Workplace H E A L T H & S A F E T Y R E P O R T

A Newsletter of The University of Iowa’s WORKSAFE IOWA Occupational Medicine Associates Network. Iowa’s university-affiliated statewide network of occupational medicine providers. Page 4 OSHA Launches Safety Web Page Page 4 Does Your Driver Need a DOT Page 6 ASK THE EXPERT for Residential Construction Physical and Medical Card? Vol. 12 No. 1 Fall 2004 Workplace working with….

many workers. A study of Michigan residents in 2000 estimated that 1 in 6 US workers had experienced bullying in the past year. This form of malicious mistreatment harms the mental and physical health of the target. It can also upset Diabetes co-workers, who withdraw from or the target, until the he Centers for Disease entire workplace is a fearful TControl and Prevention setting where social isolation estimates that 18.2 million hinders productivity as well as Americans or 6.3% of the relationships. Bullying is population have diabetes, different from unpleasant office 5.2 million of them as yet politics or general . undiagnosed (CDC, 2003). It is not the behavior of a This chronic disease “tough” boss. It is repeated acts manifests in two main ways. (of commission and omission) Most diabetics (90-95%) are that interfere with an classified as Type 2, the employee’s productivity. relatively more mild condition No workplace is immune in which the body fails to make from bullying. Appalling stories use of the insulin produced (or orkplace violence is now coming into focus: are told by targets in places to produce enough of it). In the or or bullying. More prevalent and where we expect people to past, Type 2 diabetes was a W disease of obese, sedentary discrimination make the more insidious than the have high personal integrity, headlines. Those incidents headline-grabbing behaviors, such as churches or medical adults; its increase among involve law-breaking and occurs in all centers, just as often as any American children and adoles- sometimes serious injury, even work environments, is engaged other workplaces. cents seems to be related to death. Meanwhile another in by men and women both, (Continued on page 2) growing childhood obesity. category of workplace behavior and has a negative impact on (Continued on page 4) Workplace H E A L T H & S A F E T Y R E P O R T Workplace Bullying

Types & Tactics (Continued from page 1) Attention has been focused What makes someone a bully? recently on school-age bullies. If While bullies can adopt any tactic at any time, While they act in a dominat- supported by their peers and not Drs. Gary and Ruth Namie have grouped behaviors that ing and superior manner, stopped by adults, those children bullies are in fact “haunted will continue their dominating have been reported to them into four general types: by their own inadequacy,” behavior as adults, but there are according to Gary Namie, PhD. more bullies in the workplace Many people’s image of a bully A social psychologist, Namie than can be accounted for by is the Screaming MimiMimi— created and heads The schoolyard statistics. emotionally out of control, Workplace Bullying & Trauma dominating others through fear Institute (WBTI) with his wife How does a bully operate? and . This type, Ruth, a clinical psychologist. Depending on a bully’s however stereotypical, is rare, Since the mid-1990s, the position in the organization, and they usually do not attack Namies have focused on behavior takes two general their targets in public (the helping workers cope with forms. A bully in a superior Bobby Knights of the world bullying. Through a website, position has the power to being the exceptions). telephone hotline, directly humiliate or destroy and several books, they have a target—criticizing, insulting, More dangerous is the Constant become authorities on this making impossible demands. Critic who uses put-downs, phenomenon, in the process A co-worker or subordinate , belittling comments, gathering a great deal of may be more likely to spread cross-examination. They often information from targets. disinformation or to withhold operate behind closed doors Their most recent data on the resources such as time or and, lacking witnesses, problem come from “The information that a target needs can effectively conceal WBTI 2003 Report on Abusive to succeed (see “Types & Tactics their behavior. Workplaces,” a website survey left). Namie distinguishes completed by 1,000 volunteer between the “chronic bully” The 2-Headed Snake is a respondents. who truly wants to dominate passive-aggressive individual Survey data reveal that half people in every encounter in with an indirect, dishonest style of all bullies are women, and the and out of the workplace, and of dealing with people and majority (81%) are bosses, the “accidental” ones, who hurt issues. “Jekyll-Hyde” is another although co-workers also engage others with their comments or accurate descriptor; while they in bullying, and a few even actions but will apologize and torment their target, they manage to “bully up the ladder.” change their behavior when ingratiate themselves with Namie explains that bullying confronted. the higher-ups. is an insecure individual’s response to the perceived What makes someone The Gatekeeper works to control threat embodied by a bright, a target? all resources—not only money competent co-worker or Because they are targeted but time, supplies, staffing, subordinate (who must be by both male and female even praise and approval. They undermined). Bullies are not bullies, women make up 75-80% may keep the target out of the usually psychologically of the targets of bullying. A communication loop by disturbed. On the contrary, composite of a target from stopping memos or failing they are often quite perceptive Namie survey data would be to return calls. of their organization’s power an educated woman around 40, structures and skilled at employed by a corporation or maintaining strategic alliances. government agency for about Source for graphics: Workplace Bullying & Trauma Institute 7 years. She would endure the

