• This most recent U.S. Department of Labor (DOL) summary statistics for 2001 indicate that nursing aides, orderlies and attendants, along with two other occupations (truck drivers and nonconstruction laborers), account for one out of five musculoskeletal disorders reported nationally in 2001.
  
  
• The American Nurses Association reports that ergonomic injuries occur in nurses at a rate that is twice that found in the general working population and that up to 38% of the current nursing workforce has been affected by a back injury.
  
  
• The U.S. DOL statistics summarizing 2000 workplace injury and illness data indicate that nursing aides, orderlies and attendants are listed as the second most likely occupation to sustain ergonomic injuries requiring the most time away from work.
  

• The American Hospital Association has stated that work-related MSDs account for the largest proportion of Workers Compensation (WC) costs in hospitals and long-term nursing home facilities nationwide.
  
  
• Registered nurses ranked sixth on the list of occupations suffering from work-related musculoskeletal disorders involving time away from work according to the U.S. DOL summary statistics for the year 2000.
  
  

Ergonomic Hazards and Risk Factors Specific to Healthcare Services:
In addition to the serious work-related injury trend indicators presented above, other work-related MSDs risk factors and variables are unique to healthcare services and present specific hazards in this workplace setting:

• Healthcare analysts predict that ergonomic injury trends will worsen in the future as healthcare facilities continue to experience unprecedented nursing staff shortages requiring more overtime hours for an aging workforce -- both factors often lead to a probability of increasing ergonomic injury rates.
  
  
• While the supply of nurses, LPNs and nurse aides is dropping, the demand for their services is increasing with many healthcare facilities and nursing homes reporting a forced delay or denial of new admissions based upon staffing shortages.

• Several important ergonomic reasons for the elevated ergonomic injury rates are inherent in healthcare facilities services including many sources of "high ergonomic demand" work activity such as: frequency and amount of weight lifted; static exertion; simultaneous lifting, flexing and twisting; and sudden, unexpected loading.
  
  
• A significant number of the healthcare workers (HCWs) performing these "high ergonomic demand" maneuvers are women who are routinely placed under heavy physical demand, such as lifting a 150 pound patient, when the limit considered safe for 75% of the female HCW workforce is approximately 50 pounds.
  
  
• Other unique ergonomic hazards are prevalent in the nursing home setting including: lifting in confined spaces such as bathrooms, pushing and pulling heavy loads, lifting over obstacles (such as the edge of bathtubs), bulky size of loads and asymmetric lifts, shifting of weight and unpredictability while lifting, and long horizontal distances between the lumbosacral spine and hands while lifting.
  
  
• Personal risk factors also play a role in the special ergonomic hazards that HCWs face during their routine employment activities such as poor physical conditioning, obesity and increasing age.
  

Economic Barriers to Ergonomic Injury Prevention in Healthcare Services:
Healthcare facilities and healthcare workers in the United States are obviously impacted by the disturbing trends of increasing frequency and severity of work-related MSDs as well as all of the unique ergonomic hazards associated with providing healthcare services as described above. Health service providers in the U.S. are often aware that work-related MSDs may result in significant impairment and long-term disability for their workers and often translate into hundreds of thousands of dollars of associated healthcare expenses, Workers Compensation costs, and lost work time.

However, deteriorating financial environments in many healthcare facilities often present significant barriers to effectively addressing ergonomic injury in healthcare facilities nationwide. For example, the Healthcare Association of New York State (HANYS) and the New York Association of Homes and Services for the Aging (NYAHSA) released financial profiles for healthcare facilities from 2001 and 2002 in NYS that documented the following:

• The financial performance of NYS hospitals is declining with the number of hospitals experiencing operating losses growing by more than 80% between 1997 and 1999.
  
  
• The number of New York State nursing homes with operating losses grew by 75% during the period of 1997-1999.
  
  
• To respond to severe labor shortages during the past several years, NYS nursing homes have increased payroll beyond what had been budgeted to provide overtime pay and temporary agency staffing.
  

This declining financial profile of NYS healthcare facilities and nursing homes is not unique and has resulted from a number of changes in the healthcare environment since 1997. These economic changes, when coupled with increasing trends in the ergonomic injury rates for HCWs, require unique and creative approaches to effectively develop and implement ergonomic injury prevention programs in healthcare facilities that are effective and sustainable. Shrinking healthcare facility budgets will undoubtedly lead to fewer discretionary dollars that can be dedicated to worker ergonomic awareness training and incorporation of facility-wide worksite injury prevention programs.

