When workplace threats become reality

by Susan Trossman, RN

The irony is painfully evident. In their effort to help patients get better, registered nurses increasingly are facing threats to their own health and well-being every time they come to work. What follows are the stories of three nurses who experienced occupational injuries and illnesses and how they are advocating to create safer workplaces for all health care workers and their patients.

The patient moved

In the fall of 1997, 27-year-old Lisa Black attended an inservice on post-exposure prophylaxis for needlesticks. Little did she know it was a grim foreshadowing of events that would soon play out at the small northwestern Nevada hospital where she worked as a per diem registered nurse.

On Oct. 18, 1997, Black was assigned to care for eight patients in the hospital's step-down unit. When she went to check a patient's IV, she noticed the bag was empty and the tubing occluded with blood. She didn't want to change the IV site if possible, so she grabbed a syringe, stuck it into the port and attempted to aspirate. The patient, who was in the advanced stages of AIDS, suddenly moved his arm causing the needle to flip out of the port and into Black's hand.

"When I realized I was stuck, I was horrified," recalls Black, a mother of two girls, ages 4 and 8. Having recently participated in the needlestick inservice, she knew what to do. She scrubbed the needlestick site, headed to the ER, filled out the paperwork and notified the appropriate personnel. The Nevada Nurses Association member immediately started the prophylactic cocktail of AZT, 3TC and a protease inhibitor, which she continued taking three times a day for four weeks.

Early on, Black was sure she would remain healthy -- a belief that was reinforced when her three-month screening came back negative.

Nine months after the needlestick, however, Black noticed swollen lymph nodes in her neck and groin, and she felt extremely tired. "I thought, 'What's going on? Do I have mono?'" Black says. Then one morning she woke up with an excruciating headache that sent her to the ER, where doctors initially suspected meningitis. They ordered a battery of tests, including a bone marrow biopsy and bloodwork to check for HIV antibodies and viral particles. This time, Black tested positive for HIV, and three months later, positive for Hepatitis C.

She also had another fight on her hands. Less than a month after her needlestick injury, hospital administrators fired her without warning. After she became HIV positive, they waged a campaign to have her workers compensation benefits reduced, Black says. Another workers comp hearing -- the result of the hospital's second appeal -- is slated for this summer.

Despite all that has happened to her, including having her personal life examined by a private investigator and being accused of sticking herself intentionally, Black refuses to be anything but positive.

"I went through a time where I thought, 'Woe is me, why did this happen to me?'" Black says. "But it did happen, and nothing can undo it. I really am of the mindset that when life hands you lemons, you make lemonade."

After taking three months to "regroup" following her November 1997 termination, Black began working at another local hospital, where the entire staff has been supportive. Further, she has shared her story with nursing students at area schools, and she plans to raise public awareness on needlestick prevention through ANA's media outreach program.

"I tell my story so it doesn't become someone else's story," Black explains. "There is technology out there that can prevent what happened to me. I want nurses to be proactive — to protect themselves and to demand that the hospital use the technology that's available to protect them.

"I wasn't working in a super high-risk area or in a part of the country with a high AIDS population. So if it can happen to me, it can happen to anyone."

Black recently fought off a serious infection that forced her to take a leave of absence from her staff nurse job. She also continues to deal with the unpleasant side effects of taking 22 pills a day and four shots a week. But she has good news, as well.

"My viral load is undetectable, and my T-cell count is great," Black says. "My kids keep me going. There's a reason I have to take care of myself. I need to be around to see them grow up."

It's everywhere

Before Michelle Silliker helped change the system at her southwestern New York hospital, she had become increasingly nervous about being at work. She worried about the possibility of going into anaphylactic shock. She worried that her colleagues in the emergency department would not know how to treat her safely using the medical equipment available to them. She worried about what she would do if she couldn't continue working as a nurse.

The New York State Nurses Association (NYSNA) member had developed a severe latex allergy, and avoiding natural rubber latex supplies, like exam gloves and foley catheters, was not easy. "Everything that feels or looks like rubber isn't always latex," says Silliker, RN, CEN. "That's why labeling (of latex products) is so important."

Silliker traces her latex allergy to about 1992, when she started getting hives on her hands. She first attributed them to frequent hand-washing with harsh soap. When her symptoms progressed to include sinus congestion and sneezing, she thought she had fallen victim to environmental allergies. Then she noticed a pattern: her symptoms only flared up at work.

When Silliker reported her symptoms to the occupational health nurse in 1993, she was given her own box of vinyl gloves. "In the short term, it was fine," she says.

But one day, when she was in the middle of a code with people snapping gloves on and off all around her, she broke out in hives. Since she was documenting the code and not touching equipment, she realized something airborne was inducing her symptoms.

"My reaction clearly demonstrated that it wasn't enough to give people with latex allergy their own box of gloves," Silliker says. She began educating herself about latex allergy. She discovered it could start with a skin rash, respiratory problems or anaphylaxis. And that frightened her. So she became a vocal advocate for a latex-free work environment.

