• Bring standard-labeled, leak-proof, puncture-resistant sharps containers to clients’ homes. Do not assume such containers will be available there. Promptly dispose of used needle devices and sharps, which might be contaminated, in the containers.
• Plan for the safe handling and disposal of needles before use.
• Store sharps containers out of the reach of children, pets, and others not needing access.
• Secure used sharps containers during transport to prevent spilling.
• Follow standard precautions, infection prevention, and general hygiene practices consistently.
• Participate in your employer’s bloodborne pathogens training program.
• Help your employer select and evaluate devices with safety features.
• Use devices with safety features provided by your employer. • Report any needlestick and other sharps injury immediately to your employer.
If you experience a needlestick or sharps injury or are exposed to the blood or other body fluid of a client during the course of your work, immediately follow these steps:
• Wash needlesticks and cuts with soap and water. • Flush splashes to the nose, mouth, or skin with water.
• Irrigate eyes with clean water, saline, or sterile irrigants.
• Report the incident to your supervisor.
• Immediately seek medical treatment.

This is one in a series of six fast fact cards developed to provide practical advice for home healthcare workers and is based on NIOSH Hazard Review: Occupational Hazards in Home Healthcare, NIOSH Pub No. 2010-125.

TTelephone: 1-800-CDC-INFO TTY: 1-888-232-6348 Email: cdcinfo@cdc.gov I Web: www.cdc.gov/niosh/topics/healthcare DHHS (NIOSH) Publication No. 2012-123 February 2012 SAFER – HEALTHIER – PEOPLES

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

MCP FAST FACTS

Home Healthcare Workers

How to Prevent Violence on the Job

Home healthcare workers can be vulnerable as they face an unprotected and unpredictable environment each time they enter a client’s community and home. The spectrum of violence ranges from verbal abuse, to stalking or threats of assault, to homicide. Verbal abuse from the client, family members, or people in the community is a form of workplace violence. Verbal abuse may be subtle, such as asking for help beyond the scope of the job (such as with cleaning), or it may be obvious, such as complaining about job performance or worker appearance—or even threatening to cause harm.

EMPLOYERS SHOULD
• Establish a zero-tolerance policy for all incidents of violence.
• Train workers on recognizing and preventing workplace violence.
• Investigate all reports of violence.
• Work with police to identify dangerous neighborhoods where special precautions need to be taken and provide that information to employees.
EMPLOYEES SHOULD
• Participate in violence-prevention training.
• Report to your employer all incidents of violence, no matter how minor.

MANAGING VIOLENT SITUATIONS
• Consider working with an escort in high-crime areas, and if possible, schedule visits during daylight hours.
• Be sure of the location and have accurate directions to the house or apartment.
• Always let your employer know your location and when to expect you to report back.
• When driving alone, have the windows rolled up and doors locked.
• Park the vehicle in a well-lit area, away from large trees or shrubs where a person could hide.
• Keep healthcare equipment, supplies, and personal belongings locked out of sight in the trunk of the vehicle.
• Before getting out of the car, check the surrounding location and activity. If you feel uneasy, do not get out of the car.

Safety in the Community: It is very important to this Agency that our staff remains safe at all times. Should you perceive a situation to be unsafe, first take appropriate steps to ensure your safety and then immediately call the Agency. The following guidelines have been established to assist you in maintaining your safety:

■ Wear your name badge at all times.
• Carry a charged cell phone at all times.

■ Call patients’ homes in advance to alert them to your estimated time of arrival.
• Know your route. If you get lost, look for a safe place to stop and ask / call for additional directions.
• If needed, ask the patient I caregiver for further directions to the home.
• Request that pets are properly secured before your arrival. If pets are known to be menacing, back away. Never extend your hand out to the pet; never run from animals. Walk slowly around animals so that you do not frighten them.

■ Do not carry a purse. Lock your purse in the trunk of your car or hide it from visibility in your car.

■ Have your nursing bag/equipment ready before exiting from the vehicle. Keep one arm free.
• Keep your vehicle in good working order and ensure it has sufficient gas.
• In the winter, store a blanket in your vehicle; in the summer, a thermos of cool water.
• Keep a snack in the glove compartment.
• If you have car trouble, turn on the emergency flashers, call for assistance and wait for the police.
• Keep your car locked when parked or driving. Keep windows closed.
• Cross to the other side of the street when passing a group of strangers [if you are uncomfortable].
• Carry car keys in your hand. The pointed ends of the keys between your fingers may make an effective weapon.
• Park in full view of the patient’s residence. Avoid parking in alleys or deserted side streets.
• Walk directly to the patient’s residence in a professional and business-like manner.
• Use common walkways in buildings. Avoid isolated stairwells.
• Always knock on the door before entering a patient’s home.

■ Notify the Agency immediately if you encounter any incident that may jeopardize your personal safety.

■ Seek medical attention as needed.
• If you feel that you are in imminent danger, dial 911.
• In the event of a robbery, never resist theft of the nursing bag.
• If patient’s relatives or neighbors become a safety problem, notify the Agency immediately of the hazard.

