From the Massachusetts Nurse Newsletter
November/December 2006 Edition
By Robert P. Naparstek, MD
Caritas-Good Samaritan Occupational Health Services
No one should be surprised any longer that the rate of serious back injuries among nurses and other health care workers who handle patients (HCW) is epidemic. In fact, even when looking at old data of the Bureau of Labor Statistics in 1996 one sees that the incidence of non fatal (reported) injuries in health care services was 8.5 per 100 full-time workers. It is alarming that this rate is not significantly different than that of manufacturing and construction.
These data are still relevant now because it focuses us on how predictable these injuries are and, hence, preventable. Acute back-related disorders occur in highest frequency during patient lifts, transfers and boosts. Large, non-ambulatory patients are often moved by small or average-size health care workers representing an absurd mismatch that is rarely seen in other industries.
There are significant personal risk factors that are well known to pre-dispose to back injury vulnerability as well. They are aging, obesity, smoking and previous back injury. Additionally, psychosocial issues such as job dissatisfaction, depression and various life stresses may pre-dispose nurses to a life altering back injury. These injuries commonly lead to chronic pain, depression and disability. It therefore behooves each and every nurse to maximally maintain their physical and mental health. It is clearly in their interest and fundamental contribution to prevention. If injuries are to be prevented, both the employer and employee (i.e. nurses) must embrace their share of responsibility.
However, prevention of a back injury demands maximal efforts by the employer. In fact, the preamble of the OSHA act of 1971 states, “Every employer shall furnish to each of his employees, employment and a place of employment which are free from recognized hazards that are causing or likely to cause death or serious physical harm to his employees.”
Thus, well before 1996, the preventability of back injuries in nurses and other health care workers was compelled by law. The OSHA act enshrined the legal obligation of an employer to provide work free from recognized hazards. These hazards are obvious. Additionally, where HCWs work in for-profit institutions it is a moral imperative to at least maximize workplace health and safety for those whose work provides the profit for the employer. That is the least an employer must do.
Consequently, the employer is legally and morally obligated to work to reduce injuries to zero. Ergonomic interventions are now well defined. They include an honest assessment of task related and personal risk factors for injury. The job tasks must be matched to the capabilities of the health care worker. Proactive policies that include zero lifting by nurses are feasible and proven. Other interventions are recognized. These include proper maintenance and lubrication of wheels on equipment such as medication carts, wheel chairs and dietary wagons.
Prevention of all back injuries in nurses and other health care workers is realistic and the legal and moral imperative is not subtle. It is in the employers’ interest to pursue this goal. It is equally in the nurses’ best interest to maximize their health as well, in pursuit of the same goal. Thus, both groups have a common interest.
Prevention happens when there is an active contribution from everyone. Only then can a spirit of benevolence and justice be fostered. Benevolence occurs when everyone acts, and intends to act, for the good of all. Justice happens when the dignity of everyone is acknowledged and respected. It demands fidelity to promises and a lack of coercion. Justice requires our mutual interdependence which can only be fulfilled by a communal effort.
We all share an responsibility to fashion and operate institutions that fulfill our obligations to one another. In the process, we will have created justice and health.