Charles N. Jeffress
Update on OSHA
American Nurses Association
November 6, 1999
- Keeping up with new developments in health care must be a constant challenge for
nurses. But one thing never changes -- your commitment to preserving and
improving the health of your patients. We at OSHA have one unchanging
commitment as well-sending every worker home whole and healthy every day.
- Like you, we are finding new ways of working to achieve that goal. The basic
tenet of OSHA, of course, remains. Strong enforcement will always be an
essential part of our strategy. We are continually looking for ways to improve our
enforcement targeting so that we visit those employers most in need of our help.
- For the past four years, we have been surveying about 80,000 employers in
industries with high injury and illness rates. In 1999, for the first time, about 1,000
hospitals were included in the survey. That's because, as many of you know, more
than 300,000 injuries occurred in U.S. hospitals in 1997 -- that's nearly five percent
of all workplace injuries and illnesses in the private sector.
- Out of the 80,000 employers in the survey, we sent letters this year to about 12,000
notifying them that they had very high rates and encouraging them to improve. By
the end of 1999, more than 2,200 of those with the highest rates will have met an
OSHA inspector at the door. Under this site-specific targeting program, we find
four times as many significant cases as we do from any other kind of inspections.
Next year some of those letters will go to hospitals, and some of our site-specific
targeted inspections will take place at health care facilities.
- When we inspect hospitals and nursing homes, our compliance officers will be
taking their cue from the new compliance directive on bloodborne pathogens that I
just presented to Susan Wilburn, and that you can also find on our
website -- www.osha.gov. This directive emphasizes the importance of using safer
medical devices and training workers when such devices are introduced in the
- This directive drew on information that you and others provided. Almost 400
commentors responded to our request last fall for ideas on ways to better protect
nurses and others exposed to contaminated needles and sharps. The revised
instructions to compliance officers stress that employers must update their
exposure control plans to reflect the latest available technology. This is consistent
with the requirements in the bloodborne pathogens standard. I encourage you to
take a look at the directive for yourselves.
- We're also working with ANA, SEIU, AFSCME, JCAHO and others to develop a
week-long course at the OSHA Training Institute for our compliance officers and
state consultants to guide them in inspecting or consulting with healthcare
facilities. We will draw from the courses we have already on nursing homes and
ergonomics as well as training we will be doing on the revised bloodborne
- This new course will provide background for new compliance officers and fill in
some gaps for others by addressing unique situations such as home healthcare. We
want to strengthen and expand the cadre of trained and experienced compliance
officers that we now use to conduct inspections in health care facilities.
- After strong enforcement, the second pillar in our new ways of working is
partnership. Partnership has great potential for multiplying our progress.
- Many of you are familiar with our premier partnership -- the Voluntary Protection
Program -- which recognizes worksites for their exemplary safety and health
programs. This year, we welcomed the first two nursing homes -- Citizens
Memorial Health Care Facility of Bolivar, Missouri, and Boone Retirement Center
in Columbia, Missouri, into the program. They join two other health care
facilities-Samaritan Hospital in Ashland, Ohio, and Lima Memorial Hospital in
Lima, Ohio. I would love to see more nursing homes and hospitals recognized for
their outstanding efforts to care for employees as well as patients.
- We also have a partnership with JCAHO, as we seek to have employee safety
issues become a more important part of healthcare accreditation activities.
- Beyond enforcement and partnership, expanded outreach and training is the third
pillar of our new ways of working. OSHA has only a small staff dedicated to
teaching employers and employees about safety and health at the OSHA Training
Institute in Chicago. President Clinton has asked for an additional $12 million in
OSHA's budget for the Year 2000 to place full-time occupational safety and health
training and technical assistance staff in every federal OSHA office.
- Of course, the budget situation is very much up in the air at the moment. But I
hope when all the dust has settled, we will have the funding we need to make a
greater investment in education and outreach. To be a full partner in making
progress in injury and illness reduction in this country, OSHA needs to become as
well known for our education as we are for our enforcement.
- Another aspect of our outreach effort is our website, which includes publications,
technical information, and interactive software. Among other things, you can find
there our technical information bulletin on latex allergies and another one on glass
capillary tubes. We will be publishing one on laser plume smoke shortly. More
than 15 million hits are being recorded on this website each month, so someone
out there -- including many of you, I suspect, is using this site.
