See one, do one — and save your back

Training cuts repositioning injuries

The most dangerous patient handling task is also the most frequent – and the most mundane. Nurses and nursing aides reposition patients throughout their shift, and that repositioning often leads to back and shoulder injuries. By focusing on strategies to reduce the risk, Barnes-Jewish Hospital in St. Louis demonstrated that those injuries can be reduced dramatically.

“It’s an activity that’s performed the most often in a nurse’s day,” says Lynn Canada, RN, BSN, worker’s compensation coordinator at Barnes-Jewish, who presented her findings at the fall conference of the Association of Occupational Health Professionals in Healthcare (AOHP). “There’s always some kind of repositioning going on when you’re giving care.”

Shoulder injuries account for about 13% of work-related musculoskeletal injuries among nurses, according to the U.S. Bureau of Labor Statistics. That is second only to back injuries, which represent 53% of MSDs.

Canada began by analyzing the injuries related to patient handling. About 42% of them occurred during repositioning.

Ergonomist Diane Haudrich, CES, then visited high-risk units.” She found that some caregivers were not raising the bed [to allow for proper posture],” says Canada. “They didn’t get help, they just tried to do it themselves. They didn’t ask the patient to assist when they were able.”

The hospital has adjustable beds that are designed to make transfers safer — but the nurses weren’t using those features, Canada says. For example, when possible, nurses could lower the patient’s head to allow gravity to help with the repositioning. (This isn’t possible with patients who have had a stroke or head injury or surgery, she notes.)

Nurses also had placed a quilted pad under patients and were trying to use that to reposition them — even though the quilting made it more difficult to budge the mat (and the patient).

To train nurses in the proper techniques, Haudrich and Canada visited units and piggybacked onto training for new medications or devices. Or they brought lunch for the busy nurses and then demonstrated correct repositioning. For example, they showed how raising the bed to hip level and placing one foot in front of another could allow the caregiver to use the hips and not just the shoulder and back, Canada says.

The results were dramatic. “We had no injuries due to repositioning in the units that participated,” says Canada.

Six months after the training, Haudrich and Canada conducted new observations in the units. The caregivers were still using the proper techniques 80% to 90% of the time.

“It’s been a very successful program,” says Canada, who notes, “It can be done with very little cost.”

Work conditions improve at magnet hospitals

Staffing better, work hours still high

Creating a better work environment for nurses pays off. A new study found that magnet hospitals have better staffing, and nurses who work there have higher job satisfaction and less burnout.

Researchers at the University of Pennsylvania analyzed the surveys of more than 26,000 nurses at 567 hospitals in four states.1 Nurses at magnet hospitals reported a better work environment, based on such factors as support and leadership of nurse managers and nurse–physician relations.

Nurses at magnet hospitals were 18% less likely to be dissatisfied with their jobs and 13% less likely to experience burnout. The number of patients per nurse was significantly lower in magnet hospitals in states without required staffing levels. (California law sets minimum staffing ratios.)

“Three decades of evidence showing superior outcomes for Magnet hospitals place this organizational innovation into a class all of its own as best practice, which deserves the attention of hospital leaders, nurses, and the public,” the authors concluded.

The magnet designation is a recognition program of the American Nurses Credentialing Center, a subsidiary of the American Nurses Association, and is based on such factors as nursing leadership, professional development and quality improvement. About 7% of U.S. hospitals have attained magnet status.

Magnet hospitals do not necessarily correspond with shorter working hours, however. A study of 837 nurses at 14 magnet and 157 non-magnet hospitals did not find a significant difference in work hours, although magnet hospitals had less mandatory overtime, on call duty and physical demands.2


  1. Kelly LA, McHugh MD, and Aiken LH. Nurse Outcomes in Magnet and Non-Magnet Hospitals. J Nurs Adm 2011;41:428-433.
  2. Trinkoff AM, Johantgen M, Storr CL, et al. A comparison of working conditions among nurses in Magnet and non-Magnet hospitals. J Nurs Adm 2010;40:309-315.