The Risky Business of Nursing

Musculoskeletal Injuries

Most patients can be lifted and moved without injury if proper body mechanics are used. Is this statement true or false?.

If you haven't taken a safe patient handling class for a while, you might think that this statement is true. In fact, it is a myth, the perpetuation of which is responsible for countless occupational musculoskeletal injuries to nurses and other healthcare workers. The truth is that there is no such thing as safe manual lifting, regardless of body mechanics, and that every episode of manually lifting, turning, or transferring patients can result in microinjuries to the spine.^[3] The nurse might not feel the effects immediately, but these cumulative microinjuries can eventually result in a debilitating condition.^[3]

Musculoskeletal injuries (also called "ergonomic" or "overexertion" injuries) are common among workers in all healthcare settings, from acute care hospitals to long-term care and ambulatory facilities. Wherever there are patients, there are opportunities to become injured in the course of care. Nurses, nurses' aides, orderlies, and attendants suffer these injuries at a rate much higher than the general population of workers, even those in construction, mining, and manufacturing.^[4]

Patient handling tasks, such as transferring patients from bed to chair or commode, and repositioning patients in bed, are blamed for most of the sprains and strains to the neck, shoulders, and lower back experienced by nurses. However, the manual load involved in lifting and transferring patients is not the only source of muscle strain. Tasks that involve bending over the patient, such as bathing, performing procedures, or pushing wheelchairs and gurneys, also contribute to cumulative injury.^[5] Static load, caused by working or standing in a nonergonomic position, can strain the muscles as well.^[6] Consequently, even nurses who don't routinely lift or move heavy patients can suffer back and neck pain.

The problem of musculoskeletal injury is exacerbated by the aging and increasingly overweight patient population, yet in many settings, nurses do not have the tools needed to safely lift and transfer these immobile patients. A survey of critical care nurses revealed that less than one half of employers supplied patient lifting equipment, and injury rates were higher when lifting equipment was not available.^[7] Many nurses try to prevent musculoskeletal injuries during patient handling by "keeping themselves fit," but this is another myth about safe patient handling.^[3] If you are "fit," you may be more likely to be asked to lift patients or be part of a patient lift team, providing more opportunities to be injured.

The elimination of unsafe patient handling has been a long-time goal of the American Nurses Association (ANA). The ANA recently convened a multiprofessional group of experts to reexamine the issue of safe patient handling and mobility. The outcome was the development of a set of national overarching standards^[8] for what is required to implement a safe patient handling and mobility program in all healthcare settings, Safe Patient Handling and Mobility.

"We can't afford to lose nurses to preventable injuries at a time when more people are able to access healthcare services," says Adam Sachs of the ANA. One of the core principles outlined in the standards document is investment in safe patient handling technology, locating it conveniently, and making sure staff know how to use it. "Safe patient handling technology isn't important just for keeping staff healthier," says Sachs. "It also preserves the dignity of patients. It's awkward and embarrassing when it takes a dozen people to move a morbidly obese patient."

Sadly, no federal law yet exists to protect nurses and other healthcare workers from injury caused by patient handling, although safe patient handling laws have been passed in 11 states to date. The Nurse and Health Care Worker Protection Act of 2013 if passed, would require a national safe patient handling, mobility, and injury prevention standard to reduce injuries to patients, nurses, and other healthcare workers.

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Cite this: The Risky Business of Nursing - Medscape - Jan 14, 2014.