How do I transfer non ambulatory pt from WC?

Nurses General Nursing

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Good morning everyone, I have been currently working as a home health LVN for almost a year now and soon I will be working with a new client. My question is how would I be able to transfer a non ambulatory pt from wheelchair to a bed, from wheelchair to a shower chair, from shower chair to bed, and etc. My supervisor suggested that I ask for help and that it is not possible to transfer a dead weight pt alone. However I think there must be some way. Maybe I can use a small wooden board ? Any suggestions are welcome. All I know is that I have to bend at knees and wear a back support.

Specializes in LTC, assisted living, med-surg, psych.

I'm glad you decided to refuse this case, old back injury or no. I feel sorry for the next nurse that family tries to bring in...men get hurt too.

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"Hell to the no!!!" If you injure your back, nobody will care but you!

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On 6/29/2019 at 5:20 PM, cutescrubs said:

VivaLasViejas , thank you so much for the fast response . I will talk to my agency and see if I can request for a different assignment or make sure there will be a helper to help me during the time of transfer . Orion81RN, thank you to you as well for responding. I will surly talk to the mom and my supervisor regarding this matter . I am pretty sure there will be other cases that does not required heavy lifting.

Please do not request “a helper to help me during the time of transfer” you need a lifting machine! It’s not like this is a one off situation. This will be multiple lifts a day for the length of the assignment. This is not safe for you or the patient.

Now is the perfect time to make it clear that you will not accept an unsafe work assignment. Appropriate equipment must be available before you even walk in the door to start!

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On 6/29/2019 at 6:45 PM, cutescrubs said:

VivaLasVieJas, you Are so right !! I totally forget about how mAny injuries may have went unreported. I talked to the mom and they said the other LVNs from other agency never show up consistently and therefore they are reaching out to a new agency that just hired me . She also mentioned that from now on she need a male nurse.

That says a lot right there , yessiree..

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I've done private duty work as a PCA and HHA- no agency- and find that there are many people that expect home care staff to lift clients alone. It's a major risk to you, and also to your client/patient. If you did transfer your patient alone and he/she was injured, you can be quite sure that they wouldn't blame themselves for wanting you to transfer with no assistance or lift device. And your agency wouldn't back you up if it was against their advice or policy.

Especially in home health, there are many instances where you will probably be asked to do things that may not be in your best interest. Try not to feel badly about saying no and setting firm boundaries. This is YOUR life, back, license, career- nothing wrong with protecting yourself!

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On 6/29/2019 at 6:45 PM, cutescrubs said:

VivaLasVieJas, you Are so right !! I totally forget about how mAny injuries may have went unreported. I talked to the mom and they said the other LVNs from other agency never show up consistently and therefore they are reaching out to a new agency that just hired me . She also mentioned that from now on she need a male nurse.

This shows how deep in denial the family is. In a way I kind of get it. The patient is their kid. They think of him/her as a child, and children can be picked up. Hoyers are kind of "big" and "scary." Seeing a Hoyer might be a hard, constant reminder of their child's disability.

But that's no excuse for them to stick their heads in the sand. The child is only going to get bigger, heavier, and more difficult to transfer. The parents don't really give a crap about the nurse's back, but presumably they care about their child's safety. They need to be, gently but firmly, made aware of how dangerous these transfers are for their growing child. Everything is okay, until the day it's not, and their child could end up in the hospital with an injury from being dropped.

This is an opportunity for a supervisor from your agency to do some education and lay some groundwork for the family. It's not just that the agency is not assigning you, cutescrubs, to the case, but your agency isn't going to assign any nurse (regardless of gender) to an unsafe environment. I'm willing to bet the reason those LVNs haven't been showing up regularly is more about the work environment the parents are providing, and less about the work ethic of those nurses, and the parents need to be aware of that. Granted, with such deep denial, I'm guessing you won't see them do a 180 right away, but it's a good conversation to plant the seeds of change.

If your agency doesn't see the problem here, you might discuss their responsibilities under OSHA.

An excerpt from OSHA.gov:

While OSHA does not have a specific standard for the hazard you raised, employee exposure to hazards related to heavy lifting and back injuries may be addressed under Section 5(a)(1) of the OSH Act, commonly referred to as the General Duty Clause. The General Duty Clause states:

“Each employer -- shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees...”

