Psychosocial Hazards

• Management and supervisory practices that influence work processes, production, and performance.
• Job factors such as work overload, inadequate staffing/scheduling, lack of job training and control, shiftwork, role ambiguity, patient acuity, poor or unsupportive interpersonal relationships, work-life balance, lack of benefits (e.g., childcare, elder care).
• Organization factors including downsizing, mandatory overtime, lack of infrastructure/equipment, technology overload, and inadequate/unclear policies.
• Poor safety climate and lack of commitment to occupational safety.

A survey conducted in 2019 by the American Nurses Association (ANA) of more than 20,000 nurses found that 79% stated stress was the number one job hazard, 53% stated they needed to work through their breaks to get work done, and 27% reported workloads were too heavy. Effects of poor work organization can include the following:

• Psychological- irritability, job dissatisfaction, depression, stress
• Behavioral- substance abuse, sleep dysfunction
• Physical- gastrointestinal dysfunction, headaches, elevated blood pressure

Shiftwork and long work hours can result in stress, fatigue, negative mood, discomfort, physiologic dysfunction, and poor health behaviors like overeating, smoking, and lack of exercise. Shiftwork is any schedule outside the period of 7 a.m. to 6 p.m. (National Institute for Occupational Safety and Health, 2015). Shift workers may be at higher risk for cardiovascular disease, gastrointestinal disorders, psychological disorders, cancer, diabetes mellitus, adverse reproductive outcomes, and difficulty managing chronic health conditions.

• Increases exposures to hazards at work and reduces recovery times (e.g., working long work hours, particularly for musculoskeletal work, does not give the body time to recover from fatigue and can lead to musculoskeletal disorders).
• Linked to patient care errors and dissatisfaction because of inadequate communication, poor pain control management, limited staffing.

• Fatigue is the daily lack of energy and motivation (both physical and mental) and whole-body tiredness not relieved by sleep (Wedro, 2019).
• Healthy sleep, as recommended by the National Sleep Foundation, is 7 to 9 hours per night for adults, and is linked to feelings of wellness, good mental health and body weight, safety, and preventing infections and many types of chronic illnesses (Hirshkowitz et al., 2015).
• CDC recommends that adults aged 18-60 years sleep 7 or more hours per night; those aged 61-64 years sleep 7 – 9 hours per night; and those aged 65 and older sleep 7 – 8 hours per night.
• Getting less sleep than needed is called sleep deprivation, which can lead to fatigue. Sleep deprivation causes people to feel tired and sleepy. It can also cause a decline in brain functioning such as cognitive slowing, thinking, remembering, and concentration.
• Mistakes by fatigued healthcare workers can have broad-reaching negative effects ranging from care errors and irritability, to motor vehicle crashes during the work commute.

When fatigued, health effects can include:

• Unbalanced appetite hormones promoting overeating and obesity
• Impaired mental functioning, errors, and vehicle crashes
• Irritability, anxiety, depression, and poor communication
• Heart disease and cancer
• Disrupted insulin/blood glucose system (i.e., metabolism) promoting insulin resistance, diabetes
• Compromised immune functioning

• The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “any physical assault, threatening behavior, or verbal abuse occurring in the work setting.” NIOSH defines four categories of workplace violence: criminal intent (Type I), client-on-worker (Type II), worker on worker (Type III), and personal relationship violence (Type IV) (NIOSH, 2013).

         Types of Violence

• • Type 1- Criminal intent: The perpetrator has no legitimate relationship to the business or its employees and is usually committing a crime in conjunction with the violence such as robbery, shoplifting, and trespassing.
  • Type 2- Client-on-worker: The most common type of violence in healthcare settings and includes relationships with patients, their family members, and visitors. An example is assaults on healthcare workers by patients with dementia/disorientation.
  • Type 3- Worker-on-worker: Commonly referred to as “lateral” or “horizontal” violence that frequently occurs as verbal and emotional abuse that is unfair, offensive, vindictive, and/or humiliating, and includes bullying. It is often directed at persons viewed as being “lower on the food chain” such as in a supervisor to an employee, doctor to nurse, or peer-to-peer violence.
  • Type 4- Personal relationship violence: The perpetrator has a relationship with the healthcare worker outside of work that spills over to the work environment.
• In 2010, 11,370 healthcare workers in the Healthcare and Social Assistance industry sector were victims of assaults with 19% occurring in nursing home/residential facilities.
• In a 2019 ANA survey of more than 20,000 nurses, 24% reported verbal/nonverbal aggression from persons in a higher authority level and 31% from peers; 34% experienced verbal or physical threats from patients and/or their family members.
• Most violence occurs in psychiatric units, emergency departments, waiting rooms, and geriatric settings.
• Nurses and aides who have the most direct contact with patients are at a higher risk of violence, but all healthcare providers are at some risk. Risk factors include the following:

• • Working directly with volatile people, especially those under the influence of drugs or alcohol and/or a history of violence.
  • Working understaffed especially during mealtimes and visiting hours; when working alone; and when transporting patients.
  • Long waits for service (busy, high traffic periods), overcrowded, uncomfortable waiting rooms.
  • Poor environmental design, poorly lit corridors, rooms, parking lots, and other areas.
  • Inadequate security, unrestricted movement of the public, potential perpetrator access to firearms.
  • Lack of staff training and policies for preventing and managing crises with potentially volatile patients.

Bullying involves repeated, unwanted harmful actions intended to humiliate, offend, harm, undermine, or degrade, and can cause lasting physical and psychological damage. Bullying often involves misuse of power and can become an accepted workplace norm. Actions may include, but are not limited to, hostile remarks, verbal attacks, threats, taunts, intimidation, and being unsupportive (American Nurses Association, 2015).

• Can take the form of rude and discourteous actions of gossiping and spreading rumors, and refusing to assist a coworker. Incivility left unaddressed can lead to bullying and violence.
• May also include name-calling, using a condescending tone, and expressing public criticism which can compromise coworker dignity and demonstrates a clear lack of respect.
• May occur face-to-face, on telephone, in web-based meetings, through email, or online.