Factors influencing oncology nurses' use of hazardous drug safe-handling precautions

To examine relationships among factors affecting nurses' use of hazardous drug (HD) safe-handling precautions, identify factors that promote or interfere with HD precaution use, and determine managers' perspectives on the use of HD safe-handling precautions.

Cross-sectional, mixed methods; mailed survey to nurses who handle chemotherapy and telephone interviews with managers.

Mailed invitation to oncology centers across the United States.

165 nurses who reported handling chemotherapy and 20 managers of nurses handling chemotherapy.

Instruments measured the use of HD precautions and individual and organizational factors believed to influence precaution use. Data analysis included descriptive statistics and hierarchical regression. Manager interview data were analyzed using content analysis.

Chemotherapy exposure knowledge, self-efficacy, perceived barriers, perceived risk, interpersonal influences, and workplace safety climate.

Nurses were well educated, experienced, and certified in oncology nursing. The majority worked in outpatient settings and administered chemotherapy to an average of 6.8 patients per day. Exposure knowledge, self-efficacy for using personal protective equipment, and perceived risk of harm from HD exposure were high; total precaution use was low. Nurse characteristics did not predict HD precaution use. Fewer barriers, better workplace safety climate, and fewer patients per day were independent predictors of higher HD precaution use. HD handling policies were present, but many did not reflect current recommendations. Few managers formally monitored nurses' HD precaution use.

Circumstances in the workplace interfere with nurses' use of HD precautions.

Interventions should include fostering a positive workplace safety climate, reducing barriers, and providing appropriate nurse-patient ratios.