Nursing Career: Can My Back Take It?

I field questions from nurses and people who are thinking about becoming nurses on a daily basis. In this economy, there are so many adults from all walks and stages of life who are seriously considering joining the traditional set of new high school graduates as nursing students, due to the instability of their originally chosen profession or job. Nurses Announcements Archive Article

Nursing Career: Can My Back Take It?

I've heard from hundreds of them. Among the most oft-asked questions I receive is this one: "I think I would like nursing, but I'm worried about my back...will I be able to take it physically?" In response to a question posted on this forum, I composed the majority of what I've decided to share in this article, in hopes that it may help more than just a few.

I recently read a Washington Post article about proposals in some circles to provide nurses with mechanical devices to assist with patient lifting, transferring, turning...the things that typically cause strain on the back and neck of a nurse. Arguments against such devices ranged from cost issues to general resistance from nurses because of concerns about patient dignity. While these things are argued and debated, nurses will, on a daily basis, be required to lift, transfer, and turn their patients. Discussion and debate are good...but they do not do the work of the nurse, and won't likely be implemented for some time to come.

So, in the meantime, allow me to share my experiences and what I've learned, in hopes that it might help a fellow nurse with an aching back, or prevent a student nurse from receiving an unnecessary injury, or help someone considering nursing as a career who is concerned about the potential for injury, to hear one nurse's experience and ideas.

Of course, I wouldn't be a proper, modern nurse if I didn't insert a disclaimer here...this is only my personal experience...I cannot guarantee anyone an injury-free nursing career, nor healing of an existing injury. You need to take care of your own back, and, if you're already hurt, see your own health-care practitioner for treatment and advice before you try any of my tips! Glad that's out of the way!

Personally, I have many years of nursing under my belt and have done so with a "tender back" for a number of them. My very worst years with back pain were, oddly enough, when I was a student nurse! I believe it was because I didn't feel comfortable, as a student, asking the other nurses to help me, and so I would do too much on my own...things that the staff RN's probably would not have done on their own. I would often walk back to campus bent over--literally--with each step sending pain shooting through my lower back, and then spend the next 12 hours on my heating pad!

If you wonder whether or not I was worried about becoming a nurse, I was. But I wasn't about to ask my nursing school instructors if I could "skip clinical because my back hurt." I figured that was a good way to be shown the door. So I just gritted my teeth and kept going. I picked up bits and pieces about body mechanics, but either not enough, or I didn't apply them correctly. Sometimes you just can't, when things get really hectic. I finished nursing school, received my BSN, moved to my fiance's location, and found my first job at a major metropolitan teaching hospital. It was there that the "recovery" began.

What I learned, starting from that point and continuing over the years, allowed my back to not only heal from it's early insults, but to strengthen and stay healthy. Again, I can't promise the reader anything...but if it worked for me, it may just help you, too. Here is my advice:

#1. Learn the body mechanics, learn them well, and take the lessons seriously. As a professional RN (as opposed to a student nurse), the first "orientation class" my hiring hospital sent me to was one on body mechanics, taught by the P.T. department. If you've been through PT, you probably know that those folks are able to "move mountains." That is to say, they can work with folks who require major assistance...because they understand the concept of "leverage." Granted, their equipment can be sophisticated, but it isn't always. They just know how to do it. If you could somehow connect with a physical therapist for just 1/2 an hour of body mechanics training, you'll be off to a great start. But it is just a start.

#2. Do not hesitate to ask an RN (or a fellow student nurse) to help you with a lift, or a boost up in the bed (which you will do non-stop as a hospital nurse!). It's those little things that we "think" we can do on our own that injure the back over time. Yes, it takes time to get a helper to join you. Your patient will have to wait an extra minute for a boost, and they may not like it. But you will need to keep in mind that to them, it's just one boost. But for you, it could be the 100th boost you've given that month. If you do them improperly, you WILL end up with a bad back. Done properly with the correct amount of people, you should be able to do everything safely. That said, we, as a nation, are growing heavier and heavier. Morbidly obese patients are common, and they are less able than anyone else to reposition themselves in a hospital bed. This does put the nurse at a greater risk for injury. But what of the nurses themselves? Are we in much better shape than many of our patients? It's time to consider our own bodies, and what we can do to try and prevent a back injury.

#3. This one is for ALL nurses, of all ages: did you know that weak stomach muscles are a common cause of lower back pain and injury? Most all of our muscles have "opposing" muscles...just as your biceps oppose your triceps. When one contracts, the other relaxes, and vice-versa.

With the lower back, your abdominal muscles are the "opposers," so to speak. We have to work to keep our abdominals in shape. A muscle that is in shape, or "toned," looks the way it does because it is always in a slight state of contraction. That's why, with weightlifting, the muscles seem to "stand out," and contracting them on purpose enhances that. (Think the "6-pack abs" picture.)

Do you use your abs in such a way that they're toned, every day? Most of us don't. But we DO use our backs in such a way that they're somewhat toned, in our everyday bending and lifting, and nurses use their backs a lot. In the end, our back muscles are more toned...so they contract slightly, which shortens them; this causes the arch in our lower back to become more pronounced. If our abdominal muscles were as strong as our back muscles, they would be in a state of equal contraction, and would, thus, shorten and "pull" the spine back into more natural and healthy alignment. But most of us have strong backs and weak stomachs (no nursing pun intended). Our weaker abdominal muscles are not compensating for the contracted back muscles.

