Shedding the self-sacrificing paradigm among healthcare workers

By: February 5th, 2010 Email This Post Print This Post

When stakeholders offer a piece of their collective mind during the “OSHA Listens” public meeting on Feb. 10, those in the healthcare industry would do well to reflect the thoughts of NIOSH Director John Howard, M.D on self-sacrifice in the context of occupational health and safety, appearing in last month’s NIOSH eNews.

As a physician in an acute-care hospital setting, Howard has heard the work of his profession—some even refer to it as a calling—described as noble or self-sacrificing, and admits “these descriptions are flattering and are, in some cases, accurate.” [Healthcare workers responding to the Haitian earthquake relief effort is a prime example]. He warns, however about the danger of characterizing routine work as self-sacrificing in any industry, especially healthcare.

“This characterization places workers engaged in such work outside the protections of the governmental worker safety and health paradigm that we apply to other all other industrial sectors where labor is exchanged for wages.”

Howard cites the bloodborne pathogens standard of 1991 as a significant moment in balancing caring for the patient with caring for the worker caring for the patient. Prior to that regulation, healthcare had “a long history of resolving that conflict entirely to the advantage of the patient without a rigorous consideration of all alternative ways to protect both the patient and the worker.”

Now, lessons learned from the H1N1 flu pandemic present a similar opportunity “to figure out what attitudes, what policies, what programs and what practical decisions we need to employ to guarantee a sustainable healthcare workforce,” says Howard. He points to the California Aerosol Transmissible Disease Standard, and especially the “CDC Interim Guidance on Infection Control in Healthcare Settings” with its “robust hierarchy of controls” that recommends fit-tested N95 respirators for workers in close contact with patients suspected or confirmed to have H1N1 influenza, as pivotal documents.

The response to H1N1 healthcare worker protection and the prospect of more virulent strains such as avian influenza or H5N1 influenza show that we cannot “return to an era when a healthcare worker’s exposure to transmissible diseases such as influenza can be merely considered ‘diseases of life’ for which a healthcare worker ‘assumes the risk’ when he or she offers their labor to a healthcare employer,” says Howard.

“Self-sacrifice is indeed admirable and many healthcare workers often go far beyond the duties of their job to help patients and their loved ones. However, on a routine basis in a $2 trillion industry, it should not be the operating principle if we are to create a sustainable healthcare workforce for the 21st century,” says Howard.


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