by Frank Long, MS, Editorial Director
Healthcare jobs are dangerous. Maybe not as dangerous as bullfighting or lion taming but certainly right up there with anyone who works with chainsaws or roller skates. The risk of worker injury in the healthcare space is ubiquitous and hovers in places one might think unlikely. Laboratory work, for example, with its constant traffic of pathogenic microorganisms might seem like a hot spot for mishaps. The daily grab bag of chaos that awaits first responders, too, seems a fraught environment at first glance. The reality is somewhat different.
In actuality, the widespread danger of workplace injuries for healthcare workers is dispersed mostly around points where patient lifts are performed. Therefore, as patient weights grow progressively heavier and the existing workforce grows older, an urgency has developed for healthcare organizations to take measures that will help their employees avoid worst-case scenarios.
How Many is a Lot?
The danger of hospital work is laid out plainly in recent data released by the U.S. Bureau of Labor Statistics (BLS). In 2017 the bureau reported there were 51,380 cases of injury or illness that resulted in missed work days for hospital full-time employees.1 That number is substantially greater than the same measure applied to the warehousing and storage employment sector, which reported 17,390 cases of missed work days among its full-time employees for illness or injury.1
The contrast is staggering. But despite the fact that warehouse workers frequently are surrounded by forklifts, rolling pallets, and the occasional falling object, the total number of injuries for that sector is far below those sustained by full-time workers in hospitals. The hospital category includes general medical and surgical hospitals, psychiatric and substance abuse treatment centers, and nursing and residential care facilities.
The population of hospital workers who engage in patient lifting activities cuts across disciplines. In a Venn diagram that space would be occupied by occupational therapists (OTs), physical therapists (PTs), nurses, and other inpatient personnel. Among those vocations it is nurses who seem to bear the brunt of hospital injuries. Research data show that more than 74% of all nonfatal workplace injuries and illnesses that affected registered nurses (RNs) occurred in hospitals, despite the fact that only 61% of all RNs work in hospitals.2
The most common causes of injury? Data in the literature point to overexertion and bodily reaction showing up in 46.5% of all cases within the nursing occupation; caused most often by lifting, bending, twisting, repetitive motion, and excessive physical effort.3
A study by Campo, Weiser, Koenig & Nordlin that sought to determine the 1-year incidence rate of work-related musculoskeletal disorders among PTs found that repositioning a patient or performing a patient transfer significantly increased a PT’s risk of injury compared to PTs who did not perform transfers or repositionings. The researchers found specifically that PTs who performed 6 to 10 patient transfers each day carried a 2.4 times higher risk. Those odds climbed to a 2.6 times greater chance of developing work-related musculoskeletal disorders (WRMDs) for PTs who repositioned patients more than 10 times per day.4
Campo and his team also determined that bent or twisted postures as well as job strain increased the risk for low back WRMDs.4 The group concluded that the risk for those disorders was particularly increased by manual therapy, patient handling, and physical therapy exposures.4
Self-Treatment on the Sly
While PTs and OTs share some similarity with nursing personnel in overall risk for musculoskeletal injuries, once those injuries occur therapists tend to respond in a way that is unique to their professions. According to Waldrop, one of those responses is to underreport injuries, and the other is to self-treat.5
Waldrop determined that the ability to self-treat may be one of the reasons therapists underreport their injuries.5 Access to the care that might be provided by clinical colleagues was found to be another reason for underreporting.5 The practice of self-treating is not rare and it can be plainly observed in the sample population of OTs and PTs studied by Darragh that found more than half of the study subjects reported that they self-treated their injuries.6
Regardless of how these practices are scrutinized in the literature, what the findings say about the real world is that there is a profound need to protect therapists from becoming injured in the first place.
Two of the factors that can affect the risk of work-related injury for PTs and OTs are a patient’s body weight and a therapist’s age. With many Americans on a headlong trajectory toward weight gain and many therapists in the workforce growing older, it seems self-evident that healthcare workplaces must aggressively protect the musculoskeletal health of its OT-PT professionals and make work settings and practices more resistant to the potential for injury.
Ginnie Halling, PT, chief executive officer of DSI Work Solutions, Bowling Green, Ky, underscores the potential dangers to therapists in the hospital work space.
“Patients are sicker—and bigger—than ever before, and it is no longer realistic for one employee to handle many/most of these patients,” Halling says. “Even non-clinical personnel in support departments such as housekeeping and dietary services share the risk for lifting and handling injuries,” she adds.
One way that hospitals can substantially reduce the likelihood of lifting injuries to those workers, Halling says, is to take advantage of the advances in lift and transfer device technologies that are available today. It is not enough just have the technologies on premises. Halling points out that employees must make the effort to use them correctly even when work schedules become busy and the temptation to perform a lift without mechanical support seems more expedient.
In cases where staff may not always use a lift device, Halling says, education and buy-in become critical in getting staff to use the devices. The key to getting an optimum level of staff buy-in to use this equipment, Halling adds, oftentimes will hinge on making the advantages of its use apparent to the employees themselves.
