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

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.  United States:  Work-related musculoskeletal disorders are the leading occupational health problem plaguing the nursing workforce.  Of primary concern are back injuries, neck, shoulders, wrists, and knees.  Compared to other occupations, nursing personnel are among the highest at risk for musculoskeletal disorders.  http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWi thCare.aspx

10.  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

11.  Australian Nursing Federation:  Nursing and midwifery is the profession with the highest exposure to workplace violence; further, there is a continually high incidence of back injury in nursing, especially in aged care where no lift policies remain non-compulsory.  The ANF also calls for:  The Australian Government to fund a national strategy to combat the incidents of violence and aggression toward nurses and other health care workers  Fund a national no lift strategy in health, aged care and community care http://www.anf.org.au/html/topics_workplacehs.html

12.  Japan:  A detailed analysis of musculoskeletal disorder risk factors among Japanese nurses  Musculoskeletal Disorders (MSD) represent a common occupational problem, few epidemiological studies have investigated MSD risk factors among Asian nurses, particularly those in Japan.  Japanese-language version of the Standardized Nordic Questionnaire to 1,162 nurses from a large teaching hospital. 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

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

14.  Siddharthan, K., Hodgson, M., Rosenberg, D., Haiduven, D., Nelson, A. Under-reporting of work-related musculoskeletal disorders in the Veterans Administration. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services, (2006) 19(6-7), 463-76.  Welch, C. Long term risk of repeat occupational injury or illness incidents among Veterans Health Administration nursing employees. AAOHN Journal, (2010, August) 58(8), 323-9.

15.  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 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.  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

18.  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.  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

20. 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

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

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

23.  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

24.  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

25.  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  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?