Are Nurses Protected From Workplace Hazards?


Are Nurses Protected From Workplace Hazards?

Beyond needlestick injuries and back pain

By Mariette Tachdjian, RN, MSN
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Nurses work hard enough, long enough, and in conditions that are strikingly different from other industries. We spend our hours insulated from the outside world, wearing multiple hats, building relationships of trust, applying critical thinking skills, and alleviating the pain and suffering of others. But there’s one more aspect of our job that doesn’t leave a warm and fuzzy feeling: being exposed to hazardous materials. What are these short-term interactions doing to our long-term health?

Occupational Hazards

There was a time when the biggest occupational hazards among nurses and health care workers were needlesticks and back injuries. Though still a major concern, the number of incidents have dramatically decreased, due largely to the role of the Occupational Safety and Health Administration. Take, for example, the Needlestick Safety and Prevention Act, which was signed into law in 2000. This law helped initiate new practices such as needle-less systems and thus improved the safety of nurses and technicians.

The rate of back injuries, sick days and nonproductive days among hospital employees made a downward spiral as well after a mandate was enstated by OSHA. It required all back injuries to be reported, and, subsequently, ergonomic programs and lift teams were implemented.

Although these are the kinds of injuries that are easily identifiable and reportable, there are numerous other daily workplace hazards that go unidentified, unregulated and unreported.

The  Big Survey

Few in-depth clinical studies have looked at the potential relationship between daily, long-term exposure to common chemicals and materials and disease conditions among nurses. In December 2007, the Environmental Working Group published an online survey that looked at the health issues of nurses, their respective areas of work, and the amount of exposure to common chemicals and hazardous materials. The results were alarming.

The survey looked at 1,500 nurses and their exposure to 11 different common health care hazards, including chemo drugs, radiation, sterilizing agents, housekeeping chemicals, anesthetic agents and certain other therapeutic drugs. While some of these hazards are known to have immediate adverse reactions (such as allergenic products), others have a more compounded effect over longer periods of time. The survey defined long-term exposure as being at least weekly for 10 years or more. Reported health conditions among the nurses ranged from asthma and cancer to birth defects in their children after exposure during pregnancy.

Alarming Findings

Chemotherapeutic agents have been widely known to be toxic and require special precautions during preparation and administration. Nurses who worked with chemo agents for long periods of time reported 42 percent higher rates of cancer when compared to other nurses. Of those who reported working frequently with radiation, there was a 16 percent higher incidence of cancer.

Anesthetic agents are thought to be absorbed by health care workers via leaks through anesthesia machines, tubing or patient exhalations and are known to cause not only miscarriages and birth defects, but also memory and motor impairment. Roughly 36 percent of nurses who reported working with anesthetic agents during pregnancy (including nitrous oxide and halogenated gases), disclosed that their children had birth defects (including central nervous system, cardiovascular, genitourinary and musculoskeletal disorders), which is up to seven times higher than other nurses.

The seemingly harmless use of soaps, cleaners and disinfectants in hospitals and clinics may actually be accountable for the higher asthma rates among nurses and health care workers. For example, products commonly used to clean patients, including shampoos, soaps and lotions, also contain fragrances and irritants associated with allergic reactions. Users of antiseptic hand sanitizers such as gels, soaps and foams (which contain alcohol or other asthmagens), reported 39 percent higher rates of asthma.

Increased asthma was also reported with long-term exposure to household chemicals, including disinfectants, detergents and pesticides, most of which contain asthmagens and potent irritants. Users of latex gloves, (another highly allergenic product), reported 39 percent higher rates of asthma as compared to nurses who don’t use latex. Glutaraldehyde and ethylene oxide, disinfectants used to clean hospital equipment, are both potent irritants and asthmagens, and were equally connected to higher rates of asthma.

Antiretroviral medications, when used in certain combinations on a daily basis, may be linked to higher rates of infertility among nurses. A 19 percent higher rate in difficulty conceiving was reported among nurses with frequent and long-term exposure to these drugs. Finally, long-term exposure to mercury — a known neurotoxin that is still used in some hospital equipment like sphygmomanometers and thermometers — accounted for a 130 percent higher rate in nervous system disorders.

Overall, 32 percent of the nurses surveyed were being exposed to combinations of at least five hazardous chemicals or agents for 10 years or more, while 52 percent reported the same exposure over a shorter period of time (at least five years).

Reasons for More Research

The nurses in this survey participated based on interest, and there were no selection or enrollment criteria, which is protocol in clinical studies. The responses obtained were derived from a large uncontrolled survey and are certainly not definitive. Neither does the survey take into account a variety of other factors that may provide skewed information, including health habits and genetic predisposition. What the survey does offer, however, is a glimpse of the potential correlation between chemicals and illness. More scientific research is required to investigate causal relationships.

Are Nurses Sufficiently Protected?

Although the survey is not definitive, it does raise a very obvious question: Are nurses protected? Most of the complex combinations of various chemicals handled by nurses have never been tested for safety.

Due to the fact that there are no regulatory requirements for testing these harmful substances, there is no consistent way of protecting staff. Although OSHA has set exposure limits to ethylene oxide, radiation and mercury, it has yet to impose regulatory standards for other chemicals and agents. The EWG states that the burden falls on individual hospitals to establish safe workplace practices for employees. It also suggests that motivated nurses and hospital administrators use resources from the National Institute of Occupational Safety and Health to create their own safety guidelines to reduce employee exposure.

At the end of the work day, nurses, like their physician colleagues, remain committed to upholding the most basic principle: First do no harm. But while we work hard to protect our patients, we must also learn how to protect ourselves.


– To learn more about the Environmental Working Group survey, go to and search “nurse survey” in the “Find Something” box.
– To learn more about harmful substances being used at your hospital, visit
– Recommended hospital practices for protecting employees can be found at


Mariette Tachdjian, RN, MSN, is a freelance writer and has worked in several areas of clinical and administrative nursing.

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