Handle With Care Backgrounder
Nursing and Musculoskeletal Disorders
Exacerbating the Growing Nursing Shortage
Federal Legislation/Regulation
State Legislation
ANA's Advocacy on Ergonomics
Nursing and Musculoskeletal Disorders
Over the past decade, much attention has been given to the issue of ergonomic hazards as a health and safety concern among health care workers. Professional nursing groups, labor organizations, industry, regulatory agencies, and the scientific community have converged in attempts to arrive at effective solutions to protect health care workers from ergonomic hazards associated with patient handling. Despite the recognition that manual patient handling is a high-hazard task, the incidence of musculoskeletal disorders (MSDs) persists at high rates for nurses and other nursing personnel - signaling the need for continued action. Emerging efforts to prevent musculoskeletal injuries have concentrated on reducing exposures through the use of assistive equipment and devices for patient handling.
Patient handling tasks are recognized as the primary cause for MSDs among the nursing workforce. A variety of patient handling tasks exist within the context of nursing care, such as lifting, transferring, and repositioning patients, and, are typically performed manually. Continuous, repeated performance of these activities throughout one's working lifetime results in the development of musculoskeletal disorders. Of primary concern are back injuries and shoulder strains, which can both be severely debilitating for nurses.
Compared to other occupations, nursing personnel are among the highest at risk for musculoskeletal disorders. In 2006 nursing aides, orderlies, and attendants reported the highest incidence rate of MSDs requiring days away from work —293 per 10,000 workers, according to the U.S. Department of Labor’s Bureau of Labor Statistics. This group was ranked second in overall MSDs requiring days away from work with Registered Nurses ranked fifth, above construction laborers (ranked ninth). Studies of back-related worker's compensation claims reveal that nursing personnel have the highest claim rates of any occupation or industry.
Exacerbating the Growing Nursing Shortage
The extent of musculoskeletal disorders among the U.S. nursing workforce is particularly distressing when considered in the context of the current nursing shortage. Estimates report that 12% of nurses leave the profession annually due to back injuries and greater than 52% complain of chronic back pain. Injuries secondary to patient handling tasks compound factors driving the shortage such as aging of the nursing workforce, declining retention and recruitment rates, and lowering social value of nursing. Findings of the 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries revealed that 87 percent of respondents stated safety concerns influence their decisions about the type of nursing they do and their continued practice in the field. This result is consistent with ANA’s 2001 Health and Safety Survey and 2007 Study of Injectable Medical Errors, in which responses to this question were and 87.9% and 90% respectively.
Federal Legislation/Regulation
In response to persistent outcry from labor organizations and advocates and recognition of mounting scientific evidence, the U.S. Department of Labor - Occupational Safety and Health Administration (OSHA) promulgated a standard intended to protect workers from ergonomic hazards, such as patient handling. In March 2001, Congress repealed the OSHA standard and ordered that the agency cease all work related to the standard.
The U.S. Department of Labor convened a work group called the National Advisory Committee on Ergonomics (NACE) in January 2003. The committee is charged with advising the Secretary of Labor and the Assistant Secretary for OSHA on ergonomic guidelines, research, outreach, and assistance over the next two years. In March 2003, Federal OSHA released its "Guidelines for Nursing Homes - Ergonomics for the Prevention of Musculoskeletal Disorders." In these "Guidelines," OSHA explicitly recommends that "manual lifting of patients be minimized in all cases and eliminated when feasible." While only a guideline (and not a regulation), this statement still reflects the recognition that manual patient handling is an extremely high-risk job task.
State Legislation
ANA's State Government Affairs program monitors over 2,000 health care bills affecting nursing and the general public as part of the “Nationwide State Legislative Agenda”. As part of the American Nurses Association's (ANA's) Nationwide State Legislative Agenda, ANA and its State Nurses Association's are promoting legislation that would require hospitals and other health care institutions to develop programs to prevent work-related musculoskeletal disorders and eliminate manual patient lifting.
