Making Nurses’ Jobs Safer

A significant number of nurses sustain injuries on the job. This isn’t news. But why is the incidence of nurse injuries still climbing and what can be done about it? The Occupational Safety and Health Administration (OSHA) is stepping in to find out.

According to the Bureau of Labor Statistics, nurses are at greater risk for on-the-job, lost-time injuries than workers in any other private industry—including construction workers and those who work in manufacturing jobs—despite the fact that most health care facilities actively address workplace hazards. The average incidence of injury in private industry runs around 3.4%—even for jobs in what are perceived to be hazardous environments such as oil and gas extraction. In health care, the incidence of job-related injuries and illnesses is roughly 6.8%—almost double that of other jobs. Moreover, this figure includes only lost-time injuries. It does not account for less serious injuries that do not result in missed work. When you consider that 8 out of 10 nurses report that they frequently work with musculoskeletal pain, the number of actual injuries is likely to be significantly higher.

The most common causes of injury are overexertion caused by lifting, bending, or reaching (48%); slips, trips, and falls (25%); contact with hazardous objects (13%); violence (9%); and exposure to harmful substances (4%). These hazards result in a range of injuries. Sprains and strains top the list at 54%. Strains also account for the largest share of workers’ compensation claim costs for hospitals. Other injuries that result in lost time include bruises (11%), soreness and pain (10%), fractures (5%), multiple trauma (3%), and cuts and punctures (3%).

Then there’s the cost. In addition to the pain and suffering on the part of the injured worker, hospitals pay a price for all of these injuries. Workers’ compensation claims for hospital worker injuries averaged $15,860 between 2006 and 2011. For claims that involved lost-time injuries, costs averaged $22,300 per claim. Hospitals pay $0.78 in workers’ compensation losses for every $100 of payroll. On a national scale, this adds up to a total annual expense of $2 billion.

Understanding the Risks
Why are health care workers so exposed to injury? The reason is that health care facilities present unique risks. Care providers must make split-second decisions when unpredictable events arise, which sometimes make them vulnerable to injury. Another reason is that nursing involves physical labor. Direct-care nurses reposition and lift patients, move equipment, and tote armloads of heavy supplies. They are also exposed to contaminants and sharps and, in some cases, are the target of violence. Still another factor that contributes to work-related injuries is that care providers may put their dedication to caring for their patients ahead of their own safety and health.

What’s more, the risk is rising, primarily for two reasons. First, the health care workforce is getting older and, as workers age, they become more vulnerable to injuries and infections. Second, there are more obese patients who need care. The increasing population of overweight patients presents an even greater challenge to handling them safely and without injury to caregivers.

OSHA Oversight
In an effort to make nursing jobs safer, OSHA is putting these injuries under a microscope. A new OSHA initiative, announced in June, is intended to drastically increase scrutiny of injuries that occur among nurses. Injuries caused by lifting will be of prime interest, but OSHA will also be looking at other causes that include slip, trip, and fall hazards and pathogen and hazardous material exposure. OSHA inspectors will investigate hospitals and nursing homes that have occupational illness and injury rates above the industry average. They plan to interview nurses and managers and audit hospital documents. Noncompliant hospitals may face fines of up to $70,000.

Among other factors, OSHA will be looking to ensure that each facility has appropriate lift, transfer, or reposition assistive devices available, that systems are in place to identify and analyze hazards, that employees have input in developing patient lift protocols, and that the facility has a procedure to monitor compliance with guidelines.

The Impact of Best Practices
OSHA’s goal is to ensure that best practices are in place and followed because these practices have been proven to have a dramatic impact on the incidence of injury. Research suggests that ergonomic injuries can be significantly reduced when lift equipment is used properly. For example, nursing injuries related to lifting and moving patients dropped by 40% across the Veterans Health Administration after lift equipment was adopted.

OSHA also provides information, resources, and tools to guide health care facilities in ensuring safer work environments. One of the agency’s recommendations is to adopt a Safety and Health Management System, which provides a collaborative mechanism to identify and remedy hazards before injuries occur. OSHA has evidence that these plans work. Fourteen hospitals that participated in OSHA’s Voluntary Protection Programs (VPP) have consistently kept their injury rates below national averages.
Cincinnati Children’s Hospital reduced lost-time days by 83% over three years after implementing safety initiatives. Stanford University Medical Center reaped $2.2 million in net savings over five years on an $800,000 investment in a safe lifting program. Tampa General Hospital’s lift teams are credited with reducing patient handling injuries by 65% and cutting injury-related costs by 92%.

Safer Nurses, Safer Patients
Measures that improve nurse safety also help to protect patients. Take lifting as an example: Besides posing an injury risk to nurses, improper lifting can put the patient at risk for bruising, skin tears, falls, and fractures. In the absence of proper lifting equipment, health care workers may be more reluctant to reposition patients, and insufficient repositioning contributes to pressure ulcers. Medication errors and patient infections also have been tied to the care provider’s stress, fatigue, or injury. The conclusion: When care providers are safer, their patients are safer, too.

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