effect that visible concern and leadership from high management levels can have in reducing injuries; (2) the overriding importance of good training, especially for lesser educated nursing staff; and (3) the utility of existing technologies for patient care (in hospitals) and resident services (in nursing homes) in reducing the probability of certain types of injuries.

RECOMMENDATION 7-1: The committee recommends that hospitals and nursing homes develop effective programs to reduce work-related injuries by providing strong leadership, instituting effective training programs for new and continuing workers, and ensuring appropriate use of existing and emerging technology, including lifting and moving devices and needleless medication delivery systems.

Governance, administration, and management structures of any organization should be committed to workers' safety and health in order for strong programs to be established. Unions and other labor groups and professional associations can exert pressure, and federal or state statutes and regulations can provide pressure and sanction, but effective safety programs depend on absolute support from the highest organizational levels. At the same time, supervisors and workers on the frontlines must be part of the leadership in safety and health. They know the problems and have ideas about solutions. Shared responsibility and shared resources lead to the best results.

Training in safe procedures, group dynamics, and leadership are important elements in this arena. Incentives and rewards for low injury rates must be judiciously used because in some circumstances they could lead to underreporting of incidents and therefore missed opportunities for prevention. Early intervention can help prevent accidents and injuries and ameliorate stress in the workplace that may, if not dealt with, lead to workers' compensation claims and other undesirable consequences.

Violence, Abuse, And Conflict

Violence and Abuse of Health Care Workers and Nursing Staff

In the United States, violent injuries to health care workers in the workplace were reported at least as early as the end of the nineteenth century (Goodman et al., 1994). Violence toward health care workers appears to be on the rise (Lipscomb and Love, 1992). Lack of a standard definition of violence makes it difficult to arrive at accurate estimates of the scope of the problem. Increased violence in the general population as a means of solving problems, greater use of mind-altering drugs, alcohol abuse, and the increased availability of weapons may all contribute to the problem of violence in health care settings (Lipscomb

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