When employee health leaders envision daily challenges for health care workers, desk work typically is not at the top of the list. Yet, some workers, including nurses, spend plenty of time sitting at a desk, increasing repetitive stress injuries and risk for chronic illness.
Plus, every hospital has a large contingency of office support staff whose work primarily involves sitting, keyboarding, answering phones, or handling patients. These employees are at risk of so-called “sitting disease,” shorthand for an overly sedentary lifestyle that negatively impacts health. It is viewed by medical researchers as a risk factor for obesity, high blood pressure, diabetes, cancer, depression, and other health problems.1
Ergonomics has evolved in health care settings in the past decade, but facility changes have not always kept up.
“It’s been a challenge, particularly for facilities that have made rather rapid transitions to electronic medical records and put computers in a lot of places that never were intended for computers to be,” says Rick Barker, MA, CPE, senior consultant at Humantech in Cincinnati, OH.
“Or even when the change wasn’t so rapid, the hospitals have these old work stations built 10 or 20 years ago before they considered electronic medical records, and these areas are not really suited to the specifics of using the computer,” Barker says. “This creates extra challenges that facilities that were planned around the computer do not have.”
Nurses are less at risk for sitting disease than other health care workers, such as unit clerks and secretaries and admissions and triage staff, Barker notes.
“They’re sitting at the desk the entire day,” he says. “They don’t get up and down like a nurse does, so they’re much more vulnerable to sitting disease issues than a nurse would be.”
While front desk staff and assistants are most at risk of injuries related to long hours sitting at a desk and using computers, nurses also can develop health problems resulting from too many hours sitting.
“We’ve found that a nurse typically spends 35% of the day doing clinical documentation,” says Steve Reinecke, MT[CLS], CPHIMS, assistant vice president at Ergotron Healthcare in Minneapolis/St. Paul, MN.
The Centers for Disease Control and Prevention has a “Take-a-Stand Project,” initiated to suggest strategies for reducing health problems associated with sitting disease. One of the project’s suggested solutions is for organizations to install work stations that encourage standing. Implementation of these changes in a pilot study showed 66 minutes per day reduction in sitting time, and workers had a 54% reduction in upper back and neck pain.1
Is there a light at the end of the carpal tunnel?
In addition to sitting disease, there are common ergonomic injuries that can occur to any employees – including nurses – who use computers.
Carpal tunnel syndrome is one of the most common injuries that occur as a result of desk work, but it’s not the only one, says Margaret Senn, MS, RN, informatics nurse specialist at the Mayo Clinic in Rochester, MN.
“Anytime you have repetitive use there’s a potential for injury, and some people are more prone to develop an injury than others,” she says.
Handwritten notes and charts have nearly disappeared. Their electronic record replacements are more efficient, but also increase the risk of repetitive stress injuries, Reinecke says.
“From everything I’ve observed, nurses now spend more time charting than they did before electronic health records,” Barker notes. “It’s not just that it’s so much worse, but it’s also that they spend so much more time doing it, and if you’re spending twice as much time doing something then that’s twice as much wear and tear.”
Some hospitals require record updates at point of care, which can lead to back injuries as nurses and other workers lean over work carts to update tablets and electronic charts.
“How do you address issues related to the nurse who is 4 foot, 8 inches and the nurse who is 5 foot, 11 inches?” Reinecke asks. “The tall nurse might be leaning over, looking down, and getting neck pain.”
Work stations typically are fixed stations used by many different people throughout the day. Without adjustability, it can create ergonomic issues for staff, Barker says.
“There are a couple of things that can be done to help a great deal without substantially adding to the expense,” Barker adds. “One is to make sure chairs are easily and sufficiently adjustable, and you can even provide visuals on how to adjust them.” (See story on simple ergonomic changes, p. 8.)
When first using mobile work stations, the Mayo Clinic found they were not very adjustable and caused problems, Senn says.
“We had more problems with nurses who were tall,” she explains. “The monitors would be lower than they would have liked.”
After soliciting nurses’ feedback on feasibility, the hospital system made some changes that solved various complaints, including height and lighting at work stations, she adds. Work carts now are height adjustable so nurses can lower or raise these to a comfortable level, Senn says.
“Our night shift was concerned about having to use computer screens in a dark room, so we came up with a solution where we had small lights that wouldn’t disturb patients, but would allow them to see their keyboards,” she says.
Nurses cite staffing needs
Ergotron Healthcare conducted a survey of full-time nurses, asking about how on-the-job technology impacted their physical health and comfort. Most — 81% of the 250 nurses surveyed — used standard desktop computers. Laptops, smart phones and tablet devices also were used.
The findings showed that nurses felt their health would improve with increased nursing staff to alleviate workloads and with a redesigned physical space within patient rooms and on floors.
The nurses surveyed reported back pain, exhaustion, and sore necks as their most common discomforts in the past year. More than one-quarter of nurses suggested they would like a dedicated ergonomics team to ensure equipment is ergonomically supportive to staff. 2
While replacing all work stations might not be an economically feasible solution for most hospitals, there are other ways employee health can help staff prevent injuries.
For instance, the Mayo Clinic makes sure desk workers have adjustable chairs with proper lumbar support, Senn says.
“They need to be adjustable because with different shift changes you have different sized people using them,” she explains. “We have chairs that support elbows, and all chair arms are adjustable, as is the height of the chair.”
Employee health also can suggest behavioral changes, including teaching staff how to prevent flexing their wrists at the keyboard, which can reduce carpal tunnel risk, she adds.
Staff diagnosed with carpal tunnel can wear wrist bands while they work. If a worker reports an injury related to desk work, or if a supervisor observes a worker in pain, then this worker is given an ergonomics evaluation. A specialist will watch the person work to see if the desk and chair are set up optimally, Senn says.
Following the formal assessment, any identified risks and/or concerns are shared with the worker. Recommendations to mitigate the risk and concerns are provided to the worker. Then the worker is provided any needed special equipment, such as standing desks and cushion mats.
“Ergonomics is very important for our staff,” Senn says. “We have stretching diagrams in some of our offices, encouraging workers to stand, rotate their necks, bend, stretch, and walk around during their shifts.”
- Pronk NP, Katz AS, Lowry M, et al. Reducing occupational sitting time and improving worker health: the Take-a-Stand Project, 2011. Prev Chronic Dis 2012;9:110323.
- How digital healthcare helps and hurts nurses. Ergotron survey conducted by GMI Research from March 21-28, 2014. Published online at ergotron.com/portals/0/literature/other/ErgotronNursingReport.pdf.