No lift policy

[PaulG]

Could some of you please briefly tell me the status of the no lift policies within some of your healthcare facilities where you are employed, regarding patients that are able to support their weight? Bed to wheelchair, wheelchair to toilet, etc.

[kburns0016]

This is gonna be a little long ,sorry....

I have not had time to read all the posts so forgive me if some one else had said this , but just last year I was hired in a LTC facility that had a "No-Lift" policy, so they do exist in the states ...the only problem with this SNF was the policy was only in effect on paper! Out on the floor CNA's were paired and as a new CNA I was not even shown how to operate the lifts we had sitting in the hallways and when I asked about them the parters I had said we did not have time to "mess with the equipment " while we were doing rounds or getting clients up in the a.m.....needless to say about 3 weeks in I injured my back assisting another student put a resident on a potty chair, she had no idea how to lift manually and I did not know it until too late and I was NOT dropping that lady!( minor injury thank G*d) and the company told me they would pay my medical bills out of pocket, if I passed the drug screen which i did, but refused to file anything with WC , which I was informed by the hospital as I was getting my x-rays is illegal in my state( the receptionist was actually kinda nasty about it like I was not wanting it turned in )...I got some legal advice about returning to work there after my dr's excuse was out and I was told to NOT work another shift there , since they did not create a paperwork trail of my injury if I was hurt again in that facility they could and would likely claim I had a previous undisclosed injury and therefore make me ineligible for ANY WC claim in the future.

I found out from a seasoned staff RN a few weeks later that it was about time for state to visit and a reported worker injury would have called undue attention to the fact that the No-lift policy was not being enforced as the facility was understaffed and not giving time during rounds to properly use the equipment....basically they were giving lip service to a policy they had no intention of enforcing!

Moral of this story ...if your employer says they have a No-Lift policy and you see it is not being enforced effectively BE CAREFUL and refuse to put your career and /or body in danger!

[lpnornot]

Wow..where do I begin. This is a topic that really concerns me.

Injured my back in assisted living. Lifting 150-200 lb practically immoblie pts. And this is "assisted Living" ??!!!! I had been through a semster of RN. We were told nurses only are to manually lift 31lbs ergonomically=with good body mechanics. I thought erroneously that as a CNA I would be expected to lift more. i was assured by my RN boss that it could be done safely if done right.

On day 3 I felt first pain on lifting. told boss-RN right away. Asked for advice on how to do it w/o hurting myself. She showed me the same technique.

Pain just got worse and worse with successive unsafe lifting. kept telling boss and her husband about the pain. fellow assistants knew too.

I had seen alot of patient care issues that didn't seem right. Unsafe even illegal patient care. So i started to really mistrust employers. started my own research on patient lifitng.....

Researched OSHA, Veterans of America, American Nurses Assocition :

-THE HUMAN BODY IS NOT MADE TO LIFT MORE THAN 35LBS EVEN WHEN DONE WITH GOOD BODY MECHANICS. This means feet sholder width apart, bend at knees, stomach tensed, buttocks tensed(to protect weak back muscles) bend down to lift object, hold close to body, lift with back straight, no twisting when lifting. LIFTING GREATER THAN THIS WEIGHT ERGONOMICALLY WILL WILL, SCIENTIFICALLY PROVEN TO CAUSE INJURY TO THE SPINE.You might not feel it right away but it does cause damage..

My computer is loosing power I'll post now

[lpnornot]

continued from above...

IT IS VERY DANGEROUS FOR THE PATIENTS TO BE LIFTED AND DROPPED DURING TRANSFERS. CAUSES NERVE AND MUSCULO-SKELETAL DAMAGE TO THIER SHOULDERS AND HIP FRACTURES.

-I believe the American Nurses Assoic (ANA) calls for no manual lifting. Because even lifting 35lbs of a pt is dangerous. You can't gUarentee that you can hold them close enough, they can get combattive, non-comliant and move suddenly or resist the transfer/lift, make your back twist etc. the 35lbs is an estimate from OSHA's reasearch on moving objects. They say 50lb box lifitng ergonomically is safe, anything over damages the spine. So then some have used that research to estimate safe pt handling weights.

