term effects on the health and safety of the health care giver and, ultimately, on the safety and quality of patient care (Tan, 1991). A sizable proportion of the victims of nonfatal violence are care givers in hospitals and nursing homes. Evidence also exists of abusive and violent behavior of staff toward patients, at times resulting from stress and overwork and at other times from a breakdown of quality controls and appropriate supervision.

This chapter provides a brief overview of the incidence of work-related injuries in hospitals and nursing homes, violence and abuse of nursing staff, and violence and abuse directed toward residents of homes and stress among nursing personnel in hospitals and nursing homes. It then reviews available national statistics and research literature on occupational hazards to examine the risk factors associated with work-related injuries and stress and the linkages with the structural variables of staffing levels and skill mix.

Incidence Of Work-Related Injuries And Illness

The health services industry is one of the largest employers in the United States, employing almost 9 million persons in 1993 (BLS, 1995c). More than half of this workforce is employed in hospitals and nursing homes. Recent statistics and other information suggest that these institutions are becoming increasingly hazardous places of work, exposing workers to a wide range of risks.

In 1993, private industry workplaces reported 6.7 million injuries and illnesses, a rate of 8.5 cases for every 100 full-time workers (BLS, 1994c). Of the 6.7 million cases, nearly 6.3 million were injuries that resulted in time lost from work. As shown in Table 7.1, while the injury and illness rate for private industry as a whole has remained about the same or declined slightly since 1980, the rates for hospitals and for nursing and personal care homes during the same period have increased by about 52 and 62 per 100 full time workers, respectively. During the same period, hospitals reported about 338,000 cases, an incidence rate of nearly 12 per 100 full-time workers, and nursing and personal care facilities reported about 216,000 cases, a rate of 17 percent (see Table 7.1).

Nine industries, each with at least 100,000 injuries annually, accounted for nearly 2 million, or 30 percent, of the 6.7 million injuries in 1993 (BLS, 1994a). Hospitals ranked second, and nursing and personal care facilities ranked fourth, among these industries.

Overexertion, being struck by an object, and falls at the same level1 are the leading ways in which workers are hurt on the job. These events account for


Falls "at the same level," as contrasted with "falls to a lower level" (such as those incurred by construction laborers and roofing or sheet metal workers who fall from a height), is a category of disabling event used to measure varying degrees of disabling work-related injuries. These injuries are reported by employers to the Bureau of Labor Statistics as part of the Annual Survey of Occupational Injuries and Illnesses.

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