Nursing professionals are among the groups at the highest risk for musculoskeletal injuries. The American Nurses Association (ANA) has reported that 38% of RNs have suffered work-related back pain severe enough to require taking time off work.1 Estimates of expenses range from $29.3 million to $1.7 billion.1–3 Clearly, healthcare leadership should pursue proactive programs and initiatives for preventing injuries to healthcare workers. This article outlines legislative activities, Intermountain Healthcare's initiatives, and what nursing leaders can do to make it safer for nurses in their organizations.
Regulatory and legislative 101
The National Institute for Occupational Safety and Health (NIOSH) published the guidelines "Elements of Ergonomics Programs" in 1997.4 NIOSH recommends that healthcare organizations establish comprehensive programs to reduce workplace-related musculoskeletal disorders. NIOSH advocates seven steps for an effective program:
- look for workplace injuries
- show management commitment to reduce risk
- offer training
- gather data to determine which jobs and workplaces are problematic
- identify effective controls for high-risk work activities
- establish healthcare management to detect musculoskeletal disorders early
- minimize work-related risks by building in good design.4
The Patient Safety Center of Inquiry, Veterans Health Administration, published guidelines in 2001 with an update in 2005 titled, "Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement." This resource guide recommends nine steps, which include data collection, high-risk unit identification, ergonomic assessments, and recommendations for and implementation of monitoring the effectiveness of actions taken.5 This guide also includes flowcharts and procedures for high-risk tasks that can be adapted to specific healthcare settings.
The Occupational Safety and Health Administration published guidelines for ergonomics in nursing homes in 2003. These guidelines further recommend that healthcare organizations:
- build injury prevention programs supported by management
- involve employees
- identify problems
- provide training
- evaluate the work environment using ergonomic principles.6
The ANA published a position statement in 2003 entitled "Position Statement on Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders," followed by its Handle With Care campaign (http://www.nursingworld.org/handlewithcare).7,8
The hope was that healthcare organizations would adopt these guidelines without the threat of inspection and fines. This hope wasn't realized on a large enough scale; many states are now pursuing legislation to force healthcare organizations to implement effective programs. Safe patient handling legislation has been enacted in nine states, and several states have pending legislation.9 In addition, a new House Resolution (HR 378), the "Nurse and Patient Safety & Protection Act," is pending committee action.
Intermountain Healthcare's initiatives
Intermountain Healthcare (a nonprofit corporation of 23 hospitals and more than 100 clinics in Utah and Idaho) launched a team in 2006 to study transfer and lifting risk, injury, and prevention programs, following two successful improvement projects at Cassia Regional Medical Center and Dixie Regional Medical Center in 2004 and 2005. Cassia, a 25-bed community hospital, was able to reduce its healthcare worker injuries five-fold within 1 year of implementing patient assessment with triggers, colored dots placed on the care plan, a lifting team, staff education, and careful monitoring and feedback. Dixie, a 245-bed medical center, reduced its injuries three-fold following targeted staff education, use of lifting equipment, careful monitoring, and feedback to staff and leadership.
Initial analysis of 2004 to 2006 Intermountain employee injury data found a rate of 4.7 per 100,000 healthcare workers with musculoskeletal injuries related to lifting and transfer activities. Related workers' compensation costs averaged over $7,000 per case. Analysis of healthcare worker injury reports showed that high-risk activities were repositioning patients in bed (26%), catching a falling patient (17%), and transfer on or off a stationary table (22%). Forty-nine percent of injured employees applied for long-term disability because they could no longer do the lifting component of their job. Review of these data and recent publications led the team to conclude that standardization of staff education and protocols/policies and proper use of equipment and devices could substantially reduce employee injuries.
Analysis of patient injuries related to transfers and falls yielded some interesting data. The most common clinical areas of patient injury were general medical-surgical units, inpatient rehabilitation units, imaging, and orthopedics. Those areas were targeted for team member participation and clinical evaluations of lift and transfer equipment.
Intermountain's Transfer and Lifting Team objectives for a safe patient handling program included:
- implement a cultural change for safe patient handling, with a focus on the right mix of equipment and people
- establish a lift and transfer standard for patient-care practices
- develop standard employee education and training
- evaluate and recommend appropriate equipment for transfer and lifting tasks
- reduce employee and patient injury rates.
The Utah Healthcare Association (UHA) commissioned a Safe Practices for Patient Lifting and Transfer Task Force, with representatives from healthcare systems in the state. The UHA launched this task force to analyze healthcare worker injuries and make recommendations for healthcare organizations in the state of Utah. These recommendations included a letter to hospital and nursing home leadership advocating comprehensive safe patient handling programs and sample clinical guidelines.
What can nurse leaders do?
Nurse leaders need to ensure that their employees are aware of ergonomics. Component parts of the individual training should include employees' knowledge regarding:
- assessing their patients often for lift and transfer needs
- avoiding unnecessary patient handling and movement tasks whenever possible
- using mechanical lifting/transfer devices for high-risk patient handling activities
- encouraging and participating in workplace training
- requesting an ergonomics analysis of the work environment (most organizations have access to an ergonomist).
Medicare mobility classifications can be used to assess patients' ability to transfer and ambulate that include independence, ability to weight bear, upper body strength, ability to cooperate, weight and other medical conditions.
There are many initiatives and legislative activities centered on safe patient handling programs. Healthcare organizations can prevent injuries to staff with comprehensive programs. Nursing leaders can prepare their staff members to protect themselves from injuries by using patient assessment tools, proper technique, and appropriate lifting devices.
1. American Nurses Association. Preventing Back Injuries: Safe Patient Handling and Movement
2. Patient. Safety Center of Inquiry, Veterans Health Administration and Department of Defense. Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement
3. Occupational Health and Safety Agency for Healthcare in British Columbia. Reference Guidelines for Safe Patient Handling
4. National Institute for Occupational Safety and Health. Elements of Ergonomics Programs
5. Occupational Safety and Health Administration. Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders
6. American Nurses Association. Position Statement on Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders
7. American Nurses Association. Ergonomics/Handle with Care
8. American Nurses Association. State legislation on safe patient handling