Health care tops in injuries on the job
Health care tops in injuries on the job
New push for safe patient handling law
Being a nurse's aide or orderly is the most injury-prone job in America. Those aides are four times as likely to be injured on the job as the average worker, and their rate of injury tops freight haulers and handlers, and construction laborers. It is more hazardous to lift patients than it is to hoist crates or move furniture because many hospitals and long-term care facilities still do not have adequate lift equipment, safety experts say.
The resulting musculoskeletal disorder (MSD) injuries boost the injury tally for general medical and surgical hospitals to the top. They reported 268,800 injuries in 2007, according to the U.S. Bureau of Labor Statistics (BLS) — the highest total of any industry group. While it would be reassuring, at least, if injury rates were declining, the evidence of that is slight. The overall downward trend in work-related injuries is mostly due to changes in record keeping, according to an analysis of BLS data.
"There's an epidemic of health care worker injury in the United States, even with the data we've got — even if you don't correct the inconsistencies in the BLS data," says William Charney, DOH, a national occupational health consultant based in Newfane, VT, and author of The Handbook of Modern Hospital Safety — Second Edition (CRC Press, 2009). "One-tenth of the work force files a workers' compensation claim every year," he reports.
To combat the greatest source of injuries in health care, a coalition has formed to support the federal Nurse and Health Care Worker Protection Act of 2009, or HR 2381. It follows a stream of state laws. In August, Illinois became the 10th and most recent state to enact legislation related to safe patient handling. The Illinois bill, which becomes effective on Jan. 1, 2010, requires hospitals and nursing homes to conduct risk assessments and develop strategies to reduce patient handling injuries. State-by-state efforts have built momentum, but a national law is necessary to create consistency and spur a U.S. Occupational Safety and Health Administration standard, says Marsha Medlin, RN, MPA, founder of the Coalition for Health Care Worker and Patient Safety (CHAPS), president of Safe Lifting Solutions, a consulting firm based in Mechanicsburg, PA, and director of medical products for Ergolet, a patient handling equipment manufacturer based in Minneapolis.
"Historically, I have been against legislating things that should be common sense," says Medlin, who also is a former hospital CEO. "But [progress] has been so slow. We can't let another health care worker suffer a disabling injury. It's up to us to protect them."
Proponents of the new legislation are making their case with data, scientific evidence, and personal stories. They assert that voluntary adoption of safe patient handling has been too slow. In the top 10 occupations with the most injuries and illnesses that involve days away from work, nurses' aides rank third and registered nurses rank 10th. A 2006 Washington state study found that MSD injuries were costing the state's hospitals and nursing homes $32.8 million a year, and that the workers' compensation claims rate was almost four times higher than for general industry.1 When Medlin was vice president of clinical services for a system of about 60 hospitals, she examined the workers' compensation data and discovered that about half of the claims were related to patient handling. She became a proponent of safe patient handling programs, equipment, and training.
Medlin also spoke to injured nurses, which she says was a "humbling experience. They're angry, they're confused, they need help." Medlin herself developed a ruptured disc during a 25-year career, which began as an ICU nurse.
A patient handling standard?
The Nurse and Health Care Worker Protection Act would require the U.S. Occupational Safety and Health Administration (OSHA) to create a patient handling standard, much the way the Needlestick Safety and Prevention Act triggered a revision of the bloodborne pathogens standard. Health care employers would be required to maintain a safe patient handling and injury prevention program, including risk assessment and hazard identification, and "to purchase, use, maintain, and have accessible an adequate number of safe lift mechanical devices." The act also provides for reporting of injuries, training of health care workers, and an annual evaluation of the program. "Some people have asked whether this was an effort to raise the ergonomics standard again. This is not about ergonomics," says Anne Hudson, RN, a back-injured nurse from Coos Bay, OR, who founded WING USA (Work Injured Nurses' Group), a strong advocate of the legislation. "This is about removing disastrous lifting from the backs of health care workers."
The American Hospital Association has opposed the bill as being too restrictive. "Though well intentioned, the measure contained unreasonably strict guidelines that could jeopardize — and even prevent — proper patient care," the AHA said in a position paper.
Health care employers often have the misguided notion that patient safety is a higher priority than employee safety, says Lynda Enos, RN, MS, COHN-S, CPE, nursing practice consultant/ ergonomist with the Oregon Nurses Association in Tualatin. In fact, employee safety also enhances patient safety, she says. The bill provides a framework and an important mandate, she says.
"It's broad enough so it gives the employer some choice as to how they tackle the problem," she says. Politically, it has been overshadowed by health care reform, but proponents point to the coalition as a sign of coordinated support. "No one has listened to us until recently. That's what's changed for us," says Genevieve Gipson, RN, Med, RNC, director of the National Network of Career Nursing Assistants in Norton, OH. "Nursing assistants have been talking about this for years."
With no ergonomics or patient handling standard, OSHA enforcement to reduce the hazards has been minimal. In April 2002, then-U.S. Secretary of Labor Elaine Chao announced a "four-pronged" approach to ergonomic hazards that would include enforcement under the "general duty" clause in the Occupational Safety and Health Act that requires employers to keep their workplaces free of "recognized hazards that are causing or are likely to cause death or serious physical harm." Only 13 citations had been issued to nursing homes or personal care facilities through September 2009 although in 2007 alone, 24,340 suffered MSD injuries that required days away from work. Because the injury rates in nursing homes would have triggered a "disproportionately" high number of inspections under the annual Site Specific Targeting program for high-injury workplaces, OSHA has limited those comprehensive inspections. The cutoff rate of "days away from work, restricted work activity, or job transfer" that triggers the inspection will be 17, compared to eight for manufacturing sites and 15 for nonmanufacturing sites. Three hundred nursing homes will be inspected under the program, a significant reduction from 392 such inspections conducted in 2008.
Meanwhile, NIOSH is trying to focus attention on the hazards of the Health Care and Social Assistance sector through its National Occupational Research Agenda (NORA). "Everybody thinks health care is a safe environment because you're taking care of people, but health care [workers] face many of the hazards that people face in industrial settings," commented Teri Palermo, RN, public health adviser and coordinator for the Health Care and Social Assistance sector at NIOSH in Morgantown, WV.
Specifically, NIOSH is promoting safe patient handling as a part of the curriculum in nursing schools and seeks to link health care worker safety to better outcomes for patients. For example, safe patient handling may mean fewer skin tears and less risk of dropping patients, says Palermo. In the NORA, NIOSH set a goal of decreasing strains and sprains that lead to days away from work by 25% by 2016. NIOSH also hopes to promote a greater safety culture in health care. "A particularly important need is to overcome the misconception that it is appropriate, acceptable, or necessary to risk [health care and social assistance] worker safety and health while treating patients. On the contrary, improving HCSA worker safety and health leads to improved patient safety," NIOSH stated.
Reference
- Silverstein B, Howard N, Lee D, and Goggins R. Lifting Patients/Residents/Clients in Health Care Washington State 2005: Report to the Washington State Legislature House Commerce and Labor Committee, January 2006. Available at www.lni.wa.gov/Safety/Research/Files/HealthCareExecSumm.pdf. Accessed on Sept. 14, 2009.
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