-ANA has a Safe Patient Handling campaign going. No manual lifting. Heavy reliance on mechanical devices-there are so many out there!!! Geri-chairs, sliding sheets, standing lifts from the ceiling or not, hoyers, mattresses that blow up to help pt who fell on floor (lifting someone from floor prob most dangerous lift there is) I've only seen Hoyers but have read about all these other devices.

-I think California and Texas are now no-lift states. Attempts to pass similar policies in Congress passed one house but not the other yet.

Let's write to our congressioanl reps about this problem.!!!!! We in the US are so behind other developed nations on this issue. I believe 8 European countries have no-lift policies in health care facilities.

Back to my personal work related injury...

-I went to boss/RN about my pain after I had researched a lot on the internet, organizations I listed. I refused to do it any more and offered my resignation. (stupid since they caused the injury, but learned that later) She kept insisting I lift the same pts that were causing me pain. I told her I would care for those who need minimal assistance in standing, transfers etc. She kept insisting I do all pts. I kept offering resignation. She tried guilt tactics, complimented me on my nursing potential, she told me not to see a doctor because "he" would tell me not to lift, she said if I only cared for some pts the other caregivers, who also have back pain would go to thier doctor and refuse to lift too. I kept very respectfully and even apologetically offering to leave in 2 wks., could i please have 2 weeks!!! She kept me on.

I took care of the pts I estimted were only 35lbs lifts or less. I asked othrs to do the lfiting when I thought it was unsafe. I hated doing this to the fellow caregivers but had no choice, but not on the bosses.

The pain got a bit better only. I called for DR apt. I was told if injury happened at work I need injury report, have to file workers comp or my insurance wouldn't pay.

Told this to Boss. She started for first time to be unpleasant to me. Spoke of me sticking her wiht workers comp, she whinned that her comp would have to pay for my medcal expenses. She accused me of suing her warned it would be very complicated for me etc. Then the next day when I said I have no choice, I want to see my doctor and I wont pay for the visit out of pocket she asked me not to come in that day. 2 hrs later she told me not to come in next week.

I brought in doctors note about needing to be on light duty. They refused to honor this. Had no light duty for me. essentially I was out of work from one day to the next

They refused, this is illegal, to give me their workers comp information. refused to pay for my lost wages and medical bills and refused to allow me to recover them from thier workers comp insurance by denying me access to the wc info. Iwas told to go protect my own rights because they wouldn't do it.

They were rude and hostile. Accused me of "making a living this way". Stoped returning my calls. Refused anything in writing about no light duty available but insisted when asked that I was not fired-because they knew its illegalt to fire someone after they have filed WComp.

Accoding to OSHA all employees are to have a poster up about employee and employer rights and obligations concerning work place injuries. This is supposed to be posted where employees can see on a regular basis. Workers comp information-company name, adress, employer id, workers comp company name, agress, phone number and adjsuter name is supposed to be provided. In My state it is the law that compnies wiht one employee or more have workers comp insurance.

I have my hearing in August. Lawyers wanted me to go straight for their doctors and MRI and PT. That's where they get thier cut. But NSAIDS cured my back and unnecessary MRI is like getting 10 x-rays.dr told me. So beware of that.

I will try to represent myself. i'm lucky I wasn't hurt more. i want my lost wages and copays paid for. I also want to stand up for all the other caregivers in this place and others who are abused in this way. it amounts to torture in a way the pain and physical damage this employer is causing her employees. and I'm sure so many others do it as well.

I presented my employer with the research I had about safe pt handling. all the devices that can be used. The dangers of handling such heavy weights, the damage it does to caregiver and to the pt. She came up wiht one excuse after another..takes too much time, we can't afford it etc. Bottom line...money.

