Health care tops list for MSD injuries

States consider bills on patient handling

More than 8,800 nurses suffered from a back, shoulder, or other musculoskeletal disorder (MSD) injury in 2004. Once again, nursing was among the top 10 occupations for MSDs, with more nurses suffering debilitating injuries than carpenters, meatpackers, mechanics, and many other manual laborers.

On average, they lost a week of work due to MSD injuries.

The numbers from the U.S. Bureau of Labor Statistics actually represent only a portion of the true burden of patient handling injuries, says Audrey Nelson, PhD, RN, FAAN, director of the Patient Safety Research Center at the James A. Haley Veterans Hospital in Tampa, FL, who found in one study that nurses often use sick leave or vacation time to recuperate from a sore back rather than reporting a work-related injury. Nonetheless, that serves as a wake-up call to America's hospitals to address a serious hazard.

"Health care is a very high-risk occupation," Nelson reports. "RNs, LPNs, and nursing assistants have been on the top 10 list since the [MSD data have] been reported. They're the only occupation that has remained on the list over the entire period of time. While we're making progress and implementing [interventions] in hospitals, it's long overdue and still is not enough.

"What's happening is that nurses can't have a full career," she says. "When they reach their 50s, they start to question whether they want to go home so sore and tired each night."

The nursing shortage has prompted hospitals and policy-makers to address patient handling risks. Five states are considering ergonomic legislation this year, including Washington, which has a bill that would require hospitals to establish a safe patient handling committee including frontline health care workers and to develop a program that incorporates a no-manual-lift program, assessment of hazards, and training of workers.

MSDs have declined in health care in the last five years, thanks to investments by some hospitals and nursing homes in patient transfer equipment and safe patient handling programs.

But the rate of decline is roughly the same as for general industry. Hospitals have a rate of MSD injuries that is almost twice as high as that of the general industry (87.7 per 10,000 full-time workers compared with 45.2). Together, nursing homes and hospitals represent 15% of all MSD injuries.

Meanwhile, the U.S. Occupational Safety and Health Administration (OSHA) has relied almost exclusively on voluntary compliance in the hospital sector. From 2002 to 2005, 66 hospital inspections included a review of ergonomics, but none resulted in a citation related to ergonomics. The agency issued one hazard alert letter to a hospital.

Because there is no ergonomics standard, OSHA citations must be based on the "general-duty clause" that requires employers to maintain a workplace free of serious hazards.

OSHA's acting administrator, Jonathan Snare, asserts that the agency's "comprehensive approach" to ergonomics is working, with enforcement, consultation, and outreach. "Separate and apart from the enforcement component, we have a large number of alliances that focus on addressing ergonomics hazards," he says.

Those programs don't produce the rapid change that is necessary, contends William Charney, DOH, a national consultant based in Seattle and author of seven books in hospital occupational health. "Voluntary programs do not come anywhere close to keeping up with the injury rates," he says. "We just have to eliminate manual lifting."

Worker advocates hope to create momentum with ergonomic legislation, similar to the pattern that occurred with needle safety. California was the first state to require comprehensive needle safety, but dozens of other states followed. Eventually, Congress passed the Needlestick Safety and Prevention Act in 2000.

Last year, Texas became the first state to require hospitals to have a safe patient handling program. California passed a statute in 2005 that would have required hospitals to adopt a "zero-lift" policy, but it was vetoed by Gov. Arnold Schwarzenegger. In his veto message, he cautioned, "If hospitals do not initiate these measures on their own, I will be willing to consider legislation next year that imposes the mandate."

A similar bill, which requires a zero-lift policy and the use of lift teams and lift equipment, has been reintroduced in California.

"We see this as the next big issue in the health care sector," says Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU). "There's no reason to continue to cripple nurses and other health care workers when we know there are feasible, cost-saving strategies to prevent this epidemic."

Meanwhile, hospitals need to recognize the substantial benefits of safe patient handling programs in lower medical and workers' compensation costs and greater retention and recruitment of health care workers, says Nelson.

It will take an upfront investment in equipment and training. But the payoff won't occur without that, says Nelson.

"In my experience, hospitals that do it partway see a 30% reduction in injury over a short period of time; but [the injury rate] peaks up again and [improvements are] not sustained," she says. "You can't take a problem that's costing huge amounts of money and throw a dollar or two at it and expect it to be fixed. Big problems require big dollars to be fixed."