- These are the first three pillars of OSHA's new ways of working -- strong
enforcement, partnership and expanded outreach and training. The fourth pillar is
the foundation that gives support to the others -- and that is standard setting.
- As you probably know, my top priority standard is the safety and health program
rule. We know that when worksites take a holistic approach by establishing a
safety and health program, they do a better job of protecting workers.
- Unfortunately, only 30 percent of employers have set up safety and health
programs, despite the fact that OSHA provided voluntary guidelines for effective
programs more than 10 years ago. Voluntary guidelines have been helpful. But if
we want universal adoption of safety and health programs, we need a rule
mandating them. We plan to publish our proposed rule early next year.
- By the way, our Office of Occupational Health Nursing has developed an excellent
model program called "Framework for a Comprehensive Health and Safety
Program in the Hospital Environment." This booklet is available from the
Government Printing Office, and it may be helpful to you in evaluating your health
care facility's safety and health program. You can order it from our website.
- Another, much-discussed, issue we face as we approach the new millennium is
work-related musculoskeletal disorders or MSDs. Each year more than 600,000
workers experience MSDs serious enough to cause them to miss work -- and serious
enough to cost their employers $15 to $20 billion in workers' compensation costs
alone. Nurses and other workers in hospitals experienced more than 25,000 of
these repetitive motion or overexertion injuries in 1997.
- We all know that far too many MSDs occur among healthcare workers who are
lifting patients. This past week, the Washington Post ran an excellent two-part
series on the risks and hazards facing aides in nursing homes. Chief among the
problems featured were ones related to ergonomics -- those that come from lifting,
turning and caring for patients. Many of the injuries in healthcare settings can be
prevented, and leaders in the health care field are using mechanical lifting devices
and other creative engineering controls to reduce the risk of injury.
- OSHA particularly appreciates ANA's support for moving forward with an
ergonomics standard. Unions, women's groups and 11 major safety and health and
health care organizations representing 2.8 million members have urged us to
promulgate an ergonomics program standard.
- We are on target to publish our proposal within the next few weeks. We thank you
for your support, and now we need your help again. The final standard will be
based upon the complete record of public comments and testimony in response to
the proposal. Your comments -- sent on paper with a stamp or via E-mail over the
Internet -- will help us develop a practical, protective rule. If you're able to come
and testify, we'd be delighted to have you join us. We plan to hold hearings early
next year and then publish a final ergonomics standard before the end of 2000.
- You will be glad to know that, after the successful defense of the lawsuit brought
by physicians, we are continuing our recent practice of referring to licensed
healthcare professionals as the appropriate term of art for people responding to
health issues. We will continue to allow comment on how best to address the issue
of who is qualified to make various healthcare decisions, and I'm sure you and
others will continue to respond.
- Those of you who are occupational health nurses will be interested in OSHA's
recordkeeping rule. We now expect to publish a revision of that rule early next
year. It will include clearer definitions of work-relatedness, a better explanation of
what constitutes light duty and a much improved and simpler recordkeeping form.
The changes will take effect in January 2001.
- Later next year, OSHA also will issue its final tuberculosis standard. Our goal is
to prevent occupational transmission of TB, with its potentially life-threatening
consequence to healthcare workers and their families, at more than 100,000
facilities nationwide. Again, we appreciate your support. The comments nurses
and other healthcare professionals have submitted have helped us build a strong
record to use in completing the standard.
- When the next OSHA regulatory agenda appears in the Federal Register later this
month, one of the items for action will be a new PEL for gluteraldehyde. Another
item for future review will be bloodborne pathogens. As Secretary Herman
promised last spring, we are going to take another look at the standard to
determine if it should be revised to better protect healthcare workers against the
risk of injury from contaminated needles and sharps.
- As you can see, we have a long list of regulatory plans that will affect nurses and
others working in health care facilities. But these are all important issues, and it's
time that OSHA took care of the problems that affect those who take care of us all.
- Through our new ways of working, OSHA is focusing on fulfilling its commitment
to safe and healthful workplaces. I believe we're on the right track. But as Will
Rogers once said, "Being on the right track isn't enough. If you just sit there,
you're going to get run over."
- We need to keep moving in the right direction -- emphasizing strong enforcement,
promoting partnerships, expanding training and education and setting flexible
standards that hold employers accountable for protecting workers. These new
ways of working represent the best approach to achieving our goal of sending
every worker home whole and healthy every day.
- I appreciate the support of the American Nurses Association as we move forward
together toward this common goal.