An investigation of occupational health and safety workplaces and working conditions in comparison to nursing care quality in Residential Aged Care Facilities (RACFs) in New Zealand

Abstract

Background: New Zealand is facing an ageing population and nursing workforce. There are high mental stress levels combined with intense physical workloads identified for nursing staff in Residential Aged Care Facilities (RACFs). Another challenge is the work-related absenteeism of nursing staff, which negatively influence nursing care quality for residents. Objectives: The first aim of the study was to identify critical factors of occupational health and safety workplaces and working conditions from the nursing staff perspectives in RACFs. The second aim was to determine the correlation between the quality indicators for occupational health and safety workplaces and working conditions, and nursing care quality based on the InterRAI Clinical Assessment Protocols (CAPs). Methods: This study design is based on a mixed method approach. An initial audit requested the health and safety certificates and the implemented quality management system of the enrolled RACFs. A survey and card inquiry activities identified mental stress factors and stress reduction strategies. Environmental factors, which included noise, temperature, humidity, and lighting were measured to compare it with international standards. Non-participation observation was executed to investigate high-risk nursing activities, which included lifting, pushing, pulling, and holding, and the related workload of these actions. InterRAI CAPs data set were incorporated for the correlation approach. Participants: Seventeen RACFs (1,022 beds) and 398 Registered Nurses (RNs), Enrolled Nurses (ENs), and Healthcare Assistants (HCAs) participated in this study from the Greater Auckland Region in New Zealand. Findings: The environmental factors, noise and humidity level, met recommendations. However, temperature and lighting levels failed to comply. RNs implemented on average ten and HCAs 18 high-risk nursing activities per shift. The minimum workload of RNs was 546 kilos, and HCAs handled 1,175 kilos while they walked on average between five and six kilometres per shift. Various stress factors and stress reduction strategies were found. Five significant correlations with moderate strength (r = -.407, to r = -.537, p < .001) were identified between environmental health and safety, working condition, and InterRAI CAPs. Conclusion: Workplace environment and working conditions affect nursing care quality in RACFs. Hence, both nursing staff and residents benefit from healthy and safe workplaces.