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Implementing Zero Lift  Discussion Forum

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"Stoic Disintegration" by R.V. Rhoads.
Used with permission from the artist.  Unauthorized use prohibited.

"Stoic Disintegration" represents the pain and personal struggles of suffering a severe back injury on the job, being terminated because of the resulting disability, the two spinal fusion surgeries necessary after the injury, and coping with the disappointment of an employer that failed to provide compensation for the loss. 

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Work Injured Nurses' Group Discussion Forum of WING-USA

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Dear Readers,

Welcome to the Work Injured Nurses’ Group Discussion Forum, offered in hopes of bringing information and mutual support to nurses injured providing care to others.  Back injury from lifting patients removes more nurses from the bedside than any other kind of injury.  Nurses may suffer a variety of other work-related injuries and illnesses as well.  This forum is provided for any injured or ill nurse who wishes to participate. 

After suffering a work-related spinal injury myself, I discovered what appears to be a general disregard of the needs of work-injured nurses.  That many nurses lose their physical and financial well-being to largely preventable patient handling injuries appears to go unchallenged.    

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Hopefully, WING USA will help bring to light the extreme losses of injured nurses, including lack of assistance in remaining with their employers.  Rather than utilizing the knowledge and skills of these experienced nurses in ways that will not further harm them, injured nurses are often turned out the door – through workers’ compensation “retraining,” generally away from nursing into lower-paying work, or otherwise. 

My story is similar to that of many nurses:  I was removed from floor nursing by a cumulative trauma spinal injury from years of lifting patients and, due to on-going lifting restrictions, by a hospital which does not provide permanent light duty for its injured nurses.  What happened to me is not at all unusual.  It appears, from available data, that multiple thousands of nurses have been disabled by patient handling injuries and it is quite likely that most of them lost their jobs when unable to return to heavy lifting.   

In nursing school, along with training in manual patient handling, we were told that nurses are at high risk of back injury from lifting patients.  We were advised to “take care” of our backs and “be careful” lifting patients because our jobs would depend on our backs.  We were further warned that while most nurses’ back injuries are from cumulative trauma, workers’ compensation typically accepts only single point-in-time injuries. 

Alarmed, I thought, “Why am I taking all of these classes if my job will depend on my back?!”  I dismissed it as too unethical to possibly be true.  Surely nursing schools wouldn’t allow students to enroll without disclosing such a risk.  Surely, hospitals wouldn’t require a nursing degree for work they’d toss you out of for a hurt back.  Surely, if you were injured caring for patients, they would help you continue working as a nurse.  I tried to shove the warning of potential loss of career over a back injury out of mind but continued to wonder how it would work out for a nurse with a cumulative trauma back injury.  I’ve now had opportunity to discover firsthand what can happen to a nurse with such an injury.   

Estimates range from 38% to nearly 50% for the number of nurses who will suffer work-related back injuries.  The day we were warned in nursing school, I could have asked the student on my right and left, “Which of us will it be?”  It could be any nurse required to physically lift patients.  It turned out to be me. 

An English study found that almost half of back-injured nurses were unable to return to their positions.  One researcher found that 12% of those leaving nursing cite back pain and injuries as the main or contributing reason.  Sadly, the warning in nursing school proved to be true.  After suffering serious spinal injuries from lifting patients, many nurses find themselves in pain and out of work – their jobs did indeed depend on their backs.     

The injuries seem almost obligatory as nurses are required to lift amounts of weight well-documented to be hazardous.  Many nurses are unaware that the National Institute for Occupational Safety and Health (NIOSH) has set 51 lbs. as the maximum safe lifting limit for men (46 lbs. for women) so that lifting the weight of adult patients far exceeds established safety limits.  Nurses continue lifting patients, and being injured, because they’re taught manual lifting in nursing school and then follow the tradition of manual lifting in the facilities where they go to work. 

Training in body mechanics conditions nurses to believe that patients can be lifted safely if nurses lift “correctly” while research has clearly shown that there is no safe way to manually lift adult patients and that there is little difference in the risk of injury whether with one or two lifters.  Some suggest that nurses need to take responsibility for preventing injury by exercising; others say, “It’s not what you lift, but how,” with both approaches appearing to instruct nurses to protect themselves.  Though physical fitness and body mechanics are important, neither address the root cause of disabling spinal injury among nurses.  Nurses are not disabled by the occasional muscle strain, but by damage to spinal structures from extreme compressive forces generated with lifting

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hazardous amounts of weight. 

