In 2006, the World Health Organization identified the global health workforce crisis, including the critical shortage of nurses, as a priority item for action. The reasons for the health care and nursing crisis are varied and complex, but dangerous and unhealthy work environments are key among them. ILO Convention 149 calls on member States to improve existing laws and regulations on occupational safety and health by adapting them to the special nature of nursing work.

GENEVA (ILO Online) – A hospitalized patient with AIDS became agitated and tried to remove the intravenous (IV) catheters in his arm. While several hospital staff members struggled to restrain the patient, the connector needle at the end of the IV line was pushed into the hand of a nurse.

The nurse who sustained the needle stick injury tested negative for HIV that day, but she tested HIV positive several months later.

Another health care worker who sustained a deep needle stick injury was hospitalized eight months after the incident with acute hepatitis. A month later, she was also found to be seropositive for HIV. Her clinical condition continued to deteriorate, and she died 28 months after the needle stick injury.

The two cases reported by the National Institute for Occupational Health and Safety (NIOSH) in the United States are not exceptional.

According to a new publication of the International Council of Nurses for International Nurses Day (Note 1) at least one in eight health care workers receives a needle stick injury potentially exposing them to serious or fatal infections.

American health workers suffer 800,000 to 1 million needle sticks annually, not including the vast number that go unreported. There are more than 100,000 needle stick injuries in UK hospitals each year.

"Needle sticks are virtually undocumented in developing countries, but probably equal or exceed those in the industrial world. More than 20 blood borne diseases can be transmitted as a result of exposure to blood", says Judith Oulton, Chief Executive Officer of the International Council of Nurses (ICN) based in Geneva.

Nurses have the highest rate of needle stick injury among health care workers. The probability that a single needle stick will result in disease is 3 to 5 chances in 1,000 for HIV, 300 chances in 1,000 for Hepatitis B, and 20 to 50 chances in 1,000 for Hepatitis C.

According to the American Hospital Association, one case of serious infection by blood borne pathogens can result in US$1 million of employer costs related to testing, follow-up, lost time and disability payments. Hospitals in California are expected to save over US$100 million per year after implementing legislation requiring safe needle devices.

According to the ICN publication, preventing needle stick injuries is only one of current health and social issues for the nursing profession. Unhealthy environments affect nurses' physical and psychological health – the stress of heavy workloads, long hours, low professional status, difficult relations in the workplace and a variety of workplace hazards more and more result in nurses' early exit from the profession.

Evidence indicates that one third of newly qualified nurses in the United Kingdom do not register; negative experiences in the workplace or clinical placements seem to turn these new graduates away from the profession. A study of nurses in the United States, Canada, England, Scotland and Germany showed that 41 per cent of hospital nurses were dissatisfied with their jobs and 22 per cent planned to leave them in less than one year.

Promoting positive practice environments

"Findings confirm the relationship between workplace stress and nurses' morale, job satisfaction and intention to quit. But employers have begun to realize that positive changes in the work environment result in a higher employee retention rate", says Ms. Oulton. According to the ICN representative, the beneficial effects of positive practice environments on health service delivery, health worker performance, patient outcomes and innovation are obvious. A safe work environment is critical if patient safety is to be guaranteed and good practice supported.

As the example of the agitated patient shows, health care personnel are particularly at risk for workplace violence, a significant occupational hazard in the health sector. The ILO teamed up with the International Council of Nurses (ICN), the World Health Organization (WHO) and Public Services International (PSI) to address this problem. The ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health Sector was launched in 2000 and has since carried out a series of research activities and published Framework Guidelines and an accompanying training manual on how to address this problem (Note 2).

This approach is now being implemented in a major project with five national nurses associations in Sub-Saharan Africa in order to improve health personnel's working conditions.

Developing positive practice environments is a multifaceted process and requires a minimum institutional workforce database which would include absenteeism, vacancy and turnover rates, as well as demographic information like age and experience, as a starting point. For their part, nurses can advance positive practice environments, for example by lobbying for professional recognition and remuneration and developing a position statement on the importance of a safe work environment.

In celebration of International Nurses Day (12 May), ICN's educational tool kit provides information supporting public awareness campaigns and continuing education programmes on the challenges that exist in the health sector workplace and showing the link between positive practice environments, a sustainable workforce and quality care.

Improving the working conditions of nursing personnel has been an ILO concern for more than 30 years. ILO Convention 149 concerning Employment and conditions of Work and Life of Nursing Personnel recognizes the vital role played by the nursing workforce for the health of societies. Adopted in 1977, the Nursing Personnel Convention was classified as an up-to-date instrument by ILO in 2002, reaffirming its relevance in today's socio-economic realities (Note 3).

"In times of critical nursing shortages, healthy work environments are key to attract and retain qualified and motivated personnel in health care", says Christiane Wiskow, Health Sector Specialist of the ILO Sectoral Activities Branch. "ILO Convention 149 and Recommendation 157 are important tools in improving the conditions of nursing personnel. The two ILO instruments are intended to strengthen the rights of nursing personnel and to guide policymakers, employers and workers in the planning and implementation of sound nursing policies".

With regard to occupational hazards the Convention calls on member States to improve existing laws and regulations on occupational safety and health by adapting them to the special nature of nursing work. Recommendation 157 further develops measures to prevent, reduce or eliminate risks to the health of nursing personnel, including a comprehensive national policy on occupational health, the establishment of occupational health services, access to health surveillance, financial compensation for those exposed to special risks and participation in all aspects of protection provisions.

Note 1 - International Council of Nurses, Positive practice environments, Geneva, 2007. http://www.icn.ch/indkit.htm.

Note 2 - The documents and more information are available from /public/english/dialogue/sector/sectors/health/violence.htm.

Note 3 - The brochure "ILO Nursing Personnel Convention No. 149. Recognize their contribution – Address their needs" provides more information and is available from /public/english/dialogue/sector/publ/health/c149.pdf.