Nursing Occupational hazards Internationally there is a serious shortage of nurses 76 One reason for this shortage is due to the work environment in which nurses practice In a recent review of the empirical human factors and ergonomic literature specific to nursing performance nurses were found to work in generally poor environmental conditions Some countries and states have passed legislation regarding acceptable nurse to patient ratios The fast paced and unpredictable nature of health care places nurses at risk for injuries and illnesses including high occupational stress Nursing is a particularly stressful profession and nurses consistently identify stress as a major work related concern and have among the highest levels of occupational stress when compared to other professions This stress is caused by the environment psychosocial stressors and the demands of nursing including new technology that must be mastered the emotional labor involved in nursing physical labor shift work and high workload This stress puts nurses at risk for short term and long term health problems including sleep disorders depression mortality psychiatric disorders stress related illnesses and illness in general Nurses are at risk of developing compassion fatigue and moral distress which can worsen mental health They also have very high rates of occupational burnout 40 and emotional exhaustion 43 2 Burnout and exhaustion increase the risk for illness medical error and suboptimal care provision 77 Nurses are also at risk for violence and abuse in the workplace 78 Violence is typically perpetrated by non staff e g patients or family whereas abuse is typically perpetrated by other hospital personnel Of American nurses 57 reported in 2011 that they had been threatened at work 17 were physically assaulted 77 There are 3 different types of workplace violence that nurses can experience First physical violence which can be hitting kicking beating punching biting and using objects to inflict force upon someone 79 Second psychological violence is when something is done to impair another person through threats and or coercion Third sexual violence which can include any completed or attempted non consensual sexual act 80 Workplace violence an also be categorized into two different levels interpersonal violence and organizational coercion Interpersonal violence could be committed by co workers and or patients by others in the hospital The main form of this level is verbal abuse Organizational coercion may include an irrationally high workload forced shifts forced placement in different wards of the hospital low salaries denial of benefits for overwork poor working environment and other workplace stressors 81 These problems can affect the quality of life for these nurses who may experience them It can be extremely detrimental to nurses if their managers lack understanding of the severity of these problems and do not support the nurses through them There are many contributing factors to workplace violence These factors can be divided into environmental organizational and individual psychosocial The environmental factors can include the specific setting for example the emergency department long patient wait times frequent interruptions uncertainty regarding the patients treatment and heavy workloads 82 Organizational factors can include inefficient teamwork organizational injustice lack of aggression and or stress management programs and distrust between colleagues 82 Individual psychosocial factors may include nurses being young and inexperienced previous experiences with violence and a lack of communication skills 82 Misunderstandings may also occur due to the communication barrier between nurses and patients 83 An example of this could be the patient s condition being affected by medication pain and or anxiety There are many causes of workplace violence The most common perpetrators for harassment and or bullying against nursing students were registered nurses including preceptors mentors and clinical facilitators 83 However the main cause of workplace violence against nurses were patients 80 of serious violence incidents in health care centers were due to the nurses interactions with patients There are many different effects of workplace violence in the field of Nursing Workplace violence can have a negative impact on nurses both emotionally and physically They feel depersonalized dehumanized fatigued worn out stressed out and tired 84 Because of the severity of some incidents of violence nurses have reported manifestations of burn out due to the frequent exposure This can heavily impact of a nurses mental health and cause nurses to feel unsatisfied with their profession and unsafe in their work environment Prevention There are a number of interventions that can mitigate the occupational hazards of nursing They can be individual focused or organization focused Individual focused interventions include stress management programs which can be customized to individuals Stress management programs can reduce anxiety sleep disorders and other symptoms of stress Organizational interventions focus on reducing stressful aspects of the work environment by defining stressful characteristics and developing solutions to them Using organizational and individual interventions together is most effective at reducing stress on nurses 77 In some Japanese hospitals powered exoskeletons are used 85 Lumbar supports i e back belts have also been trialed Worldwide America United States In the US scope of practice is determined by the state or territory in which a nurse is licensed Each state has its own laws rules and regulations governing nursing care Usually the making of such rules and regulations is delegated to a state board of nursing which performs day to day administration of these rules licenses for nurses and nursing assistants and makes decisions on nursing issues In some states the terms nurse or nursing may only be used in conjunction with the practice of a registered nurse RN or licensed practical or vocational nurse LPN LVN In the hospital setting registered nurses often delegate tasks to LPNs and unlicensed assistive personnel RNs are not limited to employment as bedside nurses They are employed by physicians attorneys insurance companies governmental agencies community public health agencies private industry school districts ambulatory surgery centers among others Some registered nurses are independent consultants who