Nurse and Nursing Assistants: On the Job Injuries

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Back pain and disabling back injuries affect 38% of nursing staff members. Injuries while providing care for others is something I am all too aware of.

While evaluating studies related to back and other forms of injuries it has been revealed that 12% of all nurses intending to leave the nursing field entirely permanently cited back pain as either the main or contributing factor. In the 1998 Bureau of Labor Statistics ranking of the professions at greatest risk for back or other injury, health care workers accounted for six out of the top ten positions. A plain conclusion is that the injuries medical personnel experience is contributing - at least in part, to the current shortage of nurses and nursing assistants.

The consensus seems to be that nurses and aides are being injured as they transfer people or lift them, either by cumulative injury, by lifting people repeatedly day after day and year after year, or by a direct injury such as lifting or transferring people who weigh hundreds of pounds alone. The National Institute of Occupational Safety and Health recommended a weight limitation of 20.7kg for women. The weight limitation was based on a box that was 35.6cm wide with handles. The box was lifted for a total of 25.4cm, starting with the box at knuckle height as the person lifting it was standing. The compact box with handles that weighs a mere 20.7kg in no way resembles a person, although the recommendation is recommended.

Investigators for the University of Ohio measured spinal load pressure bio-mechanically during different routine tasks related to moving people from:

• Wheelchair to a bed
• Hospital chair to commode
• Commode to hospital chair

Different transfer methods were evaluated on a 49.5kg person:

• One person hug
• Two person gait belt
• Two person hook and toss

As well as various in-bed repositioning techniques such as manual two person draw sheet method, manual two person hook, and manual two person thigh-and-shoulder methods. Each of these movements is familiar to nurses and nursing assistants believe me. In the Ohio State University investigation, each of the methods of repositioning and transferring that were studied placed nurses and aides in the high-risk population for a back injury. The fact is - even the safest of tasks presented significant risk. The study indicates that use of the appropriate body mechanics that we were all taught as nurses or aides does precious little to prevent cumulative or direct back injuries.

How Were My Actions Incorrect

For me, being an aide was something I never questioned doing; it was ingrained in me. Both of my parents were nurses, my father is still a Nurse Practitioner at age 73. I watched as my father experienced back pain over the years, as well as other nurses he worked with.

I was an aide for decades, helping people who experienced forms of disabilities, seniors and veterans. The warnings from nurses related to back injuries did not pass by my attention at all. I used the methods for lifting and transferring others that were taught to me as I was certified twice over the years. The results

Instead of experiencing a back injury, I experienced back pain. My knees, ankles and feet; however, are now in bad shape because I was taught to lift using the strong muscles in my legs instead of my back. Finally, as I helped a friend with quadriplegia after he ran his power wheelchair off the side of the ramp on his van with a couple of kind gentlemen in the parking lot, I tore the cartilage in both knees. The surgeon who operated on my knees diagnosed me with osteoarthritis in my knees and feet, as well as an, 'osteo-osteosis,' in both ankles.

When you work in long-term care facilities or in-home care, you find yourself with no one to help you lift a person far too often. A fact you do not hear too much about is that aides often times have to break down a person's power wheelchair and load it in the car, something I did for years. What did I do wrong or incorrectly? Absolutely nothing - I did what I was taught to do related to lifting, for all the good it did me.

Preventing Transfer or Lifting Injuries

The resounding answer to the question of whether or not these kinds of injuries can prevented is indeed yes. A number of investigators have evaluated the usefulness of lift teams in acute care settings. Lift teams who were responsible for all total body transfers and used appropriate mechanical lift equipment led to reduced rates of injury, fewer days lost and fewer modifications of duty associated with lifting people. At the end of a one-year study of a lift team, the study reported that nurses and aides indicated high satisfaction with the lift team approach and that the total numbers of restricted or light-duty days were reduced by a whopping 361%. The approach that is needed where handling people is concerned involves:

• A well-trained lift team
• Re-education of nursing personnel
• Modern mechanical lifting equipment
• Policies and procedures that very clearly mandate a new method of handling others

A lift team, in order to be successful, must be well-trained in how to use modern mechanical lift equipment. The team also needs training in the various needs of people in their care, people who are in traction with hip precautions, or people who have heart monitoring. The one job of the lift team is to lift and transfer. The members of the team must be very available and has to work closely with nursing personnel.

Nurses and aides are experiencing preventable back, neck and other forms of injuries. The time has come to end the behaviors that result in injuries. The agencies for protecting health care workers from injuries simply must start to do just that. Responsible agencies include individual hospitals, the Occupational Safety and Health Administration, the American Nurses Association, as well as nursing unions. Using lift teams to relieve nurses and aides from lifting and transferring will not only prevent needless and at times disabling injuries and keep nurses and aides on the job will also permit nurses and aides to spend more time performing their duties.

For nurses or aides who work in the in-home care portion of taking care of others, the options are limited at this time. Aides; for example, who work caring for others in their homes must not be expected to lift or transfer others without assistance, yet how to get a lift team to a person's home? May I suggest that in-home care agencies need to take on the responsibility for the care of their nurses and aides situation related to lifting and transferring people and their equipment

In-home care agencies need to organize lift teams with the capability to visit people in their homes who have to be lifted or transferred. The lift teams need to have the mobility to assist nurses and aides during times people need to be lifted or transferred and then move on to the next home. The question in my mind is, "will this ever happen" If such lift teams existed over the years, I might have avoided knee, ankle and foot injuries that have become disabling. How many other nurses and aides have experienced the same kinds of back and other injuries? It is time for lift teams to become the standard where lifting and transferring others is concerned, it helps everyone involved to avoid an injury that may end someone's career, or take a nurse or aide who is appreciated out of the nursing field.

Author Credentials:

Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's; para and quadriplegia to Spina Bifida.

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