are r.n's prone to serious back injury?
ummm . is the pope a catholic?
as for what we can do - we should not be lifting full stop. many hospitals in england and here in australia have adopted a "no lift" policy. how can you care for a patient without lifting?
the answer is simple - "slide sheets" aka "move tubes" they are slippery thin fabric which is actually sail cloth - you know the stuff they use on yachts.
the patient is rolled ( yes there is some moving but it does not put the pressure on your back that lifting does) the cloth is placed under the patient and then they are slid up the bed. the cloth is thin enough that you can easily slide it back out again. turning and positioning a patient the slide sheets can be used again especially for those heavy turns where the patient is placed into a lateral position and moved back into the bed. the technique is little more complex and hard to describe by words.
every time this subject comes up i try to post some references to "no lift" sites but i am unsure how many are actually following it up.
as for the hospitals spending money to introduce it --- we just showed them that they would be saving more money in workers compensation premiums than the cost of introduction as well as saving on staff turnover and they lined up like lambs.
the following was taken from the queensland nurses union website at www.qnu.org.au
as you can see they put a very persuasive argument forward
6 may 1999
no lifting 2000
what is a lifting policy and why do we need it?
at the 1997 qnu annual conference, delegates voted to adopt the following united kingdom definition of a no lifting policy:
"that the manual lifting of patients is eliminated in all but exceptional or life threatening situations. manual handling may only continue if it does not involve lifting most or all of a patient's weight." 1
this means that patients who are able to assist in their transfer should be encouraged to do so; for those who are unable to assist, lifting devices/equipment should be utilised to minimise the strain on the worker. manual handling should be minimised wherever possible.
every patient should be individually assessed for their manual handling needs at the time of admission and on an on-going basis. this should be inclusive of the patient's ability to participate in the process, and their rehabilitation needs. however, this should not be to the detriment of the worker's health. in 1996/97 sprain/strain injuries accounted for approximately 55 percent of all injuries to workers in the health industry.
1995/96 muscular stress injuries
workers' compensation data 2
registered nurses - 623
enrolled nurses - 215
assistants in nursing - 938
total claim numbers - 1776
work days absent
registered nurses - 11923
enrolled nurses - 4571
assistants in nursing - 18447
total claim numbers - 34941
the main causative factors for these injuries were 'lifting, carrying or putting down another person'. the injuries outlined are only those that were compensatable - many more injuries are sustained by nurses which are not eligible for compensation. the division of workplace health and safety estimates that the cost to the employer is more than seven times this amount. the emotional cost to the individual is considerable.
unfortunately, the problem continues. there is no prescriptive legislation that prohibits nurses lifting large and awkward weights. the workplace health and safety act does indicate that employers are to do risk assessments on every identified hazard and there is an advisory standard on manual handling - the handling of people that requires risk assessments to be done for individual people. however, this does not appear to be happening in the majority of health establishments as there are 'no safe levels for manual lifting and it should be avoided except in emergency situations'. 3 this statement was based on the weight lifting guidelines in the british manual handling regulations.
rather than deal with the alleged costly issue of providing equipment (approximately $20 000 per 30 bed medical ward), workers' compensation legislation is being changed. the current definition of injury states that work has to be the major significant contributing factor to the workers' injury. this is becoming more and more difficult for workers to prove. many claims are being rejected and the onus of proof is on the worker. alternatively, many nurses are having restrictions put on their claims due to having a previous existing condition which in the main was caused or exacerbated due to their nursing career, but is difficult to prove.
hence the motion put forward at annual conference:
"this conference of qnu delegates calls on all health establishments in queensland to implement a 'no lifting policy' by the year 2000. furthermore, we call on qnu to adopt the uk definition of a 'no lifting policy' : 'that the manual lifting of patients is eliminated in all but exceptional or life threatening situations. manual handling may only continue if it does not involve lifting most or all of a patient's weight.' we also call on qnu to develop a kit of information on implementing a 'no lifting policy' in order that members understand the concept and are empowered to raise the issue in the workplace or unit."
we have now issued the challenge and set the time frame and we will soon develop the 'how to'.
your role as nurses will be to carry it through.
