Impact of California's safe patient handling legislation on musculoskeletal injury prevention among nurses

Individual and organizational factors associated with injury history and patient handling behaviors: Results from a nationwide survey of healthcare workers

With proper compliance, safe patient handling and mobility (SPHM) programs reduce musculoskeletal disorders (MSDs). To better understand individual, environmental, and organizational factors associated with both the adoption of SPHM and prevalence of MSDs, a nationwide online survey was administered. 973 healthcare workers (HCWs) completed the survey, for which 59.6% reported past work-related MSDs or pain. Among those with pain or injury, 33.3% changed roles, 79.7% worked while injured, and only 30.9% reported workers' compensation claims. Less than half of HCWs agreed that SPHM equipment is readily available, and most considered manually handling patients weighing over 91 kg acceptable. Equipment availability, ceiling lift availability, supervisor encouragement, and annual training were associated with increased use of SPHM equipment. Availability of SPHM equipment reduced the likelihood of injured nurses changing roles. Despite overall agreement that SPHM programs are beneficial, common clinical practice remains insufficient to adequately protect HCWs from risk of injury.

Overview of Occupational Injuries Among Registered Nurses in Washington State, 2007 to 2019

BACKGROUND

Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs.

METHODS

Annual injury claims data covered under Washington State workers' compensation (WC) fund were analyzed over a 13-year period (2007-2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications.

RESULTS

Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio [IRR]: 0.99, 95% confidence interval [CI] = [0.94, 1.05]). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts.

DISCUSSION

To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.

Preserving the Bedside Nurse: Grip Strength and Orthopedic Problems Among Nurses and Nursing Students

Background:

Bedside nurses and nursing students are at increased risk of musculoskeletal injury due to the physicality and complexity of their work. The purpose of this study was to explore the relationship between grip strength and orthopedic injuries or pain among nurses and nursing students.

Methods:

A cross-sectional study of nursing staff and nursing students at a health sciences university was conducted. The survey consisted of work-related demographics, exercise habits, and validated scales. The Nordic Musculoskeletal Questionnaire was used to collect information on musculoskeletal problems. Anthropomorphic measures included height, weight, body mass index (BMI), and grip strength. Logistic regression was performed.

Findings:

Participants with grip strength at or above the national average had significantly lower odds of self-reported orthopedic problems, B = 0.86, OR = 2.35, p =.01, indicating participants with grip strength at or above national average were 135% less likely to report orthopedic problems compared to participants with grip strength below the national average.

Conclusion/Application to Practice:

Healthcare workers in direct patient care who have lower grip strength may be at increased risk for injuries. Nursing staff and students with below average grip strength were more likely to experience orthopedic problems. Increased muscle mass and grip strength are known to effectively reduce the risk of upper extremity injuries. Nurse leaders may benefit from promoting grip strengthening activities among employees to prevent workplace injuries. Further research is needed to understand the biophysiological mechanisms, confirm the findings of this study and evaluate effective interventions.

Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature

INTRODUCTION

Work-related musculoskeletal disorders (WMSDs) are among the main causes of injury and pain in healthcare professionals. Previous reviews provided a fragmented view of the interventions available for WMSDs. This review aims to provide a comprehensive description of interventions for preventing and reducing work-related musculoskeletal injuries and/or pain among healthcare professionals, and to assess the methodological quality of studies.

METHODS

A systematic literature review was performed, based on the Effective Public Health Practice Project process. A comprehensive search was conducted on six peer-reviewed databases and manually. The methodological quality of the studies included was rated as weak, moderate, or strong. The studies were organized based on the 2019 classification of the interventions by Oakman and colleagues.

RESULTS

Twenty-seven articles were included reporting individual (n = 4), task-specific (n = 4), work organization and job design (n = 2), work environment (n = 1), and multifactorial (n = 16) interventions. Overall quality rating was strong for 6 studies, moderate for 16, and weak for 5. Individual interventions such as neuromuscular and physical exercise were effective in reducing pain. Task-specific and work organization interventions could prevent certain injuries. Significant reduction of both injuries and pain resulted from multifactorial interventions, which were reported by the majority of strong (n = 5) and moderate (n = 10) quality articles.

