With proposed federal legislation in political limbo, too many nurses and their colleagues at the bedside remain at risk of life-altering injuries as they try to care for an increasing population of acutely ill, heavier patients without safe handling equipment.
If change does not come from the top down, perhaps it will come from the bottom up. Some nursing schools have added safe patient lifting equipment to their classes and curricula, creating the expectation that the injury prevention tools and devices will be available when their students graduate and take jobs in the field. And if said equipment is conspicuously absent on their first day of work?
“Our culture is that if they go to work somewhere that doesn’t have the equipment, they should be asking, for safety reasons, why not? They should be assertive and speak up so the facility can really look into this,” says Patricia O’Connor, RN, MSN, CNE, an instructor at Saint Francis Medical Center College of Nursing in Peoria, IL. “It is really not appropriate with the type of patients we are seeing. There are so many acutely ill, obese, and bariatric patients that for safe working conditions it is almost a necessity to have a least some kind of equipment to make the patient more mobile.”
While traditionally, nurses in training may have had access to the equipment as they train at affiliated hospitals, the new approach at some schools incorporates safe patient handling as essentially a standard of care.
“Having the proper equipment as part of the nursing curriculum isn’t so much about preventing injuries to the students — it is about educating the future work force,” says Mary M. Rowan, PhD, RN, CNP, clinical professor at the University of Minnesota School of Nursing in Minneapolis. “Hospitals tell us, ‘Your students show up for the new employee orientation and they know the equipment, they’re ready and they’re on board.’”
No Lifts Used in 8 of 10 Injuries
Unfortunately, these forward-thinking nursing schools are more the exception than the rule, says Kent Wilson, CIE, CSPHP, a certified safe patient handling professional and past president of the Association of Safe Patient Handling Professionals.
“There are some schools that have done that and we applaud them for it, but not enough schools overall are doing that,” he says. “We are hoping that it gets built into the curriculum of all nursing schools so when [nurses graduate] they are familiar with and understand the use of safe handling equipment. We know in the old days they just taught good body mechanics — bend your knees, keep your back straight, that type of thing. We know that doesn’t work. While good body mechanics are important — I am not against good body mechanics, quite the opposite — that in and of itself will never protect you when lifting adult patients.”
The statistics bear him out, as healthcare workers continue to suffer back, neck, and shoulder injuries that threaten their livelihood and quality of life. The CDC found these and other patient-handling injuries accounted for 44% of OSHA-reportable injuries at 112 hospitals in 19 states from January 1, 2012, to September 30, 2014.1 Of all patient handling injury reports, 62% included data on the use of lifting equipment. Of those, a stunning 82% occurred when patient lifting and handling equipment was not used.
The CDC report included 10,680 total injuries, including 4,674 caused by patient handling; 3,972 that resulted from slips, trips, and falls; and 2,034 due to workplace violence. Nurse assistants were more likely to sustain injuries than workers in other job categories, having more than twice the injury rate of nurses for patient handling. Compounding the problem, an ongoing shift in demographics could constrain a needed expansion of the healthcare workforce. To turn the old adage on its head, this trend could result in fewer hands — more work.
“We are seeing patients with acuity levels that continue to go up,” Wilson says. “We see patients in the ICUs that maybe 10 years ago wouldn’t have survived. We see patients that are in the medical-surgical units that would be in the ICUs 10 years ago. So the acuity level has gone up and the weight of patients is going up. We are seeing larger and larger patients, and it kind of creates this perfect storm when you consider the aging workforce.”
Action at the federal level has been stalled, though there is a bill in political limbo that would require healthcare facilities to reduce manual lifting of patients by using safe patient lifting equipment as part of worker safety programs. The Nurse and Health Care Worker Protection Act (H.R. 4266/S. 2408) was reintroduced late last year, but has yet to gain traction in a divided Congress. The American Nurses Association is lobbying for passage of the bill, which was introduced by U.S. Rep. John Conyers (D-MI) and Sen. Al Franken (D-MN). The ANA also is calling for implementation of safe patient handling equipment in more nursing schools and recently published a paper citing strategies to prevent injuries from manual lifting. (For more information, see related story in this issue.)
Will OSHA Fill the Breach?
“The [HCW Protection Act] is still percolating, but it is a political hot potato, so who knows where that is going to go,” says Wilson, who spoke on safe patient handling recently in Myrtle Beach, SC, at the annual conference of the Association of Occupational Health Professionals in Healthcare. “OSHA has been using the general duty clause to cite hospitals from an ergonomic perspective.”
Indeed, OSHA announced an emphasis program last year that addresses several areas of safe patient handling. (For more information, see related story in this issue.) Still, some question whether the agency has the manpower and political will to really turn the tide on the long-standing issue. When OSHA enacted ergonomic injury protections in a short-lived standard, the agency was promptly defanged by Congress in a 2001 vote that negated the rule.
