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Work-related injuries are extremely prevalent among certified nursing assistants (CNAs) working in U.S. nursing homes, with 60 percent of CNAs suffering an injury in the previous year, according to a study (pdf) by the Research Triangle Institute.

Common injuries included scratches, open wounds, back injuries, black eyes and other bruising, human bites, and strained or pulled muscles. Of those injured, nearly one quarter (24 percent) were left unable to work.

The report, which uses data from the 2004 National Nursing Home Survey and National Nursing Assistant Survey, found that:

• CNAs who were new to a facility, or to the field of direct-care work entirely, were more likely to suffer on-the-job injuries.
• CNAs who had two or more jobs in the prior five years were more likely to be injured. Due to the high turnover rates in direct-care work, three-fourths of CNAs fit that description.
• Poor training and job preparation are strongly linked to higher injury rates among CNAs. More than one-third of CNAs felt that their initial training was inadequate.
• Higher wages are associated with lower CNA injury rates.
• CNAs who said they felt rushed at work were more likely to be hurt on the job. One out of every three CNAs reported not having enough time to help consumers perform activities of daily living (ADLs).
• CNAs working mandatory overtime were more likely to be injured on the job during overtime hours. More than one out of five (22 percent) of CNAs are required to work overtime.

An unexpected finding of the study was that, although assistive equipment was readily available and often used, it was not associated with lower injury rates.

For example, lifting equipment may be too cumbersome to use properly or may require the help of additional staff who may not be available.

Additionally, the study found that positive and supportive organizational cultures in nursing homes promote safer work environments. “The odds of being injured decreased for CNAs who felt respected and rewarded for their work and for CNAs who felt that [their workplace] values CNA work,” the authors wrote.

They suggest that, in order to reduce injury rates even further, facilities should concentrate on providing robust initial and ongoing training, reducing mandatory overtime, and working to lower turnover.

– by Matthew Ozga

(L-R) Jane Lipscomb of the University of Maryland Baltimore Schools of Nursing and Medicine; Carol Rodat, PHI New York Policy Director

Occupational hazards and safety in home care were the focus of “Home Health Care Health and Safety: Emerging Occupational and Patient Safety Issues in Home Care for Patients,” a conference sponsored by the National Institute for Occupational Safety and Health (NIOSH) and the Columbia University Mailman School of Public Health (MSPH).

At the May 19 conference, three researchers presented their findings on the many serious health risks that home care aides and nurses face while on the job.

Hazards in the Home

Jane Lipscomb, PH.D., R.N., F.A.A.N., of the University of Maryland Baltimore Schools of Nursing and Medicine, says that a lack of health insurance and other job benefits combined with certain unique features of the job — such as working alone in a work environment over which they have little control — put direct-care workers at disproportionate risk of occupational illness and injury.

Lipscomb reported on the numerous hazards (pdf) that direct-care workers face when working in the home setting, including:

• back, shoulder, and neck injuries
• falls
• needle sticks
• verbal assaults
• physical violence
• sexual harassment
• infectious disease
• motor vehicle accidents
• irritating household chemicals such as cleaning compounds

Margaret Quinn, Sc.D., of the University of Massachusetts Lowell, presented her research findings (pdf) on sharps injuries and blood exposures. She noted that while nurses have higher rates of such incidents, home care aides are also at a “sizeable” risk.

Among the factors that put home care aides at risk for sharps injuries and blood exposures are handling consumers’ trash, poor container designs, and sharps left in bed linens and around the house.

Quinn recommends that all aides be covered by the OSHA Bloodborne Pathogen Standard to prevent exposure.

Double Set of Hazards

Robyn Gershon, M.H.S., Dr.P.H., of MSPH and conference director, discussed how workers who provide care in the home are vulnerable to hazards both in the household environment and also those typically associated with the delivery of healthcare.

The first step to reducing injuries in home care is to identify household hazards (large pdf), explained Gershon, who developed a Home Health Care Household Safety Checklist. (Contact Dr. Gershon for the checklist.)

“Importantly, household hazards that present a threat to home healthcare workers may also be hazardous to patients — most of whom are frail and elderly,” Gershon noted. “Combined, this results in injuries, exposure to blood/body fluids, and lack of job satisfaction and high turnover.”

Following the presentations, panelists — including PHI New York Policy Director Carol Rodat, direct-care workers, consumers, family members, and representatives from government agencies, unions, and community-based organizations discussed the research findings — shared their experiences in the field, and reported on education and training programs that could help to reduce home care occupational injuries.

For more information, see NIOSH’s Occupational Hazards in Home Healthcare (pdf).

– by Deane Beebe

A home health aide in training

A new study by Pennsylvania State University researchers found that home health aides who had training are less likely to be injured on the job, and aides who felt they did not have good support from their supervisors were also more likely to suffer injuries.

The researchers also concluded that home health aides who had not experienced on-the-job injuries had a higher rate of job satisfaction and lower turnover “intentions.”

Benefits of Training

The study found that how employees felt about their workplace and training affected the probability of injuries. Employees who felt that their training had not prepared them well enough for the job were three times more likely to be injured than employees who thought that their training prepared them well.

The aides who felt their training prepared them well, not only had lower workplace injury rates, but they were also more likely to rate their organization highly as a place to work and seek services from.

“What this suggests is that investing finances into soft resources can have tangible benefits to organizations,” Deirdre McCaughey, assistant professor of health policy and administration at Penn State and lead author on the study, said in a press release about the study.

“Organizations tend to cut back on spending on soft resources, especially during hard economic times, because there is usually no tangible benefit,” she continued.

Good Supervisor Support

How home health aides perceived the support they got from their supervisors also affected on-the-job injuries, reported the study’s authors. The aides who felt they had poor supervisor support were one-and-a-half times more likely to have one injury, and three times as more likely to have three injuries, than the aides who considered their supervisors to be supportive.

“The study confirms what PHI has found it its own work over 20 years — that well designed adult-learner centered training and good supervisory supports improve retention and job satisfaction,” said PHI National Director of Curriculum and Workforce Development Peggy Powell.

The Penn State researchers analyzed data from the nationally representative 2007 National Home Health Aide Survey, which was funded by the U.S. Department of Health and Human Services and conducted by the Centers for Disease Control and Prevention.

The research findings were reported at the 2010 Academy of Management (AOM) Annual Meeting on August 9.

“Who Needs Caring? We Do! Workplace Injury and Its Effect on Home Health Aides,” was selected as a “Best Paper” for the AOM’s Annual Meeting Proceedings. The conference proceeding article can be purchased for $20 by contacting the AOM Communications and Publishing Coordinator at mdavis@pace.edu.

Visit PHI’s Training and Organizational Development Services website for more information, including PHI Coaching Supervision^SM (pdf).

– by Deane Beebe

THE GERONTOLOGIST Vol. 49, No. 2 (April 2009)

An article in The Gerontologist (April 2009) examines the results of a first-ever National Nursing Assistant Survey and reports on the prevalence of work-related injuries, use of public assistance, and lack of health insurance among certified nursing assistants.

The lead author of the article, The National Nursing Assistant Survey: Improving the Evidence Base for Policy Initiatives to Strengthen the Certified Nursing Assistant Workforce, is Senior Policy Analyst Marie Squillace, Ph.D., of the Office of the Assistant Secretary for Planning and Evaluation within the U.S. Department of Health and Human Services. Read the full story