"Oh! My Aching Back!" Anne Hudson, RN, BSN. September-October 2002. Last Word.
Revolution: The Journal for RNs and Patient Advocacy. 3(5), 31.

Oh! My Aching Back!

Though alarmed when my nursing class was told that nurses' jobs depend on their backs (and that nurses are at high risk of cumulative trauma back injuries from lifting and moving patients), I believed, as the instructor emphasized, that practicing good body mechanics would protect me from injury. And for 10 years as an RN, it seemed I was avoiding injury while performing endless heavy lifts on medical/surgical, telemetry, and intermediate care units.

Now, since suffering a cumulative trauma injury to two lumbar discs, I have discovered abundant evidence that there is no safe way to manually lift adult patients. Lifting their weights generates compressive forces to the lumbar spine that exceed established tolerance limits.

Because the nucleus of discs lacks nociceptors, there may be no perception of pain as discs are damaged from repetitive heavy lifting. When damage extends to nerves in the annulus of the disc, pain will occur. By then, it's too late. Pain may not be a warning sign from sore muscles to slow down; it may be the stop sign to a nurse's career from severe damage to spinal discs.

Lifting tasks of nurses have been estimated at 1.8 tons per day, comparable to those of the hardest labor. It is well established that body mechanics alone cannot protect spinal structures from injury caused by hazardous compressive forces generated with lifting excessive weights.

A number of interventional studies has demonstrated great reductions in nurses' back injuries by elimination of manual patient lifting with policies requiring use of safe, gentle, mechanical lift equipment and friction-reducing devices. Yet, in spite of available equipment and methods proven to reduce injuries, nurses in many areas are still required to physically lift and move patients, needlessly placing them at risk.

Wastage of nurses to preventable back injuries is over-looked by many of those commenting on the nursing shortage. For example, the July 2001 report to the U.S. General Accounting Office, "Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors" by Janet Heinrich, Director for Health Care, Public Health Issues, fails to mention preventable injuries, although 38 percent or more of nurses will suffer back injuries requiring time away from work during their career. Of those, an estimated 44 percent will be unable to return or will be forced out of nursing.

Since being injured, I have learned some unpleasant truths:

• Nurses are required to lift hazardous amounts of weight that employers should know will harm them.
  
  
• No national agency or organization is providing protection to nurses from back injuries related to manual patient handling.
  
  
• Very few employers will voluntarily implement measures proven necessary to reduce both nurses' back injuries and related medical and compensation costs.
  
  
• Back-injured nurses - after suffering preventable, disabling injuries in the service of others - may be of no further use to their employers when they can no longer lift and haul heavy patients.

Many employers choose to expend human resources rather than invest in safe patient lift equipment. (An analogy would be requiring warehouse workers to move heavy loads without forklifts and then terminating workers whose back are injured lifting and moving the loads.) Thus, highly-skilled, experienced nurses are wasted to unsafe, out-dated, manual patient-handling practices.

The value of nurses, who may be used by employers like disposable equipment, appears to be equivalent to the strength of their backs, leading to unnecessary loss of many back-injured nurses who just want to work as nurses.

Anne Hudson is an RN in Coos Bay, Ore.

Posted online with permission from:

Revolution: The Journal for RNs and Patient Advocacy.
For more info, please visit www.revolutionmag.com.

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