2 Workplace H E A L T H & S A F E T Y R E P O R T

bullying for nearly two years associated with stress-related information.” But if the becoming the next target, for before leaving or losing her job health problems: anxiety, employer sides with the bully— example. To rationalize their (proving that the average target disrupted sleep, headaches, and his data show that many silence, they may justify cannot be dismissed as exhaustion, body aches, all the do—Namie emphasizes the the bullying: “it’s just tough someone thin-skinned or way to diagnosed clinical target must leave the job for management;” “that’s why they overly sensitive to criticism). and Post-Traumatic the sake of their health (see call it work” They may blame Attributes that contribute to Stress Disorder (including “An Ounce of Prevention” for the target, finding ways to “targethood” are: a cooperative recurrent memories and ways to approach future job characterize her as deserving attitude, a non-confrontational nightmares). Health can be interviews). or inviting the bullying. Saddest style, values of equity and further affected by the of all, they may choose to ally justice. Namie considers it financial stress of a lost job. themselves with the bully. ironic “in light of all the talk According to Namie’s data, about ‘team-ness’ being central What can someone do if they 77% of bullies involved others to successful work perfor- are targeted? in their manipulations. Male mance, that the people with a A target may well feel bullies tended to look for help more advanced stage of human powerless, which makes it even from higher-level managers, Bullies do not select development—the ability to more important to take steps while female bullies relied cooperate—fall prey to the to respond to the situation. targets at random. They more often on a target’s primitive, Neanderthal bullies.” One step that is psychological co-workers. will carefully calculate Bullies do not select targets valuable is to name the behavior As difficult as it may be, at random. They will carefully clearly: bullying—a situation and the amount of effort co-workers must stand with calculate the amount of effort behavior that they did nothing each other if bullying is to be compared to the payoff and to provoke or invite. Taking compared to the payoff stopped. Refusing to betray a look for a relatively easy mark. steps to care for physical and and look for a relatively co-worker will spoil a bully’s Behavior that might set mental health is also vital. Visits “divide and conquer” tactics. someone up as a target to health providers and legal easy mark. Sitting in on meetings as a includes self-denigrating counselors can help a target witness can tone down a bully modesty, or timidity of speech prepare to make decisions How are co-workers affected? (who may fear public expo- or behavior (Namie has heard clearly and calmly. The modern American sure). Providing testimony of an individual actually Many people shrink from workplace is a close-knit may produce retaliation by the walking backwards to listen trying to expose a bully, but system of people, and in a bully, but how much worse is as a more powerful person Namie points out that a target bullying situation co-workers that outcome than continuing is speaking). has a 7 in 10 chance of losing may well develop the same to work in an environment Workers may be targeted, his or her job once the bully stress-related symptoms as laden with fear? Namie of course, even if they don’t selects them, so the risk has targets. Even as the work emphasizes that when chal- exhibit any of these behaviors, already been sustained. environment deteriorates, lenged by a group, most bullies and the resulting damage to Presenting data to the em- however, witnesses will choose will back down. their physical health, emotional ployer on the economic impact not to come to the aid of the health, and relationships can of the bullying (turnover rates, target, for various reasons. Can bullies and bullying be considerable. Unlike absenteeism, lost productivity, They may not recognize the be stopped? temporary physical or emo- costs of replacing an employee) bullying behavior or its impact, The simple answer is yes: tional upset that might result will be more effective than especially if the status of the given that most bullies are not from isolated incidents of accounts of emotional harm. bully puts him or her beyond emotionally disturbed individu- , health can be “Some employers are looking their suspicion. Even if they do als, they can indeed be made seriously endangered by for reasons to purge their very see the behavior as harmful, to change their behavior with bullying. Respondents to the difficult bully,” Namie says, they may remain silent, rewards and punishment. 2003 WBTI survey reported ”and you are the internal worrying about the negative Unfortunately, the workplace symptoms that were clearly consultant with the necessary outcomes of speaking up— (Continued on page 5)

