It a unit in health presentation which isa unit in perioperative nursing

A unit in perioperative nursing

1. Protection against Health Hazards Two types of measures can be taken to protect employee health against occupational hazards: Preventive measures Curative measures

2. Preventive measures Pre-employment and periodic medical examination. Removal of health hazards to the maximum possible extent. Check over women, and other workers exposed to special risk. Training of first aid staff Educating workers in health and hygiene. The curative measures consist of treatment of affected workers. Of course prevention is always better than cure. Use of less toxic materials, protection devices, controlling noise, dust fumes, gases etc. are some of the convenient and inexpensive measures that can be taken by employers to prevent health hazards

3. Industrial Health Programme Every industrial establishment should formulate and implement a positive policy and programme to maintain the good health of its employees. Such a programme should consist of the following steps: Maintenance and supervision of satisfactory sanitation and hygiene in the factory/office. Inoculation and after programmes for the prevention of communicable diseases. Active cooperation with public health agencies and accident prevention authorities. Maintenance of adequate and confidential medical records.

4. Health education and information services for employees. Proper medical examination of every new employee. Annual medical check-up for those exposed to occupational hazards. Employment of professional physicians and nurses. Proper first aid treatment for occupational injuries and diseases. Reasonable first aid treatment for non-occupational ailments eg. Cold, sore throat, skin disorders, headaches etc. Adequate emergency care and hospitalisation facilities.

5. Significance of Industrial Safety Industrial safety and efficiency are directly related to each other. Safety measures prevent accidents and ensure regular flow of work. Safety also helps to improve the morale and productivity of workers. It contributes to team work and sense of belonging of employees. Surveys and studies reveal that wherever safety measures are good, labour productivity is high. This is so because employees can concentrate on their work with confidence and without fear.

6. Industrial Cost of compensation to the required employee Cost of medical aid. Cost of training a new worker. Cost of the lost time when work stops due to an accident. Cost of investigation into the accident. Cost of supervision and inspections. Cost to the government in terms of factory inspectors, and public health services.

7. Accidents cause a great loss to both the employer and the employees: Cost of spoilage of materials. Cost of damage to machinery Cost of wages payable during injury. Cost of loss of morale Cost of loss to the worker and family Society suffers a great deal due to industrial accidents. Gas leak in the Union Carbide factory in December 1984 in Bhopal killed thousands and disabled lakhs of people.

8. Systematic and up to date records of industrial accidents and steps taken to prevent them should be maintained in an industrial undertaking. These records will be helpful in identifying the areas where further action is required to ensure employee safety. It is also obligatory to maintain such records under the Workmen’s Compensation Act. Accident records should contain the following information: The total number of employees in the unit who are exposed to different types of accidents. The severity of the accident-whether it resulted in a broken bone, a deep cut and the time that was lost as a result of it.

9. The date, time and the shift during which the accident occurred. Personal data including the age and health of the injured employee The immediate cause of th accident whether it was the result of a malfunction of a machine or whether the employee failed to sue the safety devices provided for the purpose of preventing accidents.

10. Cause of Industrial Accidents Industrial accidents take place due to several reasons arising from people, working conditions, and other factors. These causes may be classified as follows: Unsafe conditions. These refer to work related or technical causes. These are the biggest cause of accidents in an industry. Work related causes are as follows: The Job itself. Some jobs are inherently more dangerous than others. For example, the job of a crane man as compared to that of a supervisor is riskier.

11. Work schedules. Night shift is more prone to accidents that day shift due to fatigue and sleepiness. Psychological conditions. Emotional disturbance and mental preoccupation often cause accidents. Overwork, monotony, boredom, anxiety, fatigue and frustration disturb concentration and mental alertness leading to accidents. Machinery and equipment. Defective equipment, unguarded machinery, breakdown of machines, hazardous arrangement of machines and equipment, inadequate safety/control devices, overloading, improper illumination, insufficient ventilation, poor housekeeping, poor maintenance and supervision are common causes of accidents in industry.

12. Unsafe acts. These arise due to lack of knowledge and skills, bodily defects and faulty attitudes. Some examples are given below: Operating without authority Failure to use safety devices Failure to listen to warning Careless throwing of materials on floor Operating at unsafe speeds Using unsafe equipment Removing or disconnecting safety devices.

