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"Algorithms for Safe Patient Handling and Movement." October 2001. Ergonomics Technical Advisory Group. Chapter 5. Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement. Patient Safety Center of Inquiry (Tampa, FL). Veterans Health Administration and Department of Defense. 59-65. Online:
Click on "Safe Patient Handling and Movement" (
at the top of the page. Click to download Part I and Part II.

American Nurses Association.  “Handle with Care.”  (Fact Sheet: “ANA's Handle with Care campaign is intended to develop and implement a proactive, multi-faceted plan to promote the issue of safe patient handling and the prevention of musculoskeletal disorders among nurses in the U.S.” )

American Nurses Association.  NursingWorld Health and Safety Survey.  September 2001. of nurse respondents continue working despite experiencing back pain.  60% fear a disabling back injury.)

"An ergonomic approach to reducing back/shoulder stress in hospital nursing personnel: A five year follow up." B.D. Owen. 2002 March. Int J Nurs Stud. 39(3), 295-302.

"An ergonomic approach to reducing back stress while carrying out patient handling tasks with a hospitalized patient." B.D. Owen, K. Keene, S. Olson, and A. Garg. In Hagberg, Hofmann, Stobel, and Westlander, Occupational Health for Health Care Workers. 1st update July 1995. Landsberg, Germany: Ecomed. 298-301. ("The number of back injuries, lost work and restricted days were decreased. In addition, patients felt more comfortable when assistive devices were used. It is important to gather patient feedback data because Bell, 1984, and Owen, 1988, found nursing personnel were reluctant to use assistive devices because they thought patients would react negatively." Pg 301.)

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"ANF's No Lifting Policy Wins Outstanding OH&S Leadership Award."
June 22, 2001. Media Release. Australian Nursing Federation (Victorian Branch) "The major cause of nurses' injuries is over-exertion and stress due to lifting patients. It was unacceptable that nurses suffered the highest injury rate in the female workforce and accounted for more than half of the health industry's workers compensation claims. The ANF listened to nurses, we funded research and we have transformed a deeply entrenched culture of injury acceptance in an area no one thought we could change." "Employers are using their no lifting policy as a successful nurse recruitment and retention tool." "ANF (Vic Branch) adopted the No Lifting Policy in 1998. It is based on the 1996 research and report 'Buried But Not Dead...' by Elizabeth Langford the ANF (Vic Branch) Injured Nurses Support Group Co-ordinator." See Buried But Not Dead below.

Applications Manual for the Revised NIOSH Lifting Equation. Thomas R. Waters, PhD, Vern Putz-Anderson, PhD., and Arun Garg, PhD. U.S. Department of Heath and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Biomedical & Behavioral Sciences. Cincinnati, Ohio. January 1994. ("…the 1991 NIOSH committee decided to maintain the 1981 biomechanical criterion of 3.4 kN compressive force for its revision of the 1991 lifting equation." Pg 755.)

"Are you holding staff accountable for safety?" American Health Consultants. June 2001. Hospital Employee Health. 20(6), 69-71.

A Back Injury Prevention Guide for Health Care Providers. Writers and editors Mario Feletto and Walter Graze. Revised November 1997. California OSHA Consultation, Education, and Training Units.

Australian Nursing Federation (Victorian Branch) "No Lifting" Policy Statement. Reviewed April 2000. Australian Nursing Federation (Victorian Branch), Box 12600 A'Beckett Street PO, Melbourne, Vic 8006. Phone: (03) 9275 9333. To order: ("The manual lifting of patients is to be eliminated in all but exceptional or life threatening situations.")

Australian Nursing Federation (Victorian Branch) "Occupational Health and Safety" Policy Statement. Reviewed April 2000. Australian Nursing Federation (Victorian Branch), Box 12600 A'Beckett Street PO, Melbourne, Vic 8006. Phone: (03) 9275 9333. To order: ("Nurses have the right to… perform their work without risks to their…health and safety.")

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"Back Pain Nurse Awarded £420,000."  16 October, 2002.  BBC. News.  Online:  
("A nurse has won a 'ground-breaking' case against an NHS trust, after she claimed poor staffing levels and inadequate equipment caused her crippling back injury...Angela Knott, 36...never returned to work after waking in agony one morning...[from] a disc prolapse...[Angela's] ward...had to share one hoist with another ward, resulting in nurses having to lift patients of up to 12 stones in weight...The importance of this case is that Angela did not have a specific accident.  Because most nurses' injuries are back injuries and not caused by specific accidents, we believe there is the opportunity for justice for other nurses as well.")

"Back Pain Prevalence in Nursing Personnel: Measurement Issues."  February 2004.  Nancy N. Menzel, PhD, RN, COHN-S.  AAOHN Journal. 52(2).  
Excerpt:  "Workplace injuries, primarily musculoskeletal disorders, are a persistent problem for nursing personnel as evidenced by the large number of lost work time cases among registered nurses (RNs) and nursing aides (NAs) reported by the Bureau of Labor Statistics (BLS) (U.S. Department of Labor [US DOL], BLS, 2001).  However, musculoskeletal injury reports obtained from data collected for purposes other than population surveillance may not be the best indicator of the extent of this problem.  Symptoms surveys not only more accurately describe the epidemiology of this problem, but also hold promise as outcome tools in ergonomic intervention studies."  Dr. Menzel is Assistant Professor, College of Nursing, University of Florida, Gainesville, FL.