CONCLUSIONS

This review provides healthcare professionals with evidence-based information to plan interventions targeted towards reducing WMSDs. In particular, more efforts are needed to implement and extend effective multifactorial interventions. Moreover, studies about each professional healthcare target group are needed.

PRACTICAL APPLICATION

Our results can guide policy-makers, healthcare managers and professionals to choose the best strategies to prevent and reduce WMSDs and to shape continuous education programs. This study prompts clinicians to develop inter-professional collaborations and to practice physical activities in order to reduce WMSDs.

Safe patient handling legislation and musculoskeletal disorders among California healthcare workers: Analysis of workers' compensation data, 2007-2016

BACKGROUND

California requires general acute care hospitals to have a comprehensive plan to prevent patient handling injuries (PHIs) among employees. The California safe patient handling (SPH) law took effect in 2012. This study assessed the impact of the SPH law on workers' compensation claims for musculoskeletal disorders (MSDs) in California hospital workers.

METHODS

We used California Workers' Compensation Information System data from 2007 to 2016 and analyzed claims for MSDs that occurred in acute care hospitals compared with nursing and residential care facilities. MSD claims were classified into PHI and non-PHI claims.

RESULTS

We identified 199,547 MSD claims that occurred during 2007-2016 in acute care hospitals (62.8%) and nursing and residential care facilities (37.2%). MSDs accounted for 42.8% of all claims. Of the MSD claims, 81.0% were strains or sprains and 33.5% of MSDs were related to patient handling activities. From 2011 to 2016, MSD claim rates showed significant reductions among both hospital and nursing/residential care workers. However, the MSD-PHI claim rate showed a significant reduction only among hospital workers (7.3% per year, incidence rate ratio [IRR] = 0.927, 95% confidence interval [CI] 0.903-0.952). There was no significant change among nursing/residential care workers (IRR = 0.990, 95% CI 0.976-1.005). The non-PHI claim rate showed no significant change among hospital workers (IRR = 0.982, 95% CI 0.956-1.009).

CONCLUSIONS

Our study identified significant reductions of PHI claims among California hospital workers after the passage of the SPH legislation, suggesting that SPH legislation played a crucial role in reducing the risk of injury among healthcare workers.

Differential effectiveness of the Minnesota Safe Patient Handling Act by health care setting: An exploratory study

BACKGROUND

The Minnesota Safe Patient Handling (MN SPH) Act requires health care facilities to implement comprehensive programs to protect their workers from musculoskeletal injuries caused by lifting and transferring patients. Nursing homes, hospitals, and outpatient facilities each face unique challenges implementing and maintaining SPH programs. The objective of the study was to compare patient handling injuries in these three health care settings and determine whether change in injury rate over time differed by setting following enactment of the law.

METHODS

Workers' compensation data from a Minnesota-based insurer were used to describe worker and claim characteristics in nursing homes, hospitals, and outpatient facilities. Negative binomial models were used to compare claims and estimate mean annual patient handling claim rates by health care setting and time period following enactment of the law.

RESULTS

Consistent with national data, the patient handling claim rate was highest in Minnesota nursing homes (168 claims/$100 million payroll [95% confidence interval: 163-174]) followed by hospitals (35/$100 million payroll [34-37]) and outpatient facilities (2/$100 million payroll [1.8-2.2]). Patient handling claims declined by 38% over 10 years following enactment of the law (vs. 27% for all other claims). The change in claims over time did not differ by health care setting.

CONCLUSIONS

In this single-insurer sample, declines in workers' compensation claims for patient handling injuries were consistent across health care settings following enactment of a state SPH law. Though nursing homes experienced elevated claim rates overall, results suggest they are not lagging hospitals and outpatient facilities in reducing patient handling injuries.