3 Workplace H E A L T H & S A F E T Y R E P O R T

working with…. Diabetes

(Continued from page 1) to adopt healthier lifestyles Type 1 diabetes (which used that reduce risk for chronic to be called juvenile diabetes) diseases. More nutritious is usually diagnosed choices might be made in children and young adults. available in the company It requires insulin injections cafeteria or vending machines, and more rigorous medical for example, or classes offered management than type 2. on healthier eating, smoking Management of either type cessation, and exercise. of diabetes can include insulin Clearly a big company has or other drug therapy, blood the resources to develop large- glucose monitoring, and strict scale programs, but while OSHA Launches Safety Web Page diet and exercise schedules. General Motors can fund a for Residential Construction Health complications from national toll-free diabetes diabetes can be severe. Diabetics health line, smaller companies, he US Occupational OSHA’s Residential Construc- have death rates from heart especially if they join together, T Safety and Health Adminis- tion Safety and Health Web page disease that are two to four can develop or promote tration (OSHA) now has a web features information about OSHA times higher than people without worksite and other programs. page containing information standards that apply to residen- the disease. Among other things, the and tips specifically related to tial construction as well as the It makes good business National Diabetes Education safety and health for workers hazards present in residential sense to support employees’ Program (NDEP) suggests in the residential construction construction and solutions diabetes control strategies. smaller organizations could industry. The website was available to the industry. Research has shown that type 2 • support a walk/run for created with guidance and To visit the OSHA Residential diabetics who improved their diabetes. assistance from the National Construction Safety and Health blood sugar control were more • display posters about Association of Home Builders Web page, go to www.osha.gov/ productive, lowered their diabetes on bulletin boards. (NAHB). SLTC/residential/index.html. absenteeism rate, and had • have representatives from fewer days of restricted activity diabetes and other health and bed rest than those who organizations speak at a did not (Testa et al., 1998). brown-bag lunch for A supportive work environ- employees. ment might include direct • distribute diabetes informa- Does Your Driver Need a DOT services such as individual and/ tion as paycheck stuffers Physical and Medical Card? or group counseling and The NDEP, which links the education, blood sugar testing, National Institutes of Health, ccording to the Iowa Department of Transportation (DOT) or health screening for the CDC, and private organiza- A Enforcement Division, drivers need a DOT physical and complications. Simpler steps tions, has websites and other medical card if they have a: should not be overlooked, information to help employers • Class A license – driving a vehicle weighing 10,000 pounds or however, such as providing a address health problems greater private place for employees related to diabetes and design • Class B license – driving a vehicle weighing 26,001 pounds or to test their blood sugar—or relevant wellness programs. greater simply raising employees’ Your nearest WORKSAFE IOWA • Class C license – driving a combination vehicle (pick-up with a understanding of the impor- Associate can also provide small trailer) over state lines using a regular driver’s license. tance of this regular activity education and ideas specific For additional information contact Iowa DOT at 800.925.6469 of their diabetic co-workers. for your company. or 515.237.3206 While forming a diabetes For additional information: A special thanks to Cristina Johari at Allen Occupational Health support group will benefit www.nedp.nih.gov for providing this information! affected employees, all workers www.diabetes.org can benefit from opportunities www.diabetesatwork.org 4 Workplace H E A L T H & S A F E T Y R E P O R T Workplace Bullying

