1. Safe Work Environments for Nurses: Safe Patient Handling Audrey Nelson, Ph.D., RN, FAAN audrey.nelson@.va.gov

2. Every work environment has its own special challenges

3. Problem Statement Nursing is one of the Top 10 high risk occupations in USA, for over 3 decades, despite the fact that 50% of injuries remain unreported Highest risk task contributing to injury is manual patient handling In an eight hour shift, the cumulative weight that nurses lift equal to an average of 1.8 tons per day.* Estimated costs in VHA are estimated at approximately $22 million/year *Tuohy-Main, K. (1997). Why manual handling should be eliminated for resident and carer safety. Geriaction, 15, 10-14.

4. The adult human form is an awkward burden to lift or carry. Weighing 200 pounds or more, it has no handles, it is not rigid, and it is susceptible to severe damage if mishandled or dropped. (circa 1950) The Ergonomic Challenge

5. Link Between Nurse Safety and Patient Safety Nurse: Occupational injury results in lost work days, absenteeism, staff turnover, decreased retention, discouraged recruitment Patient: Unsafe patient handling leads to drops and drags, as well as increase in immobility-related adverse events

6. VHA Program Core Elements Risk assessment identifying local needs, followed by monthly unit- based hazard evaluation Selection/purchase of equipment involved front line nursing staff (equipment fairs) Facility Champion Unit-based peer leader education model Minimal Lift Policy.

7. Outcomes Nursing Outcomes: 31% reduction in incidence of injuries 18% reduction in lost work days 88% reduction in modified duty days Patient Outcomes: 1. Lower depression 2. Improved urinary continence 3. Increased engagement in activities 4. Less likely to fall 5. Increase in Alertness/awake during day Business case (Cost: $8,000/bed) pay-back of the capital investment in approximately 4.13 years with an internal rate of return between.19 and.37 depending on model assumptions. Basis of the OSHA Ergonomics Guidelines for Healthcare Facilities and ANA Handle with Care program. Basis of VA Initiative to Roll out nationwide

8. Other Solutions Evidence-based facility programs Hospitals Nursing Homes Home Health Care Outpatient Change Curriculum in Schools of Nursing State Legislation (national proposed) VHA National Rollout

9. Making the change is hard……but nurses deserve this!

10. Patients deserve this!

11. Wise words The End….. Do one brave thing each day