Playing It Safe
Linda Childers

Programs to teach proper patient handling methods protect both RNs and those they care for.

Kathy Sommese, RN, still remembers the day she injured her back. The 34-year-old Walnut Creek, Calif., nurse was in her late 20s and working on a med/surg floor when she sustained an injury that put her out of commission for more than a month.
“I was repositioning an elderly woman in her bed, and she was so light, I didn’t think I needed assistance,” Sommese says.

Then she felt the excruciating pain shoot through her back, and knew she was in trouble. Fortunately, with bed rest and appropriate physical therapy, she soon returned to work. The injury did teach Sommese an important ergonomics lesson.

“Since then, I always ask for assistance when lifting a patient,” she says. “It not only reduces my risk of injury, it also ensures better safety for the patient.”

Sommese is one of many nurses who have suffered work-related back injuries or musculoskeletal disorders (MSD). According to the Bureau of Labor Statistics, nursing personnel are among those at highest risk for MSDs, with nursing assistants, orderlies, and attendants ranking first (ahead of truck drivers and laborers), and RNs sixth, in a list of at-risk occupations for strains and sprains.

Other studies show that 52% of nurses report chronic back pain, and 12% of nurses leave the profession each year because of back injuries.

Despite the high incidence of injuries, many nursing graduates leave school without learning the fundamentals of safe patient handling and ergonomics. “Unfortunately, the little content that is taught in nursing schools is not evidence based,” says Audrey Nelson, RN, PhD, FAAN, director of the Veterans Health Administration Patient Safety Center of Inquiry in Tampa, Fla., which has partnered with the American Nurses Association to promote its new “Handle with Care” ergonomics campaign.

Nelson cites a study conducted by Bernice Owens, RN, PhD, that found that 85% of nursing schools still teach manual patient handling or the “hook and toss” methods, which have been banned in several countries as unsafe for both nurses and patients. “Nursing school curriculums need to be updated to reflect new technology solutions,” Nelson says. “It used to be that low back injuries were the primary injury for nurses, but now we are also seeing shoulder, neck, wrist, and knee injuries.”

Education and Information

The ANA hopes to rectify this situation with its new campaign. One of its primary initiatives calls for creating a new curriculum model that nursing schools could implement into their programs.

“We hope to pilot a curriculum next year that teaches nursing students how to use lifting and transfer devices for safe patient handling,” says Butch de Castro, RN, PhD, MSN, MPH, a senior staff specialist in the ANA’s Occupational Safety and Health Department. “These same tools also protect nurses from sustaining injuries.” When interviewing for their first job, nursing graduates should question prospective employers on their safe patient handling and nursing care practices.

“A safe workplace should be as much of a concern as salary and benefits,” de Castro says. “Nurses need to ask what programs exist to help staff avoid hazards such as back or needlestick injuries.”

For nurses who are already employed and whose hospitals don’t have workplace safety programs in place, nurses have the opportunity to become agents of change and advocate for safer practices.

“The United States is way behind other countries such as the United Kingdom and Australia in terms of safe patient handling practices,” de Castro says.

“Nurses can make a difference in their workplace by helping their health and safety committee to document injuries, and by presenting information on some of the new technology that is available.”

The ANA campaign aims to educate nurses regarding advances in science and technology that support ANA’s goal of securing a nationwide “no-lifting” policy.

In addition to the campaign, the ANA has been lobbying Congress and working through the regulatory process to establish stronger ergonomics programs for nurses.

The goal of health care ergonomics programs is to design or “fit” job tasks and the work environment to the worker’s physical and mental capabilities to prevent injury and improve patient safety.

“Nursing graduates today have an unprecedented opportunity to advocate safer ergonomic practices,” de Castro says. “Ten years ago, we were faced with the same dilemma with needlestick injuries and today nurses don’t think twice about using safer needle devices.”

Identify the Problem

Lynda Enos, RN, MS, COHN-S, is among many nurses working to help support the ANA campaign within their state. Enos is a nurse practice specialist and ergonomist in the Occupational, Ergonomic, Health and Safety program for the Oregon Nurses Association.

Enos is working to teach nurses to think differently about ergonomics and to also realize that back injuries aren’t the result of a single incident, but rather the result of years of manual patient lifting.

“We’re working to teach nurses what a safe lift program looks like and that it involves much more than just good body mechanics,” Enos says. “A lot of nurses believe that back injuries are a nursing rite of passage, and that shouldn’t be the case.”

Enos works with nurses to identify where the problems are in their individual hospitals and units.

“Nurses should look at what kinds of injuries are being reported and the kind of patients they are caring for in their units,” Enos says. “Activities such as toileting, lifting a patient from their bed to a chair, bathing, and repositioning a patient are the culprits behind most injuries.”

Because hospitals now have access to new technology and equipment, Enos says it’s become much easier to implement safe programs. Many hospitals have begun using ceiling lifts, gait belts, and sliding boards to ensure safety for both their patients and nurses.

“When you look at how much injuries are costing health care, you realize that hospitals must begin to look at ways to reduce manual lifting,” Enos says. “You don’t want patients to be injured, and you don’t want your nurses to become patients.”

Enos encourages nurses to always try out new equipment to determine what technology is easy to use and best meets the needs of their specific unit. Most medical equipment vendors are happy to provide trials of equipment at a facility where nurses and other staff can preview and test products.

“With nurse injuries combined with nurse turnover, it’s easy for hospitals to justify implementing an ergonomics program,” Enos says. “If they don’t want to roll out a program for the entire hospital, they can begin by addressing the units that have the most injuries.”

Enos speaks from experience. Having worked as a nurse for 25 years, she experienced her own share of back pain, and estimates that whenever she addresses nursing colleagues at a conference, about 75% to 80% admit to having back and shoulder injuries. “Nurses need to realize that there is no safe way to lift or move patients manually,” Enos says.

Linda Childers is a freelance writer. To comment on this story, send e-mail to editorca@nurseweek.com.