Statement of Maggie Flanagan, Alaska Nurses Association

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Thank you for the opportunity to once again speak to Department of Labor representatives about the important issue of ergonomic safety in the workplace. My name is Maggie Flanagan and I'm a registered nurse, wife, and full time mother of two small boys. I am represented by Alaska Nurses Association in my collective bargaining unit and am here to speak for the United American Nurses, the labor arm of the American Nurses Association.

After experiencing serious back, neck and shoulder injuries that prohibited me from working for 8 months last year, I have returned to my job and currently work two 12 hour shifts on the weekends in a newborn intensive care unit. I have a total of 19 years of experience working as a nurse in hospitals.

I was here in Chicago just a little over a year ago to speak to an OSHA ergonomics panel on what I believed to be the final ergonomics standard. I have come here again today to urge the Secretary of Labor to develop and issue a new ergonomics standard to protect health care workers along with millions of other American working men and women.

Until I'm able to explain my story, people often look puzzled when I say that I sustained a disabling injury from caring for newborn infants. But, take it from me, even though our patients are small, the ergonomic hazards in this particular health care setting are very real and very serious.

Providing nursing care to sick and premature infants in a newborn intensive care unit or NICU is complex, fast paced and stressful. During my 12 hour shift, I barely have time for a rushed lunch and am rarely able to take breaks. Newborns in distress require split second interventions. And when they are not in distress, the greatest goal of NICU nurses is to provide a quiet environment. Neonatal nurses go to great lengths to do this. But no nurse should be expected to jeopardize her own health to care for her patients.

Caring for sick newborns requires long periods of standing and bending, frequently in awkward postures. I now know that these awkward postures are risk factors for musculoskeletal disorders or MSDs. Increasingly, newborn intensive care units tend to be cramped and loaded with high tech equipment. The responsibility for using and monitoring the equipment has become a part of nursings' role. All too often, the responsibility for lifting, moving and transporting this equipment also falls on the back of the nurse.

In most hospitals, the expanding amount of equipment now used in everyday patient care was not planned-for in original designs. The "human" factor seems to have been an afterthought. With equipment arranged like this, our every day work involves long horizontal and vertical reaches. Alarms from machines can number in the hundreds during a 12 hour shift and must be silenced by reaching overhead. Before my injury, I would reach past the point of discomfort to silence these alarms. Now I can't and won't do that.

Secretary Chao has asked us to help the Department of Labor define an ergonomics injury. Since I understand that the Occupational Safety and Health Administration has already fully defined these injuries using the term musculoskeletal disorders, I will spend my time trying to make this definition real to you.

I was diagnosed with several of the disorders in OSHA's MSD definition. What this really means to a nurse trying to work in a challenging environment and raise two small boys is the following:

For years leading up to my 8 month disability, I found that it took longer and longer to recover from a 12 hour shift. Back, neck and shoulder pains plagued me even on my days off. I didn't realize that these cumulative aches and pains could develop into a chronic injury. In addition to these cumulative problems, I was acutely injured while lifting patient monitoring equipment which my charge nurse deemed necessary to move.

The lifting activity involved moving a 75 pound monitor down from a shelf above shoulder height, across a room and up to a shelf above shoulder height. From my experience, I know that moving critically ill infants can have dire consequences, so I agreed to assist. The charge nurse and I tried to get help but there was not enough staff.

Many recognized risk factors were incorporated in this activity - a heavy weight, awkward postures, lifting above shoulder height, twisting while lifting. Despite the fact that we did a 2 person lift, this activity was innately hazardous. Had the charge nurse and myself been educated about the seriousness of these hazards, she never would have required either of us to perform this lift. Had the hospital already assessed and corrected these hazards, my 8 month disability and ongoing medical problems could have been prevented. Several nurses in my unit had already been injured. My severe back spasms started soon after completing the equipment move.

