Nursing Injuries

--An Ongoing Dilemma in the New Millennium

Human injury losses suffered from occupational hazards are inherent in the nursing care field, and of growing concern among healthcare professionals. In fact, nursing has the second highest incidence of all kinds of non-fatal work-related injuries in the U.S. Yet, outside of the healthcare domain itself, lack of public awareness and appreciation for the scope of this problem is inadequately addressed. This is evidenced by the ever-mounting statistical data pouring out of an industry entirely reliant upon the human element of patient care.

Historically, skilled care workers have been at greatest risk of injury loss while performing their duties with the required focus and efficiency expected. The healthcare industry notoriously suffers the most work related injuries due to musculoskeletal disorders (MSDs), accounting for 19% of those reported across all high-risk to injury workforces. 41% of all injuries in the healthcare industry alone are due to MSDs, with nearly 1.4 million skilled care nursing employees most adversely affected. (Bureau of Labor Statistics/bls.gov)

According to The Bureau of Labor Statistics, the labor market for direct-care workers is characterized by very high levels of turnover. State level studies of turnover in nursing homes report annual rates that range from 25 percent to well over 100 percent. Turnover is costly for the employer who must recruit and train replacement workers. And high levels of turnover not only cause discontinuity in care but have been shown to adversely affect patient outcomes in nursing home settings. Ultimately, quality and continuity of patient care are in jeopardy with increased demands made on fewer available staff.

A number of factors contributing to risks and losses associated with caregiver patient care include:

• overexposure to lengthy and demanding shifts
• standing for long periods of time with increased fatigue
• taking on the work of two people due to inadequate staffing
• increased patient loads per shift due to increased longevity of the elderly
• inadequate enforcement and monitoring by management of patient weight handling procedures.
• employer/employee lack of education on the use of appropriate biomechanics as applied during lifting, moving, supporting, turning and transporting patients.

Nursing Injuries often result in absence or ultimate departure from work, cost prohibitive worker’s compensation claims, and negative impact on caregiver quality of life. From the period of 1995 to 2004, approximately 800,000 nursing, psychiatric and home health aides were injured or became sick on the job, with musculoskeletal disorders the most common type of non-fatal injury or illness reported. A 2001 study made by William Charney, Department of Health, stated that, "Every day in the USA, 9,000 health care workers sustain a disabling injury while on the job." However, a report by Bernice Owen, RN, Ph.D., former professor at the University of Wisconsin-Madison School of Nursing, estimates that as many as one-third of nurses who sustain work-related back injuries do not even report them.

Patient handling injuries are the single greatest contributor to the current nursing shortage. Primary injuries reported in this U.S. segment of high risk to injury employee (HRIE) are musculoskeletal in nature, most commonly back related. (Bureau of Labor Statistics/bls.gov) These are the result of awkward bodily positions with repeated movement in support of limp human weight of the elderly and infirm.

Over time repeated demands on the caregivers’ work performance creates cumulative strain leading to back injury. A strain or sprain means the back muscles have been overloaded. By the law of physics discs have been overloaded as well. The discs separating the vertebrae have no nerve endings nor blood supply, therefore do not signal overload or compression, nor do they regenerate when damaged. This is the risk that all labor intensive work forces face daily and with serious consequence, as statistics have shown.

With nearly half of all nurses with work related back injuries unwilling or unable to return to work, (Work Injured Nurses’ Group/Wingusa.org), data indicate nursing aides as one of the most hazardous jobs for women in the healthcare field. For example, small-framed female aides are required to transport patients to and from beds several times during a shift. In some cases, patients may become agitated and/or frightened, placing increased strain on the caregiver, thereby compounding the risk of imminent back strain and injury. (Work Injured Nurses’ Group/Wingusa.org, cited from UC Davis Center for Healthcare Policy and Research, Dept. of Public Health)

The National Institute for Occupational Safety and Health (NIOSH) has set safe weight lifting limits for patient handling by female caregivers at 51 lbs. for male patients and 46 lbs. for female patients. In spite of these standards, nursing aides are expected to lift as much as 3000 lbs. per shift, far exceeding established safety limits. If these aides are doing it only 50% correctly then 1500 pounds per shift is ‘breaking the body down’. Given this reality, it is apparent why nursing aides consistently suffer 3-4 times the number of back injuries, as do registered nurses. (Work Injured Nurses’ Group/Wingusa.org, cited from NIOSH)

