Preliminary Results of the Health Care Worker Survey

Health and Safety Is Not Taken Seriously by Many Health Care Institutions

Top Reasons for Going Into Health Care

• Desire to help people

• Interest in science / research

• Working with patients

Main Issues Concerning Health Care Workers

• Short staffing• Irregular hours• Workload• Lack of management support• Bureaucracy• Workplace / Governmental politics• Lack of respect• Budget / Funding constraints• Difficulty working with physicians• Labor issues

What do you like the least about your job?

• “Working from crisis to crisis.” Employee Health Nurse

• “Dealing with non-health care worker administrators.” Physician

• “Very challenging to convince doctors to institute safety into practice.” Industrial Hygienist

Have you thought about leaving work?

• “Yes, politics of the position – sometimes you feel there needs to be an act of Congress to change anything.” Employee Health Nurse Practitioner

• “Yes, my department hardly receives any support from the administration… also in the way of providing enough staff.” Employee Health Nurse

What is the biggest problem you face at work?

• Low staffing

• Lack of funding for training

• “Injured workers coming to me after the fact.” Workers Compensation Coordinator, RN

How could your job be improved?

• Increase staffing

• Better control of work environment

• Increase funding

The White Dress

A presentation to the 10th Conference on Occupational

Hazards to Health Care Workers Seattle, WA July 31 - Aug 1, 2002

Dr. June Fisher, TDICT Project, Trauma Foundation, San Francisco

A Cosmetic Approach to Health Care Reform

The White Dress“Hotel Lobbies”

Botox at HopkinsBoutique Medicine

“RN Pin” taken from Jim Coleman, Ltd.(http://www.jimcolemanltd.com/ana)

“There’s a terrible nursing shortage going in right now…and I

have this romantic notion that if the uniforms looked more

attractive more people would want to go into the profession.”

- Designer, Yeohlee Teng, as quoted in “The White Dress,” The New Yorker, March 18, 2002

“The designer took a seat on a floral-patterned chair and looked around the lobby,

a large two-story space with expensive lighting and, in one corner, a grand piano. In recent years, hospitals have begun to look

more and more like hotels…. These changes are made partly in order to promote ‘a healing

environment,’ but they’re also expected to improve the institutions image”

- Excerpt from “The White Dress,”

The New Yorker, March 18, 2002

Waiting room of the Cosmetic Plastics Center and Same-Day Admissions Facility at Massachusetts Eye and Ear Infirmary

“It is 7:30 a.m., dark, drizzling, chilly as I board the shuttle bus. This, I ask myself, is the

pampered existence of the world’s elite? Today, I am experiencing first-hand the world of “concierge” or “boutique” medicine, a

specialized type of health care available only to those willing to spend thousands more than

standard insurance premiums in order to guarantee quality, access, and a bit of

pampering.”

- Taken from the article, “The Wealth Care System: When CEOs and VIPs need health care, they get the best money can

buy. A reporter finds out just how good that is,”

Washington Post, May 28, 2002

“As a resident of Cleveland, I am well aware of the luxury packages the Cleveland Clinic offers to wealthy customers, and so the May

28th front-page article ‘Healers Go for the Well-Heeled’ resonated with me. I am

saddened, though, because many of these “elitist” practices -- such as personal

communication, home visits and language interpretation -- are not, but should be, the

standard of care for everybody.”

- Letter to the editor, Washington Post,

June2, 2002

The Crisis in Health Care

“We’ve engaged in a massive and failed experiment in market-based medicine in the U.S….Rhetoric

about the benefits of competition and profit-driven health care can no longer hide the reality: Our

health care system is in shambles. Despite spending twice as much on average on health care per person as Sweden, Norway, Denmark, Canada,

Australia, Japan and every other developed country, over 42 million Americans have no health insurance at all, and tens of millions more are not covered for

all their medical needs. The recession we all fear could easily push the number of uninsured to 60

million.”

- Congressional testimony from Dr. Marcia Angell, former editor of the New England Journal of Medicine, May 2, 2002

“The United States in particular stands out as having the most severe health care access problems related to cost, the greatest medical expense

burdens, and the most pervasive inequities in care between adults with

above-average and below-average income.”

- “Comparison of Health Care System Views and Experiences in Five Nations, 2001,” Findings from the Commonwealth Fund 2001

International Health Policy Survey

How Some of Our Health

Care Dollars Are $pent?

For-Profit HMOs

Health Care Associates (formerly Columbia/HCA) made more than $1 billion in profits last year. It operates

nearly 200 hospitals across the nation.

