From the Massachusetts Nurse Newsletter
January/February 2006 Edition
Jamie Tessler, an occupational ergonomics consultant and an MNA advocate, recently provided key testimony to the Massachusetts Legislature on behalf of the MNA in support of H. 2662, “An Act Relating to Safe Patient Handling in Certain Health care Facilities.”
My name is Jamie Tessler. I am an occupational health professional and I have a long history of working with health care workers to prevent work-related musculoskeletal disorders. I am also a doctoral candidate in occupational ergonomics at the University of Massachusetts. My goal today is to draw a few key points from the large body of peer-reviewed scientific literature that identifies an epidemic of back injuries among nursing personal and to highlight the burden this epidemic is placing on Massachusetts’ nurses and other health care workers.
The evidence is overwhelming: An epidemic of occupational back injuries has been occurring, worldwide, and is associated with patient lifting and patient repositioning in acute and long-term care settings. As early as 1988 we knew that nurses who handled patients had 3.7 times the prevalence of low back pain as nurses who didn’t handle patients. Now we know that nurses are leaving the profession due to the physical working conditions, among other safety and quality-of-life-factors.
Biomechanical research—using key principles of physics and engineering applied to the human body—has provided us with the science to quantify the limits of human lifting capacity. We have useful tools to measure or predict the physical demands of manually moving patients in health care settings. Dozens of scientific studies focusing exclusively on the hazards of patient handling/patient transferring have been published in peer-reviewed journals. In one meta-analysis of 10 studies of low back compression from patient handling, all of the studies reported common everyday lifting tasks that exceeded the “safe” lifting guidelines established by the National Institute of Occupational Safety and Health.
Several studies documented that certain one-person lifts exceeded NIOSH’s “Maximum Acceptable Weight Limit” (MAWL). Six of the 10 studies documented that two-person lifts—intended to reduce the hazard of lifting—resulted in exertions that exceeded spinal tolerance levels in both employees.
The conclusion? Two decades of biomechanics research applied to health care workers has demonstrated that everyday ordinary patient care tasks require health care workers to use their bodies in ways that exceed human physiologic limits.
I will introduce, therefore, the radical idea that there are two types of patient handling tasks in health care facilities: 1) those that can be performed by human beings, using proper technique, and 2) those that should not be performed by people without lifting equipment because the task exceeds human physiologic limitations.
National and Massachusetts injury statistics support the foundation for this act: the toll of preventable and life-altering musculoskeletal injuries associated with manual handling of patients in multiple health care environments is devastating.
Among employees in the Massachusetts “services” industry, RNs had the second highest number of reported injuries/illnesses of all occupations with 1265 injuries among RNs reported in 2002. Only nursing aides/orderlies/attendants, with a grand total of 3155 injuries, was higher within this sector.
Throughout the state in 2001, 10,400 cases of nonfatal occupational injuries/illnesses were reported among hospital employees alone. Another 7,600 cases can be found among nursing home and personal care facilities. A closer analysis shows that well over half of all lost work time injuries in this sector are associated with sprains, strains and cumulative trauma to the back and other body regions.
Despite our advanced medical infrastructure in Massachusetts and our state-of-the-art treatment centers, Massachusetts incidence rates (2001) are no lower than the national averages. The vast medical knowledge embodied in health care facilities is not reflected in the programs to prevent occupational injury to nurses.
But we can turn the tide.
Examining national statistics, hospitals came in as the third most hazardous work environment in the United States when compared to all other industries. Nursing homes came in first, with the known-to-be-hazardous trucking industry scoring second.
The incidence of reported non-fatal occupational injuries/illnesses in the nursing home sector in 2001 was 14.8 per 100 full time employees (FTEs), 9.0 per 100 FTEs in hospitals, showing an increase for hospitals and nursing homes over 2000 data (BLS, 2000 & 2001).
Behind each statistic is the real person, often a nurse. Costs to Massachusetts’s health care workers in terms of personal suffering, the impact on families and communities is difficult to measure. Souring direct and indirect costs from employee injuries, lost work time, overtime for replacements, training and recruitment and other indirect expenses take its toll. A comprehensive safer lifting program addresses both employee health and the quality of patient care and patient safety.
Sadly, these numbers are the tip of the iceberg. Underreporting is rampant among health care workers, and RNs are the first to admit it.
Researchers have concluded that 33 percent to 69 percent of all injuries are overlooked by the Bureau of Labor Statistics. I addressed hundreds of operating room nurses last April; collectively they estimated that 75 to 95 percent of all injuries among their nursing colleagues go unreported.
In neighboring Connecticut, only 10.6 percent of all work related musculoskeletal cases filed a comp claim, with 70.9 percent using their own insurance for medical care. In one study, 50 percent of employees had persistent pain and symptoms, but only 5 percent filed injury reports, and only 7 percent of work related musculoskeletal disorders were listed on OSHA logs. Therefore we must assume that these devastating statistics are a gross underestimation of the epidemic.
The good news is that there is a long-term solution at our fingertips. While traditional “lifting techniques” training programs are proven to not work, “safer lifting” programs do work. Hazards are eliminated at their source. Patient handling technology on the market is better than even. The most hazardous lifts can be eliminated, and the risk of lifting tasks can be lowered to below the NIOSH action limit.
H. 2662 can help to transport the large body of evidence from the academy into the front door of the facility. We now have road maps in place of successful programs. Cash can be saved by facilities. The time is now to support this timely “act.” This type of program also bolsters other facility initiatives. It increases patient safety, nurse retention, job satisfaction and employee morale and loyalty.