"Back Stress Isn't Part of the Job." Bernice D. Owen and Arun Garg. February 1993. American Journal of Nursing. 48-51. ("…only one third of those nurses who said they had episodes of occupation-related back problems…actually filed an incident report; most accepted back pain as part of the job and took sick days." Pg 48.)

"Backing out: Nurse wastage associated with back pain." D.A. Stubbs, P.W. Buckle, M.P. Hudson, P.M. Rivers, and D. Baty. 1986. Int. J. Nurs. Stud. 23(4), 325-336. Ergonomics Research Unit, The Robens Institute, University of Surrey, Guildford, Surrey, GU2 5XH, U.K. ("…the nursing profession with its tradition of regarding any physical or emotional infirmity in fellow nurses as undesirable…")

Buried But Not Dead: A survey of occupational illness and injury incurred by nurses in the Victorian health service industry. Elizabeth Langford, RN, RM, BN, Grad. Dip. (Adv. Nsg). 1997. Australian Nursing Federation (Victorian Branch) Injured Nurses' Support Group. ANF (Victorian Branch), Box 12600 A'Beckett Street PO, Melbourne, Vic 8006. Phone: (03) 9275 9333. To order: ("The injuries nurses sustain are long term, with 92% of the respondents showing long term effects…the lumbar spine being the main site of back injury [at] 70%. Of these back injuries, 57% were intervertebral disc injuries…Manual handling was the main causal factor of injury at 74%..." Pg 10.)

"The ceiling lift: An efficient way to prevent injuries to nursing staff." Jocelyn Villeneuve. January 1998. Journal of Healthcare Safety, Compliance and Infection Control. 2(1), 19-23. “Patients must be lifted more often, which requires a level of effort significantly in excess of the limits recommended by NIOSH (1981 and 1991). To be safe, all manoeuvres in which patients are lifted must be performed by means of patient lifting devices.” “One remarkable result obtained by both institutions is that no workplace injury related to patient transfers was recorded in rooms where ceiling lifts were available.”

"Chiropractic Rehabilitation: Appropriate Treatment of an Acute Intervertebral Disc Syndrome." James Allen Ropicky, B.S., D.C., D.A.C.R.B., C.C.S.P. ChiroMed Rehabilitation Center. Pewaukee, Wisconsin.

"A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques." W.S. Marras, K.G. Davis, B.C. Kirking, and P.K. Bertsche. 1999. Ergonomics. 42(7), 904-926. ("Overall, patient handling was found to be an extremely hazardous job that had substantial risk of causing a low-back injury whether with one or two patient handlers." Pg 904.)

"Current Trends in Patient Handling" presented by Gary Smith, June 18, 2001. Wy'East Medical, The Transfer Specialists. Clackamas, Oregon.

"Decreasing the Back Injury Problem in Nursing Personnel." Bernice D. Owen, RN, PhD. July 1999. Surgical Services Management. 5(7), 15-21.

"The design of manual handling tasks: Revised tables of maximum acceptable weights and forces." Stover H. Snook and Vincent M. Ciriello. September 1991. Ergonomics. 34(9), 1197-1213.

"Early Return to Work Not Working For Nurses."  Anne Hudson, RN.  September 15, 2003.  "Readers Respond."  Ergonomics Today™.  "Many nurses back-injured from lifting patients are well-able to continue nursing tasks other than heavy lifting but many employers are unwilling to provide on-going light duty to keep back-injured nurses working."  Online:

"The effect of focusing ergonomic risk factors on a patient transfer team to reduce incidents among nurses associated with patient care." Eric J. Meittunen, MS, Karen Matzke, MS, RN, Heather McCormack, PT, and Steven C. Sobczak, MS, CSP, CIH. August/September 1999. Journal of Healthcare Safety, Compliance and Infection Control. 3(7), 306-312. ("The transfer team has now completed over 60,000 patient transfers in four years without injury to team members, and no staff member have been injured while working with the team during patient transfers. Pg 312.)

"Effect of Lifting Belts, Foot Movement, and Lift Asymmetry on Trunk Motions." Steven A. Lavender, James S. Thomas, Dennis Chang, and Gunnar B.J. Andersson. Human Factors. December 1995, 37(4), 844-853.

"The Effects of Preview and Task Symmetry on Trunk Muscle Response to Sudden Loading." Steven A. Lavender, Gary A. Mirka, Richard W. Schoenmarklin, Carolyn M. Sommerich, L.R. Sudhakar, and William S. Marras, Ohio State University, Columbus, Ohio. February 1989. Human Factors. 31(1), 101-115. ("…these large muscle forces are responsible for most of the compressive and shear loadings placed on the spine and hence, responsible for the resulting back injuries when these loadings become extreme." Pg 101. "Sudden loading under asymmetric conditions can be anticipated to produce even more extreme loadings on the spine than comparable sagittally symmetric conditions, thus increasing the likelihood of low back injury." Pg 102.)

"Effects of a Lifting Belt on Spine Moments and Muscle Recruitments after Unexpected Sudden Loading." Steven A. Lavender, PhD, Kharwar Shakeel, MS, Gunnar B.J. Andersson, MD PhD, and James S. Thomas, PT. June 15, 2000. Dept. of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois; and the Dept. of Kinesiology, University of Illinois at Chicago, Chicago, Illinois. Supported by NIOSH grant K01-OH03339-02. Spine. 25(12).