13. 2. Lifting things improperly Taking unsafe positions under suspended loads. Using unsafe procedure in loading and unloading. Cleaning, oiling, repairing or adjusting moving machines. Teasing, quarrelling, day dreaming or horseplay. Personality and behaviour which make some people more accident prone.

14. 3. Miscelleanous Causes . Young, untrained and inexperienced workers cause more accidents than old, trained and experienced ones. Alcoholic and drug addicted workers are more accident prone. Workers having disturbed family life are likely to cause more accidents due to stress. Unsatisfactory behaviour of supervisors may also cause accidents on the part of the workers

15. Measures to Ensure Industrial Safety The main steps that can be taken to ensure safety and security of employees, are as follows: Safety policy. Every industrial establishment should formulate and implement a safety policy. Once the safety policy has been spelt out, the establishment should formulate a safety programme. The main aim of the programme should be to reduce the number of hazardous factors which are likely to cause to accidents, and to develop safe working habits among employees. The safety programme must have top management support and active cooperation of employees. Safety must be an integral part of all phases of planning, supervision and control. According to the National Safety Council, USA, accident prevention depends on three E’s – engineering, education and enforcement. The job should be engineered for safety, employees should be educated in safe procedures and safety rules should be properly enforced.

16. Safety Committee. A safety committee should be constituted in every large factory. It should consist of the representatives of both the employer and the employees. The committee should be constituted under the chairmanship of a safety director/manager. The committee should educate and impress upon the line managers about the safety measures required in the establishment. The safety programme should be formulated and implemented through the safety committee.

17. Safety engineering. proper engineering procedures must be adopted to eliminate or minimise work hazards. Full attention should be paid to safety in the design, layout and installation of plant and machinery. Safety engineering helps to minimise unsafe conditions. The main elements of safety engineering are as follows: Guarding of machines. The machinery which pose danger to the employee working on it should be properly covered or fenced. According to Rule 82 of the I.L.O. Model Safety Code guards should be properly designed, constructed and used so that they will provide positive protection, prevent access to the danger zone, cause no inconvenience to the operator and protect against unforeseen operational contingencies.

18. Material Handling Equipment Materials handling is the common source of accidents. Therefore, the flow of materials during all stages of production should be properly planned to eliminate hazards. Proper equipment, adequate space and aisles should be provided to ensure risk free and smooth flow of materials. In addition, there should be a well-designed system for the detection, prevention and control of fires. Inflammable liquids and materials expose workers to great risks. Therefore, utmost care should be exercised in handling and storage of such materials.

19. Safety devices Safety glasses to protect the eyes from hazards of fire, glare, dust and fumes should be provided to workers. Hard protective caps may be provided to prevent head injuries. Gas may be given to prevent the inhalation of poisonous fumes. Gloves to protect hands against acids , safety shoes, overalls, skin guards, and safety apparel, etc. may be provided for use by workers. Ergonomics It deals with physiological and anatomical aspects of man and his interactions with th e working environment. It is increasingly used to improve man-machine system. For example, equipment, machinery and work procedures should be redesigned to minimise accidents

20. Plan Maintenance All equipment and machines should be kept in perfect working order through regular cleaning, oiling, repairing etc. There should be periodic inspection of machines, equipment, electrical installations and cables. General Housekeeping All passages meant for movement of employees should be kept free from all obstructions. Tools and parts should be stored safely after use. There should be solid and even flooring. All floors should be kept clean and dry. Waste cans and sand pails should be safely stored.

21. Safety Education and Training Safety education and training should be provided to workers, supervisors and executives to develop safety consciousness and safe working habits. Workers should be trained in the proper use of safety devices. The need for good housekeeping and safe material handling should be stressed. Principles of first aid and precautions in case of fire and the accidents may be explained. Posters, bulletin boards, house organs, cartoons, displays, slogans, signs and safety films may be used for safety education, training and safety publicity campaign. Safety contests may be organised and prizes awarded to the safest employee/work group/department to develop safety competition. Disciplinary actions/punishments may be used for breach of safety regulations.

22. RISK ASSESSMENT Risk assessment is the identification of risks and the estimation of associated losses. The goal of risk assessment is to develop a plan that will minimize the probability and/or impact of adverse events. Every business faces some level of risk, but not all businesses are prepared to handle them. That’s where risk assessment comes in. By identifying potential risks and taking steps to mitigate them, you can protect your business from costly damages .