I once calculated that, with all of the lifting, pulling, and pushing involved with manual patient handling, I had lifted and moved up to 3,000 lbs per shift.  This seemed an outrageous estimate until I discovered an Australian source giving 1.8 tons (3,600 lbs) as the estimated amount lifted by nurses each day – my estimate was low.  In 1992, Occupational Safety and Health Administration (OSHA) inspections of nursing homes in Pennsylvania found many nursing aides lifting over 5 tons (10,000 lbs) per shift.  Data show that nursing aides consistently suffer three to four times the number of back injuries as RNs.     

Nurses may believe they’ll have “warning signs” letting them know when to slow down in order to avoid serious injury.  Many nurses are unaware that the center of spinal discs, where injury from repetitive heavy lifting typically begins, lacks pain receptors.  Nurses may, therefore, be sustaining severe injury without perception of pain – until damage reaches nerves in the outer ring of the disc.  So, there may be no warning before sudden severe pain announces a potentially-disabling injury that may have been months or years in the making. 

Many nurses are unaware of how cumulative trauma occurs to spinal discs or why patient lifting predictably leads to spinal injury.  To educate nurses on why manual patient lifting is unsafe, please print, copy, and distribute these two items:   

"Nurses and Patient Lifting: How Cumulative Trauma Injures Lumbar Spinal Discs."

"Why Patient Lifting Leads to Spinal Injury in Nurses."   (PowerPoint presentation - long download time).  For HTML web page viewing and printing, click here.  This version will not "play" as the full version would, but it loads quickly and has the full text and pictures.

Though research with safe patient handling through mechanization has proven over many years that most patient handling injuries are preventable, the injuries and needless loss of nurses continue because the government does not require, most employers do not provide, and the nursing community does not demand protection from preventable injuries. 

With proven solutions readily-available for many years, patient handling injuries continue as possibly the single largest contributor to the nursing shortage.  It is a mystery why protection against preventable disabling injuries, and assistance remaining with the employer at injury, are not already in place.  Enactment of industry-specific legislation by the states - such as Zero Lift for Healthcare - will be required to substantially reduce patient handling injuries. 

Australia has shown that a national ergonomics standard will not necessarily reduce patient handling injuries.  The Australian Nursing Federation (Victorian Branch) No Lifting Policy, adopted March 1998, says, “In spite of the fact that Manual Handling Regulations have been in place for more than ten years, very little has been done by the Health Industry to reduce back injuries amongst nurses.”  Nurses still had the highest injury rate in the female workforce.  Industry-specific action, the $7.7 million Victorian Nurses Back Injury Prevention Project, led to recovery of program costs in one year, 74% reduction in lost days due to injury, 48% fewer WorkCover claims, 54% drop in cost of claims, and annual savings of $13 million by preventing back injury to nurses.        

Using needlestick safety legislation as a model in the U.S., it took only four years from the first state (California) to pass legislation in 1998 until needlestick safety was a national mandate in 2002.  Needleless IV systems were available and were advertised for years in nursing journals – and we nurses wondered why our hospitals didn't have them – before legislation required hospitals to provide them.  Meanwhile, nurses suffered unnecessary needle sticks, some fatally infected with blood borne pathogens.  Legislation was required to force most employers to provide safety needles and needleless IV systems. 

Likewise, gentle, mechanical, patient lift equipment and friction-reducing devices, safer for nurses and patients alike, have been available for many years, with abundant supportive research for injury prevention.  We now need state-by-state enactment of Zero Lift for Healthcare legislation to force all healthcare facilities, and nursing schools, to implement safe patient handling programs with adequate amounts of readily-accessible appropriate equipment.  As long as this remains unaccomplished, the squandering of nurses to preventable injuries will continue.    

I wish all readers well and hope this forum is of some benefit to injured nurses. 

Anne Hudson, RN, BSN, BIN – Back Injured Nurse

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