A PATIENT SAFETY program that promotes employee safety and can also improve retention of experienced nurses offers the best of all worlds. A small acute care satellite facility of a large hospital system created just such a program.
A risk analysis conducted in 2004 showed that we had the opportunity to reduce a high rate of employee injuries caused by lifting and moving patients. In response, the satellite facility implemented a safe patient-handling pilot program in 2005. Its purpose was to create a minimal-lift environment for nurses and provide safe patient handling and movement. This article describes how we initiated the program as a research project and our encouraging results.
After evaluating several vendor products, our administration chose a manufacturer that assessed our patient population mobility assistance needs. Equipment (including slide sheets, ambulation assistance devices, and lifts that could accommodate weights up to 740 pounds) was purchased to meet the needs of our medical, surgical, bariatric, and critically ill patients in inpatient, emergency, and radiology areas. Literature from the American Nurses Association's Handle with Care campaign supported the decision to invest in minimal-lift equipment.1
A review of our facility's nurse injuries in the 3 years before initiating the minimal-lift pilot program indicated that most were patient-handling injuries. Most of our nurses were over 45 years of age. Methods of moving patients included sliding with a draw sheet, using two or more lifting assistants, and the "hook and toss" method of body mechanics to get a patient from bed to chair.
Shortly after we started our pilot study, the Robert Wood Johnson Foundation published "Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace."2 The Foundation was addressing the national nurse shortage by offering grants to hospitals that would research methods to not only recruit but also retain experienced older nurses. This year, more than 51% of the American workforce is expected to be age 40 or older.2 Because our satellite facility employed 110 RNs whose average age was 46, half of whom were older than 54, we applied for and received 1 of 13 Wisdom at Work: Retaining Experienced Nurses grants from this foundation.3
The grant allowed us to research our hypothesis that a minimal-lift program would promote safe patient handling and improve retention of experienced nurses (which we defined as those older than 46) in our satellite facility. We began this research project by retrospectively collecting data for the 3 years before the minimal-lift program was initiated. We then continued collecting data for 3 years afterward.
The experienced RN turnover rate at this hospital, which had fluctuated widely during the 3 years before the minimal-lift initiative was implemented in 2005, averaged about 10%. During the pilot program, we saw turnover decrease to just over 5%, which was a 48% reduction in turnover of nurses older than age 46. This reduction provided a savings of $170,000 for the satellite facility in the year 2007.
Another successful outcome was a reduction in musculoskeletal injuries to nurses. Our analysis of the satellite facility's costs for patient-handling injuries from 2002 to 2004 indicated that injuries occurring over those 3 years cost over $230,000. During the pilot study, nurses had no lost work days and incurred no costs due to patient-handling injuries.
To get to these encouraging results, we had to recognize and overcome some obstacles we identified in our research. (See Surveying our nurses.)
Barriers to change
Our analysis showed these barriers to using the equipment and accepting a minimal-lift program as policy:
- Change is difficult for many people.
- Some nurses resist using new techniques and procedures.
- Our staff didn't feel it had ownership of the program; the staff believed the equipment consultant was responsible for it.
- The staff didn't receive many incentives or much positive reinforcement for using the specialized handling equipment.
- Patients could still be moved the old way.
Addressing and overcoming the barriers to the minimal-lift program became our top priority. We implemented a contest systemwide to name the minimal-lift program and offered a prize. Two nurses submitted the winning name: UPLIFT, an acronym for "Using Portable Lifts In Facilitating Transfers." The coaches teaching staff to use the equipment would then be called the "Uplifters."
We incorporated the name of the program into a logo and then began the branding process. We announced the winning name and published pictures of the contest winners and the logo in the systemwide newsletter. We also produced a short video, funded in part by the grant, which was reproduced for all clinical units of the hospital system. It's now part of the new employee orientation program.
Leadership quickly became a part of the team by encouraging staff and incorporating UPLIFT news and announcements at staff meetings. The Uplifters were encouraged to offer incentives such as candy (with wrappers saying, "Sweet of you to use the equipment") to those observed using the equipment.
Results from both our minimal-lift pilot program and our research outcomes encouraged us to continue our new safety program and our efforts to keep our older nurses in the workplace. We saw these positive results:
- Nursing injuries had decreased to nearly zero.
- Workers' compensation claims dramatically decreased.
- Patient safety and comfort during moving improved significantly as verified by patient discharge surveys and no patient injuries.
- According to our staff's positive comments, more of them recognized the value of the program and used the equipment. Counters on the equipment registered the hours they were used, verifying that usage was up over 50%.
A major outcome of this project, which was supported by senior leadership, was adding a new position for an ergonomics nurse. This role was filled in May 2008 by a nurse with both an MSN and certification in occupational health.
Because we have a large healthcare system comprising five campuses and eight facilities, rolling out a safe patient-handling program and acquiring the equipment needed required a major investment of finances and resources. Our leaders made the investment based on our improved safety record and cost savings.
Following in the footsteps of the pilot program, the rollout occurred in our acute rehabilitation hospital, long-term acute hospital, skilled nursing facility, and short-stay surgical hospital. We identified high-risk areas for potential patient-handling injuries for both patients and nurses in the large tertiary metropolitan medical center and rollout began in those units. A second satellite community hospital began its safe patient-handling program in 2009.
Today, the hospital system has a computerized nursing assessment tool that lets nurses assess the need for specific safe-lifting equipment in their patient's plan of care. The name of the equipment appears on the patient's computer screen. Use of the tool not only communicates a vital patient safety need but is also evolving into an evidence-based best practice that's keeping nurses safer.
A culture of safety
For a safety initiative to be successful, every member of the team, including leadership, needs to be fully engaged and supportive of each other. A true culture of safety results from fostering a positive outcome and the main objective: keeping staff and patients safe.
SURVEYING OUR NURSES
As part of our grant research project, we mailed surveys to over 100 nurses. Of the respondents, 57% were in the older age group and 81% had worked in nursing for more than 21 years. This group perceived a significantly higher level of personal risk related to patient-handling tasks. When they were asked to give the percentage of time spent using the safe-handling equipment, the older group reported using the equipment more than the younger group.
Because many of our older nurses had resisted the pilot study and were reluctant to use even the sliding sheets for moving patients, we were surprised and encouraged to discover that they used the equipment the most.
From our research, we determined
- patients were receiving safer care
- the program provided nurses more emotional and physical safety
- the impact on recruitment and retention was positive.
2. Hatcher BJ (ed), Bleich MR, Connolly C, Davis K, Hewlett PO, Hill KS. Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace
. Princeton, NJ: Robert Wood Johnson Foundation; 2006
3. Robert Wood Johnson Foundation. Wisdom at Work: Retaining Experienced Nurses
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Nelson AL. Safe Patient Handling and Movement: A Practical Guide for Health Care Professionals.
New York, NY: Springer Publishing; 2006.
Nelson A, Baptiste AS. Evidence-based practices for safe patient handling and movement. Orthop Nurs.