23. There are a number of different methods that can be used to assess risk. The most important part is to select the right method for your particular business and situation. Once you’ve done that, you can begin to identify potential risks and develop a plan to mitigate them. Objective Of Risk Assessment Some of the objectives of risk assessment are as follows: To provide a framework for the organization to make decisions about how to deal with risks associated with its activities

24. To ensure that risks are identified, analysed, and responded to in a consistent manner. To communicate the results of the risk assessment process to stakeholders. To provide a basis for monitoring and review of the risk management process. To ensure that risks are continually reassessed and managed in a proactive manner. To provide input into the decision-making process regarding the allocation of resources. To support the organization in achieving its objectives.

25. Risk Assessment Process 1. Identify The hazards: - Workplace inspection - Job/task observation - Check manufacturers’ instructions - Look back at previous accident/incident records - Take account of non-routine work e.g. maintenance - Think about long-term hazards to health - Visit the HSE website: www.hs

26. 2. Identify Who Is At Risk: Young workers - Lack of experience - Lack of training - Being unaware of existing or potential risks - Lack of maturity - Insufficient attention to safety Beyond their physical or psychological capacity - Peer pressure Migrant workers - Language and communication issues:- May not understand H&S training/instructions given - May misunderstand safety critical communications or hand signals from work colleagues

27. - May have cultural assumptions about fellow workers which could get in the way of arrangements for managing H&S. - For example, older workers may not accept a younger interpreter - Or experienced workers may not want to be slowed down by taking responsibility for a new starter - May experience workplace bullying due to cultural differences - May not ask questions to check understanding because of an unquestioning attitude to those in authority;

28. New and expectant mothers - Risks will vary depending on their:Health , and- At different stages of their pregnancy - Some of the common Risks Might be: - Lifting/carrying heavy loads - Standing or sitting still for long lengths of time - Exposure to infectious diseases - Exposure to lead - Exposure to toxic chemicals - Work-related stress - Workstations and posture Exposure to radioactive Material

29. Threat of violence in the workplace - Long working hours - Excessively noisy workplaces People with disabilities - Consult with the employee: - They will know what adjustments will be needed - The impact the job might have on them - Don’t make unnecessary assumptions - Make reasonable adjustment 3. Measure The risk and Determine the controls - Qualitative Simple subjective - Low risk areas

30. Quantitative - Can be complex - Subjective - Higher risk areas 4 . Record Your Findings - Make a record of significant findings, including: - The hazards - How people might be harmed by them, and What you have in place to control the risks - Record(s) produced should be simple & focus on controls - - 5 or more employees - you are required by law to write it down paperwork you produce should help you to communicate and manage the risks in your business

31. 5. Review your risk assessment - Regular Review of the RA is a must - Few workplaces stay the same, sooner or later, you will bring in: - New equipment - Substances, and - Procedures (these can lead to new hazards) - Change in legislation may warrant a review of your RA - An incident/accident may necessitate a review of the RA - Some workers’ situation may change requiring a review of the RA - Even change in weather condition may warrant the RA is reviewed

32. - Benefits of risk Assessment : - Comply with legislation - Increase safety performance - Reduced incidents/accidents - Increase in productivity - Happier and better-qualified employees - Cost effective (save money) - Positive image/reputation What Controls are used: - Controls are usually placed: - At the source (where the hazard "comes from") - Along the path (where the hazard "travels") - At the worker

33. Elimination The process of removing the hazard from the workplace - Most effective - hazard no longer present - Preferred control measure, should be used whenever possible - Collaborate - all involved in job process (supervisors/engineers/operators/workers) - Promotes safer thinking (developmental stages) - Can this be eliminated? - Can sample be taken where material is of lower concentration? - More difficult to eliminate/substitute after work has begun

34. Substitution : - The goal of substitution is replacing a hazardous product or process with a safer one. For example: - Use of non-toxic or less toxic chemicals - Pesticides vs Natural pesticides - Organic solvent (various effects on the body) vs water-detergent solution - Leaded glazes, paints, pigments (various effects on the body) vs versions with no lead - Upgrade aging machinery with newer equipment. - Ensure one hazard is not being traded for another – the less impact is ideal

