1. Susan Katz Sliski, RN DNP(c) CCM skatzsliski@worldcare.com | WorldCare International, Inc. AAOHN National Conference 2012 | Nashville, TN

2.  Nurse work related musculoskeletal disorders (WMSDs) within hospital organizations should be considered equal to canaries in a coal mine;  They are early indicators of workplace hazards

3.  The prevalence of unreported nurse work related musculoskeletal disorders signifies the devaluation of human capital  The paucity of occupational health and safety research about nurses around the world is a barrier to improving nurses’ workplace conditions.

4.  The Institute of Medicine estimates the economic burden of work related musculoskeletal disorders to be between $45 and $54 Billion annually in the United States  Every day 9,000 U.S. healthcare workers sustain a disabling injury while performing work-related tasks.  Disabling back injury and back pain affect 38% of nursing staff http://ajcc.aacnjournals.org/content/12/5/400.full

5.  Underreporting of WMSD  Aging nurse workforce  Obesity epidemic  create significant risks for career ending injuries

6.  The factors related to high level of WMSD among nurses are documented as:  the underreporting of nurse injuries in hospitals  the management of human capital  the role of nurse staffing patterns

7.  Strains and sprains of the back and shoulders accounted for one half of all healthcare workers injuries (U.S. Bureau of Labor Statistics, 2007)  American Nurses Association (ANA) 2001 survey reported 83% of respondents in their survey complained of back pain but continued to work

8. United States > 2010 United States 2010 > The above states introduced legislation in 2010  New York (2005)  Ohio (2005)  Texas (2005)  Rhode Island (2006)  Washington (2006)  Hawaii (2006, resolution)  Maryland (2007)  New Jersey (2007)  Minnesota (2007)  Illinois (2009)  California  Florida  Hawaii  Massachusetts  Missouri  Michigan  Montana  Texas  Vermont

9.  Canada 1999: The Manual Handling Regulations, place legal requirements on employers to provide equipment and aids to assist employees to carry out manual handling tasks and to provide training to staff in the correct use of equipment and safe handling of patients  The Victorian Nurses Back Injury Prevention Project (VNBIPP) was established to assist health care organizations to implement programs to prevent back injuries amongst nurses. http://www.health.vic.gov.au/__data/assets/pdf_file/0010/17578/back_1201.pdf

10.  Australian Nursing Federation:  AUSTRALIAN NURSING FEDERATION (VIC BRANCH) POLICY  NO LIFTING (Adopted March 1998)  Most injuries sustained by nurses were manual handling injuries, particularly back injuries.  Overexertion/ stress due to the constant lifting and handling of patients, was the most common cause of these injuries. http://www.anf.org.au/html/topics_workplacehs.html

11.  Japan:  Musculoskeletal Disorders (MSD) represent a common occupational problem among Asian nurses, particularly those in Japan.  MSD categories focused on the neck, shoulder, upper back, and lower back regions.  The 12-month period-prevalence of MSD at any body site was 85.5%. MSD was most commonly reported at the shoulder (71.9%), followed by the lower back (71.3%), neck (54.7%), and upper back (33.9%). ◦ http://www.sciencedirect.com/science/article/pii/S0022437506000302

12.  Philippines:  Philippine Nurses Association 2007 :Measured occupational injury/illness, reporting behavior, and safety concerns.  Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain.  Most who had an injury did not report it.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797477 /

13.  Nigeria  A high proportion of Nigerian nurses reported WMSDs  Many Nigerian nurses have emigrated to Europe, northern hemispheric countries and the oil rich middle-east in search of better life and condition of service.  This has contributed to the problem of inadequate staffing, and this has been associated with WMSDs among nurses  to lead to even higher rates of these disorders  http://www.biomedcentral.com/1471-2474/11/12

14.  Empirical literature on nursing injuries is replete with studies by varied voices with:  no common language  terminology or  definitions

15.  AAOHN publications creates a platform:  (1) de Castro, A. B., Cabrera, S., Gee,G., Fujishiro, K. & Tagalog,E.A. (2009). Occupational health and safety issues among nurses in the Philippines. AAOHN Journal, 57(4), 149-57.  (2) Brown, J.G., Trinkoff, A., Rempher, K., McPhaul, K., Brady, B., Lipscomb, J., Muntaner, C. (2005). Nurses’ inclination to report work-related injuries: Organizational, work-group, and individual factors associated with reporting. AAOHN Journal, 53(5), 213–17.  (3) Welch, C. (2010, August). Long term risk of repeat occupational injury or illness incidents among Veterans Health Administration nursing employees. AAOHN Journal, 58(8), 323-9.