Professional Demands

The caregiver's profession is focused on performance demands that involve the well-being of human lives. Nurses and nursing aides will often round their mid and upper backs in a soft and nurturing posture while leaning over a patient's bed, ministering to their needs. That is the nature of the psychological performance. However in doing so, the caregiver places all burden of effort on the back and shoulder muscles. The body's core power is essentially disengaged, leaving the low back and spine vulnerable, thus leading to inevitable injury, loss of work, income, and livelihood. For these reasons, nurses are often forced to leave behind the work they have dedicated years to and find most rewarding.

Employee Safety Programs

Several initiatives to prevent nursing injuries have been taken over the years, from the use of mechanical assist devices to various work behavior modification and ergonomics programs. Their success, however, is self-limiting due to the reality that certain work environments cannot be changed to accommodate the work task being performed. In particular, dynamic environments, such as convalescent care and emergency settings, cannot be controlled adequately enough due to the nature of the work and unanticipated patient handling demands. Back injuries will continue to occur as long as work environments do not change or accommodate high risk situations, forcing caregivers to repeatedly absorb the physical demands of the job.

For years employee safety training programs addressing high risk have been available through companies like DuPont (STOP—Safety Training Observation Program), Safety Performance Solutions, BST (Behavioral Science Technologies), Liberty Mutual, Aubrey Daniels International, Self-Audit Initiative(dated 90s approach to safety training), containment loss control or return to work programs, and Chubb Insurance. However well-meaning in their intent to mitigate and prevent injury and financial losses, many of these programs fall short by design:

• Patient assistive devices have been widely used and proven to be useful in hospitals and nursing care facilities, yet only to a degree that the situation realistically allows. A study conducted by the OHSAH, Occupational Health and Safety Agency for Healthcare in British Columbia, evaluated the effectiveness of ceiling lifts in extended care facilities and found that employees preferred using ceiling lifts over both floor lifts and manual techniques. Employee musculoskeletal strain and discomfort were reported as being reduced. However, staff also reported not preferring the use of the ceiling lift device when repositioning patients because using them was more time-consuming than manual techniques. (Occupational Health and Safety Agency for Healthcare in British Columbia/ohsah.bc, completed research section) This would suggest that employees may in fact avoid using these devices in favor of faster and more simple manual techniques, both for the sake of time and convenience, and/or in emergency situations. These choices increase the risk of worker injury. In addition, assistive devices are costly and may not be adequately supplied by some medical facilities. When a situation exists where one is needed emergently, it may not be readily available for use.

• Employee safety training programs are passive in nature, consisting of dialogue between company and management, then management and the employee, addressing incorrect employee work behavior on the job. Hands-on training is limited to standardized ergonomics exercises and the use of assistive devices. These programs, again, do not address the actual work performance demands of high risk to injury workers and the uncontrolled work arenas. In essence, workers are assigned blame for doing things wrong.

• In the case of DuPont’s Safety Training Observation Program (STOP), the behaviorally based safety program is designed with the assumption that almost all injuries are caused by “worker unsafe acts”. These programs attempt to eliminate injuries by reminding workers to work more safely. Programs like STOP focus almost completely on correcting employee behavior instead of abating hazards in the workplace. (dupontsafetyrevealed.org, Evolution of DuPont STOP section)

• ‘Blame-the-worker’ programs include Behavior-Based Safety, Safety Incentives, and Injury Discipline. The greatest problem with behavior based programs is that, by taking the “easy way out” of blaming the worker, real safety hazards continue to exist in the workplace injuring and, in some cases, killing workers.

