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The rate of back injuries among nurses is soaring—and inexcusable.
I write this in pain. I’ve had back problems since my early days in nursing, but this flare-up is from shoveling snow for only 10 minutes three days ago.
I had been taught proper body mechanics in nursing school in 1967, and I took pride in my strength and fearlessness in lifting and transferring patients with little help from colleagues. Perhaps it’s the result of one too many fearless lifts, but over the past few decades I have had a bout of immobilizing back pain at least annually. I’m not alone; 47% of nurses experience job-related back pain each year.
This month, AJN publishes the first of two provocative articles by Audrey Nelson and colleagues. Nelson, a nurse researcher at the James A. Haley Veterans Administration Medical Center (VAMC) in Tampa, Florida, directs the Patient Safety Center of Inquiry there and is a pioneer investigator of the safe handling of patients—safe for patients and for nurses. In investigating how nurses should move patients without injury to either party, she and her colleagues have revolutionized that institution’s approach to patient handling. The VAMC now serves as a model for every institution seeking to institute a “culture of safety” in which injuries and disabilities to nurses and patients are reduced, as are the associated costs resulting from treatments, lost work time, and lawsuits.
Certain facts Nelson presents stunned me. Did you know that countries such as the United Kingdom have national no-lift policies for all institutions? How can you not lift patients? Nelson proposes that institutions in this country adopt such policies. She knows that such policies depend on the existence of appropriate infrastructures, including the availability of mechanical lifts and the algorithms that would help nurses use them correctly. Next month in AJN, Nelson provides algorithms that nurses and institutions can use to guide decisions as to what equipment to use and how many people are needed for each patient’s lift or move. Also, Nelson shows that such equipment is not more costly than back injuries are to institutions.
Perhaps I was most stunned by her argument that teaching body mechanics to nurses and nursing students doesn’t prevent back injuries. When I first met Nelson, she said that body mechanics was a concept initially tested on men lifting stationary boxes with handles from the floor—a scenario so contrary to what nurses do I laughed out loud. She points out that most nurses are women and that women and men often have different upper body strengths. Also, nurses rarely lift stationary objects with handles from the floor. Unless dead or comatose, a patient is likely to be moving, perhaps in pain. Mostly, a nurse lifts and transfers a person who may be resisting, requiring that she twist her body in ways that men lifting boxes seldom need to.
So why are nurse educators and staff development personnel continuing to teach body mechanics? Because until now most experts believed it prevented back injuries. The next generation of nurses would be better served if they were taught instead to interview selectively for jobs, inquiring whether a facility has a no-lift policy and the infrastructure to support it, including the proper equipment.
Read this issue’s “Myths and Facts About Back Injuries in Nursing” (page 32) and next month’s “Algorithms for Safe Patient Handling and Movement,” and share these articles with your colleagues and administrative personnel. If you’re part of a union, why not negotiate with your institution to adopt and implement a no-lift policy, using the VAMC as a prototype? If you’re not part of a union, offer to form a task force that would begin to investigate the issue. In either case, work with your institution to purchase and maintain proper lifting equipment.
Nelson’s work has shown me that my back injuries early in my nursing career were most likely the result of two things: my own failure to assess critically what was needed for the safe handling of each patient and the institution’s failure to provide the proper “culture of safety.” Ignorance was the excuse decades ago. There is none now.
