Major ArticlesOrganizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses*,**
Section snippets
Sample
In 1998, 22 hospitals across the United States were selected for a study of organizational factors and outcomes of nursing care. Twenty of these hospitals were magnet hospitals.13 Sixteen hospitals that had reputations for attracting and retaining clinical nurses (magnet hospitals by reputation) and had been studied in 1986 were asked to participate in the 1998 study, which examined changes in organization and staffing over time. Thirteen of the 16 agreed to participate. In addition, all 7
Results
The mean age of the 2287 nurses in our sample was 37.3 years (SD, 9.9). Nearly two thirds of the nurses (63%) held a baccalaureate or higher degree in nursing, and 6% were men. Table 1 indicates that a sizeable majority (85.2%) reported always wearing gloves in situations in which body fluid contact was possible.Empty Cell % Frequency wearing gloves for venipuncture and procedures involving body fluids Always 87.6 Sometimes 10.8 Never or rarely 1.7
Discussion
In this relatively homogeneous group of hospitals with superior reputations for nursing or medical care during the past 2 decades, we find the clear associations between staffing and organizational climate and needlesticks that were noted in our previous survey in 1991.9 The impacts of staffing and organization on injuries and near-misses here appear to be somewhat smaller than in the first study (in which odds ratios generally exceeded 2.0), probably as a result of the similarity of the
Conclusions
This study provides evidence that the risk of sharps injuries in nurses is importantly related to nurse staffing levels and working climate. Safety equipment may have an important effect on reducing injuries, but so do the general working conditions of nurses. Working conditions appear to be more important in determining risk than does safety equipment. At a time when safety concerns and nurse shortages in hospitals are more prominent issues than ever, the consideration of organizational
Acknowledgements
We thank the nurse executives and staff nurses at the following hospitals for their participation: Arlington Hospital, Arlington, Virginia; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Evanston Hospital, Evanston, Illinois; Inova Fairfax Hospital, Falls Church, Virginia; Fort Sanders Regional Medical Center, Knoxville, Tennessee; Franklin Square Hospital, Baltimore, Maryland; Hackensack Medical Center, Hackensack, New Jersey; Hospital of the University of Pennsylvania,
References (22)
- et al.
Hospital safety climate and its relationship with safe work practices and workplace exposure incidents
Am J Infect Control
(2000) Individual and job characteristics as predictors of industrial accidents
Accid Anal Prev
(1986)Needlestick Safety and Prevention Act
(Nov 6, 2000)- et al.
A critical review of the literature on sharps injuries: epidemiology, management of exposures and prevention
J Adv Nurs
(1997) - et al.
Report of the Council on Scientific Affairs: preventing needlestick injuries in health care settings
Arch Intern Med
(2001) - et al.
Randomized prospective study of the impact of three needleless intravenous systems on needlestick injury rates
Infect Control Epidemiol
(1996) The benefits and limitations of needle protectors and needleless intravenous systems
J Intravenous Nurs
(1999)- et al.
Prevention of needle-stick injury. Efficacy of a safeguarded intravenous cannula
Anaesthesia
(1999) Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures—Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995
MMWR Morb Mortal Wkly Rep
(1997)- et al.
The effectiveness of a needleless intravenous connection system: an assessment by injury rate and user satisfaction
Infect Control Epidemiol
(1997)
Hospital nurses' occupational exposure to blood: prospective, retrospective, and institutional reports
Am J Public Health
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Collection of the data was conducted under Grant R01 NR02280-04A1, Outcomes of Inpatient AIDS Care from the National Institute of Nursing Research (Dr Linda Aiken, principal investigator). Preparation of this manuscript was assisted in part by an institutional postdoctoral fellowship (T32-NR07104), National Institute of Nursing Research, held by Dr Sean Clarke at the Center for Health Outcomes and Policy Research, University of Pennsylvania.
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Reprint requests: Sean Clarke, RN, PhD, Center for Health Outcomes and Policy Research, University of Pennsylvania, 420 Guardian Dr, Philadelphia, PA 19104-6096.