35. - Replace a chemical/substance with another? Consider all the implications and potential risks of new material - Another type of substitution is the use of the same chemical, but in a different form - Dry, dusty powder may be a significant inhalation hazard - Purchased/used as pellets or crystals, may be less dust in the air - therefore less exposure

36. Engineering Controls : - Methods built into the design of a plant, equipment or process to minimize the hazard - Reliable way to control worker exposures - Controls must be designed, used and maintained properly Administrative controls : - Administrative controls limit exposure to hazards by adjusting work tasks/schedule. Examples include: - Limiting the time a worker is exposed to a hazard - Creating written operating procedures - Installing alarms, signs and warnings - Using a buddy system

37. PPE: - Should never be the only method used to reduce exposure except under very specific circumstances - May fail (stop protecting the worker) with little or no warning - Regardless of PPE type – have a complete PPE program in place Hierarchy of risk control – Application Residual risk - The residual risk is the amount of risk or danger associated with an action or event remaining after natural or inherent risks have been reduced by risk controls. - Risk can never be reduced to absolute zero - It can only be reduced “as low as reasonably practicable” or ALARP

38. What is the risk assessment process ? -Identify hazards and risk factors that have the potential to cause harm (hazard identification). - Analyze and evaluate the risk associated with that hazard (risk analysis, and risk evaluation). -Determine appropriate ways to eliminate the hazard, or control the risk when the hazard cannot be eliminated (risk control).

39. Psychosocial Risk Factors in the Workplace Balance Present in a workplace where there is recognition of the need for balance between the demands of work, family, and personal life. This factor reflects the fact that everyone has multiple roles :employees, parents, partners, etc. These multiple roles can be enriching and allow for fulfillment of individual strengths and responsibilities, but conflicting responsibilities can lead to role conflict or overload. Greater workplace flexibility enables employees to minimize work-life conflict by allowing them to accomplish the tasks necessary in their daily lives. Work-life balance is a state of well-being that allows a person to effectively manage multiple responsibilities at work, at home and in their community. .

40. Why it is important? Recognizing the need for work-life balance: makes employees feel valued and happier both at work and at home reduces stress and the possibility that home issues will spill over into work, or vice versa allows staff to maintain their concentration, confidence, responsibility, and sense of control at work results in enhanced employee well-being, commitment, job satisfaction, organizational citizenship behaviours (behaviours of personal choice that benefit the organization), job performance and reduced stress

41. What happens when it is lacking? When work-family role conflict occurs (that is, roles within the workplace and outside it are overwhelming to a person or interfering with one another), health and well-being are undermined by accumulating home and job stress. This imbalance can lead to: constant tiredness bad temper inability to progress high job stress resulting in dissatisfaction with work and being absent either physically or mentally

42. These effects can then lead to additional stress-related illness, as well as higher cholesterol, depressive symptoms, and overall decreased health. The impact on the organization can include increased costs due to benefit payouts , absenteeism, disability, and turnover. Not all employees will have the same work-life balance issues. Age, cultural, gender, family and marital status, care-giver demands , socioeconomic status, and many other factors affect an employee's work-life balance. Organizations will benefit from having flexible arrangements to address this issue

43. Civility and Respect A workplace where employees are respectful and considerate in their interactions with one another, as well as with customers, clients, and the public. Civility and respect are based on showing esteem, care and consideration for others, and acknowledging their dignity. Why it is important? A civil and respectful workplace is related to greater job satisfaction , greater perceptions of fairness , a more positive attitude, improved morale, better teamwork, greater interest in personal development, engagement in problem resolution, enhanced supervisor-staff relationships, and reduction in sick leave and turnover. Organizations characterized by civility and respect create a positive atmosphere marked by high spirits and work satisfaction. This civility allows people to enjoy the environment, whether they are staff, clients, or customers

44. What happens when it is lacking ? A workplace that lacks civility and respect can lead to emotional exhaustion amongst staff, greater conflicts, and job withdrawal. A work environment that is uncivil and disrespectful also exposes organizations to the threat of more grievances and legal risks. One example of disrespectful behaviour is bullying. Exposure to workplace bullying is associated with psychological complaints, depression, burnout, anxiety, aggression, psychosomatic complaints, and musculoskeletal health complaints. Bullying not only affects those directly involved, but also affects bystanders, as they too experience higher levels of stress.