"The Epidemic of Back Injuries in Health Care Workers in the United States." Bernice D. Owen. In: William Charney and Guy Fragala The Epidemic of Health Care Worker Injury. Boca Raton: CRC Press. 1999. 47-56. ("Owen (1989) found that 38% [of nurses sampled] stated they had suffered at least three consecutive days of occupationally related back pain, but only 33% of that number ever reported this; Owen also found that 12% of those stating they had back pain were thinking of leaving nursing because of the back pain." Pg 54.)

Ergonomics: Ergonomic Solutions for Preventing Patient Care Worker Back Injury. Guy Fragala, PhD, PE, CSP. Wy'East Medical. Clackamas, OR. ("If the loads being lifted are excessive and beyond what is safe for a healthcare worker to lift - no matter how the lift is conducted - it will be intrinsically unsafe." Pg 8.)

Ergonomics Guidelines for Nursing Homes.  U.S. Department of Labor.  Occupational Safety and Health Administration.  Online:  "These guidelines provide recommendations for nursing home employers to help reduce the number and severity of work-related musculoskeletal disorders (MSDs) in their facilities...OSHA believes that the experiences of many nursing homes provide a basis for taking action to better protect workers....These guidelines are advisory in nature and informational in content.  They are not a new standard or regulation and do not create any new OSHA duties.  Under the OSH Act, the extent of an employer's obligation to address ergonomic hazards is governed by the general duty clause. 29 U.S.C. 654(a)(1).  An employer's failure to implement the guidelines is not a violation, or evidence of a violation, and may not be used as evidence of a violation, of the general duty clause." 

Ergonomics Program: Final Rule. Section E. "Disorders of the Low Back." Federal Register. November 14, 2000. U.S. Department of Labor. Occupational Safety and Health Administration. 29 CFR. Part 1910. 65(220), 68468-68483. Online: Scroll down to Occupational Health and Safety Administration. Select pages 68461 - 68510. Scroll down to Section E. (Discussion includes cadaver studies helpful in determining tolerance limits of compressive forces to the lumbar spine, pathophysiology of cumulative trauma injury to spinal discs, and studies on nurses' back injuries from lifting and moving patients.)

Evidence-based practices for safe patient handling and movement. Nelson A, Baptiste AS. Online Journal of Issues in Nursing.  Sept 30, 2004.  9(3):4. (  -  Full text
James A. Haley Veterans Hospital in Tampa, Florida, USA.
Abstract:    Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The purpose of this article is to summarize current evidence for interventions designed to reduce caregiver injuries, a significant problem for decades. Despite strong evidence, published over three decades, the most commonly used strategies have strong evidence that demonstrate they are ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal pain and injuries in care providers. The authors have organized potential solutions into three established ergonomic solution types: engineering based, administrative, and behavioral. For each intervention, the level of evidence to support its use is provided.

The Guide to the Handling of Patients: Introducing a Safer Handling Policy. Revised 4th edition 1999. National Back Pain Association in collaboration with the Royal College of Nursing. London, England. ISBN 0 9530582 5 5. National Back Pain Association, 16 Elmtree Road, Teddington, Middlesex, TW118ST, England. Phone 0181-977 5474. FAX 0181-943 5318. (Called the "Green Book" - contains information not included in the American edition with yellow cover.)

Handle with Care: Patient Handling and the Application of Ergonomics (MSI) Requirements
This 126-page publication discusses how to implement a "No Lift" approach to patient handling in the health care sector.
Source:  WCB of B.C.
Full document (PDF 4 MB)
Last updated: July 2003
For possible convenience in printing and downloading, Handle with Care is also available as a series of smaller PDF files:
Introduction (PDF 608 KB)
Part 1:  Legal duties (PDF 504 KB)
Part 2:  Developing an MSI prevention policy for patient handling (PDF 515 KB)
Part 3:  Consultation (PDF 395 KB)
Part 4:  Risk identification (PDF 397 KB)
Part 5:  Risk assessment (PDF 2 MB)
Part 6:  Risk control (PDF 504 KB)
Part 7:  Education and training (PDF 389 KB)
Forms: Completed examples and blank forms (PDF 1 MB)
Appendices (OHS Regulation, programs, sample policy, terms and acronyms, bibliography) (PDF 1 MB)
You can also download only the blank forms:
Blank forms only (PDF 587 KB)

"Help to Prevent Burnout." Claire Laurent. November 21, 1984. Nursing Mirror. 159(19), 37. ("Nurses spend every working day caring for others, so why can't they care for each other?")

"Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction." Linda H. Aiken, PhD, RN, Sean P. Clarke, PhD, RN, Douglas M. Sloane, PhD, Julie Sochalski, PhD, RN, and Jeffrey H. Silber, MD, PhD. October 23/30, 2002. Journal of the American Medical Association. 288(16), 1987-1993. ("…each additional patient per nurse was associated with a 7% … increase in the likelihood of dying within 30 days of admission and a 7% … increase in the odds of failure-to-rescue.")

"Hospitals discover secret to lower injury rates: Program assumes every accident can be prevented." June 2001. American Health Consultants. Hospital Employee Health. 20(6), 66-69.