Other Old Active

Ingredient s

11%

NMEs New Active

Ingredients

35%

IMDs Old Active

Ingredients

54%

Source: FDA 2001

“Two-thirds of new drugs approved in 1989-2000 used active ingredients already on the market….Only 15% of drugs approved during this period were both based on a new molecular entity and deemed by the FDA as providing significant improvement over existing medicines”.

(from “Changing Patterns of Pharmaceutical Innovation,” National Institute for Health Care Management, Research and Educational Foundation)

Comparative costs of three drugs in the U.S. and Canada

United States Canada

Lipitor 20mg $1,281-$1,393 $468

Glucophage850mg

$1,501-$1,608 $137

Norvasc10 mg

$1,499-$1,734 $664

The Eroding Safety Net

“In recent years, more than 100 public hospitals around the country have closed, and almost 300 have converted to private

ownership or management. A recent study found that one out of every 100 public hospitals closes each year, and

two more convert to private ownership.”

- Roni Rabin, "Complex Sale of NCMC is No Cure-All," Newsday, 15 March 1999,

p. A5, A20-21.

“Medical crisis could catch S.F. flat-footed”

“Drowning in chronic drunks and short on beds, city’s ER facilities ill prepared for

bioterror - or even the flu”

The San Francisco Independent, July 16, 2002

Racial and Class-based Inequity in

Health Care

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

- Rev. Martin Luther King Jr.

Medical Error

“ Most medical errors, it is said, result not from individual recklessness, but from basic flaws in the way hospitals, clinics and pharmacies operate.”

New York Times, November 30, 1999

“To Error is Human: Building a Safer Health System”

“… the results of the study in Colorado and Utah imply that at least 44,000 Americans die each year as

a result of medical errors. The results of the New York Study suggest the number may be as high as

98,000. Even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th leading cause of death. More people die in a given year as a result of medical errors than from

motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).”

- Institute of Medicine Report, December 1999

ANA Staffing Survey

• 40% of nurses surveyed said they would not feel comfortable having a family member or someone close to them be cared for in the facility in which they work

“In hospitals with low numbers of registered nurses, patients are more likely to suffer complications like urinary infections and pneumonia, to stay in the hospital longer and to die from treatable conditions like shock of gastrointestinal bleeding….’I estimate that hundreds, or perhaps,

thousands of deaths each year are due to low staffing.’”

- From article by Denise Grady, w/ quote from Dr. Jack Needleman

“Shortage of Nurses Hurts Patients Care, Study Finds,”

New York Times, May 30, 2002

The Nursing Shortage

Recruitment of foreign nurses – a drain on health care resources in developing

countries

“The nation has a serious nursing shortage, with 126,000 jobs unfilled, 12 percent of

capacity, says the American Hospital Association. The shortage is a result of

hospital mergers, layoffs and heavy workloads. Many hospital nurses shifted to other work. The average salary, $46,000 a year, has not increased much in a decade.

Even though hospitals are trying to hire again, nurses are no longer available.”

- “Shortage of Nurses Hurts Patient Care, Study Finds,”

New York Times, May 20, 2002

Health Care Worker Health and Safety

Trends Across Sectors( Injuries per 100 full-time workers)

468

101214161820

Source: Annual Survey of Occupational Injuries and Illnesses (BLS) *Baseline

Pe

r 1

00

ful

l-tim

e w

ork

ers

Farmers

Nursing andPersonal Care

Construction

NIOSH

American Nurses Association, Health and Safety Survey, Key Findings, September 2001

Stress and Overwork• 67% reported some type of mandatory or

unplanned overtime every month, (10%) as many as eight or more times a month

• Fewer than 20% of nurses responding to the survey felt safe from work-related injury

• >70% cited the acute and chronic effects of stress and overwork as one of their top three health and safety concerns

American Nurses Association, Health and Safety Survey, Key Findings, September

2001 (cont’)

• 60% feared a disabling back injury• 45% of respondents were concerned about contracting

HIV or Hepatitis B from a needlestick injury• 37% were concerned about the possibility of being

infected with Tuberculosis or another disease• 25% named an on-the-job assault as a great concern• 21% were concerned about latex allergy• 19% of nurses surveyed ranked the possibility of a

fatigue-related car accident as one their top 3 health and safety concerns

The Global Economy and Health Care

Globalization’s Threat to Health Care

Proposed trade laws in the GATS (the WTO General Agreement on Trade in Services) and the

draft FTAA (Free Trade Area of the Americas) could allow foreign corporations and governments to

challenge several U.S. health care regulations as “more burdensome than necessary.” Under these

conditions, minimum staffing ratios and safe needle laws could come under attack.