Please visit ANA’s Government Affairs Web page to view regularly updated reports on the status of state legislation regarding safe patient handling and movement, (See Link Below)
ANA's Advocacy on Ergonomics
On, June 22, 2003, the ANA Board of Directors approved a position statement presented by the ANA Congress on Nursing Practice and Economics titled, "The Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders." This position statement was crafted with the intent to deliver a message to the larger nursing and health care communities, be the cornerstone upon which to structure a multi-faceted ANA health and safety campaign focused on the prevention of musculoskeletal disorders, and position ANA as a leading voice to advance current ergonomic prevention efforts.
ANA has partnered with Audrey Nelson, PhD, RN, FAAN, Director of the James A Haley Veterans Hospital Patient Safety Center of Inquiry (www.visn8.med.va.gov/patientsafetycenter). Nelson is a nurse researcher leading the way to developing and incorporating evidence-based interventions that reduce the risk for occupational injury secondary to patient handling through the use of technology and equipment. ANA co-sponsors the Annual Safe Patient Handling & Movement Conference with the Patient Safety Center of Inquiry, the University of South Florida and other international entities. This conference offers a variety of learning opportunities and discusses diverse topics such as safety legislation, practice tips, technology solutions, effective training techniques, successful organizational strategies, and building a business case for safe patient handling programs. Information on the next Safe Patient Handling & Movement Conference in 2009 can be found at http://cme.hsc.usf.edu/sphm/
ANA received funding in 2004 from the National Institute of Occupational Safety and Health (NIOSH) to launch the Safe Patient Handling and Movement Nursing School Curriculum pilot project. ANA partnered with NIOSH and the James A. Haley Veterans Hospital Patient Safety Center of Inquiry to develop the curriculum and introduce safe patient handling and movement concepts in to the curriculum of nursing schools. Twenty-six schools of nursing served as test sites and three served as control sites.
In 2007, the Safe Patient Handling and Movement School Curriculum project received the Award of Excellence for Public Health Training for Safe Patient Handling and Movement Training Program for Schools of Nursing from the Centers fro Disease Control and Prevention.
More recently, ANA and its partners in this project received the NORA Partnering award for 2008. (Read Press Release Below) For more information on this award.
ANA partnered with organizational affiliate, Association of periOperative Registered Nurses (AORN), and the James A. Haley Veterans Hospital Patient Safety Center of Inquiry and others to prepare a safe patient handling algorithm guidance document for the Association of periOperative Registered Nurses (AORN). ANA co-authored several articles based on this document.
ANA has also collaborated with the National Association of Orthopedic Nurses (NAON) in developing algorithms for high risk patient handling tasks in orthopedic nursing. Other partners included the James A. Haley Veterans Hospital, Patient Safety Center of Inquiry and the National Institute for Occupational Safety and Health. In addition to the creation of the algorithms and a series of articles based on the algorithms, an invited paper presentation was delivered at the Sigma Theta Tau International Honor Society of Nursing, 19th International Nursing Research Congress, Singapore in July 2008.
In 2008, by invitation, ANA was represented on five workgroups established and funded by the Veterans Administration to develop “toolkits” to make it easier for a hospital to implement a safe patient handling program These tools will target Chief Executive Officers, Chief Nursing Officers, Nursing Directors, Nurse Managers, Hospital Safety Committee members, Facility Champions, Unit Based peer leaders, staff nurses and other patient handlers, and patient/families. There are 300 million dollars granted to support the development of this project. The Department of Defense is a partner in the project.
ANA has authored and co-authored numerous articles and offered numerous presentations regarding safe patient handling.
For more information about ANA's efforts related to ergonomics, work-related musculoskeletal disorders, and safe patient handling, contact Nancy L. Hughes, MS, RN, Director, Center of Occupational and Environmental Health, 301-628-5021, or via e-mail at nancy.hughes@ana.org.