Prejob screening: Evaluate the 'environment of care' before you take the position

Nevada RNformation, Aug 2003 by Lowe, Thomas J

How can I assess potential health and safety threats and the effectiveness of the occupational health and safety program at a facility during a job interview?

Nearly 90% of nurses who responded to a 2000 ANA survey indicated that health and safety was an important consideration in choosing a job, Management's commitment to the issue can be measured by assessing how health and safety needs are prioritized in the budget, how an occupational health office is staffed, and how frontline workers are involved in the program.

Begin by observing and inquiring about threats or hazards most likely to occur within the work area, including biological pathogens, sharps injuries, respiratory exposures, violence, hazardous drugs and chemical exposures, back and musculoskeletal injuries, stress, and physical injuries. Also ask much broader questions, such as the facility's response to acts of terrorism, catastrophic disasters, civil unrest, major weather events, and massive utility failures.

Assess the general environment of the facility. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) terms this evaluation the "Environment of Care" (EOC), and it includes everything from how clean the facility appears and the routine noise level to adequate staffing patterns and emergency preparedness.

Prior to your interview. drive by the facility at night and observe it for adequate lighting of the parking area and walkways. During the day see how well the grounds are kept, including the amount of litter, and in winter months take note of snow removal. Poor lighting, unkept grounds, and uncontained garbage could be a sign of inadequate facility support staff.

On the day of the interview, arrive early to observe the condition of the interior of the facility. Were you required to stop at a security checkpoint? Lack of security at entrances may indicate vulnerability to thefts or work-place violence. Are ceiling tiles cracked, stained, or missing? Are fire extinguishers easily spotted? Are hallways clear, particularly at exit points? How is the overall noise level?

The mechanism and process for monitoring these and other issues should be outlined in an EOC manual (safety manual, disaster manual, or similar document). Ask if there is a written manual on how the facility monitors the EOC, and what is the facility's process for resolving deficiencies. Test the answers you get by asking to see a monitoring tool for an area that you directly observed. Are the results reported similar to your own observations? A great disparity between what you observe and what is written may indicate that the monitoring process is not carried out routinely or comprehensively.

Another important issue to inquire about is your ability as a frontline caregiver to participate in standing committees on health and safety. The employer should name several committees, including those for EOC, sharps safety, and emergency preparedness. Participation should be from all areas and levels within the facility. If representation on these committees is uneven, it could mean that key health and safety issues are being overlooked or ignored.

Finally, ask about health and safety orientation and ongoing training. Orientation should include fire safety, right to know, bloodborne pathogens, respiratory hazards, evacuation procedures, ergonomics, security, and any health and safety issues pertinent to your assigned area. The facility should also provide an annual in-service report on its health and safety program. In addition, ask about the use of specific safety equipment, such as devices for lifting and safe needle use. Lack of a formal health and safety training program and safety equipment is indicative of a lack of commitment from the administration to protecting and enhancing the health and safety of their employees.

If you are satisfied with your observations and answers to your questions and decide to accept the position, ensure that health and safety issues continue to be addressed by becoming involved in the committees, the orientation process, and continuing education.

Resources

The ANA Workplace Health and Safety Guide for Nurses: OSHA and NIOSH explains the underlying federal authority, the resulting rights and responsibilities, and focuses on how to collect and analyze data in a health care facility. For more information, visit www.nursingworld.org.

By Thomas J. Lowe, MPH, RN, COHN-S, COHST

Thomas J. Lowe is an occupational health and safety representative at the New York State Nurses Association and president of the Hudson Valley New York Association of Occupational Health Nurses, Inc.