Nursing and Musculoskeletal Disorders
Patient handling tasks are recognized as the primary cause of musculoskeletal disorders (MSDs) among the nursing workforce. A variety of patient handling tasks exist within the context of nursing care, such as lifting, transferring, and repositioning patients, and are typically performed manually in the majority of U.S. hospitals, and in the homes of patients who are receiving hospice or home health care. Continuous, repeated performance of these activities throughout one's working lifetime often results in the development of MSDs. Of primary concern are back injuries and shoulder strain, which can both be severely debilitating for nurses.
There are over 80 publications with findings of high prevalence rates of discomfort and pain for medical-surgical nurses and those in specialized areas such as home care, peri-operative nursing, emergency medical services, and labor and delivery. When surveyed, up to 80% of nurses report pain or discomfort in at least one part of their body over the last 10 days. Student nurses begin to report musculoskeletal discomfort before graduating from nursing school due to patient handling in clinical experiences. Musculoskeletal discomfort and pain from lifting and moving patients is an international concern for nurses.
The U.S., the Bureau of Labor Statistics (BLS) within the National Institute of Occupational Safety and Health (NIOSH) tracks the number of health care workers and all other employees of private and government workplaces who are injured with a MSD and require days away from work. NIOSH is charged by the Occupational Safety and Hazard Administration (OSHA) to perform research to reduce these numbers.
- Nursing personnel have been on the top 10 list of workers with the highest risk for MSDs since 1999, compared to other occupations.
- In 2010, direct-care registered nurses ranked fifth among all occupations for the number of cases of musculoskeletal disorders resulting in days away from work — 10,900 total cases. Nursing aides, orderlies, and attendants sustained 27,020 musculoskeletal disorders in 2010, the highest of all occupations.
Exacerbating the Growing Nursing Shortage
The extent of MSDs among the U.S. nursing workforce is particularly distressing when considered in the context of a recurring nursing shortage.
- 10,000 — 13,000 RNs have been injured annually since 1999, secondary to patient handling tasks in private and public sector health care facilities and other workplaces (BLS, 2011).
- Nurses forced to leave bedside care or the profession entirely exacerbates the shortage
- 87% of nurses surveyed stated that safety concerns influenced their decision about the type of nursing they do and their continued practice in the field.(Findings of the 2008 Study of Nurses' Views on Workplace Safety and Needle-stick Injuries)
The Cost to the Nation
The direct cost for all U.S. workers out of work due to MSDs is estimated at $13-20 million annually with indirect costs between $26 to 110 billion annually.
- In the health care industry, inflation adjusted direct and indirect costs associated with back injuries were estimated to be 7.4 billion annually in 2008.
The average cost of a work-related injury in the U.S. in 2007-2008 was $34,377. In 2007-2008 a claim for cumulative trauma averaged $28,134, strains averaged $30,744, and slips and falls averaged $40,043. MSD's due to handling patients manually without equipment fit into those three categories. (National Safety Council (NSC) annual Injury Facts report representing 36 states, 2011).
Implementation and Cost-Effectiveness of Safe Patient Handling Programs
In addition to safety, a business case can be made for implementing a safe patient handling program.
- Initial investment in both lifting equipment and employee training can be recovered in 2 to 3 years through reductions in workers' compensation costs.
Source: Collins et al., 2004; Tiesman et al., 2003; Nelson et al., 2003; Garg, 1999.
- Research has shown that resident lifting programs reduce workers' compensation injury rates by 61%, lost workday injury rates by 66%, restricted workdays by 38%, and the number of workers suffering from repeated injuries. Source: Collins J.W., et al. 2004. An evaluation of a "best practices" musculoskeletal injury prevention program in nursing homes. injury prevention. Injury Prevention (10) 206—211.
- SPH programs are cost-effective due to reductions in workers' compensation claims, costs associated with absenteeism, and turnover.
Source: Bureau of Labor Statistics (BLS). (2007). Nonfatal occupational illness and injuries causing days away from work, 2006. United States Department of Labor NEWS. USDL 07-1741. Accessed 09/04/09 at www.bls.gov/iif/oshwc/osh/case/osnr0029.pdf
- The payback period for a safe patient handling and movement program is calculated at 4.3 years without including indirect benefits associated with reduced injury, employee morale and patient satisfaction. Additionally there are savings in costs related to recruitment of nurses.
Source: Siddharthan, Kris, Nelson, Audrey, & Weisenborn, Gregory. (2005) "A Business Case for Patient Care Ergonomic Interventions" Nursing Administration Quarterly. Vol 29:1, pg 63-71
The Department of Veterans Affairs allocated 205 million dollars in 2008 for purchase of SPH equipment and training programs in their over 100 veterans healthcare systems nation-wide. This demonstrates a trust in potential return in investment by our nation's largest federal health care employer.
Also In 2007, the Centers for Disease Control and Prevention (CDC) released the results of a six-year safe patient lifting field study which revealed that the investment in lifting equipment and ergonomics training was recouped in less than three years in lower worker compensation claims.
Federal Efforts
The Occupational Safety and Health Administration (OSHA) created a standard intended to protect workers from ergonomic hazards, however in March 2001, Congress repealed the standard and ordered the agency cease all related work.
The ANA has secured introduction of safe patient handling legislation for consideration during the 111th and 112th Congressional sessions.
State Legislation
Prompted by ANA's Handle with Care Campaign which began in 2003, ten states have enacted "safe patient handling" laws: California, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington. Missouri's Department of Health and Senior Services published rules in 2011 calling for hospitals to have multidisciplinary committees responsible for a comprehensive safe patient handling program and policy. (CSR 30-20.20.97)
For more information about ANA's efforts related to ergonomics, work-related musculoskeletal disorders, and safe patient handling, visit the Handle with Care website or contact ANA's Center for Health, Safety and Wellness.