NurseWeek News

Have you ever experienced a back injury after lifting and turning patients day after day? Or what about a needlestick injury? In fact nurses are exposed to harmful pathogens every time they enter the hospital, and workplace violence is yet another hazard. They’re so busy caring for others that they ignore their own safety and well being — resulting in serious workplace injuries and illnesses.

Working together, Sally Hassert, RN, director of Employee Health, Betsy Sheats, RN, Workers’ Compensation nurse case manager, and nurse practitioner Karen VanVarick-McGuire, APRN, have developed a plan to help prevent and manage employee injuries and illnesses at Saint Barnabas Medical Center, in Livingston, NJ.

The Employee Health Department uses a multidisciplinary approach when it comes to employee injuries and illnesses. Physiatry, nursing, PTs and OTs, safety management, department heads, and employees all brainstorm together about injury prevention and job safety. When an employee is involved in more than one work-related event and losing time from work, the employee meets with the group to discuss his or her own ideas on how to improve the workplace. Job satisfaction and personal issues are discussed with the employee to see if there are ways to improve job performance and eliminate injuries. “When there’s a significant or repeated injury, an independent physical therapist performs a functional capacity evaluation (FCE) to determine whether the employee can return to the workplace. If necessary, the employee may be placed in an alternative position that requires less physical strain. If no appropriate positions are available, the nurse may have to move to another institution within the hospital system or even go on permanent disability,” says Hassert.

Ergonomic worksite evaluation is done if the employee work station contributes to the problem. Knowledge of ergonomics, the science of designing and arranging the workplace to safely and comfortably fit the human body of the workers, is a critical part of any workplace injury prevention program. Occupational health nurses translate these concepts into tangible suggestions that can be easily used, for example, adjusting the computer work stations (positioning of the monitor, chair, keyboard, and mouse) to fit the many needs of the healthcare workers using them. Currently, ITS in the hospital is looking at ways to mount monitors and keyboards on the wall so that they can move up and down to accommodate the nurses using them.

The Employee Health Department works closely with management representatives, the hospital’s Safety and Accident Review Committee, and a consortium of employee health and occupational health nurses representing the Saint Barnabas Health Care System’s facilities. They review employee injuries and study trends, patterns, and precipitating factors before developing remedial plans geared to reducing workplace injuries.

The Employee Health Department team also works to lower the healthcare worker’s risk of exposure to pathogens and needlestick injuries at Saint Barnabas. An estimated 5.6 million workers in the healthcare field are at risk of occupational exposure to bloodborne pathogens, and an estimated 800,000 medical sharps injuries occur each year in hospitals across the country, with nurses sustaining the majority of these injuries.¹

“Every human being is potentially infectious,” says Hassert, and she reminds nurses to use standard precautions, follow the new CDC guidelines for hand hygiene, and dispose of sharps, soiled dressings, and other hazardous materials immediately after use.

To avoid needlestick injuries, Hassert, VanVarick-McGuire, and Sheats emphasize the importance of using equipment and instruments with safety devices. These devices, which include retractable needles, and angiocatheters, butterflies, and lancets with protective sheaths must be activated by the operator if they are to prevent injury.

“Musculoskeletal injuries are the most common types of injury reported by healthcare workers, so we work hard with our staff to help prevent these injuries,” says Hassert. “These injuries can result in modified or restricted duty, time lost from work, temporary disability, and chronic pain.” Stress and strain on the musculoskeletal system leave their mark and RNs who have been in the business of pulling, pushing, and lifting for many years are more prone to injury and illness.

Although roughly 80% of back injuries are short in duration, many work-related musculoskeletal disabilities occur from a series of seemingly minor injuries and are therefore called cumulative trauma disorders (CTDs). Over-exerting the spine by improperly lifting or moving patients over a period of time can cause tiny tears in the spinal disks, eventually leading to a bulging or ruptured disk accompanied by excruciating pain which may radiate down the buttocks and legs. Working in a bent-over position is a risk factor for CTD, and experts estimate that nurses and other caregivers work in this position for up to 90% of their shifts.²

“Besides understanding and using good body mechanics, nurses who hope to avoid back injury should stay in good physical condition, eat a healthy, well-balanced diet, engage in body conditioning and strength training exercises, and maintain a normal weight. And most important of all is for staff to seek assistance from co-workers when necessary,” says Hassert. (See sidebar.)

VanVarick-McGuire says, “Saint Barnabas has a zero tolerance for workplace violence. The ED staff, as well as the security department staff have been instructed to use the BEST program (Behavioral Emergency Safety Teams).” Employees confronted with a potentially dangerous situation are instructed to —

Many nurses instinctively speak to an upset patient or family member in a quiet, respectful voice, validating their feelings while helping them to see that there are other resources and ways to handle a situation beside violence. “Healthcare workers should also avoid using their hands while they’re speaking since this might appear threatening, and should be aware of the environmental situation and avoid letting themselves be backed into a corner,” adds VanVarick-McGuire.

“Many incidents occur because of the human element, when the healthcare professional is rushed, overworked, or so concerned for the patient that his or her own safety takes second place. These are the times to be extra careful, and to be aware of how important it is to take the precautions that can protect you — and your own health and well-being,” says Hassert.

Reduce Risk of Back Injury

When used properly, equipment that minimizes bending, lifting, pulling, pushing, and other ergonomically hazardous activities can significantly reduce the number of musculoskeletal injuries to healthcare providers. Some available equipment includes —

Devices such as shower chairs that can fit over the toilet, eliminating multiple transfers and allowing the patient to be showered, toileted, and transferred back to the wheelchair
Overhead track-mounted patient lifters, lateral transfer devices, mechanical lift equipment, trapeze lifts, and sliding boards
Height-adjustable electric beds, easy- to-slide inflatable mattresses, wheelchairs with removable arms, and roll-on weight scales
Special equipment for bariatric and extremely overweight patients

A number of hospitals have instituted the use of 24-hour lift teams — employees who are specially trained whose sole function is to lift and transport patients. Although this team relieves much of the burden from the nursing staff, further research needs to be done to see whether this is an approach that can be used in most institutions.

Hospitals can increase the scope of their ergonomic programs by educating healthcare workers on proper biomechanics and lifting techniques as a way of preventing injuries.

Editor's Note: For more information on back pain, go to the continuing education article, “Low-Back Pain: The Nurse’s Nemesis,” by Linda M. Lackey, RN, MSN, FNP, at: http://nsweb.nursingspectrum.com/ce/ce283.htm.

Barbara Williams Cosentino, RN, CSW, is a contributoing writer for Nursing Spectrum.

1. Needlestick information. National alliance for the primary prevention of sharps injuries. Available at: http://www.nappsi.org/needlestick.shtml. Accessed October 10, 2003.