By Linda Beattie, contributor
Nurses pledge to care for patients and "do no harm," but many have found that patient care can be harmful to their own health. In fact, working in a health care facility is one of the most dangerous jobs in the United States, with musculoskeletal disorders (MSDs) sidelining more nurses than any other injury or illness. Workplace safety initiatives are helping, but nurses need to take steps to protect themselves.
Nancy Hughes, MS, RN, director of the Center for Occupational and Environmental Health at the American Nurses Association (ANA), confirmed that nursing is a risky business.
“Nurses face many occupational risks including back injuries and other musculoskeletal disorders, needle sticks, fatigue-associated injuries, exposure to infectious diseases and chemicals, latex allergies, and others.”
The most frequently reported injuries are from needle sticks, according to Hughes, which can put nurses at risk of contracting a variety of bloodborne diseases, but back injuries and other musculoskeletal disorders (MSDs) are responsible for more absences and long-term disabilities. ANA representatives estimate that back injuries affect up to 38 percent of all nurses, and that 12 percent of nurses who leave the profession annually do so because of these injuries.
“Musculoskeletal injuries are dangerous partly because they are the result of cumulative exposure and are not as readily apparent,” Hughes said.
She provided a few simple reminders to help nurses stay safe: keep immunizations up to date, including an annual flu shot, wear well-fitting gloves and other protective equipment, use available safety devices and participate on safety committees. “As frontline caregivers, nurses should help select the proper equipment to do their jobs and make sure that everyone is aware of it and how to use it.”
Hughes also advises nurses to stay informed about what kind of risks they are being exposed to, such as the chemicals used in the workplace, and to listen to what their bodies are telling them.
“Too many nurses come to work with a backache and don’t report it, or they don’t stay home when they aren’t feeling well. They are trying to be good employees, but in the long run they can be doing more harm than good.”
In essence, nurses need to advocate for themselves as well as they do for their patients.
“Nurses should also seek out employers who have safe patient handling equipment and programs to protect their workers from injuries,” she added.
Avoiding the Biggest Risk of All
In an effort to help prevent the debilitating effects of musculoskeletal disorders suffered by nurses, the ANA has worked with the National Institute of Occupational Safety and Health (NIOSH) to develop the “Handle with Care” ergonomics campaign, and has been working with state and federal agencies to enact system-wide changes.
To date, eight states have already enacted "safe patient handling" legislation: Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas and Washington, with a resolution from Hawaii, and ten more states have introduced similar legislation, including California, Connecticut, Florida, Hawaii, Illinois, Kansas, Maryland, Minnesota, Missouri and New York.
Audrey Nelson, Ph.D., RN, FAAN, director of the Veteran’s Affairs Patient Safety Center of Inquiry in Tampa, Florida, applauds these legislative efforts and individual health care facilities that have adopted the assistive equipment and devices that can protect nurses. She realizes that health care safety is still a work in progress, however.
“Health care facilities and workers need to be more aware of technology solutions. I’m always surprised when I give presentations and find nurses who don’t know that this patient handling equipment exists, or they may be unaware of how easy it is to use now. We have conducted the research, we have new technologies and we have the business case for showing how it saves money. Now the problem is how to implement it effectively and to get it imbedded into each hospital.”
Nelson and her research colleagues have been instrumental in showing the link between nurses’ injuries and their caregiver tasks, which led to the Patient Care Ergonomics Guidebook, considered a national performance measure for implementation. Nelson also helped the ANA develop the “Handle with Care” campaign.
“Our research found that a lot of patient handling tasks are very high risk and cannot be performed safely by health care workers alone. A recent NIOSH study showed that health care workers cannot safely lift more than 35 pounds without causing cumulative injuries. They really need equipment to perform that.”
Nelson believes that lifting teams simply transfer risk to a group of people, and asserts that special equipment is needed to safely move patients: “No other techniques can be used that are safe. What happens is that little tears happen to the musculoskeletal system, and you’re not aware of it. They add up over time and show up when you least expect it—like the last straw that breaks the camel’s back.”
Musculoskeletal injuries can also come from completing tasks that require sustained, awkward positions or standing in place for a long time, whether in bedside care or surgery. “The key to avoiding injury is to get away from these manual tasks, and technology is the main solution,” said Nelson.
Nelson helped develop a curriculum module that can be used to teach student nurses about safe patient handling and the proper use of technology, and suggests more training and education for nurses already on the job.
“There needs to be a concerted effort to establish annual competency assessments on using the equipment correctly. Hospitals should require that equipment vendors provide training for their staff as part of their contract. After that, one unit-based person should be assigned to train people and make sure their skills stay up to date.”
In order to protect yourself from injury, Nelson agrees with Hughes that self-advocacy is the best method—starting with where you choose to work.
“You should only work where you are going to be protected; don’t stay in a facility that doesn’t have the proper equipment and a safe handling policy.”
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