If you would like more information on lifting hazards both OSHA and NIOSH have information on their respective websites which can be found at:

OSHA: www.osha.gov/SLTC/ergonomics/index.html
NIOSH: www.cdc.gov/niosh/docs/2007-131/pdfs/2007-131.pdf

If you follow that link to the NIOSH pamphlet, there is a section that states, "The Revised National Institute of Occupational Safety and Health (NIOSH) Lifting Equation (1994) provides guidelines for evaluating two-handed manual lifting tasks. It de fi nes a Recommended Weight Limit (RWL) as the weight of the load that nearly all healthy workers can lift over a substantial period of time (e.g., eight hours) without an increased risk of developing lower back pain. The maximum weight to be lifted with two hands, under ideal conditions , is 51 pounds. The RWL is based on six variables that reduce the maximum weight to be lifted to less than 51 pounds." Lifting twice that is an injury waiting to happen, especially when the stakes are so high (child could be injured if the transfer goes wrong).

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Specializes in Private Duty Pediatrics.
5 hours ago, turtlesRcool said:

This shows how deep in denial the family is. In a way I kind of get it. The patient is their kid. They think of him/her as a child, and children can be picked up. Hoyers are kind of "big" and "scary." Seeing a Hoyer might be a hard, constant reminder of their child's disability.

Another reason is the time factor; it takes longer to transfer someone using a Hoyer lift. Now, I can put the sling in place and then transfer the person from wheelchair to bed within 5 minutes. That's not too bad.

But the parent can lift the child to bed in less than a minute. And - until they are used to it - it will take the parent more like 15 minutes to do the transfer using the Hoyer lift.

Parents tend to think faster is easier. Typically, they won't get a Hoyer lift until they must.

When space is at a premium, ceiling lifts are a great choice. In fact, I prefer ceiling lifts. They're easier to move and they store out of the way.

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I can see both perspectives on this, because I'm both an RN, and the parent of a child who is eligible for PDN services. My son is approaching 40 lbs, which is the official limit for lifting with our agency, and so I've recently posted a couple times asking for thoughts on ways to transfer him.

As a nurse, I strongly value doing things the right way or the safest way, rather than the fast or easy way. I also highly prioritize protecting my back and my license because I know my career is at stake. With those priorities, then getting a Hoyer lift for a 40 lb. kid makes perfect sense.

But as a parent, those priorities compete with all sorts of other priorities, and as a result sometimes a choice that seems obvious as a nurse don't seem obvious as a parent. For example, it's really important to me that my child has a chance to experience normal things like family dinners, cheering at his brother's sporting events, and playing legos on the floor with his brothers, and it's equally important that my other kids get to experience those things too.

Now, you're probably wondering, what do those things have to do with Hoyer lifts? But if it's a typical weekday evening, and I'm trying to get dinner on the table in time to make it to the basketball game, while also helping my 12 year old write an essay at the kitchen table, and giving one 9 year old a breathing treatment while he plays legos on the floor with the other 9 year old, and the first 9 year old has to go to the bathroom? I've got 2 choices. I can stop making dinner, have the 9 year olds clean up to make a path for the lift, tell my 12 year old he's on my own with the essay, and spend 30 minutes transferring my kid into the sling, into the bathroom, back into the sling, and back into the kitchen, where I tell my son "sorry we won't make the game today, maybe we'll come next week if your brother isn't in PICU, oh and here's a sandwich." Or I can pause the nebulizer, pick up kid and make a dash for it, and keep everything roughly on schedule. I'll let you guess which one I pick. I know that the way we are doing it right now won't work forever. Hopefully it won't work for "good" reasons, like he grows too big for me to pick up, and not for "bad" reasons, but I don't think it's being "in denial" to want it to work a little while longer.

Now, I'm a nurse, and so I can see both sides, and we'll probably end up doing something like getting a Hoyer for the PDN's to use if they're home alone with my son, and otherwise just having a family member do the lifting. But that will still mean rearranging my already crowded house to make pathways for the Hoyer, and filling out a ton of paperwork, and getting my kid used to something new and potentially scary, and getting over the voice in my head that tells me you always need 2 people to run a Hoyer because that's our hospital's policy. So, while I'll probably do it, I can understand why a parent who can't see the other side would hesitate.