45. Clear Leadership and Expectations A workplace where there is effective leadership and support that helps employees know what they need to do, how their work contributes to the organization and whether there are impending changes. Why it is important? Effective leadership increases employee morale, resiliency, and trust; and decreases employee frustration and conflict. Good leadership results in employees with higher job well-being, reduced sick leave, and reduced early retirements with disability pensions. A leader who demonstrates a commitment to maintaining his or her own physical and psychological health can influence the health of employees (e.g., sickness, presenteeism, absenteeism) as well as the health of the organization as a whole (e.g., vigour, vitality, productivity).

46. What happens when it is lacking? Leaders who are more instrumental in their approach (such as focusing on producing outcomes with little attention paid to the big picture, the psychosocial dynamics within the organization, and the individual employees) are more likely to hear staff health complaints including general feelings of malaise, irritability, and nervousness. Similarly, leaders who do not demonstrate visible concern for their own physical and psychological health set a negative example for their staff and can undermine the legitimacy of any organizational program, policy and/or service intended to support employees. Middle managers are at greater risk because they must be leaders and be led simultaneously. This role conflict can lead to feelings of powerlessness and stress.

47. Engagement Employee engagement can be physical (energy exerted), emotional (positive job outlook and passionate about their work) or cognitive (devote more attention to their work and be absorbed in their job). Engaged employees feel connected to their work because they can relate to, and are committed to, the overall success and mission of their company.

48. Why it is important? Engagement is important for individual satisfaction and psychological health, and leads to: increased profitability for company greater customer satisfaction enhanced task performance greater morale greater motivation

49. What happens when it is lacking? Organizations that do not promote engagement can see: negative economic impact in productivity losses psychological and medical consequences have greater employee turnover workplace deviance (in the form of withholding effort) counterproductive behaviour withdrawal behaviours

50. Growth and Development A workplace where employees receive encouragement and support in the development of their interpersonal, emotional and job skills. It helps employees with their current jobs as well as prepares them for possible future positions. Why it is important? Employees feel that organizations care when the organization supports growth and development. Skill acquisition and career development directly enhance employee well-being. It is important to ensure that opportunities go beyond learning specific technical skills, and also include opportunities to learn personal and interpersonal skills that are critical to successfully caring for oneself and relating to others.

51. What happens when it is lacking? Employees who are not challenged by their work will grow bored, their well-being will suffer, and their performance will drop. When staff do not have opportunities to learn and improve their interpersonal and psychological skills, the result can be conflict, disengagement, and distress . Involvement and Influence A workplace where employees are included in discussions about how their work is done and how important decisions are made. Opportunities for involvement can relate to an employee's specific job, the activities of a team or department, or issues involving the organization as a whole.

52. Why it is important? When employees feel they have meaningful input into their work they are more likely to be engaged, to have higher morale, and to take pride in their organization. This feeling, in turn, increases the willingness to make extra effort when required. Job involvement is associated with increased psychological well-being, enhanced innovation, and organizational commitment. What happens when it is lacking? If employees do not believe they have a voice in the affairs of the organization, they tend to feel a sense of indifference or helplessness. Job alienation or non-involvement is associated with cynicism and distress, greater turnover, and burnout

53. Organizational Culture A workplace characterized by trust, honesty, and fairness. Organizational culture, in general, are basic assumptions held by a particular group. These assumptions are a mix of values, beliefs, meanings, and expectations that group members hold in common and that they use as cues to what is considered acceptable behaviour and how to solve problems. Why it is important? Organizational trust is essential for any positive and productive social processes within any workplace. An organization that has a health-focused culture enhances employee well-being, job satisfaction and organizational commitment, which helps to retain and attract employees. A work culture with social support also enhances employee well-being by providing a positive environment for employees who may be experiencing psychological conditions such as depression and anxiety.

54. What happens when it is lacking? A negative culture can undermine the effectiveness of the best programs, policies and services intended to support the workforce. An unhealthy culture creates more stress, which lowers employee well-being. A culture of profit at all costs and constant chaotic urgency can create an environment in which burnout is the norm. Protection of Physical Safety This factor includes the work environment itself. Steps can be taken by management to protect the physical safety of employees. Examples include policies, training, appropriate response to incidents or situations identified as risks, and a demonstrated concern for employees' physical safety.