As Leo Gerard, President of USW International, was quoted as saying, "Management's blame-the-worker programs are as dangerous to our members as any other challenge that we face today. The USW must oppose these programs with all our energy. Instead we must work just as hard to implement comprehensive health and safety programs that find and eliminate unsafe workplace conditions that cause injuries and illness to our members." (dupontsafetyrevealed.org, Evolution of DuPont STOP section)

• Other safety programs focus on controlling and managing Worker’s Compensation claims through a reward and punishment model rather than injury reduction and mitigation solutions. These programs are management oriented rather than employee oriented. The weak link is that management and employees are not physically and psychologically trained with skills to recognize the correct “kinesthetic experience” of a demanding task, as in “How does the work experience ‘feel’ when it is being done correctly

Ergonomics exercises, safety seminars, reward and punishment programs, and even assistive devices do not adequately address employee work behavior as a matter of biomechanically incorrect movement while performing an injury prone job function.

One fundamentally sound and unique program in existence is Professional Safeguard Response®, a system based on the application of behavior biomechanics, or physiologic laws of biomechanically correct behaviors. These behaviors are derived from performance demands which are derived from body mechanics of the martial sciences.

Body Mechanics of The Martial Sciences

The martial and ‘Eastern’ therapeutic sciences have for centuries taught the concept of a ‘whole’ body intelligence and, therefore, more efficient system of self-strengthening biomechanics. With correct body mechanical behaviors in place an individual is better equipped to meet the challenges of performance demands when facing a constantly changing weight, as in an aggressor. It demonstrates that a physiologically organized body behavior combining proper muscle organization and spinal alignment with controlled intra-truncal pressure and breathing reduces inter-discal pressure. Physiologically organized body behavior does not overload the spine or upper body and does not weaken the body on demand.

In the example of an organized physiological practice such as Judo, which is basically the study of leverage, the focus is not on upper body strength but rather on the entire body organized to the lowest center of gravity. A 100 lb. female Judo student is taught that, whatever demands are presented, as in an aggressor, she must go to lowest center of gravity as a leveraged unit body where the largest muscle groups are fully engaged, thus driving the force behind  the effort out to the peripheries. The force is always moving away from the center outward as a solid leveraged organized unit, rather than in a disorganized, compartmentalized manner. This enables the caregiver's handling of a patient's limp weight to shift from a vulnerable and weakening experience to a self-strengthening one. There is internal biofeedback stating what ‘feels’ correct, as with a professional athlete. This internal biofeedback creates behaviors that become “imprinted” in the body, enabling it to respond to performance demands safely and effectively.

“Imprinted” Biomechanics

Correct body biomechanics enables the body to safely and intelligently perform strenuous work tasks in an injury preventable manner. It is a fluid and reflexive behavior that is “imprinted” in the body. Once correct biomechanics are aligned and applied, the body registers what “feels right” and “imprints” the behavior, thus injury free work performance becomes self-sustaining for the life of the employee.

Based out of California, Professional Safeguard Response®, or PSR®, raises the bar on employee safety in the workplace with a uniquely designed "imprinted" biomechanics system for constantly changing work performance demands. Its methodology promotes the concept of a self-strengthening kinesthetic work experience as the viable and practical solution to the mitigation of injury loss in the high risk arena. This specialized company designs systems for those work arenas which are specifically limited in their capacity for ergonomic redesign, where changing the work environment is impractical or impossible, and where the arena is primarily involved in unanticipated and awkward weight lifting, reaching, transfers, extrications, and other work effort demands. This is what makes PSR®’s unique injury reduction programs succeed when other safety training programs fall short or fail altogether. This is a system that makes sound sense and is valued for its’ intelligent and grounded approach to a safe and sustainable workforce. PSR® applies its’ biomechanics principles across all labor intensive industries with significant loss reduction outcomes. (Psrsafety.com)

Sustainable Workforces

In this millennium of aging baby boomers, skilled care nursing remains an essential industry whose workforce is increasing. It becomes apparent that with the high risk to injury nature of this work arena certain professional development is essential. In the past standardized protocols for preventing human capital injury losses were acceptable, in areas such as public safety, emergency medical services, and nursing. This situation has changed with the public safety workforce, many of whom have accessed biomechanics training programs that hold the key to reduction in human capital injury losses.

As a society that continues to rely heavily on the human element of high quality healthcare in the new millennium, swift and intelligent action is paramount to the protection and preservation of one of this country’s most important and, therefore, necessarily sustainable assets.

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