Sexual Harassment: Sexual Harassment toward or by any Agency employee will not be tolerated. This Agency has a zero tolerance for Sexual Harassment. Any employee who feels that he/she has been sexually harassed should report this immediately to their Manager/Supervisor. An investigation of the allegation will ensue.

Violence in the Workplace:

1. No Weapons Policy:
   ■ Agency personnel are strictly prohibited from carrying a weapon of any kind to a patient’s home or to the Agency’s office, regardless of whether you are licensed to carry said weapon.
   ■ If a weapon / gun is present in the patient’s home, request that the weapon be moved to a locked location during the visit / shift.
   • If the weapon / gun poses a threat to you, the patient or caregiver, and the person will not remove the weapon, discontinue the visit I shift. Inform the person of your reason for leaving.
   • After leaving, call the Agency immediately.
   • If the person, patient or caregiver is willing to move the weapon / gun to a safe location, you must establish a verbal or written agreement that he/she will continue to store the gun elsewhere during your shifts / visits.

Contact the Agency immediately regarding this agreement.
Revision Date: 12-2006 interview Packet

A pair of genuine smiles beam wide as Chelsea Rambo, RN, reads aloud to one of her five regular home health nursing patients. The realities of tracheostomy tubes and medication schedules give way t the colorful adventures of Pete the Cat. The rhyming children’s tale follows the cartoon feline as he befriends Gus the Platypus, who is different than his other friends.

“Don’t be sad,” Chelsea reads. “Don’t be blue. There is something everyone can do.” Her patient listens closely as Chelsea’s voice rise and falls with the rhythm of the story until she reaches the end. Fror start to finish, no more than 10 minutes pass — a brief slice of her typical 12- hour shift.

“Interacting and playing with my patients,” Chelsea describes, “that’s the best part of my day. Anything that involves working together and them being happy.”

Chelsea recently earned her RN while working for a private home health care agency in the Lancaster area. She specializes in pediatric care, which includes nursing within a patient’s home and at school. Her caseload focuses or five patients, with an additional five she fills in for if another nurse cannot. She averages around 40 hours a week, and daytime shifts occupy her current schedule.

“I did nights for a while, and I still pick up night shifts here and there,” the 26-year-old explains. “… My flexibility helps with going on different cases. If they need to switch me, I can do that because I’m trained.”

In addition to her homecare nursing work, Chelsea is studying to earn her Bachelor of Science in Nursing (BSN).

“I’ve always had a passion for it,” Chelsea says. “I knew I wanted to do something in the medical field. My grandmother had dementia, and she lived with us. When I was in high school, I was her caregiver when I came home from school until my parents got home from work. I really loved that.”

Initially, Chelsea pursued a certified nursing assistant (CNA) degree with a focus on dementia and Alzheimer’s ski care. When she went to LPN school, she switched to pediatric care. “I met and interviewed with [pediatric nurses], and I ended up loving it,” she says. “… Just the overall experience with these kids — they are loving, and you get attached to them very easily.”

For Nurses new to home care

Caring for infants, children, and their families during hard times is a meaningful, rewarding, and an important responsibility. Often, those who pursue a career in pediatric nursing feel called to help this age group. The role of a pediatric home health nurse is a bit different from other pediatric jobs because rather than just helping babies and kids when they need hospitalization or routine check-ups, a home health nurse gets the chance to invest in the lives of their patients and help them achieve health milestones.

Successful home care nurses need practical, current clinical experience to care for patients who are being discharged “quicker and sicker”. Physical assessment skills need to be sharp and accurate, especially when immediate decisions regarding patient care must be made. Many agencies today offer classroom and clinical training programs to assist the nurse in the transition from hospital based care to home care. Expertise with new technology is also essential because of the machines, pumps, tubes, and medications that now accompany patients to their homes. To be effective, a home care nurse must be assertive, articulate, and persistent in collaborating with other healthcare professionals. Remember to keep the agency involved of any changes in the client’s condition or plan of care. Hospital nurses making the transition to home care need to realize that patients perceive them as guests rather than authority figures. Hospital-like rules don’t regulate home environments where personal preferences regarding diet, hygiene, lifestyle, and family relationships are important.

Few people are comfortable allowing strange people into the personal space of their homes, and a glance, tone of voice, or attitude of a nurse can build or destroy the patient’s trust in a moment. Flexibility and dependability are important in the home care relationship. A successful home care nurse requires keen adaptability to revise schedules and plans as needed to overcome inclement weather, last minute changes in case load, and staff sick calls that can challenge a well-planned day. They know that showing up on time for shifts demonstrates their respect for the patient and their family’s need to maintain some control over their lives. The flexibility of home care nursing provides nurses with the freedom that they simply cannot find in more structured environments. Nurses typically plan their own schedule and offer their time to the agency based on their needs with respect to their own family, personal and professional commitments.

Although a nurse may have difficulty maintaining a well-defined professional boundary when becoming for a time, a “member of the family”, in the emotion-packed arena of home care, nurses constantly learn valuable lessons about themselves and the people who receive their care. Home health demands are distinctive, presuming maturity and compassion from its practitioners. it also enables nurses to make profound and long-lasting differences in the equality of their patient’s lives. For individuals who choose home care nursing for that reason, the rewards are many.