(Continued from page 3) approach that will change the An Ounce of Prevention. . . setting and dynamics are far work culture.” He adds, “And from simple. Currently, Namie’s that’s much more than some statistics show the bullying is piece of paper posted some- f you lost or left a job as a result of being bullied, you can most likely to stop when where in the workplace.” be understandably “gun-shy” in your job-seeking. targets are fired (37% of targets) Dr. Gary Namie, founder of the Workplace Bullying & Trauma or resign (33%). The Namies I Institute, says you can protect yourself by approaching stress the important role of the interviews with “the perspective of an informed skeptic.” mental health professionals working in employee assistance Generally stated, here are some of his suggestions for interview Programs (EAP). Those counse- strategies: lors are specifically charged Employers need to see 1) Seek information about employee turnover. It may not signal with helping workers restore bullying if it’s high, but it’s something to keep in mind as their health, and they can play that it’s in their best you interview. an expanded role 1) as educa- tors on workplace bullying, interest to acknowledge 2) Study employee manuals carefully, checking for protection 2) as lobbyists for stopping the the problem. against general harassment by co-workers and supervisors. problem, and 3) as the conduit 3) Watch for signs that an employer ignores work hours, for relevant data (e.g. on The American workplace workplace safety, personal health, or efforts to balance work turnover, retention problems, is inevitably influenced by the and home life. Comments can be signifcant, such as “We all avoidable litigation) to reach broader culture, and the very stay late here until the work gets done” or “People here upper management. competitive ones are fueled rarely use all their sick time. We have a strong work ethic.” Taking a larger view, Namie by the mentality that elevates Ask your potential supervisor how “crunch time” is handled. points to domestic violence or “winners” and denigrates Many jobs involve deadlines, but there should also be time child abuse as issues that have “losers.” In that environment, to unwind and celebrate achievements. evolved in our society in ways Namie says, “the cooperators similar to our changing view of are second-class citizens.” 4) Talk to your future co-workers, individually and away from bullying: from being denied to In addition, economic factors their office if possible so they’re more likely to express being considered problems create a tightening job market, themselves freely. that victims needed to solve which contributes to a climate 5) Determine if the company allows bosses to be evaluated by to being unambiguously of fear, and workers choose staff. If so, are the results anonymous and computed by a condemned and ultimately to stay in jobs even when their neutral third party? Or do they go directly to the boss and addressed by either criminal health is endangered. All is not stay within the work unit, opening the door to retaliation or civil laws. Through their bleak, however, according to if ratings don’t please the boss? Institute, Drs. Gary and Ruth Namie. He knows of employers Namie promote grassroots who are taking the right steps Healing will inevitably take time. But Dr. Namie has gathered organizing for policy change to address the problem of enough data from people who have been targets for him (even introducing a California bullying. “And the really good to declare, “How you left your previous job is the number one law that would have given news,” he says, “is the growing determinant of how well you heal after an experience with a workers in health-harming, number of stories of co- bully.” Workers who leave in shame, saying nothing to others, abusive work environments workers banding together to do not bounce back nearly as quickly as those who are open cause for legal action), but they confront bullies. That’s what and share their story with co-workers before leaving. do not consider legislation the we need, more than laws or best solution. “Employers need policy—solidarity.” to see that it’s in their best interest to acknowledge the For more information: http://bullyinginstitute.org/ problem,” Gary Namie says, “ and adopt a comprehensive The Bully at Work (Sourcebooks, $14.95)

5 Workplace H E A L T H & S A F E T Y R E P O R T

Expert: Patrick Doherty, MS, President, Work Fitness Center, Bettendorf, Iowa and Moline, Illinois