"Howling at the moon--Warm and fuzzy no more: It's time for nurses to use their clout." Mark Jorgensen, RN. July 18, 2001. NurseWeek. Online: ("How far do you think an employer could push a steamfitters, electricians, teamsters or rail union? Not far and not for long. Are you sensing a trend here? These job fields are primarily male-dominated. Groups of men simply will not accept no for an answer for long. Nurses are 95 percent female. Generally speaking, nurses have accepted no for an answer for all of my 20-plus years in the field.")

"Improving safety for caregivers through collaborative practice." Hans-Peter de Ruiter, BSN, RN, Eric Meittunen, MS, and Kristen Sauder, BSN, RN. March 2000. Journal of Healthcare Safety, Compliance and Infection Control. 5(2), 61-64. ("A collaborative, multidisciplinary approach enhances the quality of patient care for a specific [morbidly obese] population and reduces staff injuries associated with that care." Pg 63.)

"The Influence of Psychosocial Stress, Gender, and Personality on Mechanical Loading of the Lumbar Spine." William Marras, PhD, Kermit G. Davis, MS, Catherine A. Heaney, PhD, Anthony B. Maronitis, BS, and W. Gary Allread, PhD. December 1, 2000. Spine. 25(23), 3045-3054. Reprint requests: ("This study provides an indication, for the first time, that there is a biomechanical pathway to spine loading associated with psychosocial stress.")

"Investigation of the Relationship between Low Back Pain and Occupation - IV Physical Requirements: Bending, Rotation, Reaching and Sudden Maximal Effort." Alexander Magora. 1973. Hadassah University Hospital, Jerusalem, Israel. Scand J Rehab Med. 5:186-190.

"Job Stress May Lead to Back Injury for Some People, Study Finds." The Ohio State University Research News. Online: Contact: William Marras, 614-292-6670, Catherine Heaney, 614-293-5837, ("We found that psychological stress seems to amplify the physical demands of lifting for certain personality types.")

"Let's Get Our Backs Up." Editorial. Florence L. Huey, RN, editor. February 1993. American Journal of Nursing. 93(2), 7. ("For years, we've blamed the victims of back injury for not using proper body mechanics as if the size, shape, and resistance of the loads we expect nurses to haul doesn't matter….We've been too eager to accept back injury as an occupational hazard and to believe that if the nurse can't take it, she needs to get out.")

"Lifting Patients Poses High Risk for Back Injuries, Study Shows." The Ohio State University Research Archives. Online: Contact: William Marras, 614-292-6670, ("…employees can't use their leg muscles because they're leaning over the edge of a bed. They have to use their back muscles to haul the patients up…")

"The lifting team: A design method to reduce lost time back injury in nursing." William Charney, IH, Kate Zimmerman, PT, and Ed Walara, MBA. May 1991. American Association of Occupational Health Nurses Journal. 39(5), 231-234. ("Lifting is an art, not a random task. If risk is concentrated where it can be controlled, incident rates can be reduced dramatically. It is much easier to control the variables that lead to injury in a team of two lifting members than in a population of nurses. ...95% reduction in lost time injuries can be obtained if a professional lifting team, rather than nurses, lift clients." Pg 234.)

"Lift team intervention: A six-year picture." Anthony W. Donaldson. February 2000. Journal of Healthcare Safety, Compliance and Infection Control. 4(2), 65-68. ("The Bureau of Labor Statistics ranks health care workers in six of the top 10 professions at highest risk for back injuries." "…90 percent reduction in frequency of claims and a 98.5 percent reduction in cost due to incurred losses." "Lift team intervention has reduced the frequency and severity of nursing staff injuries that result from patient handling." Pg 65 & 67.)

"The Lift Team Method for Reducing Back Injuries: A 10 Hospital Study." William Charney. 1997. American Association of Occupational Health Nurses Journal. 45(6), 300-304. ("Lifting teams help control risk. In the 10 facilities studied, lifting teams have successfully reduced injury rates by almost 70%, lost days by 90%, and incidence rates by 63%." "Lifting is a skill, not a random task, and should be performed by skilled teams using mechanical lifting devices." Pg 304.)

"Lift Teams - A one-year study: Another success story in an acute-care hospital." William Charney, DOH, Associate Managing Editor, and Rudy Gasterlum, RN, ANP. February/March 2001. Journal of Healthcare Safety, Compliance and Infection Control. 5(2), 65-67. ["Injuries…were reduced from 22 lost-time injuries to six. Days lost were reduced from 744 to zero, and workers' compensation costs were reduced from $224,000 (hard costs, considered only compensation and medical) …to $14,000." Pg 65.]

"Lift teamwork: MSD injuries drop from 34 to 0." February 2003. Hospital Employee Health. 24-26. ("Even though [nursing staff] had [lift equipment] there, and they had been trained on it five years ago, they didn't have the culture to support that." "It's a culture you generate within your institution about how you feel about your employees and what it is you're trying to do…It's not all about money. It's about preventing people from getting hurt." Pg 25 and 26.)

"Long-Term Effectiveness of 'Zero-Lift Program' in Seven Nursing Homes and One Hospital." Arun Garg. August 16, 1999. University of Wisconsin-Milwaukee. Sponsored by: National Institute for Occupational Safety and Health. ("The number of injuries from patient transfers decreased by 62%, lost workdays by 86%, restricted workdays by 64%, and workers' compensation costs by 84%." Skin tears to patients redeced from 16 to 5.)

"Low-Back Musculoskeletal Disorders: Evidence for Work-Relatedness." Bruce P. Bernard, MD, MPH, editor. July 1997. Chapter 6. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiological Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. U.S. Department of Health and Human Services. Public Health Service. Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Pp. 6-1 to 6-96.

"The Magnitude of Low-Back Problem in Nursing." Bernice D. Owen, PhD, RN. April 1989. Western Journal of Nursing Research. 11(2), 234-242. ("Nearly 20% [of nurses] with LBP [low back pain] have transferred to a different unit, position, or employment setting because of LBP; another 12% [of nurses] are considering leaving nursing because of LBP. They have a mean of 13 years of nursing experience and average 39 years of age. These experienced nurses seem young to be thinking of leaving a profession due to a condition they feel is job related." Pg 241.)

A Manual of Handling People: Implementing a No-Lift Approach. Kate Tuohy-Main, MCSP, MAPA. 2nd edition. 1999. ISBN 09585 9120 2. Publisher: Kate Tuohy-Main Pty Ltd. Email: Phone: (02) 4952 4076. Website: "Following twenty years working as a physiotherapist, mainly in aged-care in England, Norway and Australia, Kate Tuohy-Main has developed a systematic approach to injury prevention in the healthcare industry, now referred to as Tuohy-Main Systems®."  "When human and financial waste is minimised, healthcare workers and management are moving together toward common goals.  These include:  To improve the safety, comfort and dignity of clients and their carers. To reduce skin tears, bruising and other manual-handling injuries to clients. To reduce injuries to carers." 

"Moving violations: Working to prevent on-the-job injuries." Susan Trossman, RN, senior reporter. Sept/Oct 2000. The American Nurse. 32(5), 1 and 12-14. ("The act of nursing can be described as an ergonomic nightmare…staff nurses…consider themselves lucky when they go home without suffering a major on-the-job injury." Pg 1.)

"Musculoskeletal injuries riddle health-care workforce." Dian Cox, Department of Consumer and Business Services Communications Section. Oregon OSHA 2000 Report to Stakeholders. March 2001. Pp 6 & 12.

"No Heavy Lifting: Making Safety Work." Patricia Schuldenfrei, EdD, RN. Sept. 1998. American Journal of Nursing. 98(9), 46-48. ("Nurses and unlicensed assistive personnel regularly place their own health at risk by using their bodies to lift heavy patients." "Ergonomics professionals recommend that women in the 90th percentile of strength lift no more than 46 pounds at a time." Pp 46 & 47.)

"No Lift, No Injury Goes from Strength to Strength."
For details about the "No Lift, No Injury" program, contact Karen Jones or Lisa Mycko: phone (08) 8363 1948. Australian Nursing Federation. Head Office: Unit 3, 28 Eyre Street, Kingston ACT 2604, Australia. Telephone: 61 2 6232 6533. ("ANF SA Branch has recently won the contract to become the preferred provider of manual handling education in the State's public health system." "As well as the [17%] reduction in worker injuries…There was a significant level of reporting of decreased skin tears and bruising among residents…")

"Number and Median Days of Nonfatal Occupational Injuries and Illnesses with Days away from Work Involving Musculoskeletal Disorders by Selected Occupations, 2000." April 2002. Bureau of Labor Statistics. U.S. Department of Labor. Table 12, page 1. Online: (Of 129 occupations with work-related musculoskeletal disorders, truck drivers are #1 with 45,327; nursing aides, orderlies, and attendants are #2 with 44,660; RN's are #6 with 12,074; and LPN's are #18 with 5,598. Includes sprains, strains, tears, back pain, etc. Herniated spinal discs are not included.)

"Number and Percent of Nonfatal Occupational Injuries and Illnesses Involving Days away from Work for the Ten Occupations with the Largest Number of Cases by Case and Worker Characteristics, 2000." April 2002. Bureau of Labor Statistics. U.S. Department of Labor. Table 2, pages 12 and 3. Online: ("Health care patient" was the cause of time off work for 10,983 registered nurses and 44,854 nursing aides, orderlies, and attendants in 2000 with "overexertion" and "overexertion in lifting" the leading events.)

"Number of Nonfatal Occupational Injuries and Illnesses Involving Days away from Work Involving Musculoskeletal Disorders by Selected Worker and Case Characteristics, 1999." March 2001. Bureau of Labor Statistics. U.S. Department of Labor. Table 11, page 3. Online: ("Health care patient" was the source of 72,363 injuries and illnesses including 59,002 musculoskeletal disorders in 1999. Includes sprains, strains, tears, back pain, etc. Herniated spinal discs are not included.)

"Nurse Wins £345,000 for Back Pain."  James Meikle.  June 6, 2001.  The Guardian.  Online:,3858,4199020-106678,00.html.  ("A former staff nurse has been awarded £345,000 for the back pain she received while working in a hospital which allegedly lacked suitable equipment to help move patients.  Carmel Commons, 42, is among the first nurses to win a case involving repetitive strain rather than injury from a single incident... Richard MacMillan, her solicitor, said: "Each year thousands of nurses complain of back pain.  Many of them are retired early after years of training and experience...")  