Yes it can save a facility worker comp money for work injury expenses but if they can get away wiht intimidating and lying and illegal tactics letting you go after your injury cus you can't do what you were hired to do even thoughtthey are the reason you can't do it, all to prevent you from filing for workers comp, there is no savings to them.

I'll try to send some link but in meantime you can reserch American Nurses association. amercian veterans, OSHA(occuopational safety and health admin-you can file a complaint anonymously about unsfe working conditons) Keyword "musculoskeletsal injuires, nurses" too.

Nurses suffer more injuires than any occupation. Somethng needs to be done.

My username is LPNORNOT for a reason. I am out of the RN program (it was too intense). I'm going to study to work in a lab-MLT. But I so enjoyed the patient interaction I have expereinced, especially at the place I was hurt, ironically. but I am scared to go for an LPN career because of the potential for injury. i'll prob get my MLT cert and maybe later LPN. At least if i hurt myself I have a good career to fall back on.

[lpnornot]

musculo-skeletal injuries, safe patient handling research

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safe patient handling and transfer

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from: american federation of teachers:

http://www.aft.org/topics/no-lift/

numerous studies have documented a high prevalence of back, knee, shoulder and other joint pain among healthcare workers. based on workers' compensation claims for back injuries, nursing aides and licensed practical nurses (lpns) ranked fifth and ninth, respectively, among all occupations as those most at risk for such injuries. nursing aides are at a higher risk for back injuries than construction laborers, lumbermen, material handlers and laborers.

lifting and transferring of patients are the most commonly reported causes of back pain and knee and shoulder injury among healthcare workers.

most programs for the prevention of back and joint injury to healthcare personnel tend to focus on proper lifting techniques, body mechanics and back care.

but many researchers now recommend an ergonomics approach that focuses on workplace assessment of patient care areas, patient assessment criteria, algorithms for safe patient handling and movement, lifting and transfer equipment, peer-safety leaders, lifting teams, incident reviews and similar policies.

these ergonomic approaches to safe patient handling and transfer policies are often called "no-lift" or "zero-lift" policies.

[lpnornot]

re: musculo-skeletal injuries, safe patient handling research

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the following i copied from ana's website i did a lot of the bolding:

http://www.nursingworld.org/mainmenu...enda/sphm.aspx

safe patient handling and movement

background

as part of the american nurses association's (ana's) nationwide state legislative agenda, ana and its state nurses association's are promoting legislation that would require hospitals and other health care institutions to develop programs to prevent work-related musculoskeletal disorders and eliminate manual patient lifting.

the national institute for occupational safety and health identifies back injury as the second leading occupational injury in the us, with back pain as the most common reason for filing workers' compensation claims. in 1990, estimates of the annual cost of back injury ranged from $50 to $100 billion in the united states. (1) studies of back related worker's compensation claims reveal that nursing personnel have the highest claim rates of any occupation or industry.

compared to other occupations, nursing personnel are among the highest at risk for musculoskeletal disorders. according to the bureau of labor statistics (2006), nursing aides, orderlies, and attendants ranked second, immediately following laborers (first) and rns fifth in a list of at-risk occupations for strains and sprains. more than one third of back injuries among nursing personnel have been associated with the handling of patients and the frequency with which nurses are required to manually move patients. (2)

the extent of musculoskeletal disorders among the u.s. nursing workforce is particularly distressing when considered in the context of the current nursing shortage. it is estimated that 12% of nurses leave the profession annually due to back injuries and greater than 52% complain of chronic back pain. injuries secondary to patient handling tasks exacerbate the shortage and are of particular concern with the aging of the nursing workforce.

