Healthcare and Social Assistance

Participating core and specialty programs: Center for Occupational Robotics Research, Occupational Health Equity, National Center for Productive Aging and Work, Safe Skilled Ready Workforce, Surveillance

Employers, workers, professional organizations, researchers, and policy-makers use NIOSH information to reduce musculoskeletal disorders among healthcare and social assistance workers.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker Population* Research Type
A Musculoskeletal disorders(MSDs) Burden of hazardous exposures, ergonomic impacts and MSDs (with or without impairment) All healthcare workers including veterinary and animal care (VM/AC) workers; vulnerable workers and hard to reach populations Surveillance
B Musculoskeletal disorders(MSDs) Identify and address barriers to implementation and dissemination of effective interventions and to identify key components of sustainability. All healthcare workers including veterinary and animal care (VM/AC) workers Translation
C Work-related asthma Evaluate the effectiveness of safe patient handling policies and regulations All healthcare workers Intervention
D Musculoskeletal disorders (MSDs) Develop and evaluate interventions for vulnerable populations Vulnerable workers Intervention
E Musculoskeletal disorders (MSDs) Evaluation of exoskeletons or other innovative approaches to reduce risk of MSDs during patient handling or performing healthcare procedures All healthcare workers including veterinary and animal care (VM/AC) workers; vulnerable workers and previously injured workers Intervention

* See definitions of worker populations

Activity Goal 4.8.1 (Intervention research): Conduct studies to evaluate the effectiveness (usefulness and unexpected results) of innovative approaches to reduce risk for MSDs and to reduce the return-to-work time among healthcare and social assistance workers with MSDs.

Activity Goal 4.8.2 (Translation Research): Conduct translation research to identify and address barriers to dissemination and implementation of effective interventions to prevent MSDs,identify key components of intervention sustainability, and disseminate best practices to prevent MSDs in healthcare and social assistance workplaces.

Activity Goal 4.8.3 (Surveillance Research): Conduct surveillance research to develop new approaches to understanding the burden of hazardous exposures, ergonomic impacts and chronic MSDs among healthcare and social assistance workers not well covered by currently-available surveillance data sources.


Working directly with patients, animal or human, poses substantial risk for injury. Physical stressors can result in a variety of musculoskeletal disorders (MSDs) [OSHA 2015]. Healthcare workers are at high risk of MSDs caused by overexertion from lifting and moving patients, i.e., patient handling. Among workers in nursing and residential care subsector, 68.5% report repeated lifting, pushing, pulling, or bending; 16% report frequent, severe, low back pain in the past 3 months; and 11.6% report low back pain attributed to work [NIOSH 2015]. A survey conducted in Minnesota indicates that 31% and 45% of veterinary personnel reported musculoskeletal disorders working with small animals and large animals, respectively. This rose to 57% among veterinarians working with large animals [Fowler et al. 2016].

Patient movement and handling is not the only risk factor for MSDs among healthcare and social assistance workers. MSDs are also frequently found among gastrointestinal endoscopists, surgeons, dentists and other healthcare personnel who perform procedures in awkward or ergonomically compromised positions [Moodley et al. 2018, Stucky et al. 2018, Yung et al. 2017].