55. Why is it important? Employees who work in an environment that is perceived as physically safe will feel more secure and engaged. Higher levels in the confidence of the safety protection at work results in lower rates of psychological distress and mental health issues. Safety is enhanced through minimizing hazards, training, response to incidents, and the opportunity to have meaningful input into the workplace policies and practices. What happens when it is lacking? Failure to protect physical safety results in workplaces that are likely to be more dangerous. Not only could employees be injured or develop illnesses, those who do not see their workplace as physically safe will feel less secure and less engaged.

56. Psychological Competencies and Demands A workplace where there is a good fit between employees' interpersonal and emotional competencies, their job skills, and the position they hold. A good fit means that the employees possess the technical skills and knowledge for a particular position as well as the psychological skills and emotional intelligence (self-awareness, impulse control, persistence, self-motivation, empathy, and social deftness) to do the job. Note that a subjective job fit (when employees feel they fit their job) can be more important than an objective job fit (when the employee is assessed and matched to the job).

57. Why it is important? A good job fit is associated with: fewer health complaints lower levels of depression greater self-esteem a more positive self-concept enhanced performance job satisfaction employee retention

58. What happens when it is lacking? When there is a poor job fit, employees can experience job strain, which can be expressed as emotional distress and provocation, excessive dwelling on thoughts, defensiveness, energy depletion and lower mood levels. Organizationally, job misfit is linked to fewer applicants in the recruitment and training process, lack of enjoyment and engagement, poor productivity, conflict, and greater voluntary turnover .

59. Psychological Protection Workplace psychological safety is demonstrated when employees feel able to put themselves on the line, ask questions, seek feedback, report mistakes and problems, or propose a new idea without fearing negative consequences to themselves, their job or their career. A psychologically safe and healthy workplace actively promotes emotional well-being among employees while taking all reasonable steps to minimize threats to employee mental health. Why it is important? When employees are psychologically protected they demonstrate greater job satisfaction, enhanced team learning behaviour, and improved performance. Employees are more likely to speak up and become involved. They show increased morale and engagement and are less likely to experience stress-related illness. Psychologically protected workplaces also experience fewer grievances, conflicts, and liability risks.

60. What happens when it is lacking? When employees are not psychologically safe, they experience demoralization, a sense of threat, disengagement, and strain. They perceive workplace conditions as ambiguous and unpredictable. This demoralization can, in turn, undermine shareholder, consumer, and public confidence in the organization Psychological and Social Support A workplace where co-workers and supervisors are supportive of employees' psychological and mental health concerns, and respond appropriately as needed. For some organizations, the most important aspect of psychological support may be to protect against traumatic stressors at work

61. Why it is important? Employees that feel they have psychological support have greater job attachment, job commitment, job satisfaction, job involvement, positive work moods, desire to remain with the organization, organizational citizenship behaviours (behaviours of personal choice that benefit the organization), and job performance. What happens when it is lacking? can lead to: increased absenteeism, withdrawal behaviours, Conflict strain - which can lead to fatigue, headaches, burnout and anxiety, turnover, loss of productivity, increased costs, greater risk of accidents, incidents and injuries

62. Recognition and Reward A workplace where there is appropriate acknowledgement and appreciation of employees' efforts in a fair and timely manner. This element includes appropriate and regular financial compensation as well as employee or team celebrations, recognition of years served, Why it is important motivates employees fuels the desire to excel builds self-esteem encourages employees to exceed expectations enhances team success

63. What happens when it is lacking? Lack of recognition and reward undermines employee confidence in their work and trust in the organization. Employees may feel demoralized or they may quit. An imbalance between effort and reward is a significant contributor to burnout and emotional distress leading to a range of psychological and physical disorders. Workload Management A workplace where tasks and responsibilities can be accomplished successfully within the time available. A large workload is often described by employees as being the biggest workplace stressor (i.e., having too much to do and not enough time to do it). It is not only the amount of work that makes a difference but also the extent to which employees have the resources (time, equipment, support) to do the work well.

64. Why it is important ? It leads to job satisfaction . What happens when it is lacking? Increased demands, without opportunities for control, result in physical, psychological and emotional fatigue, and increase stress and strain. Emotionally fatigued individuals also have a diminished sense of personal accomplishment and an increased sense of inadequacy. Excessive workload is one of the main reasons employees are negative about their jobs and their employers.