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Nurses struggle with injuries despite lifting aids

Equipment costs, old habits inhibit safety efforts

Nurses struggle with injuries despite lifting aids

As nurses and other health care workers continue to suffer high levels of lifting-related musculoskeletal injuries, safety managers are working to establish workplace patient handling regimens before proposed legislation would mandate such procedures nationwide.

According to data from the Bureau of Labor Statistics, nursing assistants suffered musculoskeletal injuries at a rate of 208.4 per 10,000 full-time workers in 2013, compared with a rate of 35.8 across all industries.

Despite the widespread availability of improved hoists, full-body sling lifts and overhead lifts to help move patients, experts say the high injury rate persists for a variety of reasons, among them heavier patients and a workplace culture in which nurses and orderlies were trained to lift patients manually using proper body mechanics.

“I have been a nurse for a long time and was part of the "lifting brigade' generation,” said Carla Casia, Chicago-based employee health services manager and interim director of EHS clinical operations for Presence Health. “However, most nursing students coming out of school now are being trained on lifting equipment, so it's already embedded in them. Even some of my most experienced nurses now think that this is a good idea.”

Nonetheless, safe patient handling programs are far from ubiquitous, said Lynda Enos, Portland Oregon-based ergonomics consultant at HumanFit L.L.C. “We estimate that maybe 25% of hospitals in the U.S. are truly implementing safe patient handling and ergonomics and prevention for their health care worker injuries,” Ms. Enos said.

One reason for the low adoption rate may be concern about the cost of acquiring equipment, she said.

“However, you can make the business case just from the savings on workers compensation. Safe patient handling also improves productivity and reduces staff turnover,” she said.

Deb Fell-Carlson, Salem, Oregon-based policyholder safety and wellness adviser for workers compensation insurance provider SAIF Corp. said cultural resistance among staff members long accustomed to working without lifting equipment is another issue safety managers must address.

“There is a sense that use of equipment somehow depersonalizes the encounter for the patient. In reality, it frees up the caregiver and enables to them to look the patient in the face and talk to them while they are moving them,” she said

But states are pushing for safer lifting methods. Eleven states have enacted laws requiring safe patient handling in recent years. At the federal level, Rep. John Conyers, D-Mich., said during a May 12 briefing with the American Nurses Association that he intended to reintroduce legislation to require health care employers to develop and implement safe patient handling and injury prevention programs. A similar bill, the Nurse and Health Care Worker Protection Act of 2013, failed to pass in 2013.

Colin J. Brigham, Exton, Pennsylvania-based vice president of safety management and ergo-nomics for consulting firm 1Source Safety and Health Inc., said workers compensation insurers have led the charge on safe patient handling.

“The primary loss-producing source for workers compensation insurers in this space is patient handling,” Mr. Brigham said. “They know that if you are loading your body beyond its capacity, proper body mechanics won't help you.”

Richard Schleckser, Boston-based senior service director in the risk control department for Liberty Mutual Insurance Co., sees the scope of lifting-related injuries in health care in the company's claims data.

“The exposure is evident in the number of injuries we were seeing. But also when we began to assess the loads on the body, we realized that you just couldn't do what they were doing safely,” Mr. Schleckser said. “A guy handling 200 pounds of bricks on a construction site would at least get a wheelbarrow, but many nurses aren't even given that courtesy.”

Accordingly, underwriters are showing more interest in the patient handling procedures of health care facilities, Mr. Schleckser said.

Ms. Casia said her company's 12 hospitals and other health care facilities in Illinois have committees that evaluate safe patient handling. In addition to securing the necessary equipment, health care providers must ensure that employees adhere to patient handling procedures, she said.

“It is very easy for any employee to want to take a short cut and not use the proper equipment, but it is safer for both the employee and the patient if they do,” Ms. Casia said. “So, we hold our employees accountable for it.”

Ms. Enos agreed that health care providers need to take a systemic approach to safe patient handling.

“We have to look at the culture of health care all the way from senior management right down to physical therapists, technicians and nurses,” Ms. Enos said.

Mr. Brigham said the need for safe patient handling will become more important as the nursing population ages.

“The average age of an RN is now 50,” he said.

Scott Smith, director of ergo-nomics for Aon Global Risk Consulting, agreed that health care ergonomics is a growing concern, noting that older workers are not only more likely to be injured but also are more costly to treat.

“In a moderate-risk environment, you are going to get a different response from a 47-year-old than a 25-year-old,” Mr. Smith said. “Moreover, if somebody older does get hurt, the costs are gong to be significantly higher.”