It’s fair to assume that most nurses don’t get into the profession because they’re danger seekers.  Sure, they’re aware of the inherent risks involved with handling needles and dealing with the sometimes unpredictable behavior from patients.  But an oftentime ignored fact is that Nursing is one of the riskiest occupations in the US for back injuries, and has the second highest incidence of all types of non-fatal work related injuries across any job or industry in the US.

Think about that....according to statistics, a nurse is more likely to be injured on the job than a construction worker, a coal miner, or even an alligator wrestler (well, maybe not). 

The danger is even more severe for Nurses and Aides (especially) working in nursing home and acute-care settings, where patients are the most dependant.

The biggest driver of non-fatal work related injuries for Nurses and Aides?  Back injuries, including strains and sprains.  Manual lifting and patient handling tasks are high-risk activities for both nurses and patients.  And a rising rate of obesity in the general population increases the risk to RNs and healthcare workers charged with handling people. 

One article – here - and "Safe Patient Handling and Movement", by Audrey Nelson (buy here) - frame up the situation with amazing clarity, and include some depressing statistics from research studies, outlined here:

• In 1989, the number of reported injuries and illnesses in the health care industry surpassed for the first time the rate for all private industries, and it has remained one of the most hazardous ever since.
  
• Hospitals top the list of industries reporting more than 100,000 injuries. In 2005, the illness rate of hospital workers was 66.2 cases per 10,000 full-time workers compared to 26.7 cases for all private industry.
  The 2000 incidence rate for back injuries involving days away from work was 181.6 (per 10,000 full time workers) in nursing homes and 90.1 for hospitals.  Compare those numbers to incidence rates for truck drivers (98.4), construction workers (70.0), miners (56.3) and agricultural workers (47.1).
  
• Nursing homes, where nursing assistants provide the bulk of the care, are consistently among the most hazardous workplaces. In 2005, it ranked second only to manufacturing in percent of nonfatal workplace injuries.
  
• The weight of adult patients who required lifting (in one study) ranged from 81 to 387 lbs, and averaged 169 lbs.  Given that on a typical shift, on average an RN will lift 20 patients into bed, and transer 5-10 patients from a bed to a chair, this load can be a major danger.

Many in the industry are running around trying to figure out how to change this.  As a Nurse, you should know what’s being done and what you can do all by yourself to prevent injury.

WHAT’S BEING DONE

• Some hospitals are testing ceiling-mounted mechanical lifting devices designed to reduce manual patient handling.  The idea is, obviously, to let a machine do the work for you.  (These devices are expensive and cumbersome, and most facilities have not ponied up the money to purchase, despite case studies that show incidence of injuries was reduced by 60% - 95% when such equipment was used.)

• Hospitals are assessing the ergonomics of the patient-care environment.  In other words, they are trying to ensure that the RN’s workplace is as back-friendly as possible.

WHAT YOU CAN DO
Clearly the suits recognize the problem and are trying to make adjustments.  While that’s all nice, the question still remains what can you do as an individual today to make a difference?  You don’t control the hospital’s finances or make budget decisions, but you can control your own body.

No, this recommendation isn’t simply to maintain proper lifting mechanics.  Everybody knows that.  Actually, most recommendations related to proper lifting mechanics in the nursing environment are minimally useful, at best.  Most ‘proper lifting mechanics’ recos use a large box as the example guide.  As any Nurse knows, patients aren’t large boxes with handles on the floor.  They move around, slip and resist.  They need to be moved from a horizontal plane to a vertical plane, and sometimes there is not an abundance of space in the room.  Repositioning them on a bed or stretcher requires use of the arms and shoulders, much smaller and weaker muscles than the legs (which would help lift the ‘box’).  The old ‘bend with the knees, not with the back’ adage is nice and cute, but not realistic for Nurses.

We believe your best bet it a blended approach.  Understand the theory behind proper lifting mechanics, take full advantage of ANY and ALL mechanisms and lifting devices the hospital has at your disposal, accurately assess in advance exactly what is needed to move the patient, pair up with and solicit help from a fellow RN, and exercise with weights on an uneven surface to encourage your body to adapt and adjust to changes to prevent injuries.  The fancy name for this is Proprioception Training – you can Google it and find lots of techniques.

Specifically, you want to strengthen your Core muscles.  Link to our article for advice and workouts here.  Remember though, as the article will point out, reducing back injuries is NOT just about strengthening your back.  Pounding out lower back raises day after day is unsafe and will lead to injury (as will doing nothing at all).  A proper Core workout, incorporating Proprioception Training, recruits muscles all throughout your mid-section, and will ensure your body is better prepared for the heavy, sharp, odd and off-balance movements required to move and care for patients.

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