Paul De Raeve
RGN, MSc, MQA, Mphil/PhD
European Federation of Nurses Associations
Following the adoption of the European Directive on prevention from sharps injuries on 1 June 2010, the European Federation of Nurses Associations (EFN) is now focusing on the three-year period of implementation at national, regional and local level. The Biosafety Summit, supported by the Spanish EU presidency, focused, therefore, on bringing key stakeholders together to explore ways to implement effectively the directive across the EU.
Consequently, implementation guidelines and the development of the European Biosafety Network are important mechanisms to achieve the initial and essential objective: prevent and reduce sharp injuries, reduce human suffering and create optimal working conditions in the health sector.
Due to the fact that sharp injuries lead to distress, sickness, absenteeism and even fatal disease transmission, sharp injuries are one of the major threats to the health and safety of nurses across the EU. Keeping up the political momentum when implementing the directive in the coming three years now becomes a joint endeavour as the nursing profession takes up this challenge again.
Therefore, ‘EU Fit for Practice’ should become a political theme and priority. Although politicians and policy-makers have been tackling the challenges of higher expectations from patients, and the changing demographic and epidemiological profiles of their populations, Europe still struggles to address ill-health retirement and work-related injuries.
‘No blame, no shame’ working environment
It is a well-known fact that safety can be increased if the working environment consists of a highly qualified workforce and the culture in the workplace is based on learning instead of punishing. When implementing the directive, it is important to remember and to stress that a sharp injury is not an independent hazard. It is a workplace accident and has to be treated as such.
Therefore, we have to look at those incidents in a broader way. If we want to lower the number of accidents, it is very important to look at the culture at the workplace regarding workplace accidents, awareness-raising and a non-blaming culture. Following-up on education and continuous professional development, culture change and personal policies are equally important.
We have to look at why those accidents happen. We know that stress and long working hours cause more accidents. Another important factor is the organisation of the workplaces, which has a great impact. We know that incidents with needles on trays or needles in the bedclothes increase if there are no buckets near patients for the used needles. This is an example where the employer has the responsibility for ensuring a no-blame culture and a shift in attitude in the workplace.
If we want the number of sharp injuries to decrease, it is not enough to just implement a law; it is equally important to look at the whole complex of culture, personal policy, employer’s responsibilities and the organisation of the workplace. This shows that a good reporting system and a ‘no blame, no shame’ culture are of utmost importance if sharp injuries are to be avoided.
An open-learning safety culture that encourages both a safe working environment and non-violent behaviour leads to high-quality patient care as the empowered patient meets a highly confident nurse working in a team of health professionals. Within this open-learning culture, incidents are communicated without fear of ‘blame and shame’.
So governments, health organisations and senior managers have to take responsibility for developing a safety culture, creating a legal separation between sanctions and learning, and for engaging staff, patients and patients’ relatives in safety. Change can be achieved through co-ordinated action and effective approaches at EU, national and regional level. Best practices in ‘no blame, no shame’ culture along with policy changes must be identified and discussed, making sure Europe is pro-actively improving the sustainability of the health and social security systems.
One of the success stories of EFN advocacy is the development in 2010 of the directive on the prevention of biological risk of infections caused by needle-stick injuries. Since 2004, EFN and its members have been lobbying the European Parliament and the European Commission for a legislative action which led the directive after six years of sharing information and bringing into the EU policy development arena the best practices which reduced needle-stick injuries at regional and local level.
Many stakeholders became part of this endeavour; the social partners, the health professionals, the education and research community, the patient organisations, the policy-makers and politicians and last, but not least, the industry – all becoming part of a business case for success. EFN’s experience in leading on the development of a ‘Memorandum of Stakeholder Engagement’ as part of the governance review of the Health Grouping of the Council of Europe now forms the baseline for a more realistic and effective directive and consequently an improved implementation by 2013.
Since 2004, greater information and broader exchanges of experiences made it possible to get political commitment, mainly from the European Parliament. Key MEPs championing our cause needed objective, unbiased information and case studies to build their political case. And again, going back to the constituency, the policy outcome needed to have an impact on the community they serve.
EFN, as non-governmental organisation, brought in the concerns of the nurses and encouraged the political participation through provision of information, analysis and expertise. When implementing the directive, we need to keep this political momentum alive so the EU does not end up with a Commission report referring member states to court for not implementing the directive.
Social Cohesion Funds
Given the complex character of the healthcare sector and the need for quality, patient safety and adequate organisation and delivery of health services to the people of Europe, strong leadership in governance is a precondition when addressing the prevention and reduction of work-related injury, especially within the enlarged EU. Delivering quality services to our communities will not happen by chance; it will only happen by political choice, pro-active agenda-setting by stakeholders and political leadership.
As starting point, member states, health professional and healthcare facilities need to go beyond searching for a common terminology and sharing of information. When reducing sharp injuries, we need concrete action to prevent it happening again. A reporting system should lead to comparable data facilitating a better understanding of causes and circumstances in the working environment where injuries occur. Therefore, the Biosafety network and the European Agency for Safety and Health at Work have an important role to play in collecting this information, translating the data into an understandable language and informing the concerned parties what measures to take to prevent sharp injuries.
These measures will obviously cost money! Therefore, even in our on-going financial and economic crisis, social cohesion funds need to be used to implement some measures immediately, mainly in those EU member states where local working environments have no measures in place at all. We can be sure that, within the current cash-saving budgets of all governments, health and social policies will suffer first and more injuries will happen if the nursing community is not pro-active in applying for the social cohesion funds. For the current seven-year period 2007-2013, these funds will be investing some €76.2bn to support employment and social cohesion across the EU. A clear link with the labour market is a fundamental requirement for determining the scope of intervention in the area of health from the European Social Fund.
The Biosafety Network could play an important role in supporting national, regional and local stakeholders applying for these funds. By using the social cohesion funds, the Biosafety Network and its partners contribute effectively to the Europe 2020 Strategy. The network could be inspired by the success achieved in Poland, which received over €40m from the social cohesion funds to invest in advancing the training of 36,000 nurses up until 2015.
Although the use of non-safety needles was not made completely illegal through social dialogue, the education surrounding the use and availability of safe medical devices leads to the elimination of many of the injuries. Just as the social dialogue succeeded in getting all recapping banned, nurses now need to lobby for the general use of safety-engineered devices and the optimal availability of sharps containers for the disposal of used sharps.
Sustained collaboration on safety
The link between the Biosafety Network and the government is crucial for success. Therefore, special emphasis should be given to the establishment of a culture of mutual learning among member states. The added value of sharing knowledge and experiences among member states is considered important to make the implementation sustainable.
A permanent collaboration among member states, through the development of a joint action, in which the network partners engage to achieve concrete outcomes and inform policy development at national and regional level, is an option to consider. It would fit within the on-going work on safety and quality by the Directorate General for Health and Consumer Affairs (DG Sanco). Together with DG Sanco, the Directorate General for Employment, and the European Agency for Safety and Health at Work, the Biosafety network becomes the focal point, a platform for permanent interaction among member states on the topic of prevention of sharp injuries. Furthermore, this platform needs to go beyond the EU and Europe. International partners should enrich the EU discussions and solutions.