Workplace health and safety for nurses in Hong Kong Hospitals: An Occupational Health Service study

Working in a healthy and safe environment is a basic right for workers and is governed by local and international law with various levels of compliance in different countries and industries. In Hong Kong (HK) Occupational Health and Safety (OH&S) is governed by local and international laws. Compliance is a complicated issue encompassing the employer - employee relationship, the level and type of risk and the legal requirements. Some industries are at higher OH&S risk than others, for example health services. Health services also tend to have more invisible risks in the working environment compared with other industries and this presents a great challenge for those responsible for ensuring the OH&S of health care workers. The Avian Influenza epidemic in 1997, and later the severe acute respiratory syndrome (SARS) outbreak in 2003, lead to a public questioning of existing OH&S practices within HK. Following the avian influenza, the Occupational Safety and Health Ordinance (OS&HO) (Chap 509) was enacted in 1997 and together with Occupational Health Service Providers (OHSPs) had begun to play a key role in establishing healthy and safe work environments.
The purpose of this study is to explore, in the aftermath of the OS&HO, how HK hospitals are meeting the health and safety needs of nurses. This is the first study of workplace safety of nurses in HK hospitals, and the findings will present a significant first step in understanding current Occupational Health Service (OHS) concerns and current practices within hospitals in HK. Data collection was undertaken in two phases. Phase I Stage I employed a quantitative approach. A paper survey was used to collect the data on views of the OHSPs. The results then informed a qualitative approach in Phase I Stage II, a follow-up interview with a subset of OHSPs. Phase II Stage I also employed a quantitative approach and a paper survey to collect the data on the views of the registered nurses (RN) working in hospitals. The results informed Phase II Stage II which was a qualitative approach, a follow-up focus group study on the views of the Occupational Health Service Consumers (OHSCs) for further clarification and explanation of the Phase II and Stage I result.
The Phase II results reflecting HK OHSCs’ voices echo the OHSP feedback on the provision of OHS. Concern was raised about OHS and related policies and procedures. However, the most significant findings from the OHSC at Phase II Stage II revealed that nurses experienced a range of OHS concerns; most commonly work stress, workplace harassment and back strain without formal or official report to their supervisor. The lack of reporting was mainly due to past experience with the management incident handling attitudes and practices. This study reveals that HK hospitals are willing to invest resources into OH&S, which focus on providing a service such as an OHSP. However, the study found that OHSPs in the sample were not adequately meeting the needs of nurses or ensuring their workplace safety. This was demonstrated by the study’s major findings: lack of personal communication by OHSPs with nurses, failure to ensure accurate and complete reporting of OH&S incidents, and workplace safety and rehabilitation programs which lacked relevance for nurses. The most common OH&S issues for nurses have not been captured or reported in official reports due to under-reporting by nurses for a range of reasons.
Recommendations are made for developing a real working, workplace culture where OH&S competence for nurses is prioritised equally with clinical competence to advance the intentions of the OS&HO for this workforce at significant risk. The OHSPs are the key to success as the conduit between nurses with workplace health and safety risks, and employers prepared to spend money on programs of improvement. Yet OHSPs work in a complex environment where employers are perceived by nurses as uncaring and untrustworthy on OH&S matters and they are reluctant to provide data which may compromise their relationship with their employer. OHSPs therefore, need to be better prepared and supported in their complex role in affecting workplace culture change where stakeholders can have very different views on OH&S. They need to become dual qualified in Occupational Health (OH) and Occupational Safety (OS), with skills in research, communication, empowerment, rehabilitation and cultural awareness. Nurses, OHSPs and employers must also take ownership of their OHS competence to ensure nurses’ confidence in their workplace health and safety in Hong Kong hospitals.