Nurse Work Related Musculoskeletal Disorders:

A Global Concern

Susan Katz Sliski, RN DNP(c) CCMskatzsliski@worldcare.com | 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 (busisiwe.nyantumbu@nioh.nhls.ac.za)

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

A Global Concern:Underreporting in Developing Countries

A Global Concern:Underreporting in Developing Countries

A Global Concern:Underreporting in Developing Countries

A Global Concern:Underreporting in Developing Countries

"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has."

»Margaret Mead