Definition/Introduction

Occupational Safety and Health Administration (OSHA) is an agency of the United States Department of Labor, created under the Occupational Safety and Health Act (OSH Act) of 1970 by Congress and signed into law by President Richard Nixon on December 29, 1970. OSHA was created to ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education, and assistance.[1] 

The passage of the OSH Act and subsequent creation of OSHA has led to unprecedented changes in workplaces across America, and a significant reduction in workplace hazards which can cause injuries, deaths, or illness.[2] However, the limitations in resources and funding allocated to OSHA, standardized processes, civil and criminal penalties, and coverages for workers have still led to millions of workers being injured or killed from workplace-related incidents. OSHA has an important impact on the healthcare industry through a suite of requirements that impose measures on healthcare facilities and hospitals to implement workplace safety systems to protect employees from bloodborne pathogens, enhance patient handling programs, and ultimately save resources.[3]

Issues of Concern

Despite the implementation of the OSH Act in 1970, workplace incidents still lead to injuries and deaths, accounting for over 5000 workers being killed on the job each year.[2] Though the creation of OSHA has drastically improved safety in the workplace, the fatality rate from work-related injuries and deaths has not decreased. This weakness has been attributed to OSHA's standard-setting process, which takes a large scale of resources and time to issue new standards without political opposition. Thus, there are few new standards in place to protect workers from modern causes of injury, such as biological or chemical safety hazards on the job. The outdated standards prevent OSHA from executing its mission in the realm of these subsets of workplace incidents. This dramatically impacts employees in healthcare settings who run the risk of being injured from advanced technological instruments, which may not be recognized under OSHA's outdated standards.

Further limiting OSHA is the lack of resources and funding. The annual budget of OSHA is less than $600 million, compared to the annual budget of other government entities such as the Environmental Protection Agency (EPA), which boasts of a budget greater than 8 billion dollars.[2] With its relative lack of funding and staffing, it becomes difficult to implement jurisdictions and restrictions at workplace sites throughout the United States or conduct even visitations and inspections at all U.S. workplaces.

The lack of stringent measures and consequences when employers/workplaces are penalized do very little to deter employers in the long-term. OSHA's weak criminal sanctions and meager financial penalties to employers have led to continued abuse of the policies and lack of adherence from the corporate level. This results in employees not having access to protections afforded by OSHA due to the regulations only being placed at the employer level. 

Lastly, the structural differences in today's economy versus those in 1970 when OSHA was commissioned into law are vastly different. Today, far fewer individuals are represented actively by a union, which was more common in 1970. Furthermore, many individuals are independent contractors or self-employed, which falls outside of OSHA's jurisdiction. With the increasing number of online jobs and unique employment contracts, OSHA's standards and restrictions cannot keep up to provide coverage and policies that protect all areas of American employment. The healthcare workforce is advancing in many ways through structure and job duties afforded to mid-level providers and other members of the healthcare team as well, which limits the extent of enforcement that OSHA plays.[4]

Clinical Significance

OSHA has a notable influence on clinical practice within healthcare institutions. The enforcement of this influence is through standards of hazard communication, bloodborne pathogens, ionizing radiation, exit routes, electrical, emergency, fire safety, medical/first-aid, and personal protective equipment (PPE) within healthcare settings. In the perioperative setting, the risk of exposure to bloodborne pathogens and potentially infectious materials to employees is markedly high, which makes the implementations and regulations set forth by OSHA ever more important.[5][6] OSHA has also issued guidelines to specifically protect healthcare workers from violence.[7]

In 2001, OSHA revised the bloodborne pathogens standard also to include components of the needlestick safety and prevention act.[8][9] This act allowed for the expansion of further engineering controls to include further input from employers in identifying and evaluating standards regarding patient care and required employers to maintain a log of injuries from contaminated sharp objects to employees. By calling on healthcare employees to use safer technology, the practice of safer work procedures has been further accelerated.

Nursing, Allied Health, and Interprofessional Team Interventions

Interprofessional partnerships between healthcare professionals are key to ensuring a healthy work environment that emphasizes safety as a top priority within the healthcare workplace; this aligns with the focus and mission of OSHA which protects all healthcare employees as a group without differentiating amongst their independent roles within the workplace, just as policies of the Health Insurance Portability and Accountability Act (HIPAA) are enforced. Healthcare professionals can work together to identify potential threats and hazards in the workplace, find ways to mitigate these threats, develop management training programs in collaboration to promote workplace health and safety and enhance the accuracy of OSHA-related recordkeeping.

The coordination of care amongst all healthcare providers can translate into coordinating health and safety measures for the entire workforce. In addition to working together in collaboration between all members of the interprofessional healthcare workforce, these professionals can also plan routine screenings and inspections of workplace facilities to ensure safety standards and develop programs to promote better health and safety for the workplace.[10]