Nursing consistently ranks among the top occupations for work-related musculoskeletal disorders, according to data from the Bureau of Labor Statistics, yet 40 states lack laws or regulations for safe patient handling and national legislation has stalled. Many facilities, regardless of the existence of legislation in the state, have safe lifting programs that protect nurses and other healthcare professionals. But some nurses say legislation provides the oversight needed to make policies widespread and comprehensive.
Nurses in pain
Muscle and joint pain affects eight out of 10 nurses, according to a 2011 health and safety survey from the American Nurses Association, which showed disabling injuries from lifting are a top concern among 62% of nurses despite National Institute for Occupational Safety and Health guidelines that say nurses should lift no more than 35 pounds at a time.
Rising obesity rates, a shortage of nurses and the aging of the workforce combine to form a perfect storm for injury, said William Charney, a social activist who co-edited Back Injury Among Healthcare Workers: Causes, Solutions and Impacts (released in 2003). About 65% of all patients in hospitals are considered obese, Charney said. Thats huge, and if you have less staff, fewer nurses moving more patients per day, thats a formula for disaster.
Nurses and other healthcare workers are overrepresented for musculoskeletal disorders among workers compensation claims, according to the ANA. Injured nurses contribute to about one-fourth of all claims and one-third of total compensation costs.
When patient handling is painful for nurses, patients may suffer, too. Recent research published in The American Journal of Nursing and Clinical Nurse Specialist revealed that musculoskeletal pain and depression affect nurses productivity, which in turn affects quality of care and patient safety.
Researchers asked 1,171 RNs working at hospitals in North Carolina about their health and how their injuries or illnesses might affect their work. Nearly 20% of the nurses said they had symptoms of depression, compared to 9% for the general population. In addition, 71% of the nurses experienced some degree of pain from a muscle sprain or strain while doing their job. Researchers also found when nurses were in pain or depressed, the risk of a patient fall or medication error increased by about 20%. They estimated these mistakes carry an exorbitant price tag: about $2 billion annually on the healthcare system.
Programs plus legislation
It is outrageous that many nurses lack safe, assistive equipment to use while they perform routine patient care, said Anne Hudson, RN, BSN, founder of Work Injured Nurses Group USA based in Coos Bay, Ore., and co-editor of Back Injury Among Healthcare Workers: Causes, Solutions and Impacts. Pushing SPH legislation forward is imperative to ensure the safety of nursing staff as much as the safety of patients, she said.
In many areas, employers still require nursing staff, 95% of whom are women, to lift hazardous amounts of weight by hand, said Hudson, who started her advocacy organization after suffering a spinal injury from lifting patients.
Today only 10 states California, Illinois, Maryland, Minnesota, Ohio, New Jersey, New York, Rhode Island, Texas and Washington have passed laws or regulations requiring SPH policies. National bills for SPH in the House and the Senate died in the last session of Congress and have not been reintroduced.
Implementing SPH strategies and installing specialized equipment would create a safer workplace, benefit healthcare facilities by decreasing costs associated with injuries to staff and patients and reduce the financial impact of workers compensation and legal fees, said Willa Fuller, RN, BSN, executive director of the Florida Nurses Association. Often, lift injuries are life-altering or career-ending, and strategies must be implemented to avoid these types of occurrences at all costs, she said.
Many hospitals have policies to prevent workplace injuries. Some advocates for legislation call Tampa (Fla.) General Hospitals handling policy among the best. The Florida hospital has had an injury prevention program in place for 12 years that consists of a 26-member lift team and involved the purchase of more than $1.5 million in transfer and lifting equipment. Since the programs inception, we have reduced our overall patient handling injuries by 61% and our RN patient handling injuries by 78%, said JoAnn Shea, ARNP, MS, COHN-S, director of employee health services. We have had over an 80% reduction in patient handling injury cost.
Other benefits of the program include increased patient and family satisfaction, patients being turned more frequently, safer patient transfer and increased nursing satisfaction.
A comprehensive SPH policy should cover criteria for using equipment, education, training and patient assessment, Shea said. If Florida passed SPH legislation, it would not affect the hospital much as strong support already exists for the safe handling program, but legislation would provide some support to hospitals that may need a little push to get the equipment in, she said.
Marianne George, RN-BC, BSN, a nurse educator at Sparrow Hospital in Lansing, Mich., said the hospitals safe handling program includes a no single-lift policy, a lift team that moves heavier patients with equipment and yearly back safety training. The lift team was added in 2009. From 2009 to 2010, we decreased injuries by 47%, said George, who has worked at the hospital for 30 years. We went from 789 restricted work days to 313. The only reason we were able to get [the program]off the ground [is because]its in our contract.
For the state, SPH legislation would make it safer for other institutions in the state that dont have bargaining union contracts, she said.
SPH legislation makes sense, George said. The nursing population is getting older. Our average age at Sparrow Hospital is 52 years old, she said. And our patients are getting heavier.
Harborview Medical Center in Seattle, Wash., has had a safe lift team since 2000 years before SPH legislation was passed in 2006. Before the legislation, it also had a committee that reviewed how lifting typically heavier bariatric patients can affect safety, said Paula Minton-Foltz, RN, MSN, assistant administrator of education, quality and patient safety at Harborview. What the legislation did was help us look at other patients.
Normal weight patients who are unable to help or are frightened and struggling also create a hazard for employees trying to lift them. I think weve gotten that, as an industry, [while working with]heavier patients we need some help, Minton-Foltz said. Now we are trying to bring awareness that its not just those patients. Now you have to size up every patient and do an assessment. We actually have an assessment tool.
Being a public hospital also posed opportunity in this regard. Because of the financial incentives on the taxes, we were able to kickstart the purchasing of our ceiling lifts and the lifting equipment, so that was really helpful, she said.
Since 2010, the hospital experienced more than a 50% reduction in time lost related to lifting.
Laura Nelson, RN, a nurse manager who has worked at Harborview for 25 years, recalled when the program started. I was just leaving the bedside when our lift team came on board, and I remember thinking it was one of the greatest programs to assist nurses to manage patients, especially our bariatric patients, said Nelson, chairwoman of the safe patient handling committee and manager of the lift team. It was a very welcomed group of people to have help us.
The hospital is halfway through installing ceiling lifts in all inpatient rooms, she said.
Individual facilities may have good programs in place that are making a difference, but that does not eliminate the need for widespread legislation, Hudson said. States have different laws and regulations, so the oversight may be different, which illustrates the need for a national standard, she said.
Caring for nurses
Obstacles to getting SPH bills enacted include lack of legislative will and the steep price tag for the assistive equipment, nursing leaders said. Also, other issues rank higher, said Wayne E. Reich Jr., RN, BSN, CCRN, deputy CEO of the Pennsylvania State Nurses Association. According to our annual survey, our members identify [SPH legislation] as an issue, but not as high or as much of a concern as safe staffing, nurse title protection, whistleblower protection and delegation, he said.
Nurses in the 40 states without legislation must become active, said Jeff Breslin, RN, president of the more than 10,000-member Michigan Nurses Association. We need nurses who are the frontline caregivers to talk to their legislators to make sure they get the truth on what is required to take care of patients safely, he said.
While the movement to protect nurses from manual lifting-related injuries is far from complete, Hudson said there is a need for a second campaign by national nurse leadership for employers to retain their back-injured nurses in nonlifting nurse positions. To this point, caring for nurses injured by manual patient lifting has not been part of the SPH picture. I believe that should be corrected by nurse leaders developing programs to advocate for and assist injured nurses nurses caring for nurses, she said.