The risky business of health care and nursing: what’s gender got to do with it?

1 September 25, 2012

The risky business of health care and nursing:

what’s gender got to do with it?


Pat Armstrong

Ph.D., Sociology, Carleton University

M.A., Canadian Studies, Carleton University

B.A., Sociology, University of Toronto

CHSRF/CIHR Chair in Health Services and Nursing Research


Risk epidemic

Why are we not more alarmed by the serious risks faced by health care workers?


Absenteeism due to illness and injury

• Every week in 2010, an average of:

• 19,200 nurses were absent due to own illness or disability.

— 9 per cent of nurses were absent due to own illness or disability.

• This is nearly twice the rate of all other occupations, and remains higher than all other health-care occupations in 2010.

(Informetrica Ltd,2010)


If data indicates that risk is higher in health care…

why has it been ignored?

• Numbers?— Not likely: the health and social care sector accounts for one in ten

workers.

• Media?— Lack of media attention: it is easier to produce a nasty picture of a

retirement home than it is of a personal support worker at home with a bad back.

• Gender?— Women represent four out of five health care workers — One in five employed women works in health and social services


Women Working in Health Care – Statistical Profile Women Working in Health Care – Statistical Profile

Days Lost Per Year Due to Illness or Disability, Women and Men, Health Care and Social Assistance Industry, 1987 & 2009

8.5

12.8

7.8

8.7

0

2

4

6

8

10

12

14

1987 2009

Nu

mb

er o

f D

ays

Women; Health care and social assistance Men; Health care and social assistanceCANSIM, 2010


Sex All Health Jobs Assisting Health Jobs

MenIllness and injury incidence 5.7 8.1

Days lost per year, per worker 8.2 12.6

WomenIllness and injury incidence 8.4 8.9

Days lost per year, per worker 12.5 14.2

Absence rates, Full-time Workers, 2010


Days Lost Per Worker Due to Personal or Family Responsibility, Men and Women, 1987 and 2009 (Source: Statistics Canada Labour Force Survey)

1.1

2

4.8

2

0

1

2

3

4

5

6

1987 2009

Nu

mb

er o

f D

ays

Men; Health care and social assistance Women; Health care and social assistance


Karen Messing, One-Eyed Science

Research on health hazards fails to accurately assess health hazards in female dominated work.

1) Assumptions are made about women’s work being “safe”

2) The focus is on the kind of hazards that result in sudden injury or death; in other words, on the kinds of hazards

men are much more likely to face.

• Women’s claims more likely to be rejected by Workers’ Compensation, compared to men.

— Especially stress related claims


Other factors to consider:

• Ageing labour force

— The proportion age 45 and over is higher than in the labour force as a whole, suggesting age may be one factor in the high rates of absence.

— Nurse supervisors and registered nurses have the highest proportion of those 65 years of age and over.

— 47 per cent of nurse supervisors and registered nurses in Canada are age 45 and over and many continue to do direct care work




Other factors cont’d:

• Changing resident populations

• Increasing physical workloads

“Getting residents ready for the day - bathing - feeding all.

There is not enough time in the day.

45 minutes to get 12 residents for breakfast!!!

How do you think that works?”

Armstrong P, Banerjee A, Szebehely M, Armstrong H, Daly T, Lafrance S. ‘TheyDeserve Better’: The long-term care experience in Canada and Scandinavia. Ottawa: Canadian Centre for Policy Alternatives; 2009.


• Fatigue

— 63 per cent of the Canadians surveyed say they finish work almost always physically exhausted.

— 44 per cent report they almost always feel mentally exhausted. — One in four said they have worked when sick more than five times in

the last year. (Armstrong et

al, 2009)

— CNA & RNAO (2010) reported on the rising levels of nurse fatigue— due to the relentless heavy workloads of nurses— ever-increasing cognitive, psychosocial and physical work demands.


From gender specific

to shift in power


An international comparative study of employees in long-term residential care.

Survey of workers in Norway, Sweden, Denmark and Finland, and the Canadian provinces of Ontario, Nova Scotia and Manitoba

Focus groups with workers in the Canadian provinces.

‘They Deserve Better’

The long-term care experience in Canada and Scandinavia

(Armstrong et al, 2009).


• Violence

—Canadian research participants reported that they experienced high levels of physical violence:

— 43 per cent, the violence was a daily occurrence

— 23 per cent said they experienced physical violence on a weekly basis.


Canada vs. Nordic Europe Physical violence experience by workersCanada vs. Nordic Europe Physical violence experience by workers

7%

43%

11%

23%

9%

8%

45%

16%

29%

10%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Daily Weekly Monthly Less often Never

Nordic Europe Canada


When I finish work I almost always experience:When I finish work I almost always experience:

29%

63%

11%

44%

12%

36%

0%

10%

20%

30%

40%

50%

60%

70%

Physical Exhaustion Mental Exhaustion Back Pain



Working Short StaffedWorking Short Staffed

15%

44%

30%

34%

24%

9%

27%

11%

4% 3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Daily Weekly Monthly Less often Never



CountryAll or most of the time

(%)

Sometimes(%)

Rarely(%)

Never(%)

Denmark 30.2 53.2 14.6 2.0

Finland 50.6 44.0 4.5 0.9

Norway 39.2 53.4 6.7 0.7

Sweden 40.0 50.5 8.9 0.6

Nordic countries 40.2 50.2 8.5 1.1

Canada 57.8 38.2 3.4 0.5

Having too much to do, comparing countries


In Summary:

• Scandinavian workers:

— face far less physical violence,

— go home with less pain

— are less exhausted mentally and physically

— have less disturbed sleep

— feel less guilt about not doing a good job because they look after fewer residents and have more time to complete tasks.

• What does this mean for Risk?

— Risks similar, managed better


Additional data:

• According to the Statistics Canada nurses survey:

—Canadian nurses also show different rates of illness and injury across locations, with LTC having the highest rates

—LTC is mainly care for women by women, with work often understood as what any woman can do

—Also differences across Canadian jurisdiction in injury rates, as well as staffing, discretion, extra work

—All indicate work, not gender, the major factor


Conclusions

• Gender is a factor in dismissing the health risks for nurses created by working conditions. Employers promote “compulsory altruism”, often blame nurses or the nature of the work, while increasingly creating conditions that put nurses at risk and offering solutions, like stress reduction exercises that reinforce notion that gender is the issue

• Women contribute by

A) doing extra work to fill the care gap

B) failing to connect their injury to the workplace

C) leaving or seeking individual solutions


Thank you

Merci

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The risky business of health care and nursing: what’s gender got to do with it?