Work-related musculoskeletal pain in prosthetists and orthotists: a comparison between Australia and other countries

BACKGROUND

Musculoskeletal pain (MSP) is a substantial societal and personal burden resulting in loss of employment and reduced productivity. Prosthetics and orthotics professionals working in Australia have previously reported a high prevalence of MSP; however, little is known about the prosthetic and orthotic communities in other countries.

OBJECTIVES

To explore the prevalence and range of workplace exposures associated with MSP in a convenience sample of the international prosthetic and orthotic profession.

STUDY DESIGN

A cross-sectional study using a convenience sample was conducted with prosthetists and orthotists worldwide.

METHODS

Prosthetists and orthotists were invited to participate in a survey to explore work-related factors associated with MSP. Bivariate and regression modelling was used to examine associations between self-reported demographic and workplace characteristics including job satisfaction, work-life balance, and physical and psychosocial hazards.

RESULTS

Seventy-six percent of respondents (n = 173) reported MSP in the previous 6 months. However, MSP was associated with different factors in Australia compared with other countries. Among Australia-based prosthetists and orthotists, MSP was associated with sex, physical hazards, and psychosocial hazards. For the international sample, MSP was only associated with length of employment.

CONCLUSIONS

Three-quarters of all respondents reported having MSP. Differences in associations between MSP and other factors by respondents' geographical location suggest the need for context-specific identification of hazards to enable the development of targeted and contextually appropriate prevention strategies.

Ergonomic Challenges in the Perioperative Setting

Working in health care can be physically stressful. The perioperative setting, which is largely concealed from other health care workers and the general public, places unique physical demands on its workers. Perioperative personnel are responsible for a variety of physical tasks, including moving and positioning patients, holding extremities, and moving equipment and supplies. As the nursing workforce ages, the physical demands of the perioperative environment may affect the development of musculoskeletal disorders in older nurses. The purpose of this article is to review published research and describe the ergonomic challenges of working in the OR. There currently is a paucity of literature on the effects of ergonomic risk factors on perioperative nurses in the United States. This article also provides some recommendations for perioperative staff members and leaders that may assist them with creating and maintaining a healthy and safe work environment.

Exploring Nurses' Perceptions of Safety: A Phenomenological Study

The purpose of the study is to explore the lived experiences of nurses with regard to their personal safety and to identify the fundamental structures underlying nurse safety. A qualitative descriptive phenomenological design, using the data analysis method proposed by Colaizzi, was used. Eleven nurses participated in the study between March and July 2019. The research findings indicated the fundamental structure of nurse safety encompasses 3 categories: "nurses' personal protection systems," "safety support systems," and "risk factors." The fundamental structure identified in this study can contribute to better understanding and insight regarding the safety of nurses.

Impact of California Safe Patient Handling Legislation: Health Care Workers' Perspectives

BACKGROUND

Musculoskeletal injuries from patient handling are significant problems among health care workers. In California, legislation requiring hospitals to implement safe patient handling (SPH) programs was enacted in 2011. This qualitative study explored workers' experiences and perceptions about the law, their hospital's SPH policies and programs, patient handling practices, and work environment.

METHODS

Three focus groups were conducted with 21 participants (19 nurses and 2 patient handling specialists) recruited from 12 hospitals located in the San Francisco Bay Area and San Joaquin Valley. Qualitative content analysis was used for data analysis.

RESULTS

Multiple themes emerged from diverse experiences and perceptions. Positive perceptions included empowerment to advocate for safety, increased awareness of SPH policies and programs, increased provision of patient handling equipment and training, increased lift use, and improvement in safety culture. Perceived concerns included continuing barriers to safe practices and lift use such as difficulty securing assistance, limited availability of lift teams, understaffing, limited nursing employee input in the safety committee, blaming of individuals for injury, increased workload, and continuing injury concerns. Participants indicated the need for effective training, sufficient staffing, and management support for injured workers.

