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No work yet on hospital-based guidelines
Employers who want "to do the right thing" to confront musculoskeletal disorder (MSD) hazards can expect more help from the U.S. Occupational Safety and Health Administration (OSHA) with case studies of best practices and increased outreach. Yet for those who haven’t addressed ergonomics, encouragement — not enforcement — remains OSHA’s predominant strategy. For hospitals, an industry with one of the highest rates of work-related MSDs, even the release of voluntary guidelines has not been determined.
Hospitals were among the 19 industries targeted by the National Advi-sory Committee on Ergonomics (NACE) for ergonomic guidelines. But development of hospital-based guidelines has not begun, and it is likely to include all hospital workers rather than focusing on patient handling, says Audrey Nelson, PhD, RN, FAAN, director of the Patient Safety Research Center at the James A. Haley Veterans Hospital in Tampa, FL, and chair of the NACE outreach subgroup.
That broader focus may dilute the impact on nursing and patient handling, where most of the hospital injuries occur, she says. Nelson notes that the Bureau of Labor Statistics has identified nursing as one of the top 10 most hazardous occupations, year after year. "The fact they remain on the list tells me . . . there certainly is room for improvement," she says.
The challenges involved in addressing ergonomics were apparent as NACE completed its two-year tenure, which sometimes was marked by contentious debate. Some ergonomic experts boycotted a symposium hosted by NACE last year; they asserted the panel was just rehashing issues that already had been well studied. Then NACE stalled as it debated the definition of MSDs. Ultimately, it was unable to come to an agreement.
NACE managed to turn controversy into consensus with its recommendations for OSHA to publish resource guides and success stories and support further research. But action on ergonomics will depend upon the new leadership at OSHA.
MSDs remain the No. 1 work-related injury in hospitals. Defining MSDs actually was not a task that had been assigned to the committee, notes chairman Carter Kerk, PhD, PE, CSP, CPE, associate professor in the industrial engineering program at the South Dakota School of Mines and Technology in Rapid City. "In the end, we did unanimously reach consensus on the wording in this document," explains Kerk, who points to the myriad recommendations released by the panel over the two-year period. A full list of recommendations is available at www.osha.gov/SLTC/ergonomics/recommendations.html.)
With no ergonomics standard, OSHA must convince employers that it is in their best interest to implement an ergonomic program. The NACE recommendations focus on this persuasive effort.
Expect more templates of success, including case studies of best practices on OSHA’s web site. Look for more research focused on the benefits of ergonomics.
Some employers won’t implement ergonomics without a regulation, Kerk concedes. But for the majority of companies, better information about cost benefits and best practices will help them make improvements, he adds. "Some of those companies’ [administrators] are going to say, I like those examples; we can do that, too,’" Kerk says. "A lot of things are low cost or no cost. That’s where the biggest impact is going to be in terms of reaching the most workers."
For hospitals, that means molding ergonomic interventions to the needs of different units. "There is not a one-size-fits-all solution for this," Nelson notes. "You end up with a different solution for critical care than long-term care." New nurses also should be taught to expect lift equipment and other tools to reduce their risk of injury, she says.
Critics charge that NACE was dominated by opponents of ergonomic interventions and the panel’s recommendations would have little effect. "It was more of a charade than a real effort to address the staggering number of injuries that workers suffer from the leading cause of workplace injury and illness in the country," says Bill Borwegen, MPH, health and safety director of the Service Employees International Union.
Yet Nelson found some benefit in the makeup of NACE and expressed hope that OSHA would continue to work with stakeholders on ergonomics. "There was a diversity of thinking and backgrounds and approaches, and I think that’s important," she says. "It just mirrored the controversy that’s going around nationally. All the sides were represented."