Question: Health care costs for employers are averaging double digit increases Integrated health care seems to be a new buzz word for over the past 3 years. Since employers pass those increases on to employers, what does ‘integrated health care’ mean? their employees, employees also benefit from participation in the integrated model. Answer: A third challenge for employers as they move toward To me, integrated health care means caring for all of the integrating their health care model is that their third party employee’s health needs as well as the needs of the employee’s administrator (TPA) and risk management area has not family. This is a change from treating only a work-related injury progressed to the new model. As the employer tries to financially or illness. manage all their costs, the payor is still working in a traditional The buzz relates to cost savings: a 15% to 20% reduction in model and needs to assign costs to claims, follow/manage the workers’ compensation costs is miniscule when compared to a case in the traditional model. Therefore, work is duplicated. 2% to 3% reduction in group health costs. Question: Question: Describe the evolution in occupational health that has How do employers develop an integrated health care system? produced this model. Answer: Answer: An employer may accomplish the integration of health care in The original model of occupational health was a practitioner a variety of ways. Some allow a medical provider to care for model, a patchwork of services. This model was physician centered personal injuries and illnesses as well as work-related injuries and physician driven. There were minimal financial pressures in and illnesses. Others integrate only disability issues, formalizing this model, and profitability was not essential. The physician’s role programs that assist employees with all return-to-work issues. was paramount. In this case, return to modified duty following a work-related In the mid-’80s the delivery of occupational health care was injury is handled the same as returning from another type of less organized. Medical intervention knowledge was crucial to injury utilizing short or long-term disability. For other employers, worker safety and health, and providers and clinics responded to an urgent care model is utilized, allowing families’ to utilize the local demand and targeted local employers. designated provider. In the mid-’90s, occupational health care became coordinated. Providers created multiple delivery sites with comprehensive Question: service options. A knowledgeable physician was no longer What are some of the issues an employer faces when moving enough; nurses needed to be certified, sales and marketing efforts to this integrating health care model? were formalized, and information systems were needed. Answer: Employers often demanded a coordinated approach for national One of the challenges for employers is getting everyone on board and regional accounts. Outcomes and return to work were being with the concept. The old mindset puts the emphasis on discounts, measured and tracked. Occupational health care was now which are effective in controlling costs. However, discounts have customer driven with control of associated workers’ compensation a very short life span. After a few months, all the real savings costs of utmost importance. vaporize with the employer/payor. In other words, what worked We are now in 2004. A comprehensive system of care with in the past may have no impact on the future. integrated disability management is demanded. Workers’ Another challenge is educating employees to the benefits of the compensation is no longer the driver of all change as in the past. program, emphasizing the fact that not all medical issues need a Employers demand cost containment and the integration of all doctor or urgent care visit. The employer needs to share with the employee health and safety services. employees that the program can be a win/win situation for all.

