Nurse Work Related Musculoskeletal Disorders:
A Global Concern
Susan Katz Sliski, RN DNP(c) [email protected] | WorldCare International, Inc.
AAOHN National Conference 2012 | Nashville, TN
Nurse work related musculoskeletal disorders (WMSDs) within hospital organizations should be considered equal to canaries in a coal mine;
They are early indicators of workplace hazards
Statement of the Problem
Statement of the Problem
The prevalence of unreported nurse work related musculoskeletal disorders signifies the devaluation of human capital
The paucity of occupational health and safety research about nurses around the world is a barrier to improving nurses’ workplace conditions.
Statement of the Problem
The Institute of Medicine estimates the economic burden of work related musculoskeletal disorders to be between $45 and $54 Billion annually in the United States
Every day 9,000 U.S. healthcare workers sustain a disabling injury while performing work-related tasks.
Disabling back injury and back pain affect 38% of nursing staff
http://ajcc.aacnjournals.org/content/12/5/400.full
Statement of the Problem
Underreporting of WMSD Aging nurse workforce Obesity epidemic
create significant risks for career ending injuries
Statement of the Problem
The factors related to high level of WMSD among nurses are documented as:- the underreporting of nurse injuries in
hospitals
- the management of human capital
- the role of nurse staffing patterns
Scope of the Problem:U.S., Australia, Canada
Strains and sprains of the back and shoulders accounted for one half of all healthcare workers injuries (U.S. Bureau of Labor Statistics, 2007)
American Nurses Association (ANA) 2001 survey reported 83% of respondents in their survey complained of back pain but continued to work
Safe Patient Handling Policies & Regulations:U.S., Australia, Canada
United States > 2010United States 2010 >The above states introduced legislation in 2010
New York (2005) Ohio (2005) Texas (2005) Rhode Island (2006) Washington (2006) Hawaii (2006, resolution) Maryland (2007) New Jersey (2007) Minnesota (2007) Illinois (2009)
California Florida Hawaii Massachusetts Missouri Michigan Montana Texas Vermont
Safe Patient Handling Policies & Regulations:U.S., Australia, Canada
Canada 1999: The Manual Handling Regulations, place legal requirements on employers to provide equipment and aids to assist employees to carry out manual handling tasks and to provide training to staff in the correct use of equipment and safe handling of patients
The Victorian Nurses Back Injury Prevention Project (VNBIPP) was established to assist health care organizations to implement programs to prevent back injuries amongst nurses.
http://www.health.vic.gov.au/__data/assets/pdf_file/0010/17578/back_1201.pdf
Safe Patient Handling Policies & Regulations:U.S., Australia, Canada
Australian Nursing Federation: AUSTRALIAN NURSING FEDERATION (VIC
BRANCH) POLICY NO LIFTING (Adopted March 1998) Most injuries sustained by nurses were
manual handling injuries, particularly back injuries.
Overexertion/ stress due to the constant lifting and handling of patients, was the most common cause of these injuries.
http://www.anf.org.au/html/topics_workplacehs.html
Nurse WMSD has No Boundaries
Japan: Musculoskeletal Disorders (MSD) represent a
common occupational problem among Asian nurses, particularly those in Japan.
MSD categories focused on the neck, shoulder, upper back, and lower back regions.
The 12-month period-prevalence of MSD at any body site was 85.5%. MSD was most commonly reported at the shoulder (71.9%), followed by the lower back (71.3%), neck (54.7%), and upper back (33.9%).
◦ http://www.sciencedirect.com/science/article/pii/S0022437506000302
Nurse WMSD has No Boundaries
Philippines: Philippine Nurses Association 2007 :Measured
occupational injury/illness, reporting behavior, and safety concerns.
Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain.
Most who had an injury did not report it.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797477/
Nurse WMSD has No Boundaries
Nigeria
A high proportion of Nigerian nurses reported WMSDs
Many Nigerian nurses have emigrated to Europe, northern hemispheric countries and the oil rich middle-east in search of better life and condition of service.
This has contributed to the problem of inadequate staffing, and this has been associated with WMSDs among nurses
to lead to even higher rates of these disorders http://www.biomedcentral.com/1471-2474/11/12
Global Concerns:Review of Recent Articles & Studies Empirical literature on nursing injuries is
replete with studies by varied voices with:- no common language
- terminology or
- definitions
Global Concerns: 3 Research Studies of Significant Relevance
AAOHN publications creates a platform: (1) de Castro, A. B., Cabrera, S., Gee,G., Fujishiro, K. &
Tagalog,E.A. (2009). Occupational health and safety issues among nurses in the Philippines. AAOHN Journal, 57(4), 149-57.
