Why do RN injuries keep happening?

adventure_rn, MSN, NP · Dec 20, 2018

What is missing from this picture?

Adequate staffing?

Equipment and in-services are all fine and good, but if every nurse is swamped with too many patients, there isn't time to track down and utilize complicated equipment or find people to help you reposition (since they're probably busy, too).

In these situations, nurses risk their backs, but the alternative is to go too slowly, miss cares/meds, and lose your job. Then, if you're injured on the job, the hospital can claim that they don't need to take responsibility due to said equipment and in-services.

https://allnurses.com/general-nursing-discussion/unsafe-staffing-with-1181073.html

beekee · Dec 20, 2018

At one job, there were two employees on the floor and two patients that weighed over 300 lbs who were paralyzed on one side as a result of a stroke. Every two hours and with every incident of incontinence, these patients had to be repositioned. We had no fancy equipment. Just two employees that together weighed less than either of these patients.

At another job, it was a no lift facility. They put in tracks for overhead lifts in every room. But no one budgeted for the actual lifts. They were never purchased because it was too expensive.

Another time, a patient refused to use the lift. We complained to management that it was not safe, but management said make it work. In an "assist of three," an employee sustained a permenent injury.

So, we have poor staffing, lack of equipment, and lack of support from management (and usually a combination of those three). Patients are getting bigger. Staffing and budgets are getting cut. Management doesn't always have your back (literally and figuratively). It's a recipe for injuries.

GeoffPT · Dec 20, 2018

@adventure_rn

I've heard of the constant struggles between RN's and hospitals for ratios favoring RN/patient safety. I never thought of the dilemma you described w not meeting job expectations/pace at your own peril (!) nor a hospital's equipment/in-services used as a disclaimer against WC claims.

I've used a variety of SPHM devices and none of them seem as fast as transferring the patient solo. Pretty sure I've read some article that the time difference is "minimal" but a few seconds difference adds up to minutes by the end of a shift, which I would guess can put you in the 'red.'

Back to your point, if hospitals magically agreed to improve ratios per shift, do you feel this would pretty much solve the problem? When is a RN EVER free enough to comfortably leave their patient(s) to help out a coworker for several minutes without feeling that loss of time?

GeoffPT · Dec 20, 2018

@beekee

your situation sounds like 75% of the stories I've heard and is certainly consistent to my own experience treating in hospitals; not enough budget or emphasis on purchasing expensive SPHM equipment and developing that infrastructure to make it as effective as it can be.

Also, can't help but lol about a facility that has a 'no lift policy' but doesn't actually have any lifts available. As ironic as hospitals serving soda, hamburgers and pizza in their cafeterias.

Regarding staffing, sounds like you actually did have sufficient staffing to at least attempt 2-3 person assist transfers...little good it does for patients requiring a lift, though...

Let's say you were the Director of Nursing (maybe you are?) but couldn't increase staffing, buy fancy equipment, or change management culture. What do you think would help your nurses survive in that current environment?

"nursy", RN · Dec 20, 2018

I'll probably get a lot of flack for my comment but here goes...I totally agree with all of the previous posters, we need all the training, equipment, etc. But it also helps if you are in good shape to begin with. I left the ICU 5 years ago when I was 58. I've never had an injury. I exercise, strength train, eat healthy and try to stay in as good shape as possible. I worked alongside nurses who were half my age, constantly complaining how exhausted they were, and having injuries right and left. These nurses also tended to be eating junk food all day long, many were overweight, some smoked, and generally speaking were not great representatives of good health. I suppose this all sounds very judgy, but unfortunately nursing is a very physical profession. And if you are involved in heavy physical activity, it stands to reason that the better shape you're in, the easier the job, and less chance for injury. OK I'm now taking cover.....

GeoffPT · Dec 20, 2018

Nursy, there's truth there and I see it all the time. People who are healthier and fitter tend to be, well, healthier doing whatever it is that they do vs folks suffering from chronic health issues and less-than-optimal lifestyles/practices.

I personally feel that being healthy and strong can be a bit of a trap though. This may already be a topic in the 'Male Nurses' forum, but being viewed as 'strong' by your peers can lead to more requests to help move patients than somebody who is not viewed that way (regardless of gender or actual strength/health). Regardless, I'm glad you managed to stay healthy in a taxing career.

In your opinion, do you feel that it is your raw strength that kept you free from injury? Or have you developed a variety of techniques for yourself that have let you work smarter (not harder) than your younger coworkers while still getting the job done right?

Serhilda, ADN, RN · Dec 22, 2018

I recently sustained a minor back injury at work primarily due to inadequate staffing/a lack of consideration when creating the assignment (I had multiple incontinent AMS patients on a cardiac tele floor) and a lack of help from our nursing assistants. I reported the PCA for consistently refusing to help patients throughout the shift but ultimately as the RN, I'm responsible for ensuring they're cared for. The previous poster without any back injuries should count her lucky stars. I'm healthy in many ways but scoliosis complicates a lot. Often times back problems have nothing to do with your lifestyle or not exercising enough, it's simply the hand you're dealt.

UndecidedBSN · Dec 22, 2018

Short staffing and length of orientation are some causes. I've been injured during a code green where I walked in on 1 security officer attempting to fight off a patient alone. I stepped in-still there are only 2 of us now. That's why every unit manager structures a manning table for what the unit requires for staff in all levels of unit census. Most often in my experience as a supervisor, the unit is down multiple staff when falls, codes, and injuries occur.

guest52816 · Jan 15, 2019

Sorry, but I need to call BS, on nursy.

I am fairly fit, as I don't smoke, don't eat junk food or meat, and I am not overweight.

But more and more patients are Morbidly obese these days, and no matter how fit you are, these obese folks are going to hurt you, if you don't have appropriate help or equipment.

The fact is, most of this nation is obese.

JKL33 · Jan 15, 2019

20 minutes ago, Lil Nel said:
I am fairly fit, as I don't smoke, don't eat junk food or meat, and I am not overweight.
But more and more patients are Morbidly obese these days, and no matter how fit you are, these obese folks are going to hurt you, if you don't have appropriate help or equipment.
The fact is, most of this nation is obese.

Agree.

In response to the OP question of what is missing from this picture, I would say beliefs and attitudes are still working against us. There are still a good number of nurses who seem to place workplace value on the ability and willingness to perform superhuman feats.

I've never experienced a lifting injury but as the situation has...been changing (as noted by Lil Nel) I preemptively decided that it wasn't really all that necessary or heroic to lift, drag, push/pull 3, 4, 5x my weight in attempt to prove I'm all that. Just the other day someone meant to ridicule me over this by implying that it would just take enough physical strength and a positive attitude to physically move someone who was truly more than 4x my weight. I told the individual their comments were inappropriate and incorrect. I think we need to challenge this whenever we encounter it for two reasons: It is unsafe and 2) implying that superhuman feats are a legitimate component of nursing care is inappropriate and sets a bar that having a (nonsensical) "can-do-at-all-costs" attitude is some superior thing.

coachRN · Jan 16, 2019

Thanks for asking nurses for their opinions! I would like to add that it is a multifaceted problem. Nurses are continually pushed to their physical limits compounded by lack of breaks, possible chronic sleep deprivation, malfunctioning equipment, etc. (I swear only 2-3 wheels on every bed work which makes transporting patients difficult. Plus, hospitals never get the upgraded transport wheels.) You might be interested in the company exos and their workplace wellness campaign at the Cancer Treatment Centers of America.

Good luck in finding the answers you seek.