"Nurse Wins £800,000 for Back Injury."  15 February, 2000.  BBC News.  Online:  ("A former intensive care nurse has accepted £800,000 compensation after injuring his back at work...Mr. Karl Douglas, then 28, injured his back lifting a 12-stone patient...because no mechanical hoist was available...with the assistance of just one other colleague...Christine Hancock, general secretary of the RCN [Royal College of Nursing], said: "...manual lifting of patients is always dangerous - employers have no excuse to avoid investment in the right training and equipment.")

"Nurses and Patient Lifting: How Cumulative Trauma Injures Lumbar Spinal Discs." Anne Hudson, RN, BSN. 8-4-03. Info from Section E. "Disorders of the Low Back" of the rescinded Ergonomics Program Final Rule (see above in Bibliography). ("Insidious onset is described in some cases of work-related low back pain 'rather than a single, point-in-time event with immediate low-back pain'...explained in part by absence of nociceptors in the disc and facet joints other than the synovial lining..."These load-bearing structures may, therefore, become injured without immediate recognition (e.g., sudden pain), and the eventual manifestation of low-back pain may only occur after a series of point-in-time events have sufficiently injured these spinal structures to the point where nociceptors become irritated (e.g., in the outer one-third annulus or facet synovium)." "The intervertebral disc is especially vulnerable when loaded in the flexed position or when subjected to repetitive loading.")

“Nurses and Preventable Back Injuries.”  Deborah X. Brown, RN, BSN.  2003.  American Journal of Critical Care.  12(5), 400-401.  Posted online 11/10/2003.  Medscape from WebMD.  ("Nurses are sustaining preventable back and neck injuries.  It is time to end the behavior that results in these injuries.  The agencies employed to protect workers must begin to do just that...What is needed is an approach to handling patients that involves (1) reeducation of the nursing staff, (2) a well-trained lift team, (3) modern mechanical lifting equipment, and (4) policies and procedures that clearly mandate a new method of handling patients.")

"Nurses back injuries slashed." November 2002. State Government Department of Human Services. Victoria, Australia. ("A $7.7 million nurse back injury prevention program has resulted in a 74 per cent reduction in injuries and halved WorkCover claims by nurses. Launching the Victorian Nurses Back Injury Prevention Project Evaluation Report, Health Minister John Thwaites said the program would recover its costs within a year and save...millions of dollars...'More importantly, however, is...reducing back injuries among nurses and ensuring they have a safer workplace...The fall in claims is mainly due to nurses incurring fewer strains and sprains when moving patients...The program has led to a policy of 'no lifting' in the workplace.' ")

"Nurses Get Bionic Power Suit." 7-27-01. The World's No. 1 Science & Technology News Service. Online: ("In tests, a nurse weighing 64 kilograms was able to pick up and carry a patient weighing 70 kilograms." "…health authorities will be able to buy a commercial version of the suit for around £1200 within two years.")

"Nursing burnout may lead to major health care crisis: Caregivers overworked, study finds." Kathleen Fackelmann. May 7, 2001. USA Today, Arlington, VA.
("In the USA, one out of five nurses of all ages said they intended to quit within a year; among younger nurses, one out of three said they would quit during that period.")

Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors. Janet Heinrich, Director, Health Care-Public Health Issues. July 2001. United States General Accounting Office. GAO-01-944. Report to the Chairman, Subcommittee on Health, Committee on Ways and Means, House of Representatives. (The report covers multiple factors contributing to the nursing shortage - 15 pages without mention of the needless loss of nurses to preventable disabling spinal injuries from being required to physically lift patients.)

"Occupational Health and Safety Compliance in Nursing Homes." Abdalla Mutawe, Ronald Tsunehara, Jerrold Hockett, and Mark Hatch. November 2000. Professional Safety: Journal of the American Society of Safety Engineers. 45(11), 18-21.

"Oh, My Achin'…" Phil Barber. January 20, 2003. NurseWeek. Pg. 11. Online: ("…many [back-injured] nurses [are] effectively being forced out of the industry because few hospitals offer permanent light duty.")

"Oh! My Aching Back!" Anne Hudson, RN. September-October 2002. Last Word. Revolution: The Journal for RNs and Patient Advocacy. 3(5), 31. Online: ("No national agency or organization is providing protection to nurses from [preventable, disabling] back injuries related to manual patient handling.")

Oregon's Nursing Shortage: A Public Health Crisis in the Making. April 2001. Northwest Health Foundation. Issue Brief No. 1. (The Northwest Health Foundation "has awarded more than $6 million to organizations providing innovative health programs and projects throughout the [Oregon and Southwest Washington] region." The report includes major findings and recommendations - 28 pages on the nursing shortage without mentioning the unnecessary wastage of nurses to preventable disabling spinal injuries from lifting and moving patients.)

"Pain in the Critically Ill." Chris Pasero, MS, RN, and Margo McCaffery, MS, RN, FAAN. January 2002. American Journal of Nursing. 102(1), 59-60. ("Turning was the procedure most painful and distressing to adults ages 18 and older.") Also, see "Ready to Roll" below.

Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement. Ergonomics Technical Advisory Group. Patient Safety Center of Inquiry (Tampa, FL). Veterans Health Administration and Department of Defense. Oct. 2001. Online: Click on Publications and Products. Click on Safe Patient Handling and Movement at the top of the page. Click to download Part I and Part II. (Pages 11-12 "Summary Table of Ergonomic Intervention Case Studies.")

