Ergonomics in the workplace

AORN Journal, Sept, 2006 by Catherine A.G. Sparkman

Musculoskeletal injuries suffered by nurses have been well documented for more than two decades. (1) In 2002, RNs ranked seventh among workers in all occupations for the number of nonfatal occupational injuries involving musculoskeletal dis-orders. (2) Back injuries and other injuries caused by overexertion frequently are cited as contributing factors in a nurse's decision to transfer employment to a less physically demanding job or to leave the field of nursing permanently. (3)

Many perioperative nursing tasks trigger back pain and associated musculoskeletal injuries. (4) This includes the transfer of patients on and off OR beds or repositioning patients on OR beds. The mounting scientific evidence connecting these nursing tasks to back pain prompted the Occupational Safety and Health Administration (OSHA) to promulgate a standard intended to protect workers from ergonomic hazards such as patient handling. In 2001, however, the US Congress repealed the OSHA standard and directed the agency to cease all work related to the standard. (5)

In 2003, OSHA released its "Guidelines for nursing homes--Ergonomics for the prevention of musculoskeletal disorders." (6) In these guidelines, OSHA explicitly recommends that manual lifting of patients be minimized in all cases and eliminated when feasible. No other federal laws, regulations, or guidelines have been published, however, that specifically relate to musculoskeletal injuries in nurses outside of the nursing home setting.

STATE STANDARDS

During the time OSHA was developing its guidelines, ergonomic standards were being addressed at the state level. In 1996, California adopted ergonomic standards focusing on repetitive motion injuries. (7) Washington also adopted an ergonomics standard with phased-in enforcement; however, the rule was repealed by initiative in 2003. (7) Alaska held public meetings in 2002 on a draft standard for workplace safety and ergonomics, among other issues, but the Commissioner of Labor dropped the ergonomic provisions in response to a number of adverse comments by stakeholders. (7)

Minnesota established an ergonomics task force to receive suggestions, evaluate approaches that address work-related musculoskeletal disorders, and report to the Minnesota Department of Labor and Industry. (7) Oregon's Occupational Health and Safety Administration adopted a strategic plan that included activities designed to reduce musculoskeletal injuries through outreach and use of voluntary services. These acts included the creation of an ergonomic stakeholder group to identify strategies to promote a reduction of ergonomic injuries in targeted industries. (7)

STATE LEGISLATION

Legislative response in various states began in earnest in 2003. Three states proposed legislation addressing ergonomic injuries, but none of these bills passed. By 2005, more than eight states had introduced ergonomic legislation, with other states following in 2006.

California. California reintroduced Senate Bill (SB) 363 in 2005, after the Sept 22, 2004, veto of a similar bill (ie, California Assembly Bill 2532). California's SB 363 required general acute care hospitals, except those in rural areas, to

* conduct a needs assessment identifying

* lifting devices, lifting equipment, and

* patients needing lift teams;

* implement a "zero lift" policy;

* provide specialized training in the appropriate use of lifting devices and equipment; and

* establish a health care worker back injury prevention plan. (8)

Gov Arnold Schwarzenegger vetoed that legislation, stating that although he supported the goals, the bill created an inflexible mandate. He urged hospitals to use recently acquired federal funds to pay for education, equipment, and additional staff members to comply with the spirit of the vetoed bill. (9)

Florida. In 2006, Florida introduced the Patient Handling/Safe Movement Bill (ie, SB 2244 and parallel HB 1177), which required the governing body of each hospital or nursing home to adopt and ensure implementation of a policy and program to identify, develop, and assess strategies to control the risk of injury to patients and nurses associated with lifting, transferring, repositioning, or moving a patient. (10) The bill died in the Committee on Health Care and expired sine die (ie, without a day specified for a future meeting) when the legislature adjourned in May 2006.

Hawaii. The Hawaii legislature also addressed the issue of appropriate safeguards to minimize the occurrence of musculoskeletal injuries suffered by nurses. The Hawaii House and Senate passed a house concurrent resolution (ie, HCR 16) supporting the policies contained in the American Nurses Association's "Handle With Care" Campaign on April 24, 2006. (11)

Iowa. Iowa House File (HF) 635, introduced in the General Assembly in 2006, directed the Iowa Department of Public Health to adopt rules requiring hospitals to establish and implement protocols relating to manual patient handling by nurses to prevent musculoskeletal and other injuries. (12) This bill died in committee.