Human factors and ergonomics in consumer product design: uses and applications. Karwowski W, Soares MM, Stanton NA, eds. Boca Raton, FL: CRC Press, 2011 Jun; :89-100
Workers in the healthcare industry who perform physically demanding patient handling tasks as part of their jobs, such as nurses, nurses' aides, physical therapists, and healthcare technicians, are at high risk for development of work-related musculoskeletal disorders (MSDs). These workers are exposed to significant risk factors for MSDs when lifting and moving heavy patients and equipment, pushing and pulling heavy equipment, working in extreme postures, and standing for long periods of time without adequate rest periods. When the physical demands of the job exceed the capabilities of the worker, the worker is at increased risk of developing an MSD, such as back pain. Moreover, the risk of developing a work-related MSD is even greater when the worker is exposed to more than one risk factor at the same time (NIOSH 1997; National Research Council and Institute of Medicine 2001). Although healthcare workers report a high number of medical problems in the shoulders, neck, and legs, by far the most common occupational injuries in the healthcare industry involve back disorders (United States Department of Labor Bureau of Labor Statistics 2007). Often, these back disorders prevent workers from doing their job and also cause many of them to change jobs because of back pain. In 2001, nurses working in the private sector reported 11,800 MSD cases, with the majority (nearly 9,000) of the reported injuries involving the back. More than one-third (36 percent) of the injuries resulted in lost time from work due to back disorders. Work-related MSDs are associated with excessive back and shoulder loading from manual patient handling, applying excessive forces during pushing and/or pulling objects, awkward posturing during patient care, and working long hours (Waters et al. 2006). Another study reported that 12 percent of nurses who planned to leave the profession cited back injuries as either a main or a contributing factor (Stubbs el al. 1986). Work-related MSDs are very costly to the healthcare industry. Employees that suffer from musculoskeletal pain on the job are often less productive, more likely to make mistakes, and have more accidents at work. Workplaces with high levels of reported patient handling injuries report higher rates of lost/modified workdays, higher staff turnover, increased costs, and adverse patient outcomes (Collins et al. 2004). The extent of the problem is probably worse than reported in official injury reporting records due to likely widespread underreporting of injuries. A study by Cato, Olson, and Studer (1989) reported that 78 percent of nurses with back pain in the previous six months did not report it to management. In another study of nurses, Owen (1989) reported that 67 percent of nurses who reported low-back pain related to work did not report the incident in writing. Finally, work-related MSDs contribute to the critical nursing shortage in the healthcare industry, which also leads to more overtime for working nurses. In 2005, the U.S. Department of Health and Human Services reported 4,577 unfilled nursing jobs in Missouri, representing 8 percent of the total nursing workforce and the number is expected to grow to 17,024, including 25 percent of the nursing workforce, by 2020 (Elwood 2007). In the past decade, tremendous strides have been made in identifying high-risk tasks and in developing and implementing solutions for reducing the risk. In the United States, effective programs for safe patient handling that rely on the use of ergonomic technology have been developed and implemented by many healthcare enterprises. Also, some states have passed legislation mandating implementation of safe patient handling programs. Nationally, ergonomic guidelines have been developed to provide useful information to the industry to help them efficiently implement effective programs that have been shown to reduce both the risks and costs associated with work-related MSDs. Most importantly, easy to use equipment that reduces the amount of physical demand required to perform these tasks has been developed for many of the high-risk tasks and is widely available. Studies have been conducted demonstrating that implementation of these programs and use of this equipment is cost effective, often paying for itself in less than three years (Collins et al. 2004; NIOSH 2006). Finally, recent findings have also suggested that implementation of a safe patient handling program can also increase the quality of care of patients while at the same time reducing the risk of MSDs for caregivers (Nelson et al. 2008). It is clear that a large number of workers are routinely exposed to high levels of work-related risk factors for MSDs when performing patient handling tasks and these exposures lead to increased reports of work-related MSDs over their working lifetime. Nevertheless, it should be recognized that these hazards can be identified and controlled so that work-related MSDs can be prevented.