16.  The World Health Organization (WHO), the International Labor Office, the International Council of Nurses, and Public Services International collaborated in 2000 to study the global implications of and approaches to the problem  In 2002 the WHO released Framework Guidelines for Addressing Workplace Violence in the Health Sector  Violence in health care settings is a global issue that particularly threatens access to primary health care in developing countries, which already suffer shortages of health care workers  Underreporting of violence is also a widespread problem, the WHO report says, perhaps because workers see the abuse as an expression of patients' illnesses or as an acceptable part of the job http://www.who.int/violence_injury_prevention/violence/activities/workplace/en/i

17.  Musculoskeletal Disorders And Associated Factors In Nurses, Bank And Postal Workers In South Africa  20 countries are participating. The project is called Cultural and Psychosocial Influences on Disability (CUPID).  The main aim of CUPID is to determine if work-related musculoskeletal symptoms and resultant disability are influenced by cultural beliefs and expectations as well as by physical activities and mental health.  South Africa is an ideal place to conduct this research because of her multicultural population.  Three occupational groups have been selected for CUPID. These are nurses who are involved in patient handling tasks, office workers who use computers and postal workers who sort the mail manually. These three occupational groups were selected because their jobs entail physical demands that have been linked with musculoskeletal pain and disability.  Ms. B. Nyantumbu (busisiwe.nyantumbu@nioh.nhls.ac.za)

18.  First line nurse managers are at the intersection between organizational culture and staff nurse work  Little is known about their challenges in managing staff nurse WMSD injury  A qualitative study using Max van Manen’s phenomenological method was used to explore first line nurse managers’ lived experiences with WMSDs in staff nurses

19.  Participants met inclusion criteria: ◦ Had been a nurse manager for more than 1 year ◦ Had experience with staff nurse work related musculoskeletal injuries ◦ Worked in acute care setting  Yielded a cohort who were : ◦ Highly seasoned nurses- average years as RN=26.6 ◦ Highly seasoned first line nurse managers-average years as a FLNM = 13.6  Snowball recruitment resulted in participants who worked for the same healthcare organization

20.  The organization had implemented many recommended prevention strategies, yet career ending injuries and high rates of assault were reported  Findings revealed: ◦ 3 Major Themes ◦ 11 Sub Themes

21. Major Theme 1 : The Complexity of Work Related Musculoskeletal Injuries Sub Themes: Pre-existing Injury Poor Performance Age of the Nurses Lugging and Tugging Different Setting/Different Issues Training, Education, Management of Injuries Assault

22. Major Theme 2 : The Impact of Work Related Musculoskeletal Injuries Sub Themes:  The Burden on other Staff  Light Duty

23. Major Theme 3: The Response to WMSD Sub Themes:  Feeling of uncertainty  Spectrum of feeling about the injured person

24.  Staff nurse risk of musculoskeletal injuries needs to motivate healthcare organizations to change behaviors and invest in strategies which reduce nurse musculoskeletal injuries, such as:  lift devices,  electric beds with bed weights  enact no-lift policies

25.  Within the acute care hospital setting, staff nurses who chirp like canaries in the coalmines can report a full range of injuries in an environment with safety committees, and occupational health nurses  Additionally we understand that in spite of all of the existing efforts, there remain factors, which create underreporting even in the hospital setting rich with available prevention strategies

26.  Research is needed to assess the staff nurse in environments which lack even the most basic support systems such as home care that provides care to patients who are:  discharged earlier and earlier from the hospital  are less mobile  more obese  where the nurse is typically working alone in homes which lack even the most basic lift systems.  In these situations, it is not even about the canaries chirping in the coalmines, it is more akin to the old adage: if a tree falls in the forest and no one is around to hear it, does it make a sound?