States putting teeth into safe lifting standards

Washington, Texas enact safe patient lifting laws

Washington state's new law mandating hospitals provide mechanical lift equipment to safely move and position patients is just the latest sign that nurses are taking charge of their ergonomic health.

Health care workers perennially rank among top occupations for work-related musculoskeletal disorders, and back injuries are among the most common. Frustrated by federal ergonomics guidelines with no teeth to push employers to comply, nurses have taken their cause to their state legislators, who have been sympathetic. Washington's Safe Patient Handling law, signed into law in March, is the first legislation in the nation to require hospitals to provide mechanical lift equipment for the safe lifting and movement of patients.

Nurses say the Washington law will protect patients from unintentional pain and injury, as well as protect the nurse from acute and chronic muscle and joint pain cased by repeatedly lifting and positioning patients, some of whom far outweigh the nurse.

"I was just reading that nurses, during a typical eight-hour shift, lift a cumulative weight of 1.8 tons," says Susan Randolph, MSN, RN, COHN-S, FAAOHN, president of the Atlanta-based American Association of Occupational Health Nurses. "It's astounding. It's a cumulative thing — you may find yourself repositioning or turning a patient several times a day, so many times a week, and it adds up."

A survey conducted by the American Nurses Association (ANA) showed 52% of nurses have complained of chronic pain lasting more than 14 days within the six months prior to the survey, and 12% are forced to quit nursing each year due to chronic or acute back pain or injury.

"Health care lags way behind many other industries as they have mechanized to remove the causes of acute and chronic back injuries," according to Judy Huntington, MN, RN, executive director of the Washington State Nurses Association (WSNA). "These injuries not only lead to higher workers' compensation and insurance costs, but also drive many registered nurses out of direct patient care."

According to the Occupational Safety and Health Administration (OSHA), nursing homes and personal care facilities have one of the highest rates of nonfatal injury or illness cases in the United States, at more than 14 injuries for every 100 full-time workers — more than twice the incident rate for the health care industry in general. OSHA data say just more than half of those injuries occur when caregivers are lifting, moving, or repositioning patients.

This presents a lose-lose situation, says Barbara A. Blakeney, MS, APRN, BC, ANP, president of the Washington, DC-based American Nurses Association. "These statistics tell us two things — that poor ergonomics hurts nurses, who are choosing to leave the profession rather than suffer unnecessarily, and that poor ergonomics hurts patients."

Indeed, proponents of the bill say even the cost involved in purchasing and maintaining mechanical lifting aids is likely to prove cost-effective when hospitals and nursing homes see a drop in absenteeism and turnover due to injuries, according to the president of the Washington State Hospital Association.

"Making sure patients are lifted and transferred safely, keeping staff healthy, and reducing staff injuries are very important to hospitals, and we cannot afford to have injured or absent staff because of improper lifting," points out WSHA president Leon Greenwalt.

Nurses have long led the campaign to draw attention to the risks posed by musculoskeletal injuries in their profession, but lately have taken that fight a step further, into state legislatures, where they have been successful in getting ergonomics protections enacted into law in several states, with several more in the process of weighing bills.

"It's gaining momentum," say Randolph. "It's difficult to get legislation passed. There have been attempts to have legislation passed on the federal level, but ergonomic standards were not real successful, so the other tactic was to have states look at the problem on a state-by-state basis."

Cost of lifts

The ANA took the lead a couple of years ago when it launched "Handle with Care," its patient lifting safety campaign. The campaign's main point is that musculoskeletal injuries don't have to happen, and are far less likely to happen if the right equipment is in place.

The cost of the mechanical lifts is, of course, a point of debate, and the Washington patient safety act addresses that by offering to subsidize some of the equipment. But Randolph says besides employer reluctance to sink money into the equipment in the past, another holdup was the equipment itself not being viewed by nurses as particularly helpful.

"In the past, there were a few kind of equipment, but they were hard to use; the patients didn't feel particularly safe in them, and both the nurse and patient could get injured," recalls Randolph. "The equipment that is out there now is a huge improvement."

Newer versions of the old, bulky, awkward patient lifts are lighter weight and portable from room to room. Randolph says they offer greater protection to patients and, because they function more smoothly and easily, the process is more dignified for the patient.

"It's a win-win. For the nurse, you have protection and reduced workers' comp and disabilities, and for the patient you have a safer move and repositioning, without the worry of 'Am I going to get dropped?'" she adds.

Under the new legislation, Washington hospitals have three years to implement safe patient handling policies and acquire mechanical lifting aids.

Push for safe handling gaining momentum

The ANA's Handle with Care campaign is a collaboration among the ANA, other nursing and specialty organizations, the research and academic community, and health care systems to prevent back and other musculoskeletal injuries through greater education, training, and increased use of assistive equipment and patient-handling devices. The campaign also seeks to reshape nursing education and federal and state ergonomics policy by highlighting the ways in which technology-oriented, safe-patient-handling techniques benefit patients and the nursing work force.

"While it is encouraging that the federal guidelines explicitly recommend elimination of manual lifting, they are not mandated and are not enforceable," Blakeney explains. "We had to do better than that. What we need is another strong federal ergonomics mandate, and the Handle with Care campaign will help in achieving this goal."

The National Institute for Occupational Safety and Health recently released new guidelines and a nursing education curriculum titled, "Safe Patient Movement and Handling," designed to cut the number and severity of health care musculoskeletal injuries and reduce the vulnerability of patients to injuries that can be incurred when they are moved. According to NIOSH, the program is already in place at 26 U.S. nursing schools.

"The Washington safe lifting law addresses a number of issues, including the aging nursing population and the aging patient population and the increased problem of obesity," she explains.

While Washington is the first state to require safe lifting instruments to be provided for health care workers' use, Texas in 2005 became the first state to require hospitals and nursing homes implement safe patient handling and movement programs.

The Texas law took effect Jan. 1, and like the Washington law, received important backing from the state nurses association. Texas' bill discourages, but does not prohibit, manual lifting of patients.