Nurses: You've Been LIED to about your Back and Body Mechanics

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Specializes in telemetry, med-surg, post op, ICU. Has 4 years experience.

Lift with your knees and not your back has been drilled into nurses as often as patient safety comes first. Just follow these body mechanics rules, and you will protect your back, nurses are told. The only problem is that it isn’t true, and everyone but nurses knows all about it. You are reading page 2 of Nurses: You've Been LIED to about your Back and Body Mechanics. If you want to start from the beginning Go to First Page.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 9 years experience.

At my facility, we use blue plastic "liners" to put under pts to slide them, which is like greasing the bed. We have lifts, we call for assistance when we need to move someone and there is usually a minimum of 4-5 people when moving person from bed to stretcher (or vice versa) we have a minimum of 2 people to change/clean an incontinent person or linens. I work on an ortho unit where pt safety is a must and teh safest way to move an ortho pt is with multiple people, we work as a team with OT/PT as well. We are lucky that it is the culture of our unit that no one tries to do anything alone. We move the beds to proper heights. Our veteran nurses are great role models in that they know the policies and don't allow the newer nurses to take chances. It is just the way we do things.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 8 years experience.

To begin with, nothing is 100% safe. Nurse still can get injured by holding just one extremity (being exact, a lower extremity of paralyzed 500+ lbs. patient).

Hoyers are just cumbersome and require at least two persons to operate - more if patient has equipment/lines around. Ceiling lifts are very prone to malfunctions and difficult to use with some patients (wound vacs, some wounds on the flanks, claustrophobics, chronic pain). Both are insanely difficult to decontaminate, which should be a factor in our days of MRSA and CRE.

Lift teams would be an excellent solution, as well as mandating appropriate staff ratios and teaching not only body mechanics (which is, IMHO, works when done correctly, but is almost always done wrong) but also things like standing alignment and basic yoga for back conditioning.

P.S. just out of great curiosity: is that the only one subject the OP feels like she was lied about while in nursing school?

Lynda Lampert, RN

Specializes in telemetry, med-surg, post op, ICU. Has 4 years experience.

To begin with, nothing is 100% safe. Nurse still can get injured by holding just one extremity (being exact, a lower extremity of paralyzed 500+ lbs. patient).

Hoyers are just cumbersome and require at least two persons to operate - more if patient has equipment/lines around. Ceiling lifts are very prone to malfunctions and difficult to use with some patients (wound vacs, some wounds on the flanks, claustrophobics, chronic pain). Both are insanely difficult to decontaminate, which should be a factor in our days of MRSA and CRE.

Lift teams would be an excellent solution, as well as mandating appropriate staff ratios and teaching not only body mechanics (which is, IMHO, works when done correctly, but is almost always done wrong) but also things like standing alignment and basic yoga for back conditioning.

P.S. just out of great curiosity: is that the only one subject the OP feels like she was lied about while in nursing school?

LOL, no I felt I was lied to about a lot more, but I won't get into that here. Maybe another article on that one.

As for lifts, Hoyers have come a long way and there are now a lot of disposable means of moving patients mechanically. Yes, they do take a lot of time, but so do gait belts. Why would we go the extra mile to keep our patients safe yet not take the time to make ourselves safe?

There is no 100 percent solution, but people, some places aren't even trying. There are TONS of equipment solutions out there that can be adapted to any nursing floor, including isolation. Overbed lifts break, but so do IV pumps. Does that mean we don't use them? No. We get them fixed, we find a way, because they make our lives easier and everyone involved safer.

The language may be inflammatory, but that is for a reason. Nurses need to know they are in danger, and no one is saying anything. Why aren't people angry about this? It's like being told you will definitely be in a car wreck, no matter how safely you drive. It is about protecting nurses, their health, their livelihoods, and the future of the profession. Yes, I'm angry. I've talked to many experts over the course of these two articles and what I learned made me extremely sad for the nurses at the bedside.

Barnstormin' PMHNP

Specializes in psychiatric. Has 4 years experience.

I tried following your links to the "works" cited and they don't work. I am also surprised that they are blogs and not peer reviewed research that you are using to support your position statement. To make such statements you should be prepared to back it up with credible research with proper citations about the fact that nurses have been "LIED" to. I for one have had not had such experience and to make your statement hold water you need to be able to provide more than blogs to support it.

i have only been a nurse for 3 years. Before that, I worked with horses, which is how I got hurt so much. No teaching of body mechanics in that career! I am saying that NOW that I am a nurse, I am much more aware because of policies in place to keep me healthier. Nursing has done that for me as opposed to what the horse business did to me.

Ah, yes, nursing is a cakewalk compared to horses. Been there, done that, have the back spasms to prove it :grumpy:

Lynda Lampert, RN

Specializes in telemetry, med-surg, post op, ICU. Has 4 years experience.

I tried following your links to the "works" cited and they don't work. I am also surprised that they are blogs and not peer reviewed research that you are using to support your position statement. To make such statements you should be prepared to back it up with credible research with proper citations about the fact that nurses have been "LIED" to. I for one have had not had such experience and to make your statement hold water you need to be able to provide more than blogs to support it.