(2) Brown, J.G., Trinkoff, A., Rempher, K., McPhaul, K., Brady, B., Lipscomb, J., Muntaner, C. (2005). Nurses’ inclination to report work-related injuries: Organizational, work-group, and individual factors associated with reporting. AAOHN Journal, 53(5), 213–17.
(3) Welch, C. (2010, August). Long term risk of repeat occupational injury or illness incidents among Veterans Health Administration nursing employees. AAOHN Journal, 58(8), 323-9.
The World Health Organization (WHO), the International Labor Office, the International Council of Nurses, and Public Services International collaborated in 2000 to study the global implications of and approaches to the problem
In 2002 the WHO released Framework Guidelines for Addressing Workplace Violence in the Health Sector
Violence in health care settings is a global issue that particularly threatens access to primary health care in developing countries, which already suffer shortages of health care workers
Underreporting of violence is also a widespread problem, the WHO report says, perhaps because workers see the abuse as an expression of patients' illnesses or as an acceptable part of the job
Global Concerns: World Health Organization
http://www.who.int/violence_injury_prevention/violence/activities/workplace/en/i
Musculoskeletal Disorders And Associated Factors In Nurses, Bank And Postal Workers In South Africa
20 countries are participating. The project is called Cultural and Psychosocial Influences on Disability (CUPID).
The main aim of CUPID is to determine if work-related musculoskeletal symptoms and resultant disability are influenced by cultural beliefs and expectations as well as by physical activities and mental health.
South Africa is an ideal place to conduct this research because of her multicultural population.
Three occupational groups have been selected for CUPID. These are nurses who are involved in patient handling tasks, office workers who use computers and postal workers who sort the mail manually. These three occupational groups were selected because their jobs entail physical demands that have been linked with musculoskeletal pain and disability.
Ms. B. Nyantumbu ([email protected])
Global Concerns: New Study : CUPID 2012
First line nurse managers are at the intersection between organizational culture and staff nurse work
Little is known about their challenges in managing staff nurse WMSD injury
A qualitative study using Max van Manen’s phenomenological method was used to explore first line nurse managers’ lived experiences with WMSDs in staff nurses
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses
Susan Katz Sliski RN Doctoral Thesis
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses
Participants met inclusion criteria:
◦ Had been a nurse manager for more than 1 year◦ Had experience with staff nurse work related musculoskeletal
injuries◦ Worked in acute care setting
Yielded a cohort who were :◦ Highly seasoned nurses- average years as RN=26.6 ◦ Highly seasoned first line nurse managers-average years as a
FLNM = 13.6
Snowball recruitment resulted in participants who worked for the same healthcare organization
The organization had implemented many recommended prevention strategies, yet career ending injuries and high rates of assault were reported
Findings revealed:
◦ 3 Major Themes ◦ 11 Sub Themes
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff NursesMajor Theme 1 : The Complexity of Work Related Musculoskeletal
Injuries
Sub Themes:
• Pre-existing Injury• Poor Performance• Age of the Nurses• Lugging and Tugging
• Different Setting/Different Issues
• Training, Education, Management of Injuries
• Assault
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses
Major Theme 2 : The Impact of Work Related Musculoskeletal Injuries
Sub Themes: The Burden on other
Staff Light Duty
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses
Major Theme 3: The Response to WMSD
Sub Themes: Feeling of uncertainty Spectrum of feeling about the injured person
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses
Staff nurse risk of musculoskeletal injuries needs to motivate healthcare organizations to change behaviors and invest in strategies which reduce nurse musculoskeletal injuries, such as:- lift devices,
- electric beds with bed weights
- enact no-lift policies
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses
Within the acute care hospital setting, staff nurses who chirp like canaries in the coalmines can report a full range of injuries in an environment with safety committees, and occupational health nurses
Additionally we understand that in spite of all of the existing efforts, there remain factors, which create underreporting even in the hospital setting rich with available prevention strategies
Research is needed to assess the staff nurse in environments which lack even the most basic support systems such as home care that provides care to patients who are:- discharged earlier and earlier from the hospital
- are less mobile
- more obese
- where the nurse is typically working alone in homes which lack even the most basic lift systems.
In these situations, it is not even about the canaries chirping in the coalmines, it is more akin to the old adage: if a tree falls in the forest and no one is around to hear it, does it make a sound?
Exploring First Line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses