Taking a Toll: Back Pain Sidelines Nurses Every Day

Debilitating injuries could be prevented

[Editor’s note:  Every day, 150 healthcare workers suffer musculoskeletal disorders (MSDs) that cause them to lose time from work.  Countless more end their shifts with aching backs, shoulders, or necks.  In hospitals, overexertion in lifting is the most common cause of lost workday injuries.  Here are the stories of two nurses who suffered debilitating injuries – and the steps they say could be taken to prevent others from a similar fate.]

Anne Hudson of Coos Bay, OR, was walking across her kitchen when she suddenly felt a surge of incapacitating pain.  She barely could move.  Ten years of lilting patients without mechanical aids had led to cumulative trauma injury to two lumbar discs.

As she stood immobilized in her kitchen, Hudson didn’t know about the condition of her back.  She kept thinking the pain would go away and she would be able to return to work on her weekend shift that Saturday.

Her most immediate concern was finding temporary relief from pain.  “I could just creep around,” says Hudson, who is now 54. “I couldn’t sit; I couldn’t lie down; I couldn’t get in a car to go to the doctor.

“I didn’t recognize my pain as severe muscle spasms in response to spinal injury.  All I knew was that I had pain like I had never experienced before.  A deep severe ache and intense burning settled into my lower back, and I had pain and burning into my lower legs and sometimes into my feet.”

The pain lessened at times, enabling Hudson to at least lie down and rest.  But she was in no condition to return to the hospital that Saturday, where she worked as a floor nurse in the medical/surgical, telemetry, and intermediate care units.

Hospital nursing career was over

Hudson began her conservative back therapy with the same mantra in her head:  “This will pass, and I will be better.”  She couldn’t imagine life without nursing, without caring for patients.

But her career as a floor nurse already was over.

While Hudson visited physical therapists, orthopedic doctors, and neurologists, and tried anti-inflammatories, heat and cold treatments, and pain medications, she faced a struggle over workers’ compensation.  At first, she was allowed to work in limited-duty jobs that used her nursing skills.  That avenue shut down when workers’ compensation denied her claim. 

Hudson convinced one of her physicians to give her a work release, as long as she wore a back brace.  That lasted three weeks--until she helped care for and reposition a 400-pound patient.  She realized she could no longer handle the lifting and transfer tasks.

A workers’ compensation judge and the workers’ compensation board ruled that Hudson’s injury was work-related.  The hospital continued to appeal.  Meanwhile, Hudson was allowed only two 90-day periods of light duty.  There were no permanent accommodations for a floor nurse who could lift no more than 20 pounds.

Today, Hudson works for the county health department, a job she enjoys but one that pays significantly less.  Workers’ compensation payments, which brought her income up to two-thirds of her wage at injury, stopped at claim closure.  Still, Hudson is very grateful to be working as a public health nurse.  “Many back-injured nurses never work as nurses again.  Either they are too severely injured to work or they are unable to find an employer willing to accept an injured nurse.”

A chiropractor helped ease her pain, and a neurosurgeon fused two of the discs, giving her relief from some of the most intense pain.  But not a day goes by without a deep aching in her back.

Hudson can no longer work in the garden.  Doing laundry or grocery shopping brings pangs of pain.  She rarely enjoys a night of sound sleep.

But for Hudson, there is another pain that is not physical.  She has become an unwitting expert on the ergonomic hazards of manual patient handling and MSDs among nurses, and she now knows that a zero-lift policy and proper lifting equipment could have saved her career and her back.  She also stresses it is unethical for hospitals to deny permanent light duty to injured nurses after not providing safe patient lift equipment and policies to protect them from lifting injuries.

Hudson formed WING USA (Work Injured Nurses’ Group USA), an advocacy organization patterned after similar organizations in the United Kingdom and Australia. Hudson also has co-edited a book with health and safety expert William Charney, which includes the personal stories of injured nurses as well as technical information on ergonomics and safe patient handling.  (For more information, see editor’s not following.)