"I felt I needed to do something not only for employees, but for patients," Silliker says. "When a patient comes into the ED in anaphylaxis, the source can be unknown -- perhaps a bee sting, a medication or a response to latex. If it's a latex reaction, further exposure can result in the patient's death."

By 1996, Silliker's allergy intensified: "I'd have a reaction every day at work, and it seemed that even a minor exposure would provoke a reaction. If a nurse removed her gloves in another room and came within six feet of me, I started sneezing and coughing."

With her persistence and the support of NYSNA and the hospital's occupational health nurse, management agreed to form a latex allergy task force. So far, occupational health has identified seven employees with latex allergy. In the ED alone, a third of the staff have had some type of reaction when wearing powdered latex gloves.

Although Silliker stops short of calling the hospital system totally latex-free, it's well on its way. All exam gloves are non-powdered and non-latex. Further, non-latex substitutes for foley catheters and resuscitation equipment are available. A program on latex allergy safe practices also has been implemented for all hospital staff.

Silliker, now the assistant nurse manager in her ED, wants other health care facilities to kick the latex habit. As part of her effort, she's participating in NYSNA's "train the trainer" workshops on latex allergy this spring.

Silliker maintains that nurses who want to eliminate latex from their workplace must first build an awareness about its potential hazards. To do so, she suggests RNs push for the creation of a latex allergy task force at their facility with representatives from all departments.

Silliker also advises that nurses experiencing reactions document and report their symptoms to the occupational health nurse.

Finally, she says, persistence is key: "It took a year of working hard with the task force before changes were made. This commitment by administration proved their concern for employees' and patients' wellness and safety.

"My working days are now symptom-free, and I feel quite safe and fortunate to be working. It is certainly cheaper to keep employees healthy and working than to pay workers compensation."

Backlash

Rosalie Nemeth has been on staff at the same Youngstown, OH, hospital for 34 years. For the first 20, she worked in labor and delivery and had no intention of switching to a different unit.

But in 1984, Nemeth, a registered nurse and Ohio Nurses Association (ONA) member, suffered a severe back injury that forced her to change her area of practice -- and her life.

As with many work-related injuries, her's happened suddenly. Her patient had just delivered when Nemeth noticed that one of the stirrups was out of position. Concerned about the patient's safety, she momentarily balanced the woman's leg on her shoulder while she tried to get the stirrup securely placed. Before Nemeth could finish, the 180-lb. patient shifted her weight against the nurse's shoulder. Hours later, Nemeth could barely move.

Now a strong safety advocate, Nemeth is particularly interested in preventing job-related back injuries. She successfully lobbied for the purchase of lifting equipment at the hospital, and she's encouraging nurse managers to promote safe lifting techniques on their units.

Nemeth believes many factors contribute to back injuries, including the cumulative effect of constantly lifting, bending and twisting, and the daily stress of heavy assignments. Nurses also lift more weight than they should, and often must react to situations so quickly that they jeopardize their own health.

"When you're trying to prevent someone from falling, you're not worried about proper body mechanics or alignment," Nemeth says.

And then there's the unrelenting pace of trying to provide care to many, acutely ill patients.

"Many times nurses will tell me they don't have time to get the lifting equipment or wait for help before they transfer a patient. But I tell them they'll have plenty of spare time if they get injured," Nemeth says.

She knows it can be a tough message to get across. "If you've never had an injury, you don't realize how devastating it can be," she says.

When Nemeth was first injured, she was in a classic state of denial.

"I worked with a ruptured disk for three months, because I refused to believe I was seriously injured," she says. After a CAT-scan proved otherwise, Nemeth had back surgery and took a six-month leave. Without her work, Nemeth says she lost her sense of identity. She also worried that she wasn't meeting her family's needs.

"I felt so alone and like my life was out of control," Nemeth says.

But once again things changed -- this time for the better. She now works in the hospital's pediatric clinic and helps nurses on two fronts.

With the backing of ONA District 3, she started a support group for nurse members in northeastern Ohio who've been injured or have chronic conditions. In its sixth year, Nemeth's group frequently brings in speakers who lend their expertise on issues ranging from workers compensation to nutrition.

For the past four years, Nemeth has worked to improve workplace safety through her position on the hospital's 30-member safety committee, which previously had no staff nurse representation. She already helped win stronger contract language regarding injury-related leaves of absence and return-to-work programs.

She also is advocating for the use of skilled "lifting teams" to assist nurses on all units and wants to implement a bedside card system that details the transfer requirements for every patient.

In closing, Nemeth offers this advice to all nurses:

* Work in teams whenever possible.

* Don't be afraid to call for support to prevent unsafe transfers.

* Use lifting equipment.

* Exercise to maintain a strong, healthy back.

Susan Trossman, RN, is the senior reporter for The American Nurse.