To be clear, I'm not saying that the person who started this should lift the kid. I think she should do what's safe and right for her body, which means setting limits and looking for solutions. But I do think she should come at it from the point of view that what the parents want is understandable, even if it's not possible for to provide, and problem solve with compassion.

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25 minutes ago, nursenmom3 said:

I can see both perspectives on this, because I'm both an RN, and the parent of a child who is eligible for PDN services. My son is approaching 40 lbs, which is the official limit for lifting with our agency, and so I've recently posted a couple times asking for thoughts on ways to transfer him...

I know that the way we are doing it right now won't work forever. Hopefully it won't work for "good" reasons, like he grows too big for me to pick up, and not for "bad" reasons, but I don't think it's being "in denial" to want it to work a little while longer.

I don't think you're in denial, and I agree that it's a tricky situation for sure. You have a kid approaching 40 lbs, and you're already aware that the situation can't continue indefinitely. OP's patient is already 85 lbs, and his/her parents don't seem to be open to any answer other than a bigger caregiver and a back brace. Big difference.

I have children who are about those respective weights. My 4-year-old I can still pick up fairly easily; my 9-year-old would break my back (and I might break his when I most likely drop him).

It's really important for the agency's powers that be to insist on safe practices for both staff and the patient. It's a delicate conversation, but it needs to be had. You can have the conversation with compassion, but I do think it is denial for the family to think they can just keep asking for progressively stronger caretakers. Sooner or later someone's going to get hurt, and it could very well be the child.

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On 6/28/2019 at 12:16 PM, rdsxfnrn said:

There should be orders in place from PT so you can safely transfer this patient. Generally a hoyer lift is used and should not be used alone.

Who does your supervisor think is going to help you?

I agree, we are not required to lift more than 50% of patient weight with out a lift or assistance. A hoyer lift can be safely used by one, properly trained person.

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8 minutes ago, turtlesRcool said:

I don't think you're in denial, and I agree that it's a tricky situation for sure. You have a kid approaching 40 lbs, and you're already aware that the situation can't continue indefinitely. OP's patient is already 85 lbs, and his/her parents don't seem to be open to any answer other than a bigger caregiver and a back brace. Big difference.

I have children who are about those respective weights. My 4-year-old I can still pick up fairly easily; my 9-year-old would break my back (and I might break his when I most likely drop him).

It's really important for the agency's powers that be to insist on safe practices for both staff and the patient. It's a delicate conversation, but it needs to be had. You can have the conversation with compassion, but I do think it is denial for the family to think they can just keep asking for progressively stronger caretakers. Sooner or later someone's going to get hurt, and it could very well be the child.

I have kids both weights too, they just both happen to be 9. So, believe me, I understand the difference.

I'm absolutely not saying that the agency should expect or allow their nurses to lift this child. I agree 100% that it's a dangerous expectation and can't continue. But I do think that coming at it from the perspective that the parents are unreasonable for wanting things to continue, doesn't help with compassionate problem solving. I imagine if it was larger son, rather than my little one, who needed this, I'd still have all the same feelings, and having someone come in say that yes, the ability to play on the floor are keep are routines are important, so let's problem solve how we can figure out safe transfers and protect those things; or if that's not possible let's acknowledge that it's just another thing that sucks about this situation and provide the parent some space and permission to grieve.

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On 6/30/2019 at 7:05 PM, Wlaurie said:

I don't think this is safe for you or the patient. My pt. weighs 100 lbs and is non weight bearing and I use a hoyer. I wouldn't and couldn't even consider lifting the patient.

Thank you very much Wlaurie for the input. With a hoyer lift, do you still need assistant from another co woker? There was one time I saw the CNA did it alone and I felt so uncomfortable. I tried to do it alone when I took after the shift luckily I did not get hurt back then and the pt was safely transferred. But I request for another assigment right away becuase I felt unsafe transferring the pt alone using the hoyer lift.

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