An observational study was performed to estimate the relative importance of special problems in nursing which may contribute to back pain and of specific preventive actions. Nine hospital units, including licensed vocational nurses and aides/orderlies, were studied; 63 subjects (50 women) were included. All aides/orderlies were male. Isometric and non isometric actions, and related circumstances and patient characteristics were coded and recorded. A total of 3131 actions were recorded, with direct patient contact in 23 percent and 17.0 percent being isometric. A common special problem was the presence of patient attachments (30 percent); this was most common in intensive care. Obstructions occurred in 15 percent of all instances and showed less interunit variation. Rare problems included unstable footing, fighting uncooperative patients, and slippery surfaces. Attachments were commonly a problem in actions involving beds or gurneys, and obstruction was common in isometric actions (sometimes forcing an isometric action). The most common preventive method was assistance by another person. Other common methods included bed height adjustment and side rail lowering. A mechanical assist device was used only seven times. Specific preventive methods were associated with specific situations. Weight of the person moved appeared to relate to use of assistance by another person. A surprising finding was the rarity of assistance by another for toilet/commode transfers. The authors conclude that the results provide identification and assessment of special problems in hospital nursing and specific strategies used individually to limit back stress. This information is valuable for design of jobs and worker training programs and for future research priorities.