A Successful Approach to Ergonomic Injury Prevention Training in Healthcare:
The main purpose of this website is to provide access to educational information that addresses the entire spectrum of challenges that healthcare service providers and HCWs face with regard to the prevention of work-related ergonomic injuries. The Center for Occupational and Environmental Medicine (COEM) and Arnot Ogden Medical Center (AOMC) are sponsors of this website and are uniquely positioned to address these healthcare challenges. The COEM has been successfully providing comprehensive training to healthcare employers and HCWs in the development and implementation of effective ergonomic injury prevention programs for several years.

In 2001, the COEM was awarded a Susan Harwood Training Grant from the Occupational Safety and Health Administration to provide educational outreach training to healthcare service providers and healthcare workers to assist them recognize and prevent work-related ergonomic injuries in the healthcare setting. This targeted ergonomic injury prevention program was extremely successful and the response from the healthcare employers and healthcare workers participating in this educational outreach program was very impressive. During a two year period, the following program goals were accomplished:

• During a two-year period, 252 ergonomic injury recognition and prevention training sessions were completed in 33 different healthcare facilities in southern New York and northern Pennsylvania.
  
  
• In the course of these sessions, 903 healthcare service employers and managers and 5691 healthcare workers were trained in the recognition, management, and prevention of ergonomic injury in the healthcare environment.
  
  
• A total of 33 healthcare facilities and 4 labor councils and international unions representing HCWs in the region endorsed and participated in the ergonomic injury prevention training sessions.
  
  
• Six statewide videoconference training sessions were completed with 10 medical center participants including large metropolitan medical centers such as Beth Israel Medical Center in New York City.
  
  
• Both healthcare service employers and healthcare workers participating in our ergonomic injury prevention program training sessions routinely evaluated the quality of the training program as outstanding to excellent.
  

Patricia L. Meinhardt, MD, MPH, MA presenting training to healthcare facility CEOs and financial officers, healthcare employers and providers, medical center administrators and hospital risk managers, and healthcare related small business owners addressing the cost effectiveness of ergonomic injury prevention programs in healthcare settings.

Certified physical therapist, Peter Lechowski providing ergonomically correct patient lifting and transfer techniques to healthcare workers, nursing supervisors and medical center department heads, and ergonomic team leaders during a training session.

Objectives of this ErgonomicsInHealthcare Website and Educational Resource:
The primary purpose of ErgonomicsInHealthcare.org is to provide access to the many educational training tools and web-based resources that have been developed to assist both healthcare employers and healthcare workers address ergonomic injury recognition, management and prevention in their home facilities. Visitors to this website will have access to: 1) all of our COEM ergonomic training PowerPoint presentations prepared for our regional ergonomic injury prevention outreach program, 2) a repository of ergonomic safety materials, e-tools, and other web-based training materials and 3) information and guidelines addressing the development, implementation and maintenance of ergonomic injury prevention programs and safe work practices for healthcare facilities.

• We have summarized over 75 ergonomic injury prevention websites that we believe provide both reliable and accessible information addressing various aspects of ergonomic injury recognition, management, and prevention in the healthcare setting.
  
  
• We have developed several technology tools including targeted search engines by topic as well as a general Internet search engine allowing quick and easy access to worthwhile information available on the Internet searchable by key word or concept.

Patricia L. Meinhardt, MD, MPH, MA, Author

Funding for this site has been provided by the Occupational Safety and Health Administration and Arnot Ogden Medical Center. External sites and linkages are not endorsed by the Occupational Safety and Health Administration or Arnot Ogden Medical Center.
This page may be reproduced noncommercially by healthcare employers and healthcare workers to share with one another for educational purposes.
Any other reproduction is subject to approval.

© 2003 - 2010 Patricia L. Meinhardt, MD, MPH, MA and Arnot Ogden Medical Center. All Rights Reserved.



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Disclaimer: This material was produced under grant number 46B1-HT07 from the Occupational Safety and Health Administration, US Department of Labor. It does not necessarily reflect the views or policies of the US Department of Labor nor does mention of trade names, commercial products or organizations imply endorsement by the US Government.