National Public Radio featured the first in a series of reports on one of the most dangerous jobs in America, one that they say has more debilitating back injuries than the construction industry or law enforcement. In Hospitals Fail To Protect Nursing Staff From Becoming Patients, Daniel Zwerdling investigates the high rate of back injuries that plague the nursing profession, largely the result of poor patient-lifting practices, which are greatly exacerbated by the obesity epidemic.

The impact of obesity cannot be overstated -- nurses are required to lift or support morbidly obese patients as many as 15 to 20 times a day. NPR puts this in context, citing National Institute for Occupational Safety and Health Manager James Collins: "... before studying back injuries among nursing employees, he focused on auto factory workers. His subjects were "93% men, heavily tattooed, macho workforce, Harley-Davidson rider-type guys," he says. "And they were prohibited from lifting over 35 pounds through the course of their work."

Yet nursing employees in a typical hospital lift far heavier patients a dozen or more times every day. Tom Lynch discusses safe lifting limits in a prior post:

    "... according to NIOSH, the most a nurse or aide in the 90th percentile of strength should lift at any one time is 46 pounds. But a typical 8-hour workday in this field involves lifting about 1.8 tons. Twelve percent of registered nurses who quit the field report that they do so because of back pain due to patient handling."

A Case in Point

Zwerdling talks to a number of nurses who discuss their injuries and how they happened. He focuses on the experiences of nurses at Kaiser Permanante in Walnut Creek, which he notes is no worse and perhaps better than many health care facilities. Although the hospital had dedicated lifting equipment and teams, there were not enough machines and not enough teams to staff them when needed. When patients need help, the need is often urgent and immediate.

Nurses who worked at Kaiser Permanante asked for a state investigation into lifting practices shortly after California's 2012 Hospital Patient and Health Care Worker Injury Protection Act went into effect. In January 2014, a state administrative law judge issued an order that declared that Kaiser had failed to have "specific procedures in place to ensure that sufficient staff was available to perform patient handling tasks safely."

While this report is one that frames the issue in terms of nursing injuries, it's also a safety issue for patients.

The American Nurses Association tracks legislation related to safe patient handling and mobility (SPHM). They note that:

    "...eleven states have enacted "safe patient handling" laws or promulgated rules / regulations: California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii.

    Of those, ten states require a comprehensive program in health care facilities (California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Rhode Island, Texas and Washington), in which there is established policy, guidelines for securing appropriate equipment and training, collection of data, and evaluation."

Exacerbating Factors

In our prior post cited above, Tom talks about some additional factors contributing to the problem -- the aging workforce and nursing shortages.

    "The average age of a registered nurse is now nearly 47. For Home Health Aides (HHA), it's 46; for Certified Nursing Assistants (CNA), 39. Wages for the aides and assistants average between $11 and $12. Forty percent have been on food stamps and many get their own health care through Medicaid (see: HHS Direct Care Workforce). The BLS (Bureau of Labor Statistics) estimates that the demand for HHAs between 2010 and 2020 will grow by 69%; CNAs, 40%. Collectively, we are confronted with a critical shortage of healthcare talent. According to the U.S. Department of Health & Human Services, "Direct care work is difficult, the wages are low and fringe benefits are often limited."

It's the same with registered nurses where, oftentimes, the shortage is self-inflicted. A study of 21 hospitals in the Twin Cities found that when registered nursing positions were decreased by 9%, work-related illnesses and injuries among nurses increased by 65% (Trinkoff, et al., 2005)."

Additional Resources:

• SPHM Interprofessional National Standards and Implementation Guide.
• OSHA: Safe Patient Handling.
• NIOSH: Safe Patient Handling.
• Retrofitting Hospitals for obese Patients.

Prior Workers Comp Insider posts highlight other dangers involved in nursing:

• Working the Graveyard Shift.
• Exposure to workplace violence from patients and peers.
• Chemical exposure risks.