CONCLUSIONS/APPLICATION TO PRACTICE

This study identified improvements in hospitals' SPH programs and practices since the passage of California's SPH law, as well as continuing challenges and barriers to safe practices and injury prevention. The findings provide useful information to understanding the positive impacts of the SPH law but also notes the potential limitations of this legislation in the view of health care workers.

Safe patient handling legislation and changes in programs, practices, perceptions, and experience of musculoskeletal disorders by hospital characteristics: A repeated cross-sectional survey study

BACKGROUND

Safe patient handling legislation has been enacted in 11 states in the United States to protect healthcare workers from patient handing injuries. Implementations and outcomes may vary across hospitals by the characteristics of the institution.

OBJECTIVES

This study was to investigate the changes in safe patient handling programs in hospitals, and nurses' perceptions, work practices, and musculoskeletal symptoms by hospital characteristics after the passage of California's safe patient handling legislation.

DESIGN

Repeated cross-sectional surveys.

SETTINGS

Two statewide surveys of registered nurses were conducted in California, where a safe patient handling law became effective in 2012. Random samples were selected from the lists of the California Board of Registered Nurses (2000 nurses in 2013 and 3000 nurses in 2016).

PARTICIPANTS

Among survey respondents (26% in 2013 and 20% in 2016), the study sample included 254 nurses in 2013 and 281 nurses in 2016, who met the eligibility for this study: nurses employed in a hospital and had direct patient care or patient handling duties.

METHODS

Data were collected by postal and on-line surveys. Data were compared by hospital size, geographic area, hospital teaching status, and ownership (for-profit, non-profit, government).

RESULTS

Between 2013 and 2016, nurses' reports showed improvements in safe patient handling policies and programs across the different characteristics of hospitals. In 2016, nurses in large, teaching, non-profit, and rural hospitals reported slightly better scores for safe patient handling program variables than their counterparts; however, changes in the use of mechanical lifting devices and experiences of musculoskeletal symptoms and injury were not significantly different by hospital characteristics. Overall, teaching hospitals consistently showed greater improvements than non-teaching hospitals for both hospital-level (safe patient handling programs and organizational practices) and individual-level (perceptions and symptoms) variables.

CONCLUSIONS

Our findings indicate overall improvements of safe patient handling programs in California hospitals after the passage of safe patient handling legislation. Positive changes appear to be greater among teaching, non-profit, and rural hospitals. However, greater positive changes in safe patient handling programs shown in certain hospital characteristics were not necessarily linked to more improvements in nurses' safe work practices and experiences of musculoskeletal symptoms or injuries.

Evaluation of the Minnesota Safe Patient Handling Act: trends in workers' compensation indemnity claims in nursing home workers before and after enactment of the law

OBJECTIVES

The 2007 Minnesota Safe Patient Handling Act aims to protect healthcare workers from injuries caused by lifting and transferring patients. The effectiveness of the law in nursing homes is unknown. This policy evaluation measured changes in patient handling injuries before and after the law was enacted. Additionally, it assessed whether effects of the law were modified by facility levels of staffing and retention.

METHODS

Workers' compensation indemnity claims for years 2005-2016 were matched to annual direct care productive hours and facility characteristics (eg, profit status, hospital affiliation and region) for all Medicaid-certified nursing homes in Minnesota. Trends in patient handling claims were analysed using negative binomial regression with generalised estimating equations. The primary predictors were time period, staff hours per resident day and staff retention.

RESULTS

The patient handling indemnity claim rate declined by 25% in years 4-6 and 38% in years 7-9 following enactment of the law. Claims for all other injuries and illnesses declined by 20% in years 7-9 only. Associations between time period and patient handling claims did not vary by levels of staffing or retention. However, independent of time, facilities with annual retention ≥75% (vs <65%) had a 17% lower patient handling claim rate.

CONCLUSIONS

Results suggest the law reduced patient handling claims in nursing homes. However, claim rates were elevated in facilities with low worker retention and those that were non-profit, not hospital-affiliated or in a non-metro area. Facilities with these characteristics may benefit from targeted state grants and consultation efforts.

