A Sample of my Writing

There is so much emphasis on achieving the best outcome for patients, but what about for nurses? Too many nurses end up with broken down bodies after only a few years on the job. In this paper, I review data about the high rate of injury among nurses, likely causes of this issue, and possible solutions to the issue.

High Rate of Injury among Nurses

Nursing is harder on the body than construction work. That is a statement that many would find hard to believe, but it’s true. The Bureau of Labor Statistics reported that “nursing has the highest rate of nonfatal occupational injuries of any profession” (Biggers, 2018). This can be traced to the nature of the job. Nurses spend a long time on their feet, bend over for a lot of the tasks that they are required to do, have to lift patients regularly, and are exposed to a slew of potentially harmful substances such as “drugs, diseases, radiation, accidental needlesticks, and chemicals used for cleaning” (Dressner & Kissinger, 2018). All of these injuries can affect a nurse’s performance, which leads to lower patient satisfaction and errors. Sometimes they can even lead to disability among nurses, which only exacerbates the current issue of nursing shortages. According to a survey of nurses done by GMI Research, 22% of nurses reported that they are “less friendly or engaging with their patients” due to their physical discomfort; 22% also reported having had to “modify or limit their activity/movement on the job” due to injury (Judd, 2014). These statistics prove the serious negative effects that injuries suffered on the job have on nurses, and emphasizes the importance of tackling this issue.

Before looking into how to tackle the issue, one must first delve deeper into the demographics of the issue. Nursing job types, nurse ages, and work environments are varied and numerous. Thus, the types, locations, and severity of injuries are also diverse. It is important to first analyze the relevant data in order to begin to draw conclusions about it. A review of data done by the Bureau of Labor Statistics in 2016 titled “Occupational injuries and illnesses among registered nurses” does just that. In the review, data collected from the Survey of Occupational Injuries and Illnesses is analyzed in order to figure out how the “type and severity of [nurse’s] workplace injuries and illnesses differ by worker age and work environment” (Dressner & Kissinger, 2018). The analysis revealed many connections that are useful in developing measures to decrease the rate of injury among nurses. In terms of workplace environment, the hospital setting was found to be most dangerous. This is backed by the fact that despite only 61% of RNs work in hospitals, “74.1 percent of all nonfatal workplace injuries and illnesses to RNs in 2016 occurred in hospitals” (Dressner & Kissinger, 2018). This has implications of increased training and preventative measures in hospitals. In terms of causes, at 45.6%, overexertion and bodily reaction was found to be the most common cause of nonfatal injuries among nurses. Overexertion includes the long hours standing; excessive lifting, twisting, and bending; and repetitive motions that are commonplace in nursing. The implications of this include allowing nurses more time to sit, the implementation of no-lift policies, and more thorough training of body mechanics to keep nurses safe from injury. The review also found that unlike younger nurses who are most commonly injured due to overexertion, nurses over the age of 65 are most commonly injured due to “falls, slips, and trips” at 53.0% of injuries. This has the implication of possibly limiting an aging nurse’s assignments to ones that require the least amount of mobility of physical exertion.

This data inspires many possible interventions that can be done to decrease the rate of injury among nurses. However, different studies often vouch for differing and sometimes conflicting solutions. For example, there is a lot of conflict about the implementation and effectiveness of no-lift policies in healthcare settings. For example, an article written in the journal of Hospital Employee Health titled “Back injury claims drop with no-lift law” had only good things to say about no-lift policies. On the flip side, an article written in the same journal titled “Why a ‘no-lift’ policy may not be good enough” claims to expose the shortcomings of no-lift policies. The article in support of no-lift policies explained that a state law was implemented in Washington in 2006 that required hospitals to provide better policies and equipment to protect their nurses when handling patients. Most hospitals in Washington state implemented a no-lift policy as a result of this law. Through an analysis done by Washington State Department of Labor and Industries, it was found that “from 2006 to 2010, the lost-time workers compensation claims rates for back injuries related to patient handling declined by about 32% in the state’s 95 hospitals” (“Back injury claims drop with no-lift law,” 2011). In contrast, the analysis revealed that claim rates did not decrease as much at Washington nursing homes, as they were not affected by the law. The decrease in claim rates was a measly 12.9% at nursing homes, which is less than half of the decline in claim rates at hospitals. These statistics seem impressive, but the other article states that “even the best equipment and lift policies will not eliminate work-related musculoskeletal disorders (MSD)” (“Why a ‘no-lift’ policy may not be enough,” 2005). The article suggests that the high rate of MSDs among nurses is closely linked with other factors such as long hours and stress. Long hours are said to increase the risk of back injuries among nurses because of the effect standing has on a person’s intervertebral disks. The longer a person stands, the more dehydrated and prone to injury a person’s disks become. As for the way stress is linked to MSDs among nurses, the author explains how stress can cause the body’s muscles to tense up, which can increase the chance of injury. Another interesting statistic that seems to back up this claim is that in a study evaluating the NIOSH lifting equation, it was found that “If [nurses] were not satisfied at all, they were seven times more likely to have back pain in the past year” (“Why a ‘no-lift’ policy may not be enough,” 2005). Now, despite claims that no-lift policies and lifting equipment are not enough, the author does admit that they are still important measures. This leads to a conclusion that a comprehensive approach must be taken to minimize the risk of injuries among nurses.