"Preventing Injuries Using an Ergonomic Approach." Bernice Owen, RN.  December 2000.  Association of Operating Room Nurses Journal.  72(6), 1031-1036. ("Researchers found all three of these tasks to be in the high-risk category for injuries; all of the [three methods of lifting patients up in bed] surpassed the maximum safe level of compressive force to the L5S1 disc, as determined by the National Institute for Occupational Safety and Health. The amount of force produced by these tasks to the L5S1 disc ranged from 3,819 newtons (N) to 6,570 N; the maximum level for safety is 3,400 N." Pg 1033.)

“Prevention of Disabling Back Injuries in Nurses by the Use of Mechanical Patient Lift Systems.”  Richard F Edlich, Kathryne L Winters, Mary Anne Hudson, LD Britt, and William B Long.  November/December 2004.  Journal of Long-Term Effects of Medical Implants.  14(6): 521-533.  Online at the Guldmann, Inc, website:

"The psychosocial implications of back injury at work." Mandy Mitchelmore, RGN, BA (Hons), MSc. June 12, 1996. Nursing Standard. 10(38), 33-38. Online: ("Nurses who sustained a back injury suffered both physically and psychologically, and generally felt unsupported and isolated." "It is clear that apart from very small children, all patients are too heavy to be lifted by nurses.")

"Ready to Roll." Duncan Graham-Rowe. 4-27-02. New Scientist Magazine. Online: (Turning patients can give nurses and carers back strain…some nurses can perform as many as 50 rolls in a single eight-hour shift." "…a simple portable frame…uses the sheet beneath the patient to lift and turn…with the electric motors built into the frame. Software controls which way the patient tilts by reeling the sheet in on one side only, and keeps the rolling motion gentle and smooth.") See "Turning Device Lifts Burden for Nurses" below for online site with photo of device.

"Reducing back injury in nursing: A case study using mechanical equipment and a hospital transport team as a lift team." William Charney, DOH, Associate Managing Editor. March 2000. Journal of Healthcare Safety, Compliance and Infection Control. 4(3), 117-120. ("Manual lifting was forbidden…The facility was given…12 pieces of mechanical patient lifters…The transport department acting as a lift team accomplished 3,188 lifts during the study year without lost time injury to the transport staff." "Hospitals should take seriously the profound effect that the mechanization of lifts could have on the reduction of injury." Pp 117 and 119.)

"Reducing back stress to nursing personnel: An ergonomic intervention in a nursing home. A. Garg & B. Owen. 1992. Ergonomics. 35(11), 1353-1375.

"Reducing Perceived Physical Stress While Transferring Residents." Bernice D. Owen, PhD, RN, and Guy Fragala, PhD, PE, CSP. July 1999. AAOHN Journal. 47(7), 316-323. ("Residents reported feeling more comfortable and more secure while being transferred via the chair and pad versus the traditional methods of transfer in and out of bed." Pg 316.)

"Reducing Risk for Back Pain in Nursing Personnel." Bernice D. Owen, PhD, RN and Arun Garg, PhD. January 1991. AAOHN Journal. 39(1), 24-33.

"Reducing the Burden of Patient Handling." Richard Bohannon, EDD, PT, NCS. February 18, 2002. Advance for Physical Therapists and PT Assistants. 45-46. ("Friction-reducing devices…can decrease the forces required to move individuals horizontally. Force reductions…far surpass …sliding boards alone.")

"Revised NIOSH Equation for the Design and Evaluation of Manual Lifting Tasks." Thomas R. Waters, Vern Putz-Anderson, Arun Garg, and Lawrence J. Fine. 1993. Ergonomics. 36(7), 749-776. In Applications Manual for the Revised NIOSH Lifting Equation. Thomas R. Waters, Ph.D., Vern Putz-Anderson, Ph.D., and Arun Garg, Ph.D. U.S. Department of Health and Human Services. Public Health Service. Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Division of Biomedical and Behavioral Science. Cincinnati, Ohio. January 1994. ("The 1991 NIOSH committee decided to maintain the 1981 biomechanical criterion of 3.4 kN compressive force for its revision of the 1991 lifting equation." Pg 755.)

"The Role of the Steward and Safety Representative in Manual Handling." Power point by Maria Bryson, RN, Steward, Safety Rep. Royal College of Nursing.

Royal College of Nursing. Introducing a Safer Patient Handling Policy. Working Well Initiative. Publication code 000 603. First published April 1996, revised Nov. 2000 by the Royal College of Nursing. 20 Cavendish Square, London, England W1M 0AB. Telephone 020 7409 3333. ("…staff should not attempt to lift any patient manually, whatever their weight." Pg 4.)

Royal College of Nursing. RCN Code of Practice for Patient Handling. Working Well Initiative. Publication code 000 604. First published April 1996, revised September 2000 by the Royal College of Nursing. 20 Cavendish Square, London, England W1M 0AB. Telephone 020 7409 3333. Online: ("The aim is to eliminate hazardous manual handling in all but exceptional or life-threatening situations." Pg 3.)

“Taking a toll: Back Pain Sidelines Nurses Every Day.”  February 2004.  Hospital Employee Health.  23(2), 14-16.  ("A zero-lift policy and proper lifting equipment could have saved her career and her back...It is unethical for hospitals to deny permanent light duty to injured nurses after not providing safe patient lift equipment and policies to protect them from lifting injuries... Injured nurses retain all their clinical knowledge and skills.  Many times, the only thing they can't do is heavy lifting.  But they're still not welcomed back to work by many hospitals."  Anne Hudson, RN)

The three-year economic benefits of a ceiling lift intervention aimed to reduce healthcare worker injuries. Applied Ergonomics, Volume 36, Issue 2, March 2005, Pgs 223-229.
Rahul Chhokar, Chris Engst, Aaron Miller, Dan Robinson, Robert B Tate and Annalee Yassi.

