Taking a Toll: Back Pain Sidelines Nurses Every Day
Debilitating injuries could be prevented
[Editor’s note: Every day, 150 healthcare workers
suffer musculoskeletal disorders (MSDs) that cause them to lose
time from work. Countless more end their shifts with aching
backs, shoulders, or necks. In hospitals, overexertion in
lifting is the most common cause of lost workday injuries. Here
are the stories of two nurses who suffered debilitating injuries – and
the steps they say could be taken to prevent others from a similar
Anne Hudson of Coos Bay, OR, was
walking across her kitchen when she suddenly felt a surge of incapacitating
pain. She barely could move. Ten years of lilting patients
without mechanical aids had led to cumulative trauma injury to two
As she stood immobilized in her kitchen, Hudson didn’t know
about the condition of her back. She kept thinking the pain
would go away and she would be able to return to work on her weekend
shift that Saturday.
Her most immediate concern was finding temporary relief from pain. “I
could just creep around,” says Hudson, who is now 54. “I
couldn’t sit; I couldn’t lie down; I couldn’t get
in a car to go to the doctor.
“I didn’t recognize my pain as severe muscle spasms
in response to spinal injury. All I knew was that I had pain
like I had never experienced before. A deep severe ache and
intense burning settled into my lower back, and I had pain and burning
into my lower legs and sometimes into my feet.”
The pain lessened at times, enabling Hudson to at least lie down
and rest. But she was in no condition to return to the hospital
that Saturday, where she worked as a floor nurse in the medical/surgical,
telemetry, and intermediate care units.
Hospital nursing career was over
Hudson began her conservative back therapy with the same mantra
in her head: “This will pass, and I will be better.” She
couldn’t imagine life without nursing, without caring for patients.
But her career as a floor nurse already was over.
While Hudson visited physical therapists, orthopedic doctors, and
neurologists, and tried anti-inflammatories, heat and cold treatments,
and pain medications, she faced a struggle over workers’ compensation. At
first, she was allowed to work in limited-duty jobs that used her
nursing skills. That avenue shut down when workers’ compensation
denied her claim.
Hudson convinced one of her physicians to give her a work release,
as long as she wore a back brace. That lasted three weeks--until
she helped care for and reposition a 400-pound patient. She
realized she could no longer handle the lifting and transfer tasks.
A workers’ compensation judge and the workers’ compensation
board ruled that Hudson’s injury was work-related. The
hospital continued to appeal. Meanwhile, Hudson was allowed
only two 90-day periods of light duty. There were no permanent
accommodations for a floor nurse who could lift no more than 20 pounds.
Today, Hudson works for the county health department, a job she
enjoys but one that pays significantly less. Workers’ compensation
payments, which brought her income up to two-thirds of her wage at
injury, stopped at claim closure. Still, Hudson is very grateful
to be working as a public health nurse. “Many back-injured
nurses never work as nurses again. Either they are too severely
injured to work or they are unable to find an employer willing to
accept an injured nurse.”
A chiropractor helped ease her pain, and a neurosurgeon fused two
of the discs, giving her relief from some of the most intense pain. But
not a day goes by without a deep aching in her back.
Hudson can no longer work in the garden. Doing laundry or
grocery shopping brings pangs of pain. She rarely enjoys a
night of sound sleep.
But for Hudson, there is another pain that is not physical. She
has become an unwitting expert on the ergonomic hazards of manual
patient handling and MSDs among nurses, and she now knows that a
zero-lift policy and proper lifting equipment could have saved her
career and her back. She also stresses 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.
Hudson formed WING USA (Work Injured Nurses’ Group USA), an
advocacy organization patterned after similar organizations in the
United Kingdom and Australia. Hudson also has co-edited a book with
health and safety expert William Charney, which includes the personal
stories of injured nurses as well as technical information on ergonomics
and safe patient handling. (For more information, see
editor’s not following.)
“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,” she
says. “Through activities with WING USA, I hope to bring
injured nurses together and let them know they are not alone.”
Hudson also is working on state initiatives for Zero Manual lift
for Healthcare legislation and promotes industry-specific ergonomic
solutions that could spare other nurses from a similar fate. “Their
careers, their finances, their lives are being impacted by a preventable
injury,” she says. “It’s devastating.”
Maggie Flanagan, a 46-year-old registered nurse,
cared for tiny neonates in Anchorage, AL.
So how could she have work-related MSDs? There was no problem
with patient lifting. Flanagan’s injury stemmed from constant
reaching and twisting in the cramped neonatal unit, where she was
silencing the incessant alarms that sounded on monitors positioned
above shoulder level.
After months and years of that daily action, Flanagan didn’t
realize how vulnerable she was to the effects of cumulative trauma. “I
would have some soreness on my days off, but it would go away,’ she
says. “Eventually, it didn’t go away. That
to me is one of the most serious problems with the injuries. You
think it’s going to go away, but all of the sudden it doesn’t. It
can have subtle onset.”
Actually, Flanagan can pinpoint the action that turned her aches
into debilitating pain. One day, her charge nurse needed to move
a monitor. She had called for help, but no one was available. The
alternative to moving the monitor involved moving a neonate who was
barely clinging to life, and Flanagan agreed that was too risky. She
offered to help move the monitor.
“I had seen men move it by themselves,” she says. Surely,
the two of us could do it safely. Never in a million years
did I think I would be injured from that.”
The monitor weighed about 75 pounds. It was positioned on
a recessed shelf above shoulder level. The movement mimicked
the same one she had done for hours on end.
“I realized I moved the monitor in the exact same movement
as the reaches,” Flanagan says. “It was the same
exact height. It was the same distance. I did it this
time forcefully with incredible weight. That was my weakest
Half an hour later, she began to feel muscle spasms. She continued
to work, monitoring a critically ill neonate who had just come out
of emergency surgery. She needed to constantly twist to watch
the infant and monitor skin temperature.
By the time Flanagan got home, she couldn’t reach for a milk
carton in the refrigerator or hold her 3-year-old.
She returned to work the next weekend, but it became too painful. “Every
shift becomes the down payment for the injury. I made the final
down payment on my injury.”
Flanagan says she was lucky. After eight months of medical
rehabilitation, without surgery, she has returned to work. (She
moved from Alaska and now lives near Tacoma, WA.) While she
has no medical restrictions, she works eight-hour shifts by choice
and vows to be careful.
She also has noticed that the design of neonatal units hasn’t
improved. When possible, she uses remote control devices or
pulls small monitors or keypads to a better position. But the unit
still is rife with twists and reaches.
“I’ve worked in five different hospitals. Most
of the NICU [neonatal intensive care unit] monitors are above our
shoulders. I think that’s a pretty common situation,” Flanagan
“We have not increased our patient space, but we have increased
the machines that need to be in the space,” she adds. “It’s
a cluster around the beds. The nurse can’t see them all;
the nurse can’t reach them all. Our technology has exceeded
the space we give our patients.”
Flanagan is a member of her hospital’s safety committee. She
also is working with the American Nurses Association to promote ergonomics
legislation that would protect health care workers.
“We see where the problem is; we know how to fix it; and we’re
going to be after that fix,” adds Flanagan.
[Editor’s note: Back Injury Among Healthcare
Workers: Causes, Solutions, and Impacts, edited by William Charney
and Anne Hudson, is available from CRC Press (Catalog No. L1631,
$79.95). Phone: (800) 272-7737, Web: www.crcpress.com.]
Hospital Employee Health. February 2004. Vol.
23, No. 2. Pages 14-16.