in spite of initiatives in other nations such as the united kingdom and australia, the concept of a no lift policy has been slow to be accepted in the us. in 2004, ana developed a program, "handle with care" that supports safer practices with regards to patient handling. approaches to addressing this issue include recommended changes in nursing school curriculums as well as legislation. safe patient movement and handling benefits patients. the potential for patient injury (such as falls and skin tears) as a consequence of a manual handling mishap is reduced by using assistive equipment and devices. equipment and devices provide a more secure process for lifting, transferring or repositioning patients. patients are afforded a safer means to progress through their care, have less anxiety, are more comfortable and maintain their dignity and privacy. assistive patient-handling equipment can be selected to match a patient's ability to assist in his or her own movement, thereby promoting patient autonomy and rehabilitation.

safe patient movement and handling benefits the nursing workforce. patient handing tasks are recognized as the primary cause for musculoskeletal disorders among the nursing workforce. a variety of patient handling tasks exist within the context of nursing care, such as lifting, transferring, and repositioning patients, and are typically performed manually. continuous, repeated performance of these activities throughout a nurse's working lifetime results in the development of musculoskeletal disorders. of primary concern are back injuries and shoulder strains, which can both be severely debilitating for nurses.

for more information, visit ana's handle with care program.

enacted to date

prompted by ana's handle with care campaign which began in 2004, nine states have enacted "safe patient handling" legislation: maryland, minnesota, missouri, new jersey, new york, ohio, rhode island, texas, and washington, with a resolution from hawaii.

in 2008, ten states introduced legislation seeking health care worker protections through programs restricting or eliminating manual lifting of patients. they include: california, connecticut, florida, hawaii, illinois, kansas, maryland, minnesota, missouri, and new york; two of which passed legislation: maryland and missouri. related bills died in florida, kansas, minnesota, and vermont.

summary of states having passed legislation

(2008)

missouri will provide tax credits for hospitals for the cost of purchasing lifting and other devices intended to minimize patient lifting following enactment of safe patient handling legislation. by january 1, 2009, each hospital will establish a safe patient handling committee or assign required functions to an existing committee. functions of the committee, of which membership is to be at least half non managerial employees who provide direct care, will be responsible for design of a safe patient handling program and recommendations for the process for implementation. the implementation process considers: development of associated policy, including methods for addressing all units and shifts; conducting a patient handling hazard assessment; acquisition of equipment, with minimum requirements defined in statute; staff training; and provisions for conducting an annual evaluation of the program.

maryland extended safe patient handling practices to residents and employees in nursing homes. 2007 legislation applied to hospitals only. on or before december 1, 2008, each nursing home will establish a safe patient handling workgroup with equal membership between management and employees. on or before july 1, 2009, the workgroup shall have developed policy, the goals of which are to reduce employee injuries associated with lifting; develop or enhance the use of patient handling hazard assessment processes; enhance the use of lifting devices with the incorporation of lift teams (role not defined); and determine the process for evaluating the program.

(2007)

both maryland (april) and new jersey (passed december, 2007 enacted january, 2008) chose a comprehensive programmatic approach, requiring health care facilities to establish a safe patient handling programs comprised of committees to establish policy and monitor the program.

maryland's "safe patient lifting" law, requires hospitals to establish a safe patient lifting committee with an equal number of managers and employees on or before december 1, 2007; requiring the committee to establish a safe patient lifting policy on or before july 1, 2008; and requiring the committee to consider specified factors while developing a safe patient lifting policy and program.

new jersey requires licensed health care facilities, state developmental centers, and state and county psychiatric hospitals to establish a safe patient handling program to reduce the risk of injury to both patients and health care workers at the facility within 18 months of the bill’s enactment. (july 2009) each facility would be required to maintain a detailed written description of the program and its components and provide a copy to the department of health and senior services or department of human services, as applicable, and make the description available to health care workers at the facility and to any collective bargaining agent representing health care workers at the facility. a facility would also be required to post its safe patient handling policy in a location easily visible to staff, patients, and visitors; and to designate a representative of management at the facility who will be responsible for overseeing all aspects of the program. within 12 months following enactment, each facility must establish a safe patient handling committee, responsible for all aspects of the development, implementation, annual evaluation and revision of the facility’s safe patient handling program, including the evaluation and selection of patient handling equipment and aids and other appropriate engineering controls. at least one-half of the members of the committee shall be health care workers who provide direct patient care to patients at the facility or are otherwise involved in patient handling at the facility. the remaining members of the committee shall have experience, expertise, or responsibility relevant to the operation of a safe patient handling program. the law provides that a health care facility shall not retaliate against any health care worker because that worker refuses to perform a patient handling task due to a reasonable concern about worker or patient safety, or the lack of appropriate and available patient handling equipment or aids.