I learned that If I did "crunches" (situps), my stomach muscles would become toned, and would "pull" the back muscles into a better balance. Without the balance, the lower back arches too much, and the vertebrae begin to compress the intervertebral discs. Over the years, you can suffer herniated discs and other lower back problems.

My advice? You've got it...do those crunches! You do NOT need to join a gym...do them in your living room. You don't need to do 100 of them...start with 8. Your abdominals will ache! That means you're using them. Look for video instruction online (like this one, HERE) if you're new to crunches to be sure you're doing them correctly; if you do them wrong, you can do more harm than good! And if you already have a back injury, check with your health care practitioner before you begin exercising.

I hope this will be of help to you as you go about your work as nurses. Hopefully, someone will come up with a mechanical/technological solution to this age-old problem we face...until then, do your crunches, and help your fellow nurses with their transfers, so they'll help you with yours. Take care of yourself, as well as your patients!

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MsLoriRN

About MsLoriRN, BSN, RN

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great info

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Thanks for this information that was very informative. I am a student nurse. I have incorporated a 45 min workout with cardio at the gym that will be part of my nursing school. I need to say in shape. I was not focused on my stomach muscles but I will add that to my routine.

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Specializes in Critcal Care.

YES, YES, AND H--LL YES!!! Crunches AND YOGA WILL SAVE YOUR BACK! I was amazed at how this combination has helped me and I was REALLY out of shape and a not so young lassie. Moreover, last week I was not ashamed to ask FOUR of my colleagues to help boost a patient who was obese and who had several IV pump and a ventilator in his too small room. Like the commercial says, 'You only have this one back!'

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:)Thank you, thank you!! I am a student nurse and will take your advice seriously. I have also just begun a new workout regimen and will definitely focus more on ab work. What you wrote makes so much sense.

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Abdominal strengthening is a good start.

I would caution that core strengthening alone simply moves the injury elsewhere during overexertion. For example. those trained in proper lifting lifting techniques have fewer back injuries on average. Those trained in proper lifting lifting techniques also have on average a greater number of latissimus and deltoid tears, and shoulder, and neck injuries.

In addition, only cohort studies, anecdotal evidence, and folklore support stretching for injury prevention.

The answer is a zero-lift policy for everyone except a well trained, well staffed, and well paid lift-team. This approach works really well for patient safety, patient confidence in care, patient well-being, risk management, and staff morale.

No two happier groups than nurses who never lift all day, and a group of dudes and gals who get paid to lift and train all day.

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The injuries I am most familiar with come not from lifting, but catching a patient, steadying a patient, performing a quick and "easy" repositioning in bed without raising the bed first... I honestly have never seen anyone try to actually lift a patient by themselves. I am a pretty fit male that Goes to the gym 5 days a week and I would never try to lift an awkward human body because I know I can't without straining.

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Abdominal strengthening is a good start.

I would caution that core strengthening alone simply moves the injury elsewhere during overexertion. For example. those trained in proper lifting lifting techniques have fewer back injuries on average. Those trained in proper lifting lifting techniques also have on average a greater number of latissimus and deltoid tears, and shoulder, and neck injuries.

In addition, only cohort studies, anecdotal evidence, and folklore support stretching for injury prevention.

The answer is a zero-lift policy for everyone except a well trained, well staffed, and well paid lift-team. This approach works really well for patient safety, patient confidence in care, patient well-being, risk management, and staff morale.

No two happier groups than nurses who never lift all day, and a group of dudes and gals who get paid to lift and train all day.

Must admit..have not heard of a lift team..are these primarily in rehab facilties?

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I have never heard of or seen one in a LTC or SNF. For that matter, none of the three hospitals I did clinicals in had them either.

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I just completed my first day of student nursing. We went over lifting mechanics with a PT. We talked about a lift team and that some hospitals are beginning to impliment lift teams. Several of the student nurses were too small to even attempt to lift patients even with the sheet tucked under the patient. Should they be exempt from becoming a nurse; because they can't lift patients. I think with the nursing shortage a lift team should be implimented in all hospitals. A bad back from on the job lifting should be zero tolerance. As was noted in the meeting lift teams are much cheaper that workman's comp.:typing

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Specializes in OB/Gyn, L&D, NICU.

Thank you. Yes yes yes, those all help greatly. I have degenerative arthritis of the spine, pinched nerves, fused cervical vertebrae, carpal tunnel, and tendonitis. Whew! So I must do my exercises, keep my weight low, use my back properly, massage, and take NSAIDs. My friends and neighbors think I am taking a leisurely jog when I exercise, but it is for medical reasons.

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I just completed my first day of student nursing. We went over lifting mechanics with a PT. We talked about a lift team and that some hospitals are beginning to impliment lift teams. Several of the student nurses were too small to even attempt to lift patients even with the sheet tucked under the patient. Should they be exempt from becoming a nurse; because they can't lift patients. I think with the nursing shortage a lift team should be implimented in all hospitals. A bad back from on the job lifting should be zero tolerance. As was noted in the meeting lift teams are much cheaper that workman's comp.:typing

Maybe when that nursing shortage shows up here I will suggest lift teams to our office. In the mean time, since we have a line of nurses looking for work we dont need them yet.

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