Safe Patient Handling and Mobility [SPHM] interventions involving the use of ergonomic equipment and methods to lift and move patients have been demonstrated to result in statistically significant reduction in injuries [Teeple et al. 2017] and produce savings from injury cost reductions that surpass program costs within three years on average [Nelson et al., 2006]. Additionally, 11 states have implemented legislation regarding SPHM practices [ANA 2016, Weinmeyer 2016).] Nevertheless, comprehensive SPHM programs and interventions are not implemented in many U.S. healthcare settings [Lee et al. 2015]. These programs require support and implementation throughout the healthcare organization. While SPHM interventions at the worker-level are important, interventions that occur at the organization level or take a systems-based approach are much more likely to be sustainable over the long term [The Joint Commission 2012].In addition, much of the work regarding MSDs has been done in acute healthcare settings. MSD risk factors are also prevalent in many other subsectors of the healthcare and social assistance workforce (e.g., home health care); however, these risks have not been fully characterized and assessed. MSDs among workers in the healthcare and social assistance workforce are often not acute injuries but often the result of continuous injury and damage that has occurred over a long period of time [Zwerdling 2015]. Injuries among healthcare personnel who perform repetitive procedures or perform procedures in ergonomically compromised positions are especially at risk for MSDs, yet a recent systematic review of musculoskeletal pain among surgeons performing minimally invasive surgery noted the limitations of current literature and the need for high quality exposure and intervention studies [Dalager et al. 2017]. Emerging engineering controls such as exoskeletons have been shown to reduce musculoskeletal stress during manual labor [deLooze, et al. 2015], but may have unanticipated consequences. Among painters and welders, exoskeletons have been found to reduce shoulder discomfort while increasing productivity and work quality [Butler 2016]. There is a need to explore the risks and benefits of these and other innovative preventive interventions in healthcare settings to reduce MSD hazards and to disseminate best practices for these innovative approaches if they are found to be effective.

American Nurses Association (ANA) [2016]. Safe patient handling and mobility (SPHM). Silver Spring, MD: American Nurses Association,

BLS [2015] Table R8. Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers by industry and selected events or exposures leading to injury or illness, private industry, 2015. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics,

Butler T [2016]. Exoskeleton Technology: Making workers safer and more productive. Prof Safety 61(9):32-36

Dalager T, Søgaard K, Bech KT [2017]. Musculoskeletal pain among surgeons performing minimally invasive surgery: a systematic review. Surg Endosc 31(2):516-526.

de Looze MP, Bosch T, Krause F, et al. [2015]. Exoskeletons for industrial application and their potential effects on physical work load. Ergonomics 59(5):671-81.

Fowler HN, Holzbauer SM, Smith KE, Scheftel JM [2016]. Survey of Occupational Hazards in Minnesota Veterinary Practices in 2012. JAVMA 248:207-218.

Lee SJ, Lee JH, Gershon RR [2015]. Musculoskeletal Symptoms in Nurses in the Early Implementation Phase of California’s Safe Patient Handling Legislation. Res Nurs Health 38(3):183-93. doi: 10.1002/nur.21657.

Moodley R, Naidoo S, Wyk JV [2018]. The prevalence of occupational health-related problems in dentistry: A review of the literature. J Occup Health 60(2):111-125.

Nelson A, Matz M, Chen F, et al. [2006]. Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. Int J Nurs Stud 43:717-733.

NIOSH [2015]. NIOSH Worker Health Charts, NHIS Occupational Health Supplement (NHIS-OHS). Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,

OSHA [2015]. Inspection guidance for inpatient healthcare settings. Memorandum from deputy assistant secretary to regional administrators and state designees. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration,

Stucky C-CH, Cromwell KD, Voss RK, et al. [2018]. Surgeon symptoms, strain, and selections: Systematic review and meta-analysis of surgical ergonomics. Ann Medicine Surg 27:1-8. doi:10.1016/j.amsu.2017.12.013.

Teeple E, Collins JE, Shrestha S, et al. [2017]. Outcomes of safe patient handling and mobilization programs: A meta-analysis. Work 58(2):173-184. doi: 10.3233/WOR-172608.

The Joint Commission [2012]. Improving patient and worker safety: Opportunities for synergy, collaboration and innovation. Oakbrook Terrace, IL: The Joint Commission,

Weinmeyer R [2016]. Safe patient handling laws and programs for health care workers. AMA J Ethics. 18(4):416-421.

Yung DE, Banfi T, Ciuti G, et al. [2017]. Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review. Expert Rev Gastroenterol Hepatol 11(10):939-947, DOI: 10.1080/17474124.2017.1356225

Zwerdling D. [2015] Even “proper” technique exposes nurses’ spines to dangerous forces (transcript). National Public Radio (NPR). February 11,

Note: Goal 4.8 was added in November 2018.

Page last reviewed: November 2, 2018