with a voluntary approach, minnesota law, signed at the end of may, provides for grants to support safe patient handling programs and activities in health care facilities by transferring money ($500,000 per year for two years) from the workers compensation special fund to an assigned risk safety account.

(2006)

rhode island legislation requires each licensed health care facility to have a committee developed, by july 1, 2007, to develop a written safe patient handling program. by july 1, 2008, facilities must be prepared to implement a safe patient handling policy for all shifts and units that will achieve the maximum reasonable reduction of manual lifting, transferring, and repositioning of all or most of a patient's weight, except in emergency, life-threatening or otherwise exceptional circumstances. the statute also addresses completion of patient handling hazard assessments, staff training and the provision for reporting to a safe patient handling committee within each facility annually. washington legislation promotes safe patient handling and reduction of injuries among health care workers by establishing a safe patient handling committee (with at least half of the committee comprised of direct care providers) and implementation of a safe patient handling policy to prevent musculoskeletal disorders among health care workers and injuries to patients. the law mandates hospitals to acquire the much needed lifting equipment and provide staff training. hospitals will receive a tax credit when purchasing lifting equipment.

hawaii passed a house concurrent resolution calling for the legislature of the state of hawaii to support the policies contained in the american nurses association's handle with care campaign.

(2005)

new york state (nys) passed legislation that creates a two-year safe patient handling demonstration program and was extended by two additional years in 2007. the program will serve to collect evidence based data, reflecting the incidence of employee and patient injuries resulting from patient handling, comparing the use of manual and technology based techniques. any type of licensed health care facility interested in participating in this program applies to the nys department of health for funding. all participants must develop a risk identification and assessment plan, a comprehensive employee training program, be willing to commit to a culture which avoids manual patient handling to the greatest extent practicable, and provides ongoing reporting through the facility health and safety committee as well as the department of health. appropriations were designated in the 2006 budget.

ohio legislation resulted in the long term care loan fund program, to be operated by the bureau of workers' compensation. the administrator of the program shall use the program to make loans without interest to nursing homes for the purpose of purchasing, improving, installing lifts, as well as to support the cost of staff education and training in support of a policy of no manual lifting of residents.

legislation enacted in texas, effective 2006, requires the governing body of a hospital or the quality assurance committee of a nursing home to adopt and ensure implementation of a policy to identify, assess, and develop strategies to control risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient. the code stipulates there be collaboration with and annual reporting to a nurse staffing committee, as well as reports to the governing body or quality assurance committee. there is also the provision that in developing architectural plans for constructing or remodeling a unit of a hospital or nursing home in which patient handling occurs, consideration of the feasibility of incorporating patient handling equipment must be considered.

2008 summary of proposed legislation

california (sb 1151/ab 371) is the latest to join ranks in recognizing that musculoskeletal disorders (msds) in health care personnel far surpass that of other occupations and report that according to the 2006 bureau of labor statistics, california leads the nation in the number of workers reporting musculoskeletal disorders. this factor, combined with an aging workforce has prompted the state to seek a legislative solution this year. the california bill, the “hospital patient and healthcare worker injury protection act”, would establish a zero lift policy and lift teams within general hospitals. it would also require each hospital to establish a patient protection and health care worker injury prevention plan, based upon a needs assessment to determine the patients needing lift teams, and types of lifts and repositioning devices.

florida (hb 471/sb 508), hawaii (hb 2126), and missouri (hb 1940) have each introduced legislation requiring hospitals to establish safe patient handling and movement policy and programs. maryland (hb 585) would establish a work group to create policy for nursing homes. kansas (hb 2846) would require safe patient handling policy and program to apply to all “medical” facilities.