case study 1
nurse a, a 51 year old registered nurse, sustained an injury to her back in 1990 after lifting a medicine trolley over the lip between carpet and tiles in her workplace. this resulted in a disectomy of lumbar 4/5. for the next five years nurse a was off work on workers' compensation and other leave. she was retired from her workplace on the grounds of ill health in 1995 and her common law settlement was finalised in 1997. she received a payment of $102 000 with approximately $55 000 having to be refunded to workcover.
while on compensation she did a medical receptionist course, but these positions are very difficult to find. currently, she does some relief work in an aged care facility but does no hands-on nursing. nurse a has had major changes imposed on her life and on her family. her children were no longer able to go to university as had always been their expectation. her monetary loss has been substantial and her own future plans of being a nanny escorting children on planes to england were fast dissipated. she also believes she has had a personality change due to the stress associated with this injury.
case study 2
nurse b is a 44 year old enrolled nurse who went off work with back pain in 1996. she had a gradual increase in pain over a period of time. she worked in the aged care industry, responsible for 8 - 10 residents per shift.
after many problems her claim for compensation was finally accepted by workcover, but not however by her employer, who continued to question workcover's decision and harass nurse b at home. she finally resigned from work as she was advised that she would no longer be physically able to carry out her duties as a nurse.
nurse b was diagnosed with prolapsed intervertebral disc lumbar 4/5 and eventually required surgery. this claim was ceased by workcover as 'her continued absence from work is not the result of "injury" within the terms of the act" as her injury was seen as an aggravation of a pre-existing injury and although no longer able to work as a nurse she was fit for alternative work. she had worked as a nurse for 23 years.
the qnu is currently assisting this person to appeal this decision and investigate the possibility of taking a common law action against her previous employer.
how to implement it
in this paper we discuss some of the processes that need to be followed to assist you to implement a no lifting system of work.
the first step is to raise the issue within your work unit area, either informally or via a staff meeting. when doing so you must be prepared with information about what it means; the rights of nurses versus the rights of patients; and examples of good systems.
once your colleagues are supportive the issue should be raised with your employer or hospital management. this can be done through health and safety committee meetings, nursing executive meetings or qnu branch meetings. at this stage you are seeking a commitment from management to move to a no-lifting system by the year 2000. you should stress that the benefits to the employer include:
decrease in compensation payments;
decrease in common law actions;
decrease in fatigue;
decrease in sick leave;
increase in productivity; and
assistance with recruitment and retention issues.
it is important to note that the true benefits of implementing this policy are long term and will not be fully realised for three years.
the process could involve a working party being set up to do up an implementation plan with costings. (it is important to factor in training costs as well, as no system will work without proper training. in some areas this may include patient and relative education as well.)
this plan may need to be phased in therefore you need to set your priorities. you may be able to improvise whilst the system is being put in place.
the implementation of a no lift system should not be to the detriment of staff numbers. in the majority of cases, two staff members will still be required to use the equipment.
whilst this is going on at the ward or unit level you need to start looking at the type of patient you have coming into your area and their manual handling needs.
generally, there is no one stop shop. you will need a variety of devices and equipment such as hoists, slings for hoists, slide sheets, lifting straps, slide boards, air mattresses, to name but a few. you may even need to look at the types of beds available that will allow for flexibility with the type of patient you have, the equipment needed to be used and most importantly allowing for differences in the height of staff.
the system of work may also need to be looked at. for example, is it really necessary to do 2 hour turns when a person is on an air mattress? in the aged care area, is it necessary for everybody to be out of bed for breakfast?
the work environment is very important, it is no use having hoists if they don't fit through the doorways, or you cannot manoeuvre them in the room. is the bath at the right height or the right type? can you assist people onto the toilet with ease?
other things that need to be considered are storage areas for hoists and equipment, and the floor covering, if not of the correct type, can also cause problems.
uniforms can also restrict movement, therefore you may need to look at the options available in this area. non slip sole lace up shoes should also be considered in order to prevent slips.
the implementation of a no-lift system should not be to the detriment of staff numbers. in the majority of cases two staff members will still be required to use the equipment.