Another measure that should be added to the comprehensive approach according to many is the implementation of effective training programs. The current effectiveness of this measure is examined in a study titled “Musculoskeletal Injury Prevention for New Nurses.” In this study, “a descriptive survey design was used to elicit information regarding hospital safety culture, SPHM education and training, and incidence of musculoskeletal injury among new nurses.” (Panprase & Pittiglio, 2016). This survey was sent to 435 new nurses with actual work experience.  The data collected from this survey was analyzed using statistical software, which aggregated the data into sample characteristics using descriptive statistics. This analysis uncovered a shocking lack of proper education given to new nurses about safe patient handling and mobility (SPHM). The study revealed that “hospitals provided some type of SPHM education and training, but 46% of study participants were not informed or aware of national SPHM standards or guidelines” (Panprase & Pittiglio, 2016). This leads one to believe that hospitals aren’t educating new nurses about SPHM and even if they are, they aren’t educating them thoroughly enough. Even more surprising is the fact that only “13.9% of participants stated a written ‘no manual lifting policy’ had been implemented” where they work (Panprase & Pittiglio). As mentioned earlier, no-lift policies are proven to be highly effective in preventing musculoskeletal injuries among nurses. The fact that such a small percentage of new nurses reported having such a policy at their workplace is a sign that not enough is being done to prevent injury. Furthermore, analysis of the data found that only 32.9 % reported having enough staff to carry out SPHM tasks such as the utilization of lift teams, and only 39.4 % of the new nurses indicated that their hospital had the equipment needed for SPHM tasks such as using a Hoyer lift to transfer obese patients in and out of bed. These statistics prove that nurses not only lack the staff required for SPHM; they also lack the equipment required. All of this suggests a need for improved SPHM training and resources in hospitals, in order to decrease the rate of injury among new nurses and increase retention among them at the same time.

More reasonable shifts have been also proven to decrease the rate of injury and health problems among nurses. Long shifts lead to fatigue, and fatigue has been linked to the development of numerous health problems. These problems include a depressed immune system, mood disorders, diabetes, hypertension, obesity, and cardiovascular disease. All of these ailments may not fit the category of injuries, but they are still relevant to the issue because a generally unhealthy person is going to be more prone to injury. Furthermore, fatigue can also lead to injuries because an exhausted person is more likely to slip up, figuratively and literally. This can lead to accidents such as falls, needle sticks, etc. Long hours on the job has been proven to be directly related to the risk of injury as well. In a 2009 study, 13 years of occupational data was examined for the occurrence of injuries. Analysis of the data “revealed the greatest injury risks to healthcare workers occurred when they worked 60 or more hours per week” (Rose, 2015). Something even more shocking that was revealed in another study is that crazy shifts can kill you. Well, maybe not literally. The American Journal of Preventative Medicine found that “nurses working rotating night shifts for five or more years are more likely to die from any cause than nurses who have never worked night shifts” (Rose, 2015). All of this information proves the need for more reasonable shifts in nursing in order to prevent workplace injury, whether it be in the form of more consistent shift timing, shorter duration of shifts, or lower total hours a week worked.

There is an absurdly high rate of injury among nurses, something that shouldn’t be. Some might say that the risks are inherent with the requirements of the job. After all, nurses have to bend over to assess patients, have to lift patients to transfer them in and out of bed, and have to stand for long hours in order to monitor the many patients on the floor. All of this might be true, but there are measures that can be done to minimize the risks taken while doing all of these tasks. For example, a nurse may have to lift patients during their shift. Even though equipment such as Hoyer lifts are available, let’s face it: a nurse will not always have the time to set it up. This is where proper lifting techniques would come in handy. Other measures found to decrease the risk of injury among nurses include the implementation of more reasonable shifts, no-lift policies, early and comprehensive training of safe patient handling and mobility, and more time allowance for sitting during a nurse’s shift. In conclusion, the issue of a high rate of injury among nurses is multifactorial, and thus requires a varied and comprehensive approach to solving it.

References:

Back injury claims drop with no-lift law. (2011). Hospital Employee Health, 30(5), 56–58. Retrieved from https://advance-lexis-com.citytech.ezproxy.cuny.edu/api/document?collection=news&id=urn:contentItem:52W6-R4M1-JBDY-04CX-00000-00&context=1516831.

Biggers, L. (2018, September 7). Nurse Injuries Hurt Patients & Hospitals. Retrieved from https://www.colowrap.com/blog/nurse_injury_hurt_patients_hospitals.

Dressner, M., & Kissinger, S. (2018). Occupational injuries and illnesses among registered nurses. Monthly Labor Review. doi: 10.21916/mlr.2018.27

Judd, M. (2014, August 7). Work-related Injuries and Their Potential Impact on Quality Patient Care. Retrieved from https://www.ergotron.com/ar-ae/resources/resource-details/resourceid/3780.

Penprase, B., & Pittiglio, L. (2016). Musculoskeletal Injury Prevention for New Nurses. Workplace Health & Safety, 64(12), 573–585.

Rose, A. (2015, April 27). Are Long Shifts Hazardous to Your Health – And Patients? Retrieved from https://www.healthecareers.com/article/career/are-long-shifts-hazardous-to-your-health-and-patients.

Why a ‘no-lift’ policy may not be good enough. (2005). Hospital Employee Health, 24(7), 88–90. Retrieved from https://advance-lexis-com.citytech.ezproxy.cuny.edu/api/document?collection=news&id=urn:contentItem:7YJX-GSB0-Y8S7-J0P8-00000-00&context=1516831.