legislation was again introduced in new york (ab 8165/ sb 315) to require hospitals and nursing homes to install ceiling lifts. this is in addition to the extension of a demonstration project first enacted in 2005.

illinois (hjr 61) reintroduced legislation that creates a safe patient handling task force to study safe patient handling policies and create recommended policy guidelines for all health care facilities to eliminate the manual lifting of patients by direct-care registered nurses and other health care providers. although legislation passed in 2007, minnesota (hb3870/sb3559) introduced bills that would require every clinical setting that moves patients to develop a written safe patient handling plan with attention to identification of risks, establishment of policy, acquisition of resources, training, and evaluation of the plan.

connecticut (sb470)’s bill is directed to addressing a number of different nurse retention issues, including a provision for purchasing lift equipment.

last updated 7/03/08

[nursehoodylpn]

We have a no lift policy in my area of British Columbia Canada. You are not allowed to lift a patient by yourself unless they can weight bear on one leg or use both arms.

What it really means...if you hurt your back, they have covered their butts with the no lift policy and you are on your own. No financial help while you are off with an injured back.

[renygirl]

A "No Lift" policy went into effect at my hospital in July 2008, Mt. Vernon, WA. I was injured, by stopping a pt fall, in January 2008. I went to surgery and attemped a return to work too early, had to take off for another 4 months, I lost my FTE, now I'm going back into the float pool since this is the only position I can have for now. I will have to live by the "No lift" policy or I could really get hurt.

[lpnornot]

Is the policy really followed. can you refuse to lift the pts that shouldnt be lifted according to the guidlines you mentioned. If so I think that sounds encouraging.

Here you hurt your back and the only way to get compensation from you employer if they let you go is to get a lawyer who wants to run expensive radiation screening and doctor and PT sessions even against your own physians advice. you loose your case you are left wiht those medical bills. Luckily I only suffered from muscle strain but was out of work and took a while to get comprable wages again.

[wanderlust99]

I have heard that Washington has a no lift policy, or maybe it is just some of their hospitals? Someone was telling me how their are lifts on all the beds, and you never lift your patients without it. Sounds great.

We need need to do this in the usa, why don't we?

[wanderlust99]

This thread reminds me of something I have noticed, being fairly new to this region of the country- patients WANT to be lifted. I ask them to scoot over about 12 inches across a level table to another level table and they look at me like Ive just asked them to run a marathon. Im talking about otherwise healthy individuals admitted from home(where they presumably walked around unassisted) with ortho injuries to one extremity. I wheel them in, obviously very much working alone, ask them to scoot and they say "cant you all just pull me over" or "dont you have any help?" Whats up with that?? Is it just a cultural thing- if you are in the hospital part of getting your money's worth is not having to literally lift a finger or what? Just curious.

I've noticed that nationwide. I have learned to refuse to pull pts up in bed, etc... if they can do it themselves. Even if they roll their eyes, it's so much better for them to be independent. They probably feel we are their servants & should do everything for them. Like, pour me a cup of water, I'm too lazy to do it myself.

[HM2VikingRN, RN]

MPLS VAMC has a goal to be a zero lift facility....

[jaxdaugherty]

I work in an ED and I can tell you we have no equipment or assistive devices to lift patients. Being a man I am asked to come help lift patients who are unable to get out of the wheelchair. ( I still do not know how they got into a wheelchair from the car) I do not have the stongest back after over 25 years of nursing and I am afraid I will really get hurt one day.

The Nursing Administration takes a very slow approach in dealing with this problem. (I guess the Nursing administration doesn't have a problem with lifting.) No body likes goverment intervention but unless there are mandates that hospital workers be given the proper equipment to lift patients it will not get done.

The patients and nurses are at risk to get injuried and with the way Americans are putting on the pounds the problem is only going to get worse.