Prevalence and Characteristics of Multisite Musculoskeletal Symptoms among District Hospital Nurses in Haiphong, Vietnam

Background

Musculoskeletal disorders (MSDs) are commonly observed among workers around the world. These diseases not only affect the health of workers, their quality of life, and their performance, but the effects of such diseases also represent a great burden for the health and social systems. These issues are even more prevalent in developing countries, and nurses are no exception. Many studies worldwide have shown a high prevalence of work-related MSDs in each body position among nurses. However, there are very few studies that have mentioned multisite musculoskeletal symptoms (MMS).

Objectives

To describe the prevalence and characteristics of MMS among district hospital nurses in Haiphong, Vietnam. Material and Methods. A cross-sectional study was carried out on 1179 nurses working in all 15 district hospitals using the Modified Nordic Questionnaire at 9 anatomical sites on the body (neck, shoulder/upper arm, elbow/forearm, wrist/hand, upper back, lower back, hip/thigh, knee/lower leg, and ankle/foot). The following main indicators were calculated: the prevalence of musculoskeletal symptoms (MS) (at least 1 of 9 sites), MMS (two or more sites), and widespread musculoskeletal symptoms (WMS) (MS of the upper limb, the lower limb, and the back or the neck).

Results

The prevalence of MS during the past 12 months and symptoms lasting for at least 30 days was 60.6% and 17.2% in men and 77.6% and 21.5% in women, respectively. The lower back, neck, upper back, and shoulder/upper arm were the most common sites affected. In terms of MMS, the prevalence was 37.6% in men and 57.1% in women during the past 12 months while 8.6% of men and 11.3% of women reported that symptoms lasted for at least 30 days. The prevalence of MMS tended to increase with age, seniority, having a history of musculoskeletal diseases, and in nurses working in district hospitals located in urban areas. Nearly 90% of MMS concerned two or three anatomical regions during the past 12 months, and almost 80% of MMS lasting at least 30 days involved two or three anatomical regions. The prevalence of WMS was 10.4% in men and 18.6% in women during the past 12 months and 0.9% in men and 2.1% in women lasting at least 30 days.

Conclusions

This study showed the high prevalence of MMS and WMS among nursing staff. Further and more extensive research is needed to improve our understanding of multisite musculoskeletal symptoms and act as the foundation for developing preventive measures for nurses.

Comparison of lift use, perceptions, and musculoskeletal symptoms between ceiling lifts and floor-based lifts in patient handling

Lifting equipment can reduce the risk of injury from patient handling, but limited availability and adoption have been a persistent problem. Data from statewide surveys of California nurses (N = 389) in 2013 and 2016 were analyzed to evaluate lift use, perceptions about lifts and injury risk, and musculoskeletal symptoms by type of available lifts. Nurses with ceiling lifts (23%) were significantly more likely to use lifts and had more positive perceptions about lifts, regarding worker safety, patient safety and comfort, ease of use, access, and storing, than nurses with only floor lifts (77%). Nurses with ceiling lifts reported less low back pain and shoulder pain. Our study findings suggest that providing ceiling lifts can result in superior outcomes to floor-based lifts in multiple aspects, including better acceptance and use by nurses for patient handling, as well as being associated with reduced work-related musculoskeletal symptoms in the low back and shoulders.

The physical demands and risks of working in healthcare simulation center

BACKGROUND

The purpose of this study was to describe the physical demands and risks associated with working in a simulation center.

METHODS

The 26-item online survey included questions about the physical nature of a simulationist's role and about what engineering and administrative controls they most commonly used. The sample consisted of 119 simulation operators and educators recruited from simulation interest groups based in the United States.

RESULTS

Fifty-five percent of participants reported that their job description did not match their work, and 59% of participants believed that they experienced a musculoskeletal disorder resulting from their work in a simulation center.

CONCLUSION

This study highlights the need to address workplace safety in simulation centers. Future research is needed to inform best practices for safe handling policies and procedures in simulation programs.