"Trunk kinematics and trunk muscle activity during a rapidly applied load." James S. Thomas, Steven A. Lavender, Daniel M. Corcos, and Gunar B.J. Andersson. 1998. Journal of Electromyography and Kinesiology. 8, 215-225. ("Sudden exertions can occur due to slips or falls, lifting of unstable loads…or failed two-person lifts." "…An unexpected perturbation which results in increased trunk muscle activity creates greater compressive loads on the spine and is a potential mechanism for injury to contractile and non-contractile spinal structures." Pg 215-216.)

"Trunk Muscle Loading in Non-Sagittally Symmetric Postures as a Result of Sudden Unexpected Loading Conditions." Steven A. Lavender, Carolyn M. Sommerich, L.R. Sudhakar, and William S. Marras. Biodynamics Lab, Industrial and Systems Engineering Dept., The Ohio State University, Columbus, OH. Proceedings of the Human Factors Society 32nd Annual Meeting. October 24-28, 1988. 665-669.

"Turning Device Lifts Burden for Nurses." BBC News 4-27-02. New Scientist. Online: ("The new device…helps turn patients without either them or the person turning them hurting their backs.")

Victorian Nurses' Back Injury Prevention Project Evaluation Report 2002.  October 2002.  Published by the Policy and Strategic Projects Division, Victorian Government Department of Human Services, Melbourne, Victoria.  Also published at  Obtain from website or contact: Nurse Policy Branch, Department of Human Services, phone (03) 9616 7528.  Online:  ("This Government recognizes the outstanding success of the VNBIPP... [with] reduction in WorkCover claims for injuries sustained by nurses by 48 per cent...days lost due to injury by 74 per cent, and...cost of claims by 54 per cent [saving $13 million per year]...Victorian nurses will now feel that they can practice in a safer, better equipped work environment..."  Hon. John Thwaites, MP, Minister for Health.)

"What are we teaching about lifting and transferring patients?" B.D. Owen, N. Welden, and J. Kane. 1999. Research in Nursing and Health. 22(1), 3-13. ("Lifting patients under the axilla has been found to be physically stressful for nurses and uncomfortable for patients…Eighty-three percent of the educators teach the under-axilla method for in- and out-of-bed transfers; 94% observe it used in the clinical field…None of the authors of the 3 most frequently used textbooks describe the use of the under-axilla method; authors of 2 textbooks state patients should not have pressure placed on the axilla area.”)

“What is this ‘no lifting’ business?” Trish Butrej, OHS Officer, Australian Nursing Federation (NSW Branch). February 2000. The Lamp. 18-19. (“Because the risk of serious and crippling back injury is greatly reduced [with the ‘no lifting’ approach], nurses can look forward to a longer and more fulfilling career. Nursing practice is improved and made more efficient…[nurses] get to go home far less tired and with fewer aches and pains.”)

"Why Manual Handling Should be Eliminated for Resident and Carer Safety: And How." Kate Tuohy-Main. 1997. Geriaction. 15, 10-14. [ "It has been stated that in an 8 hour shift, nurses lift on average 1.8 tons a day." (The Gazette. August 13, 1992. 6(37), 5.) ]

"Why Patient Lifting Leads to Spinal Injury in Nurses." PowerPoint by Anne Hudson, RN, BSN. August 4, 2003. "Three decades of body mechanics have not reduced back injury among nurses because patient lifting exceeds safety limits for weight and compressive force to spinal discs."

"Why This Hospital Nursing Shortage is Different." Howard S. Berlinger, ScD, and Eli Ginzberg, PhD. December 4, 2002. JAMA 288(21), 2742-2744. ("…nurses' tendency to retire in their mid and later 50's…" "…when nurses are finding it difficult to continue to lift and move patients and equipment without assistance.")

WING Quarterly.  The Royal College of Nursing Journal of the Work Injured Nurses Group.  WING Journal Editor: Barbara Miller.  Email:  Postal address: c/o WING, Room 302, Royal College of Nursing, 20 Cavendish Square, LONDON  W1G 0RN.  Phone:  0845 408 4392.

"Work Injured Nurses Group (WING): Supporting nurses who suffer from work-related injury or illness." Power point by Maria Bryson, RN, Steward, Safety Rep. Royal College of Nursing.

Work Practices Guide for Manual Lifting. D.W. Badger. 1981. Pub No 81-122. U.S. Department of Health and Human Services. Public Health Service. Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Division of Biomedical and Behavioral Science. 124-125. (Source for 3,400 N lifting limit.)

"Work-Related Musculoskeletal Disorders and Psychosocial Factors." Bruce P. Bernard, MD, MPH, editor. Chapter 7. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiological Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. U.S. Department of Health and Human Services. Public Health Service. Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. July 1997. Pp. 7-1 to 7-16.

"Your Aching Back: A Look at Back Strain in the Workplace." Kerri L. Lawrence. Fall 1990. Job Safety and Health Quarterly. 25-27.

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