“Injured nurses retain all their clinical knowledge and skills.  Many times, the only thing they can’t do is heavy lifting.  But they’re still not welcomed back to work by many hospitals,” she says.  “Through activities with WING USA, I hope to bring injured nurses together and let them know they are not alone.”

Hudson also is working on state initiatives for Zero Manual lift for Healthcare legislation and promotes industry-specific ergonomic solutions that could spare other nurses from a similar fate.  “Their careers, their finances, their lives are being impacted by a preventable injury,” she says. “It’s devastating.”

Maggie Flanagan, a 46-year-old registered nurse, cared for tiny neonates in Anchorage, AL. 

So how could she have work-related MSDs?  There was no problem with patient lifting. Flanagan’s injury stemmed from constant reaching and twisting in the cramped neonatal unit, where she was silencing the incessant alarms that sounded on monitors positioned above shoulder level.

After months and years of that daily action, Flanagan didn’t realize how vulnerable she was to the effects of cumulative trauma.  “I would have some soreness on my days off, but it would go away,’ she says.  “Eventually, it didn’t go away.  That to me is one of the most serious problems with the injuries. You think it’s going to go away, but all of the sudden it doesn’t.  It can have subtle onset.”

Actually, Flanagan can pinpoint the action that turned her aches into debilitating pain. One day, her charge nurse needed to move a monitor.  She had called for help, but no one was available.  The alternative to moving the monitor involved moving a neonate who was barely clinging to life, and Flanagan agreed that was too risky.  She offered to help move the monitor.

“I had seen men move it by themselves,” she says.  Surely, the two of us could do it safely.  Never in a million years did I think I would be injured from that.”

The monitor weighed about 75 pounds.  It was positioned on a recessed shelf above shoulder level.  The movement mimicked the same one she had done for hours on end.

“I realized I moved the monitor in the exact same movement as the reaches,” Flanagan says.  “It was the same exact height.  It was the same distance.  I did it this time forcefully with incredible weight.  That was my weakest point.”

Half an hour later, she began to feel muscle spasms.  She continued to work, monitoring a critically ill neonate who had just come out of emergency surgery.  She needed to constantly twist to watch the infant and monitor skin temperature.

By the time Flanagan got home, she couldn’t reach for a milk carton in the refrigerator or hold her 3-year-old.

She returned to work the next weekend, but it became too painful.  “Every shift becomes the down payment for the injury.  I made the final down payment on my injury.”

Flanagan says she was lucky.  After eight months of medical rehabilitation, without surgery, she has returned to work.  (She moved from Alaska and now lives near Tacoma, WA.)  While she has no medical restrictions, she works eight-hour shifts by choice and vows to be careful.

She also has noticed that the design of neonatal units hasn’t improved.  When possible, she uses remote control devices or pulls small monitors or keypads to a better position. But the unit still is rife with twists and reaches.

“I’ve worked in five different hospitals.  Most of the NICU [neonatal intensive care unit] monitors are above our shoulders.  I think that’s a pretty common situation,” Flanagan explains.

“We have not increased our patient space, but we have increased the machines that need to be in the space,” she adds.  “It’s a cluster around the beds.  The nurse can’t see them all; the nurse can’t reach them all.  Our technology has exceeded the space we give our patients.”

Flanagan is a member of her hospital’s safety committee.  She also is working with the American Nurses Association to promote ergonomics legislation that would protect health care workers. 

“We see where the problem is; we know how to fix it; and we’re going to be after that fix,” adds Flanagan.

[Editor’s note:  Back Injury Among Healthcare Workers: Causes, Solutions, and Impacts, edited by William Charney and Anne Hudson, is available from CRC Press (Catalog No. L1631, $79.95).  Phone: (800) 272-7737, Web: www.crcpress.com.]

Hospital Employee Health. February 2004.  Vol. 23, No. 2.  Pages 14-16.