1. Nurse Work Related Musculoskeletal Disorders: A Global Concern Susan Katz Sliski RN DNP(c) AAOHN National Conference 2012 Nashville, TN

2. Statement of the Problem 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. Statement of the Problem The prevalence of unreported nurse work related musculoskeletal disorders also signifies the devaluation of human capital.

4. Statement of the Problem 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 9000 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. Statement of the Problem Underreporting of WMSD, An aging nurse workforce The obesity epidemic – create significant risks for career ending injuries

6. Statement of the Problem. 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. Scope of the problem in United States, Australia, England, Canada

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

9. Countries with Safe Patient Handling Policies and Regulations United States, Australia, England, Canada United States Nine (9) states: New York (2005), Ohio (2005), Texas (2005), Rhode Island (2006), Washington (2006), Hawaii (2006, resolution), Maryland (2007), New Jersey (2007), Minnesota (2007), and Illinois (2009). The following states introduced legislation in 2010: California, Florida, Hawaii, Massachusetts, Missouri, Michigan, Montana, New York, Texas, and Vermont (ANA 2010).

10. Countries with Safe Patient Handling Policies and Regulations United States, Australia, England, Canada 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 http://www.health.vic.gov.au/__data/assets/pdf_file/0010/17578/back_1201. pdf Australia Australian Nursing Federation (Vic Branch) adopted a No Lifting Policy in Mar

11. Countries with Safe Patient Handling Policies and Regulations United States, Australia, England, Canada England : Health care organizations in England have accepted the specific legal duty to control risk among health care workers (Smedley et al, 2004)

12. Global Concerns: A review of some recent articles and studies Empirical literature on nursing injuries is replete with studies by varied voices with: no common language terminology or definitions

13. Global Concerns: A review of some recent articles and studies Siddharthan, K., Hodgson, M., Rosenberg, D., Haiduven, D., Nelson, A. (2006). Under-reporting of work-related musculoskeletal disorders in the Veterans Administration. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services, 19(6-7), 463-76. Siddharthan, KHodgson, MRosenberg, DHaiduven, DNelson, A 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.

14. Global Concerns: World Health Organization The World Health Organization (WHO), – the International Labour 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 they released Framework Guidelines for Addressing Workplace Violence in the Health Sector (for links to the report go to 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/workplac e/en/i http://www.who.int/violence_injury_prevention/violence/activities/workplac e/en/i

15. Countries with Safe Patient Handling Policies and Regulations United States, Australia, England, Canada

16. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis 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.

17. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis 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

18. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis 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

19. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis The organization had implemented many recommended prevention strategies, yet career ending injuries and high rates of assault were reported

20. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis The finding revealed : 3 Major Themes 11 Sub Themes

21. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis 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, T – raining, Education, and Management of Injuries, – Assault,

22. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis Major Theme #2: The Impact of Work Related Musculoskeletal Injuries, Sub Themes: The Burden on other Staff Light Duty

23. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis Major Theme #3 : The Response to WMSD – 2 sub themes : – Feeling of uncertainty, and – Spectrum of feeling about the injured person.

24. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis 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. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis 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. Exploring First line Nurse Managers Experiences with Work Related Musculoskeletal Disorders in Staff Nurses Susan Katz Sliski RN DNP Thesis Research is needed to assess the staff nurse in environments which lack even the most basic support systems such as the home care that provide patient care to patients who are: – discharged earlier and earlier from the hospital, – are less mobile, – more obese, and – 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?

27. A Global Concern : Under reporting in developing countries

30. " Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has." ~ Margaret Mead