6 Workplace H E A L T H & S A F E T Y R E P O R T

Upcoming Occupational Health Courses

NIOSH-Approved Spirometry Training for Workers CAOHC-Approved Occupational Hearing Screening Course Conservationist Recertification Course November 4-5, 2004 March 3, 2005 April 14-15, 2005 The University of Iowa College of Nursing, Iowa City, IA July 28-29, 2005 A CAOHC-certified course director teaches this 1-day recertification November 3-4, 2005 course. For more information or to register, contact Nancy The University of Iowa, Oakdale Hall, Iowa City, IA Lathrop, College of Nursing, The University of Iowa, Iowa City, This NIOSH-approved course is designed to provide a comprehen- Iowa at 319/337-7075 or e-mail [email protected] sive theoretical framework combined with practical training necessary to conduct spirometry testing and screening for Central States Occupational Medical Association workers. Enrollment is limited to 12 for each course date listed Seminars above. For details or to register, contact Colleen Gross-Advani at 2005 Spring Seminar 319/335-4684 or by e-mail [email protected]. March 18-19, 2005 Hilton Lisle/Naperville Hotel, Lisle, IL Midwest Rural Agricultural Safety and Health Forum 2005 Fall Seminar November 18-19, 2004 September 16-17, 2005 Holiday Inn of Iowa City/Coralville, Coralville, IA Holiday Inn Dubuque/Galena, Dubuque, IA The objectives of the conference are to provide an overview of These seminars will provide current information on previously recommended policy changes; educate partners on occupational medicine, as well as resources and networking how policy change occurs; raise awareness of the role of advocacy opportunities. Intended for occupational health physicians, in promoting public health; develop organizational and advocacy physician assistants, nurse practitioners and occupational skills; facilitate working relationships between researchers, health health nurses. Contact Colleen Gross-Advani at 319/335-4684 care professionals, and farmers; and provide a workshop opportu- or by e-mail at [email protected] nity for collaborative policy effort. For more information, contact Eileen Fisher at 319/335-4224 or by e-mail at eileen- Occupational Health Symposium [email protected] March 30-April 1, 2005 Sheraton Hotel, Iowa City, IA Sixth Annual Occupational Health Nursing Conference This symposium will provide important resources and networking November 12, 2004 opportunities to keep one current in occupational health. Contact The Grand River Center at the Port of Dubuque, Iowa Colleen Gross-Advani at 319/335-4684 or by e-mail colleen-gross- This conference will allow participants to enhance their knowledge [email protected] of current issues and opportunities related to occupational health nursing. The course is intended for occupational health nurses Agricultural Occupational Health Training and other health care professionals who are responsible for A Certificate Program for Health and Safety occupational health and safety. Contact Colleen Gross-Advani Professionals at 319/335-4684 or [email protected] for Session I – May 18-20, 2005 more information. Session II –June 8-10, 2005 The University of Iowa, Iowa City, IA CAOHC-Approved Occupational Hearing This two-part course provides basic information and skills to Conservationist Certification Course enable health care professionals to function as practitioners March 2-4, 2005 in the prevention of occupational illnesses and injuries in the The University of Iowa College of Nursing, Iowa City, IA farm community. For a detailed course syllabus, contact A CAOHC-certified course director teaches this 3-day certification Kay Mohling at 319/335-4219 or by e-mail at kay-mohling@ course. For more information or to register, contact Nancy uiowa.edu. Lathrop, College of Nursing, The University of Iowa, Iowa City, Iowa at 319/337-7075 or e-mail [email protected] For updated course listings see our website at http://www.public-health.uiowa.edu/Heartland/continuinged.htm

7 Workplace H E A L T H & S A F E T Y R E P O R T WORKSAFE IOWA Occupational Medicine Associates Network

Work Well Clinic Trimark Corporate Work Fitness Center The Workplace Health and Safety Report is published St. Luke’s Hospital Health Services Trinity Health Enterprises quarterly by WORKSAFE IOWA for members of its Cedar Rapids, IA Trinity Regional Quad Cities Occupational Medicine Associates Network. WORKSAFE (319) 369-8153 Medical Center (309) 764-9675 IOWA is an occupational and environmental health outreach program of the Department of Occupational Fort Dodge, IA and Environmental Health, College of Public Health, Iowa Methodist (515) 574-6810 Allen Occupational The University of Iowa. For more information on the Occupational Health Health WORKSAFE IOWA Occupational Medicine Associate Iowa Methodist Medical St. Luke’s Allen Memorial Hospital in your area, please refer to the list at left. Center Occupational Waterloo, IA Editors: Kimberly J. Gordon, RN, MA, BSN, COHN-S West Des Moines, IA Health Services (319) 235-3885 Del Bonney, MSW (515) 241-2020 St. Luke’s Health System South Sioux City, NE UI HealthWorks http://www.public-health.uiowa.edu/worksafe Tri-State (402) 494-2065 University of Iowa WORKSAFE IOWA Occupational Health Health Care The University of Iowa 100 Oakdale Campus Medical Associates Clinic Alegent Health North Liberty, IA Iowa City, IA 52242-5000 Mercy Health Center Mercy Hospital (319) 665-2111 (319) 335-4423 Dubuque, IA Council Bluffs, IA 48734/10-04 (563) 584-4600 (712) 325-2500