This study of registered nurses was designed to estimate the occurrence of work-related neck, shoulder, and back musculoskeletal pain/disorders (MSD) in registered nurses (RNs) working in a variety of settings, and to identify physical demands related to neck and shoulder MSD. We then examined the relationship of physical demands to MSD, as modified by organization of work and preventive initiatives. Data from 1163 randomly selected currently working nurses (1 + years on the current job) were collected in anonymous mailed surveys (74% response rate). Reported MSD cases had relevant symptoms lasting at least 1 week or occurring at least monthly in the past year, with at least moderate pain intensity, on average. MSD problems with a frequency, duration, or pain intensity below this level were defined as MSD symptoms. Physical demands such as force, awkward postures and heavy lifting were significantly associated with reporting an MSD case. Nurses with highly physically demanding jobs were 5-6 times more likely than those with low demands to report an MSD. Scheduling was associated with MSD cases, especially when working off-shifts (non-daytime) combined with weekend work. Negative changes in the health care work environment such as increased nurse layoffs, patient loads per RN, and job responsibilities were significantly associated with reported MSD in nurses. These associations were not explained by the physical and psychological job demands. Nurses with pain/disorder meeting the MSD case definition were far more likely to report functional consequences (seeing a provider, missing work, modifying work) than nurses with problems defined as MSD symptoms. For prevention, 10% of nurses had a lifting team in their workplace; almost half had mechanical devices. Lifting teams and mechanical devices in the workplace were both associated with significantly lower odds of back MSD, whereas transfer boards and adjustable beds had significantly higher odds of back MSD. Lifting devices were also protectively associated with neck MSD. Factors that were associated with nurses inclination to report workplace injuries included having on-site occupational health services, functioning health and safety committees with nonmanagement nurse or occupational health staff representation, a supervisor/boss that pays attention to what workers say, and who is concerned about their welfare. Administrators can work with occupational safety departments and employees to assess working conditions, scheduling and the availability of optimal equipment, and support evidence-based lifting strategies. Work settings can be modified to reduce the occurrence of physically demanding work, through incorporating equipment and procedures that reduce these demands. Scheduling and patient loads can be designed to be more optimal, to reduce workplace exposures, MSD occurrence and promote retention of nurses. As shortages of nursing personnel have developed, it is even more important to maintain the health of nurses that are currently working. The need to recruit and retain nurses could provide an incentive for employers to implement healthful workplace changes, such as lifting teams, in their facilities. Most studies indicate that initial costs for preventive programs and equipment are considerable, but that total cost savings are significant, and often occur within the same year of implementation.
University of Maryland, School of Nursing, Department of Behavioral and Community Health, 655 West Lombard Street, Baltimore, MD 21201-1579
University of Maryland, School of Nursing, Department of Behavioral and Community Health, Baltimore, Maryland 21201-1579