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By: Laurie Clune RN, PhD Associate Dean Research and Graduate Programs

Where the nurse gets hurt: Understanding the social organization of injury management in Ontario hospitals. By: Laurie Clune RN, PhD Associate Dean Research and Graduate Programs. Dedicated to Ellen Pence. What to expect in this presentation. 1.

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By: Laurie Clune RN, PhD Associate Dean Research and Graduate Programs

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  1. Where the nurse gets hurt: Understanding the social organization of injury management in Ontario hospitals By: Laurie Clune RN, PhD Associate Dean Research and Graduate Programs Dedicated to Ellen Pence

  2. What to expect in this presentation 1 To building from my doctoral work and develop a program of research To discuss how IE approaches can be used in research teams 2

  3. My doctoral work Boss text Professional discourses and Ideologies The social organization of health care Early Return to work The social organization nursing work The Injured Nurse

  4. Early Return to Work

  5. Experienced nurses are being removed terminated from their jobs. • Boss text: Ontario Workplace safety and insurance board act • If after 2 years you fail to return to your pre-injury position the employer can terminate

  6. Occupational health nurse 1 (3, 4) “Working in a hospital (OHS department) is totally different than working in private industry”.

  7. Post Doc ?!#%* • The Institute for Work and Health • Primarily quantitative researchers (STATS, STATS, STATS and boot strapping ), economic evaluation, epidemiologic, and systematic review approaches • Non- nurse researchers doing research about nurses

  8. The Project Collaboration: Co-PI An economist - “I like your maps!” Funder: Workplace Safety and Insurance Board of Ontario Research Advisory Council Title: OHS economic evaluation resource needs for the health care sector in Ontario

  9. The Grant Objective: • To understand the OHS culture in health care • To understand the occupational health and safety resource allocation decision making in the health care sector. • (To assess the need for tools and training in the area of economic evaluation of OHS interventions.)

  10. This project Worker Compensation Legislation Discourse of abuse A nurses body must be an able body Decision making in health care surrounding occupational health The social organization nursing work

  11. Methodology • An exploratory approach using schema mapping, in-depth in person interviews and telephone interviews • Stakeholder guides (n=10) • Who to ask : purposive sampling • What to ask: Initial interview guide • Where to ask: create connections • What are we seeing: refining interview guide, immersion and crystalization

  12. Stakeholder guide map: How does it work?

  13. Data discovery approaches Interviews Sites • In person n = 20 • 22 informants • Telephone n= 25 • 28 informants • Roles • OHS operations • OHS directors, managers • OHS coordinators • Senior VP • Hospitals • Long term care • Community nursing • Ministry of Health • Urban and rural • Size (> 10,000, under 250) • Speciality hospitals (children, cancer, orthopaedics)

  14. Scaffold map: Guiding the interview Idea for OHS initiative Planning Decision-making Implementation Evaluation

  15. There’s a difference Not for profit For profit VS

  16. Scaffold map: Creating Work • Incident reporting trends • Technology tracking Prevention hunches Health Promotion Months (Jan= quit smoking; Feb = heart; March = nutrition) Idea for OHS initiative

  17. Scaffold map: Planning Work • Business plan for the board • Benefits to patients • Budget Planning

  18. Decision Making: “I am not sure. It goes to the Board. I have no idea how they make the decision”

  19. How decisions are made? • Most initiatives generated from OHS department • “no money” • Initiatives that have a direct effect on improving patient outcomes • Eg: flu shot • Ministry directives (labour and health) • Eg: harassment, over bed lifts

  20. This project Worker Compensation Legislation Ontario Hospital Act (funding) Discourse of abuse A nurses body must be an able body Decision making in health care surrounding occupational health The social organization nursing work

  21. Hospital funding mechanisms • Hospitals are funded for patient care and capital initiatives only • Hospital funding is based on a comparative approach based on • Facility size • Case types codes • Lengths of stays • Key performance indicators (eg: infection rates, wait times) • Hospitals that perform well are rewarded financially • No funds are allocated from the Ministry for occupational health and safety

  22. Going back to the occupational health nurses’ comments: • Money for occupational health and safety initiatives are not a part of funds received by hospitals. • OHS initiatives that do take place in hospitals are • Mandated by the Ministry of health or labour • To protect the patient “Working in a hospital (OHS department) is totally different than working in private industry”.

  23. Thank you

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