“Patient handling equipment is provided for the safety and comfort of patients as well as workers,” Halling explains. “Since patient comfort and satisfaction are critical measures for hospitals and other care facilities, the use of such equipment for the benefit of the patient should be emphasized, written into patient treatment protocols and procedures, and trained on,” she adds.
Support for Safe Handling
Safe Patient Handling (SPH) is supported by the American Physical Therapy Association (APTA). A position statement from the organization clearly states that it supports PTs and PTAs “…employing the concepts of safe patient handling and mobility while providing services, and leading the development, implementation, refinement, and maintenance of safe patient handling and mobility programs on an institutional level…”
Support for these concepts can be of particular benefit in acute care hospitals, where the types of interventions PTs are called on to perform as well as a complex patient population and environment create a heightened risk for them to experience a WRMD.7 SPH programs can influence the perceptions of PTs who work in acute care settings in such a way that the PTs are more likely to use patient handling equipment and agree that SPH equipment is feasible to use during PT sessions.7
Furthermore, most acute care PTs who were surveyed in one study indicated that using SPH equipment improved safety for patients and providers as well as the quality of the interventions they provided.7
Many types of SPH equipment were reportedly used during this research. Sit-to-stand lifts were the equipment most often used followed by floor-based sling lifts, lateral transfer aids, and repositioning aids. After that, ceiling lifts, walking harnesses, and limb slings were most frequently used. Lack of equipment was cited most often as the factor that limited the use of SPH equipment and practices.7
4 Steps to Safer Work
While lift equipment can make a substantial contribution to worker safety, it is only one part of a greater strategy facilities can adopt to reduce or eliminate work-related injuries. Halling details four important measures that rehab directors and managers can use to help support an overall strategy to reduce injuries.
First, she says, it is important to understand the job tasks and safety challenges that employees and managers face. “Getting the facts, which includes measuring the forces and movements or positions routinely encountered by workers in their jobs, is essential,” Halling says.
The second measure Halling recommends is to reduce forces and postural stresses where they are significant. Ergonomic improvements and safer patient and material handling methods are the cornerstone of this measure, she says.
Educating the workers based on the facts is the third measure that Halling says employers can take to reduce injuries. She underscores that healthcare organizations must make certain that workers understand the “why” behind any process changes. To help get employee buy-in, Halling says, employers should be clear in expressing to employees what the benefits to them will be. “Reduced fatigue, reduced body mileage, and reduced risk of injury are some of the points that may help win that buy-in,” Halling notes.
The fourth measure is to establish the fit between individual workers and their jobs. Halling says this part of the process involves physical demands testing that are specific to the worker’s job or proposed job, such as lifting, pulling, and bending.
“It is a fact that not everyone physically fits every job,” Halling says. “There is a wide range of ‘normal’ human capacity, and employers can and really should determine whether a prospective employee possesses the minimum safe physical abilities that a job will require of them.” It is this step, she says, that is critical for the safety of the worker, their co-workers and, the patients served.
Functional Testing: It’s a Fact
Recognition of the wide range of normal limitations combined with hiring/placing workers accordingly has proven that it can substantially reduce work-related injuries, according to Halling. She points out that when injury or illness occurs, and a doctor releases a worker to full duty, that release is not a guarantee that the worker is at full work capacity.
“The physician releases based on healing and recovery criteria being met,” Halling says. “Functional testing is a substantive way to assure the patient, who is the worker in this case, and the employer that the worker is ready to resume full duty—or not ready.”
When functional testing identifies a deficit, Halling says, it can be directly addressed in ways such as a transitional work approach, or with targeted strengthening and conditioning approaches. It is a process that allows employers to ferret out risk issues so they may be addressed and improved upon rather than wait until an injury occurs.
In short, Halling says, annual functional testing can provide objective information to help employees remain fit for duty and reduce injuries. “That’s a fact,” she adds. RM
Frank Long, MS, is editorial director of Rehab Management. He can be contacted at [email protected].
1. U.S. Bureau of Labor Statistics. Employer-Reported Workplace Injury and Illnesses, 2017. News Release. Available at https://www.bls.gov/news.release/osh.nr0.htm. Accessed September 26, 2019.
2. Occupational outlook handbook, “Registered nurses.” Sixty-one percent of RNs work in hospitals. (U.S. Bureau of Labor Statistics)
3. Occupational injury and illness classification manual, section 2.4.2, “Event or exposure—titles and descriptions” (U.S. Bureau of Labor Statistics, January 2012), https://www.bls.gov/iif/osh_oiics_2010_2_4_2.pdf.
4. Campo M, Weiser S, Koenig KL, Nordin M. Work-related musculoskeletal disorders in physical therapists: A prospective cohort study with 1-year follow-up. Physical Therapy. 2008;88:608-619.
5. Waldrop S. Work-related injuries: Preventing the PT from becoming the patient. Physical Therapy. 2004;12(2);35-41.
6. Darragh AR, Huddleston W, King P. Work-related musculoskeletal injuries and disorders among occupational and physical therapists. Am J Occup Ther. 2009;63:351-362.
7. Olkowski BF, Stolfi AM. Safe patient handling perceptions and practices: a survey of acute care physical therapists. Physical Therapy. 2014;94(5):682–695.