Safe Patient Handling

December 2005

Nursing is the highest risk occupation in the United States with respect to lifting and handling-related injuries. It is the profession most associated with work-related musculoskeletal disorders and back injuries. Injury data show that nearly 12 out of 100 nurses in hospitals and 17.3 out of 100 nurses working in nursing homes report work-related musculoskeletal injuries, including back injuries, which is about double the rate for all other industries combined.

According to a United States Bureau of Labor Statistics 2000 report, six of the top 10 professions at greatest risk for back injury are: registered nurses, nurses’ aides, licensed practical nurses, radiology technicians and physical therapists. The rate of injury among workers in nursing care facilities is higher than in the trucking, logging or construction industries.

In 2000, the Veterans Health Administration (VHA) found that nurses were injured six times more frequently than any other single occupational group; back injuries represented 19.1 percent of all injuries; and another 25.5 percent, upper extremity injuries. Back injuries resulted in the most lost workdays.

Greater than one-third of back injuries among nurses are attributed to the handling of patients and the frequency with which nurses are required to manually move patients. From a worldwide perspective, back injuries to nurses have point prevalence of approximately 17 percent, an annual prevalence of 40–50 percent and a lifetime prevalence of 35-80 percent. (See A Business Case for Patient Care Ergonomic Interventions, 2005).

Nurses lift, move and turn patients who may easily weigh 250 pounds or more on an hourly basis, and most would consider a 100-pound patient to be “light.” However, many U.S. industries and the U.S. Postal Service follow lifting regulations to the letter by supplying lifting and handling equipment for any loads over 50 pounds or above shoulder height. The National Institute of Occupational Safety and Health (NIOSH) guideline for the maximum lifting load that anyone should routinely lift is 51 pounds. That 51-pound federal guideline applies to lifting of a stable object with handles. Moreover, nurses must frequently lift or move patients while also cautiously handling their patients’ intravenous (IV) or other tubing, casts, wound dressings, injured limbs, etc., which limits nurses’ flexibility in their lifting movements and which places them at risk. Patients don’t come equipped with “handles.” Patient lifting and handling is significantly more difficult and more demanding than moving boxes around.

Some of the factors exacerbating the risk of work-related injuries for caregivers include those listed below. These factors are multiplicative: the more of these occurring at a given time, the greater the risk of injury.

  • Heavy physical work
  • Lifting and forceful movements
  • Bending and twisting (awkward postures)
  • Whole-body vibration
  • Static work postures

Additional risk for nurses comes from the increasing levels of obesity among the general population; the marketing by hospitals of weight loss treatments, resulting in previously relatively unseen numbers of bariatric surgery patients (who receive surgical treatment for morbid obesity; gender (high numbers of female workers); the aging nurse workforce (more vulnerable to injury or repeat injury); staffing shortages with fewer staff to share in the lifting and turning of heavy patients; cumulative trauma?both long term and short term, related to nurses working long hours; stress due to organizational change (nurses working as temporary workers or “floating” to units where they may be exposed to unfamiliar or completely unrecognized manual handling risks, unfamiliar patients or unfamiliar lifting equipment).

Finally, nursing education has historically emphasized patient safety but has been lacking in emphasis on self-protection in contrast to the physical therapy discipline, which underscores both self-protection and patient safety during all patient handling and movement tasks. The physical therapy culture also emphasizes promotion of the patient’s functional status and independence, which can mean limits on use of handling aids. These professional cultural differences have led to discrepancies in strategies and techniques for patient handling among nurses as well as between disciplines. It is time to promote an interdisciplinary approach to patient handling that will optimize caregiver and patient safety as well as patient rehabilitation.

A plan of action

The MNA calls for an approach that would require all health care facilities in the state to develop and implement a health care worker back injury prevention plan to protect nurses and other caregivers, as well as patients, from injury. The plan would mandate the following:

  • A systematic process in each facility for addressing ergonomics, recognizing occupational health and safety hazards and preventing injuries specific in each health care facility.

Each facility will have a written organization-wide safe lifting and handling plan containing: policy and procedures describing their safe patient handling and lifting philosophy and approach; procedures; equipment type, numbers and location; mechanism for addressing nurses’ refusal to perform unsafe lifting and handling; and education and training programs conducted or utilized at their facility by qualified personnel.

Each facility will implement safe handling and lifting methods that are appropriate for their patient populations, size and scheduling needs.

  • Needs assessment by facilities of patients’ lift and transfer requirements and resulting handling, lift and equipment needs.

Each facility will develop needs assessments appropriate to the lifting and handling requirements of their patients, with the policy describing how the institution will manage the enforcement of policies and procedures.

  • Specialized training of health care workers and lift team members by qualified personnel, with demonstration of proficiency in handling techniques and use of handling equipment.

Each facility will use qualified personnel, i.e., personnel with recognized certification such as Back Injury Resource Nurse (BIRN) Trained Faculty, as resource nurses and educators in their patient lifting and handling education and training programs.

  • Protection of workers against disciplinary action for refusal to lift or handle patients due to concerns about patient and worker safety.

When there is insufficient or unsafe lifting or handling measures and/or equipment available and/or the lack of trained personnel, health care workers shall not be subject to disciplinary action by the hospital or any of its managers or employees. Each facility must have a policy and procedure in place describing a non-punitive process for resolution of such situations.

MNA has filed legislation for passage in the commonwealth’s 2005-2006 legislative session: HB 2662, “An Act Relating to Safe Patient Handling in Certain Health Facilities.” This bill prescribes the measures required to produce safer working conditions for nurses and as a result, for patients as well.