NursingOccupational hazardsInternationally, there is a serious shortage of nurses.[76] One reason forthis shortage is due to the work environment in which nurses practice. In arecent review of the empirical human factors and ergonomic literaturespecific to nursing performance, nurses were found to work in generallypoor environmental conditions. Some countries and states have passedlegislation regarding acceptable nurse-to-patient ratios.The fast-paced and unpredictable nature of health care places nurses atrisk for injuries and illnesses, including high occupational stress. Nursing isa particularly stressful profession, and nurses consistently identify stress asa major work-related concern and have among the highest levels ofoccupational stress when compared to other professions. This stress iscaused by the environment, psychosocial stressors, and the demands ofnursing, including new technology that must be mastered, the emotionallabor involved in nursing, physical labor, shift work, and high workload. Thisstress 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 ofdeveloping compassion fatigue and moral distress, which can worsenmental health. They also have very high rates of occupational burnout(40%) and emotional exhaustion (43.2%). Burnout and exhaustion increasethe 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. OfAmerican nurses, 57% reported in 2011 that they had been threatened atwork; 17% were physically assaulted.[77]There are 3 different types of workplace violence that nurses canexperience. 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 impairanother person through threats and/or coercion. Third, sexual violencewhich 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 violencecould be committed by co-workers and/or patients by others in the hospital.The main form of this level is verbal abuse. Organizational coercion mayinclude an irrationally high workload, forced shifts, forced placement indifferent wards of the hospital, low salaries, denial of benefits for overwork,poor working environment, and other workplace stressors.[81] Theseproblems can affect the quality of life for these nurses who may experiencethem. It can be extremely detrimental to nurses if their managers lackunderstanding of the severity of these problems and do not support thenurses through them.There are many contributing factors to workplace violence. These factorscan be divided into environmental, organizational, and individualpsychosocial. The environmental factors can include the specific setting(for example the emergency department), long patient wait times, frequentinterruptions, uncertainty regarding the patients' treatment, and heavyworkloads.[82] Organizational factors can include inefficient teamwork,organizational injustice, lack of aggression and/or stress managementprograms, and distrust between colleagues.[82] Individual psychosocialfactors may include nurses being young and inexperienced, previousexperiences with violence, and a lack of communication skills.[82]Misunderstandings may also occur due to the communication barrierbetween nurses and patients.[83] An example of this could be the patient'scondition being affected by medication, pain, and/or anxiety.There are many causes of workplace violence. The most commonperpetrators for harassment and/or bullying against nursing students wereregistered nurses including preceptors, mentors, and clinical facilitators.[83]However, the main cause of workplace violence against nurses werepatients. 80% of serious violence incidents in health care centers were dueto the nurses' interactions with patients.There are many different effects of workplace violence in the field ofNursing. Workplace violence can have a negative impact on nurses bothemotionally and physically. They feel depersonalized, dehumanized,fatigued, worn out, stressed out, and tired.[84] Because of the severity ofsome 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 andunsafe in their work environment.PreventionThere are a number of interventions that can mitigate the occupationalhazards of nursing. They can be individual-focused or organization-focused. Individual-focused interventions include stress managementprograms, which can be customized to individuals. Stress managementprograms can reduce anxiety, sleep disorders, and other symptoms ofstress. Organizational interventions focus on reducing stressful aspects ofthe work environment by defining stressful characteristics and developingsolutions to them. Using organizational and individual interventionstogether is most effective at reducing stress on nurses.[77] In someJapanese hospitals, powered exoskeletons are used.[85] Lumbar supports(i.e. back belts) have also been trialed. WorldwideAmerica(United States)In the US, scope of practice is determined by the state or territory in whicha nurse is licensed. Each state has its own laws, rules, and regulationsgoverning nursing care. Usually the making of such rules and regulations isdelegated to a state board of nursing, which