All I can say to this is that I just checked all of my links, and they work. For instance, this one CDC - Safe Patient Handling - NIOSH Workplace Safety and Health Topic. All of this research is based on peer-reviewed, evidence base science that proves that nurses are at least twice as likely to hurt their backs, facilities don't care, and body mechanics are a placebo. Were the experts quoted, experts who dedicate their life to studying the safety of nursing at work, not enough for you? Also, check the NPR article that had far more resources than I could ever manage to get for such a small site. If you even Google "NPR nurses body mechanics" you will see the four-part investigative series they did on this problem. It is real, and it is back by research. How much more proof do you need?

In addition, these are not blogs. They are fact sheets put out by the CDC that explain their research. All quotes in this article were obtained over the phone by me, transcribed, and inserted into the article. This is not a rank opinion. It is the truth.

Lynda Lampert, RN

Specializes in telemetry, med-surg, post op, ICU. Has 4 years experience.

Still don't believe? Here's one from the ANA:

Evidence-Based Practices for Safe Patient Handling and Movement

And more:

Handle With Care®: The American Nurses Association’s Campaign to Address Work-Related Musculoskeletal Disorders

To quote: "Because patient handling tasks are conventionally performed manually, nurses are significantly exposed to the ergonomic hazard associated with this high risk duty. Manual patient handling characterizes the lifting, transferring, and repositioning of patients without the use of assistive equipment. Nurses have historically been trained to use "proper" body mechanics to prevent injury from lifting and transferring patients. However, questions arise as to the true value and applicability of body mechanics training to the practice of nursing (Nelson, Fragala, & Menzel, 2003)."

Edited by Lynda Lampert, RN
added quote

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 29 years experience.

The references cited in this article are all from reputable sources such as the CDC.

Some additional references:

Here is an article about Kent Hospital's lift teams: Kent Hospital's Lift Team Becoming Model for Other Healthcare Facilities

This is from UC Irvine: http://www1.ucirvinehealth.org/magnetnursing/clienthtml/69/attachments-and-reference-documents/118/EP8j,%20%20Lift%20Team%20Analysis%20and%20Proposal.pdf

Arjo is a company that has provided lifts for ooodles of years (I remember Arjo mechanical lifts when I was a CNA in 1977) and now they offer ceiling lifts:

Ceiling lift systems from ArjoHuntleigh enable residents/patients to be transferred in a safe, comfortable and dignified way.

​Easy-to-operate ceiling lifts - ArjoHuntleigh

We are, as nurses, merely plug-in's. When we break, they plug someone else in. And there is an endless supply of us.

We are our own keepers of our health. Following guidelines helps, but it is not the cure. Nursing by default carries risks. It's up to us as individuals to protect ourselves and to say when we've had enough.

Look at any pro football running back...he has a short career span due to the nature of his work. Likewise, nurses are at high risk for an early career demise.

brandy1017, ASN, RN

Specializes in Critical Care.

I don't think it is overheated! The truth is most hospitals and even the employee health director doesn't really give a damn about the workers. There have been a lot of injuries where I work and all the employee health did was count the injuries and even badger the employees to get back to work sooner. One case where employee health contacted the workers Dr and had him change her return to work date! Unbelievable. When I complained about all the injuries and why wasn't anything being done, they introduced cheap plastic garbage bag liners as if that would help solve the problem! When a million dollar remodel was done on our unit the manager flat out refused to provide ceiling lifts because he wasn't going to spend the money! There was no staff feedback, something as simple as putting in high toilets would help get people up since many patients are weak or have hip and knee problems! We have only recently started to have access to hover mats which make a world of difference and can really help. I hope this will become standard practice but fear hearing it is not in the budget because we here that when we have shortage of or broken equipment too often! Sometimes money needs to be spent and it should not be all about the budget, but the safety of patients and staff should be a higher priority!

Unless things change nurses should be making plans to work at the bedside for only a short time. Consider going back as an NP where at least your back will be safe! Seriously!

I've seen too many people injured some permanently disabled and others in chronic pain. Also if you are injured you may need to get an attorney to fight for your workman comp rights. If you are in such a position where the employer or workman's comp is denying you, get an attorney right away! I even had a family member have to get an attorney when she was injured at work and it took a while but she finally got all her medical bills paid and her rights were upheld!

Edited by brandy1017

What role does physical fitness play in back related lift injuries?

Lynda Lampert, RN

Specializes in telemetry, med-surg, post op, ICU. Has 4 years experience.

What role does physical fitness play in back related lift injuries?

From what I've learned talking to these experts, physical fitness does play a role, but even the most physically fit nurse would still hurt their back without using mechanical assistive devices. Perhaps Dr. Powell-Cope can speak more to this tomorrow. I'm sure she will be around again. The maximum weight a person can safely lift regardless of physical fitness is 35 pounds.

That being said, it may be a slippery slope to imply -- not that you did, but you could have -- that only physically fit people are good nurses, allowed to be at the bedside, able to safely lift. I'm sure we could have a big fight about that one.

Incidentally, I talked to a physical therapist for my next article, and he said that back pain can be caused by weak leg and core muscles. Those muscles, however, are overtaxed by lifting more than 35 pounds without mechanical assistance, according to both my source at the CDC, the ANA, and Dr. Powell-Cope.

So, it's a difficult question and one that I am not entirely qualified to answer. I can find out for you though, or she will post tomorrow.

ETA: Nurses who use chiropractors and physical therapists in a preventative fashion tend to do better than those who don't. They still have the back pain, but the use of the professionals can keep them going longer and prevent the back from becoming seriously injured.

Edited by Lynda Lampert, RN