop best
practice indicators for healthy work environments.

Educational Systems
Recommendations
• 7.0 Nursing education institutions should strive
to be leaders in the integration of health,
safety and well-being into their own workplace
culture.
• 8.0 Nursing education institutions should
build health, well-being and safety into the core
curriculum of nursing education programs.

Systems Recommendations
• 9.0 Governing/Accreditation bodies enforce
and evaluate the utilization of health and safety
standards in healthcare organizations.

Applying the Guideline to Your
Context
• Study the model
• The conceptual model was created to allow users to
understand the relationships between and among the
key factors involved in the healthcare work
environments.
• Understanding the model, is critical to using the
guideline effectively.
14
5

Context
• Identify an area of focus:
• for yourself, your situation, or your organization, that
you believe requires attention to enhance the health,
safety and well-being of the healthcare worker.
14
6

Context
• Read the recommendations and the summary of
research for your area of focus.
• For each major element of the model, a number of
evidence-based recommendations are offered.
• The recommendations are statements of what
organizations/researchers/educators/governing
bodies should do to promote healthy work
environments.
14
7

Context
• Focus on the recommendations or desired
behaviours that seem most applicable to you and
your current situation. The recommendations
contained in this document are not meant to be
applied as rules, but rather as tools to assist in
specific workplace situations.
14
8

Context
• Make a plan.
• Make a tentative plan for what you might actually do
to begin to address your area of focus.
• If you require more information, you may wish to
refer to some of the references cited, the evaluation
instruments or the helpful websites
14
9

Context
• Discuss the plan with others. Take the time to
solicit input into your plan from people whom it
might affect,
• those whose engagement will be critical to its
success, and from trusted advisors
• For the intervention to be most effective, support is
required from multiple levels within the
organization/program unit.
15
0

Context
• Revise your plan and
get started: It is
important to begin, and
then make adjustments
as you go.
15
1

WORKPLACE VIOLENCE BPG
RECOMMENDATIONS

External/System: Governments
• Review and enact legislation (Bill 168)
• Resources – financial and human
• Role modeling respectful behaviour
• Monitoring key indicators
• Responding to recommendations from coroners’
inquests
• Funding from multi-sectoral strategies that address
root causes of violence

External/System: Research
• Research to increase understanding of the impact
of violence on staffing, recruitment and retention
• Inter-professional research
• Research on the conceptual model constructed for
these guidelines to assess fit with the concept of
violence in the workplace

External/System
Accreditation
• Standards that support violence free workplaces
Education
• Education for all healthcare professionals that includes
skills, communication strategies, reporting methods,
policies and procedures
• Recognition of intended and unintended forms of incivility,
violence and aggression can reproduce and escalate violent
behaviours

External/System: Professional/Regulatory
• Role model
• Outreach programs
• Policies, standards, guidelines and educational
materials

Organizational
• Promote and support a workplace free of violence
• Prevention program with monitoring in place
• Ensure all staff have knowledge and competencies
• Develop and implement a process to evaluate programs
• Clear strategies for responses to violence

Individual
• Knowledge to identify, prevent and respond
• Self-reflection
• Knowledge and implementation of organizational
strategies and processes
• Support team members
• Collaborate with team members in a manner that fosters
respect, trust and prevents violence

Spectrum of Workplace Violence

Typical Responses to Violence
PASSIVE
• Accept
• Avoid
(International Council of Nurses)
ACTIVE
• Defend verbally
• Negotiate
• Defend physically

Accountability
Responsibility for one’s conduct or the willingness to
be answerable for one’s actions.
Concise Oxford Dictionary, 1982; Bergman, 1981

“A safe work environment free from danger
is a basic element for providing quality
health care.”

Web Resources
• RNAO: www.rnao.ca
• Ontario Ministry of Labour:
www.labour.gov.on.ca/english/hs/sawo/pubs/fs_workpl
aceviolence.php
• Canadian Nurses Association: www.cna-nurses.ca
• International Council of Nursing
• Position Statement “Abuse and Violence Against
Nursing Personnel”
www.icn.ch/psviolence00.htm

Opportunity for Audience
Clarification Questions

Your task
•Get coffee, move into small groups
•Assign a recorder and a facilitator in your group
•Address the questions on the worksheet
•Be prepared to report back after discussion

1. What opportunities does CAOT have to collaborate with other
groups/initiatives to enhance workplace safety?
2. What can be done to raise awareness about workplace health
and safety among OTs?
3. What can be done to safeguard our practices to mitigate risk
for OTs and other employees?
Questions

Next Steps
Please address any questions or feedback to
practice@caot.ca.

Workplace safety PIF 2012 Presentaton.ppt

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