The Association of Occupational Health Professionals in Healthcare (AOHP) is updating its guidance on ergonomics for new employee health professionals, emphasizing the basics while providing links to key resources.
“Ergonomics is very important, and I am committed to it. It has been part and parcel to my own practice,” says the author of the new guidance, Alfred Carbuto, MS, RN-BC, FNP, COHN-S, nurse practitioner in the Occupational Health Service at Montefiore Medical Center in New York City. “This will explain ergonomics for folks just entering the field.”
Expected to be issued this fall, the update will reference the Occupational Safety and Health Administration (OSHA), which defines ergonomics as “the science of fitting the job to the worker. When there is a mismatch between the physical requirements of the job and the physical capacity of the worker, work-related musculoskeletal disorders (MSDs) can result.”1
When looking at healthcare worker injuries, consider whether the work practice played a contributing role and how that may be mitigated.
“If you are seeing injured people, evaluate the injury and develop prevention measures,” Carbuto says. “We don’t want to fix broken people. It is better to prevent the injury.”
That said, ergonomics goes beyond just “being careful,” becoming part of a work culture to the extent it is emphasized and practiced.
“I think there has to be manager or corporate commitment to it, to data-gathering and breaking that down into different categories of injuries,” he says. “I’ve been gathering data for years on injuries from falls, strains, contusions. Ergonomics is certainly as important now as it was when it was first brought up 20 years ago.”
OSHA calls for assessment of work tasks that includes looking at factors like duration and frequency in light of known ergonomic stressors like force and repetition.
“About two years ago they tasked all employers with checking all walking surfaces to assess for hazards,” Carbuto says. “Employers have to be proactive. Don’t rely on data from injured employees, but go out to look at potential hazards.”
Depending on the organization, employee health professionals may or may not be involved in these assessments.
“Even though an occupational health professional may not provide the direct evaluations, they will certainly be called upon as a referral when an employee comes with a complaint of some situation or awkward posture,” he says.
At a minimum, employee health needs to be able to make the correct referral for ergonomic issues that go beyond the scope of their department.
“If their program doesn’t provide that service, then who in your institution would be the resource person like an ergonomist or an industrial hygienist?” Carbuto says. “I think each place is going to be different, but the employee health professional has to be versed in this, at least, and find out who will be doing this if not them.”
In general, many ergonomic injuries in healthcare could be prevented, says Laura Punnett, ScD, co-director of the Center for the Promotion of Health in the New England Workplace at the University of Massachusetts in Lowell.
“The need is enormous,” she says. “These are the predominant type of injury in the healthcare sector. They very much impact direct care providers such as nurses, nursing aids, orderlies in hospitals, and other sectors like nursing homes.”
Hospital Employee Health asked Punnett to comment further on this issue in the following interview, which has been edited for length and clarity.
HEH: Given the ergonomic injury levels cited, there seems to be a need for more understanding of the scope of this problem and how to prevent it.
Punnett: There is a tremendous amount of research and yet the problem is not going away. There is a gap between what we know scientifically and what is being done in practice. There has been quite a lot of research documenting the magnitude and the relationship between these disorders and patient-handling demands. Other factors you could look at as upstream determinants — the amount of patient handling, for example, and nurse-patient staffing ratios.
There is the direct cause — the biomechanical effects — and then preceding that there are these organizational issues that to some extent dictate how much of that exposure each individual nurse has. There are also intervention studies evaluating the effect of introducing multicomponent safe patient-handling programs. These have a very real benefit in reducing the incidence of problems, and the costs and the amount of time that nurses are off work. That, in turn, impacts staffing ratios until they are back at work.
HEH: In terms of safe patient-handling programs reducing ergonomic injuries, is it primarily an issue of acquiring the lifting equipment?
Punnett: I would certainly say that having good patient-handling equipment would be a key element to a program, but it is not sufficient. There are many stories of equipment being purchased and then not being used for a variety of reasons. It may be in the back of the linen closet, or the safe way of using it may require two people.
Sometimes, these are emergency situations where there is a patient on the floor and we have to get them up, so nobody had time to go get the lift. It is much more often things like the battery isn’t charged, or the nurse can’t find a clean sling. These “administrative” aspects of the program, if not taken seriously, will lead to the equipment not providing the benefit that it ought to.
Another issue is that patients are becoming heavier, so some equipment is not safe to use for very overweight patients. You need a variety of equipment available, and that can cause issues for storage space, which is always at a premium. The really convincing studies show that multicomponent safe patient-handling and movement programs are the ones that stand out. They incorporate the procedures and protocols for all of these issues that will affect whether the equipment is actually used once it is purchased.
HEH: What about moving patients in bed, which can lead to musculoskeletal injuries?
Punnett: There are times when alternatives are possible. For example, when moving a patient in bed, a whole-body lift isn’t necessarily the device that you want. A frictionless sheet or slide board can be a low-tech, easily available device. This is one of the activities where nurses do get back injuries.
It is not only lifting people out of a bed or out of a wheelchair — leaning into the bed to push and pull and turn someone can also put a huge strain on the lower back biomechanically. We have the technical research to show this. There are a variety of technical solutions, but we can’t ignore the importance of the whole-body lifts for the patients who are bedridden.
HEH: Is it difficult to convince administrators of the value of preventing ergonomic injuries?
Punnett: It is really not. There are studies showing a fairly quick return on investment for a program that is implemented well. I think it is not so much resistance as lack of awareness. This is the gap I was referring to between the research and practice. That is really the gap we are trying to meet.
- OSHA. Healthcare-wide Hazards: Ergonomics. Available at: https://bit.ly/2I8UYN1.