“When the ergonomic standard came out — it was on the books for three months before it was repealed — the argument was that it was going to be extremely costly and that type of thing,” Wilson says. “Some of the same arguments are discussed now, but I think with patient handling the risk factors are much more clearly defined. There is not really an argument about what the risk factors are. The only argument is what is the best way to control it.”
A report issued last year by watchdog group Public Citizen concluded that despite widespread support for safe patient handling programs by OSHA, NIOSH, healthcare associations, and labor unions, “industry representatives reject regulatory proposals to reduce injuries to healthcare workers, [and] they also oppose proposals aimed at improving reporting of workplace injuries.”2 Despite the resistance, 11 states have enacted safe patient handling or regulations of some type to address the issue, but again, there are questions about the resources needed to inspect and ensure compliance.
“It is extremely frustrating when we see that there are hospitals that have very robust programs and they have been able to reduce their injuries to nurses by a significant amount — 80% and 90% compared to the baseline,” Wilson tells Hospital Employee Health. “Other hospitals just kind of dance around the edges of this and are excited about a 10% reduction — that could just be a statistical anomaly. We need to really see hospitals take a more aggressive approach.”
Hospitals may be understandably resistant to mandates for specific equipment and policies, but if lifting equipment is purchased as part of a comprehensive program, worker protections and cost savings can ultimately result.
“If it is just purchasing equipment — if you don’t have a program and the policies and procedures — then I would tend to agree with hospitals that it’s not going to work,” Wilson says. “You have to implement a plan on how you’re going to use the equipment. What type of equipment and where is it going to be deployed? What training is involved? The caregivers need to understand not only how to use the equipment, but how you are going to deploy the equipment.”
In the interim, employee health professionals may face entrenched opposition to purchasing the equipment, which can include slings, ceiling lifts, and hydraulics to help patients stand.
“The sad part is that the vast majority of hospitals don’t have a robust program,” Wilson says. “They treat it as kind of an afterthought, or they have bought some equipment but they have no program. Some hospitals have purchased equipment but they have yet to implement a plan, so it quickly migrated to a closet storage room and that’s where it has been sitting. [OSHA] is emphasizing a programmatic approach, which is do your risk assessment and make sure you develop policies and procedures that are clear, precise, and consistent. You have something to hold people accountable to.”
The Business Case
Regardless, it makes business sense to use the equipment and avoid the injuries, as an accumulating body of research has shown. A key driver of the adoption of patient safe lifting equipment at St. Francis was that new nurses were incurring injuries when they left school and began working at the medical center, O’Connor says.
“One part of it was really financial-driven,” she says. “Hundreds of thousands of dollars were going into rehabilitation, medical bills, and facilitating people being off — everything that is entailed when a worker is injured. It was a large financial burden to the medical center, and those numbers kept increasing.”
Research shows that an initial investment in “safe patient handling policies, programs, and equipment can be recovered in fewer than five years,” OSHA emphasizes in a report3 that cites several specific programs and the attendant return on investment. According to the agency, employee health professionals trying to make the business case to justify purchase of lifting devices should compare the cost of the equipment with the amount the facility pays out annually in workers’ compensation claims. In addition, include indirect costs like staffing, overtime, turnover, and reduced productivity. Include data on improved patient care in like reduced falls and pressure ulcers. Estimate the percent reduction in patient handling injury costs expected over time as a result of a safe patient handling program. For example, an $800,000 investment in a safe lifting program at Stanford University Medical Center saw a five-year net savings of $2.2 million. “Roughly half of the savings came from workers’ compensation, and half from reducing pressure ulcers in patients.” OSHA reported.
The patient safety component is a point of emphasis for safe lifting advocates, who argue that vulnerable workers put those under their care at risk.
“We emphasize this to hospitals because we know that patient safety is their No. 1 priority,” Wilson says. “The edict within healthcare is to do no harm, but as I tell administrators, it is impossible to accomplish that task if you’re not addressing the safety of the caregivers that take care of them. When you think about it, it is the same event, the same activity, the same circumstances. If the caregiver is not safe, the patient is not safe.”
- Centers for Disease Control and Prevention. Occupational Traumatic Injuries Among Workers in Health Care Facilities — United States, 2012–2014. MMWR 2015:64(15);405-410. http://1.usa.gov/1JKjtd5.
- Public Citizen. Little Support From Above: Health Care Industry Leaders Neither Endorse Nor Suggest Proposals to Address the Epidemic of Patient Handling Injuries. July 8, 2015: http://bit.ly/2cfio6W.
- OSHA. Safe Patient Handling Programs. 2013: http://bit.ly/2drjha9.