Health care environments contain many risks that nurses and other health care workers should know about to keep safe and avoid injury or illness. A good place to begin ensuring a safe workplace is in the job interview. Asking the right questions requires knowledge, planning, and preparation.

What immunizations are required for employment and are offered in the workplace?

It's important to be vaccinated against such diseases as tetanus, measles, rubella, and chicken pox. Hepatitis B can be prevented with a three-dose vaccine series, with a second vaccine series sometimes required for full immunity. Health care workers also are at risk for seasonal influenza and passing on the virus to vulnerable patients. Ask whether your potential employer has a seasonal influenza vaccine program. Vaccines are not 100% effective, but it's better to make every effort to be immune than not to be vaccinated at all. Finally, keep important papers as a record of all immunizations and laboratory titers or other work-related testing.

What safety-engineered devices are available to prevent blood-borne pathogen exposure?

The Occupational Safety and Health Administration (OSHA) requires the use of safer sharp devices (and other safety-engineered devices) to protect health care workers from becoming infected with HIV, hepatitis B, and hepatitis C from work-related exposure to blood and body fluids. The Needlestick Prevention Act of 1999 (signed into law in 2000) requires that frontline health care workers be involved in selecting these devices. Ask how you might become involved in this group.

What type of respiratory protection plan does the facility provide? How often does fit testing occur?

OSHA requires respiratory protection to be provided to health care workers who are at risk for exposure to active tuberculosis. The commonly used N-95 respirator requires medical evaluation, education, and fit testing. Currently, the Centers for Disease Control and Prevention recommends periodic fit testing for wearers of N-95 respirators. OSHA's general industry rule for respirator use by workers requires annual fit testing. However, legislation prevents enforcement of the annual fit testing requirement at this time. Being fit tested for an N-95 respirator is important not only for preventing exposure to tuberculosis, but also for protection from other biological agents.

Does the organization have a "no manual lift" policy? What lifting equipment is available?

The cumulative effects of manual patient handling put nurses at risk for back and other musculoskeletal injuries. There is no safe way to manually lift a patient. Safe patient handling programs that employ mechanical lifting and transferring devices have proven to reduce this risk while patients experience safer handling and movement.

What is the policy on mandatory overtime? What are the work hour requirements of the job?

Research has shown that fatigue from overtime and extended work hours can

* decrease reaction time.

* cause lapses in attention to detail and increase errors of omission.

* compromise problem solving.

* increase exposure to biological hazards.

* increase the risk of musculoskeletal disorders and vehicular accidents.

* decrease the energy one has to complete required tasks successfully.

* increase the risk of smoking and alcohol use.

* reduce motivation.

What policy is in place to address workplace violence?

According to a Bureau of Labor Statistics report in 2004, health care and social service workers have the highest rates of nonfatal assault injuries of all U.S. workers. Find out what security measures are in place to protect nurses from violence from patients, visitors, or coworkers.

Is the workplace mercury free?

Mercury is a potential neurologic and reproductive toxin affecting the central nervous system, liver, and kidneys. Recent efforts at many hospitals have been successful in removing mercury thermometers and sphygmomanometers from the workplace.

What is the system for making workplace chemical hazards known?

Many chemicals to which health care workers are exposed can pose health risks. Discuss how chemical information is made available to employees.

Being prepared to assess the potential work environment and safety culture can positively affect the quality and longevity of a nurse's career.