My back disorder also involved my shoulders and my neck. I attended physical therapy several times a week. I had a hard time sleeping. I experienced spasms and a lot of pain and needed to be on pain-killers for months. I was on such high doses of anti-inflammatory drugs that I eventually developed side effects. The chronic pain made me feel hopeless and helpless. I was unable to be a nurse and unable to be a mother.

For months after I was hurt, I could not bathe or dress my children. I couldn't perform simple chores like laundry or using the dishwasher. My 5 year old had to buckle his 3 year old brother into the car seat. The one time I had to shop during this time period, my 5 year old had to push the shopping cart. Just lifting a gallon of milk was extremely painful. I couldn't participate in recreational activities -- gardening, swimming or bike riding. During my physical rehabilitation and work hardening, I experienced several setbacks. It took me 8 months to return to work.

My family life also suffered because we had to put the children in daycare while I attended rehabilitation services. My husband and I have worked hard to find work and schedules that allowed one of us to always be with our children. After I was hurt, I was told by the insurance adjuster that my family was "not my priority," that I needed to find daycare for my children so that I could participate in rehab – yet we were not going to be reimbursed for daycare expenses that were directly related to my occupational injury. I want you to know that no money will give me back the time I lost with my children or quell the resentment about employer and insurer- imposed decisions about my personal family life.

The Secretary has also asked us to shed some light on the work-relatedness of ergonomics injuries. Again, this seems to be an issue that has already been fully addressed by OSHA and state workers compensation systems. Long-standing federal recordkeeping guidelines instruct employers like mine about what injuries and illnesses are OSHA-recordable. In my case, my injury was clearly viewed by my employer as work-related. But even it risk factors had aggravated a pre-existing injury or illness, it still would have been work-related. So I am not sure what all the fuss is about regarding work-relatedness.

As a nurse who believes fully and wholeheartedly in primary prevention, it seems to me that the more effective area on which the Department of Labor needs to focus is preventing worker exposure to these hazards in the first place.

The final question is what government action is needed. My answer is clear. Issue an ergonomics standard. Make it mandatory for employers to correct the hazards that exist in order to keep workers safe. This is OSHA's reason for being.

In the unit where I was hurt, several ergonomic evaluations had been done because other nurses had been injured before me. Despite clear recommendations from ergonomics experts to implement control measures and eliminate hazards, my hospital took no action because it wasn't required by law. My employer's response to these evaluations has been that it would be too costly to modify our work stations, too expensive to replace machines. In fact, moving monitors down to existing waist high shelves in our unit would cost the hospital little to nothing.

My hospital uses few lifting devices. We have no lifting team. Our air transport nurses routinely move and lift all sizes of patients while bending over in the small confines of aircraft. Their trips take hours. Our operating room nurses on the open heart team are required to hold human hearts still and steady outside the patients body, while awkwardly bending over the operating field. They need to hold these postures for long periods of time. Because there is a shortage of operating room nurses, they work up to 60 hours a week doing this kind of hazardous work.

The release of OSHA's Ergonomics Standard last year at least spurred our hospital to form an ergonomics committee. But we're only at the beginning and there's no guarantee that the hospital will make the interventions so desperately needed.

In closing, I'd to offer some reflections about my experience.

Work shouldn't hurt.
A job shouldn't rob you of your health.
A job shouldn't rob a child of a healthy parent or a marriage of a healthy partner.
I am here to say that workers compensation is never a better option than injury prevention.

Workers need protection from workplace injuries and illnesses.
American workers deserve workplaces where people are considered more "expensive" than machines, more "valuable" than profits.

American workers need the knowledge that an OSHA ergonomics standard would provide so they can protect themselves and recognize the signs and symptoms of musculoskeletal disorders.

I know I am not the first person hurt at my job.
But what I can't live with is that I won't be the last.......unless we start protecting American workers immediately from ergonomic hazards in the workplace. American workers deserve a place of employment free from recognized hazards ---- because ----- when a worker develops a musculoskeletal disorder.......

It is not just a lost work day
it can be a life lost forever to pain and disability.

Let the protection begin.

Thank you.

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