- Taken from “How trade rules threaten health care workers and consumers,” The Alliance for Sustainable Jobs and the Environment

“Two companies (including Sodexho Marriott Services ,a French subsidiary of Marriott),

wanting to provide privatized health-related services in B.C. were accused Friday by labour leaders of planning to blacklist 20,000 or more

members of the Hospital Employees Union who now do the work.... Union leaders said the companies are proposing to pay wages in the $10-per-hour range for work that now earns

HEU members about $17 per hour.”

Vancouver Sun, May 4, 2002

Are there reasons for optimism?

There is increasing public discontent with the current health care situation. Concerns include:

1. Access

2. Cost of care

3. Cost of drugs

4. Quality of care

5. Nursing Shortage

Health and Safety

1. Needle Stick Legislation

2. Contract language on staffing and hours

3. Pending legislation on staffing and hours

4. Contract language for access to data

NIOSH

Increasing Interest in Health Care Worker

Health & Safety

At best, these suggest guarded optimism

“Nigerian Women, in Peaceful Protest, Shut Down Oil Plant”

“ESCRAVOS, Nigeria, July 13 (AP) -- Anunu Uwawah let a small smile escape as she told

how she and a band of 150 village women have shut down most of a multinational oil

company’s(Chevron) operations in Nigeria for nearly a week.”

New York Times, July 14, 2002

“’It is the trade unionists, students, environmentalists - ordinary citizens - marching in the streets… who have put the need for reform [of these institutions] on the agenda in the developed world…. Until the protestors came along there was

little hope for change, and no outlets for complaint.’ After all, millions in the developing

world have been protesting for decades - rioting when IMF austerity measures were imposed or

when social services funding was cut to service mounting foreign debt - to no avail.”

- from”Globalization and Its Discontents”, by Joseph Stiglitz

An Agenda for Action

Global Action

1. Support :

- solidarity programs - access to drugs for HIV and other infectious diseases - efforts to assure that environmentally safe medical equipment and procedures are used world wide

2. Assure that HCW health and safety is promoted in all countries

National Action

1. Support efforts for universal health insurance

2. Take the profits out of health care

3. Run for office

Local Action

1. Work with your neighbors for health care reform

2. Run for office

Workplace Action

1. Negotiate contract language for worker participation in:

- Health and safety programs- Determination of staffing levels- Access to data- Purchasing

2. Develop local networks

Specific Efforts in Health Care Worker Health &Safety

1. Establish international standards for safer sharps devices2. Assure that the BBP standard is implemented in all healthcare institutions ( more OSHA inspections and complaints)3. Develop national networks for pooling “real life” efficacy data4. Develop the concept of worker participation in all aspects of healthcare5. Develop training for participation

Specific Efforts in Health Care Worker Health & Safety

6. Mandate that the FDA require worker health and safety testing for all device and drug approval

7. Mandate the use of environmentally safe products 8. Lobby for congressional funding of a NIOSH initiative for HCW H&S9. Creation of a Worker Health and Safety Center10. Push NIOSH to create programs to certify nurses in hospital health and safety

Power, participation, public, political

Activation, alliances, action,

Community,collaboration, cooperation, cosmetics

Together,triumph

Struggle, strength

“The answers you provide for yourself to the question. WHY ME will be of great consequence to the way you answer

WHAT AM I DOING HERE… one of the answers to the WHAT question ought to be: I am here to organize. I am here to be political. I am here to be a citizen in a pluralist democracy. I am here to be effective, to have agency, to make a claim on power, to spread it around, to rearrange it, to democratize it, to legislate it into justice. Why you? Because the world will

end if you don’t act. You are the citizen of a flawed but actual democracy. Citizens are not actually capable of not acting. It is not given to a citizen that she doesn’t act; this is the price

you pay for being a citizen of a democracy. Your life is married to the political beyond the possibility of

divorcement.”

- Excerpt from “A Word to Graduates: Organize!” by Tony Kushner,

speaking to students at Vassar College on May 26, 2002

“Never doubt that a small group of thoughtful, committed people

can change the world. Indeed, it’s the only thing that ever has.”

- Margaret Mead

Other resources for information:

Public Citizen - www.citizen.orgAmerican Nurses Association -

www.nursingworld.orgHealth Care Without Harm –

www.noharm.org