once management commitment is forthcoming policy development is essential. this ensures that both staff, patients and relatives know where they stand.
an assessment process should be set up for your patients. is this to be done by the registered nurse on admission? what type of tool is needed? how is it evaluated and when?
in larger health establishments there may be the need for a coordinator of all these activities as is already happening in some of the metropolitan hospitals. this is nursing practice and should be driven by nurses and implemented in consultation with their colleagues.
when implementing the system be conscious of setting your assessment criteria in order that you are able to gauge your progress. the process will need to be evaluated at regular intervals and be flexible enough to allow for the unknowns.
the aim is to eliminate manual handling in all but life threatening situations. manual handling may only continue if it does not involve lifting most or all of a patient's weight.
once again, it is important to note that the patient's quality of life goes hand in hand with the nurses quality of life. by implementing a no lifting system you are not endeavouring to compromise the independence of the patient.
the policy in action
there are a number of diverse health care facilities throughout queensland that have implemented, or are implementing a structured "no lift" patient handling system. these include princess alexandra hospital, mt olivet hospital and redcliffe hospital nursing home annexe in brisbane, lady smallhaven on the gold coast and wahroonga retirement village in biloela.
mt olivet hospital fully implemented the "no lift" patient handling system throughout their hospital in february 1996. subsequent evaluation clearly demonstrates its effectiveness. results include:
significant reductions in workers' compensation costs including number and cost of claims;
reduced staff and patient injuries;
improved patient quality care;
cost-effective work practices; and
while the full results cannot be expanded upon in this article, mt olivet workers' compensation costs savings are outlined here. these were presented by louise o'shea and margaret gorman at the international productivity, ergonomics and safety conference held on the gold coast on 24-27 november 1997.
workers' compensation savings - 18 months pre and post implementation.
a comparison of mt olivet's workers' compensation statistics in the 18 months pre and post implementation period revealed the following reductions:
total workers' compensation costs for patient handling claims decreased by 95%;
average cost of a patient handling claim decreased by 84%;
number of patient handling claims decreased by 70%; and
average number of days lost per patient handling claim decreased by 81%.
total workers' compensation costs and days lost
prior to the implementation of the "no lift" patient handling system, patient handling claims accounted for the majority of workers' compensation costs and days lost at mt olivet. following implementation, the hospital experienced dramatic reductions which are demonstrated in the following table.
patient handling claims
financial year % total days lost % total costs
1993/94 43% 43%
1994/95 71% 60%
1995/96 88% 64%
1996/97 11% 6%
there are a number of critical factors that contribute to the successful implementation of a no-lifting policy or system. they include:
executive management support to ensure compulsory adoption and maintenance of the program throughout the facility;
line management support to ensure successful implementation and ongoing compliance of the program into the ward or unit;
ongoing staff consultation and involvement throughout the implementation, implementation and monitoring of the program to identify changing needs and ensure staff ownership of the program;
a standardised program that is able to be adapted to meet the needs of the ward or unit;
structured and planned approach to implementation; and
compulsory competency based training and assessment for all staff involved in patient handling to ensure standardisation and quality.
the successful implementation of a no lifting patient handling policy for the health care industry has proved to be achievable and has already provided organisations with significant industrial, financial and social benefits.
the blue nursing service - brisbane central demonstrates a strong commitment to workplace health and safety issues, and significant health and safety improvements have been made in the region.
an example of this is the implementation of the risk management program, which includes a no-lifting program.
the organisation's no-lifting policy was introduced five years ago. it focuses on educating and empowering staff to use the risk management model to minimise the risk of injury. the key to the organisation's no-lifting policy is the identification of potential manual handling risks, assessment of those risks using a multidisciplinary approach, implementation of control measures, and ongoing monitoring and evaluation.
on admission of a client, the holistic assessment includes an assessment of the potential hazards within the working environment. if the possibility of lifting is identified appropriate aids are recommended. the lifting aids come from a variety of sources, eg. home medical aids, queensland health, department of veterans affairs, private sources or by the client hiring equipment. if the environment needs modification, resources such as home assist and volunteer carpenters are used.
staff empowerment through education and executive commitment are the vital links to implementing and maintaining the no lifting policy.