Taking Action
Advocating for Nurses Injured in the Workplace
Anne Hudson
“If you ever think you’re too small to be effective, you’ve never been in bed with a mosquito!”
—Wendy Lesko
When I was a nursing student, I learned to lift and move patients with techniques such as the under-axilla “drag lift,” “bear hug,” “pivot transfer,” two-person “cradle lift,” two-person “arm and leg lug,” and others. I later learned that these techniques could be dangerous to the person performing them and were not approved for use in the United Kingdom.
One of my instructors warned about cumulative trauma back injury from lifting patients. She said, “Be careful with your back. Your job depends on your back.” I dismissed this as impossible. Surely nurses would not lose their jobs because they were injured at work. I was unaware of the scope of back injuries in nurses or that manual lifting had been described as “deplorable … inefficient, dangerous to the nurses, and often painful and brutal to the patient” (Owen, 1999, p. 15). Patients can suffer pain, bruising, skin tears, abrasions, tube dislodgement, dislocations, fractures, and being dropped during attempts at manual lifting.
As an RN on medical/surgical, telemetry, and intermediate care units, I kept my patients pulled up in bed, turned frequently, and well-positioned, as well as lifting them to assist them to their walker, chair, and commode. In 2000, I suffered herniated lumbar discs and “cumulative trauma degenerative disc disease” from lifting patients. After spinal fusion surgery for placement of cadaver bone grafts and hardware, I had permanent lifting restrictions. I had to get an attorney and fight two court battles to prove that my spinal injury was from lifting patients in order to receive workers’ compensation. I could not return to my position with lifting patients and was not selected for other nursing positions that did not require lifting. As a result, I was terminated. I became aware what happened to me was part of a larger problem, and I began educating myself. I was troubled by what I found. Though patient-lift equipment used by “lift teams” or nurses had proven since 1991 to prevent injury, nurses were still suffering severe injuries from performing manual patient lifting (Charney et al., 1991). I couldn’t find any efforts to develop “safe patient handling” legislation.
My online research revealed nothing about “back-injured nurses.” I contacted nursing schools, my state nursing association, and college and public librarians; still I found nothing. I contacted the American Nurses Association and learned that the preferred search term for the problem I was exploring was patient handling. Using this term, I found that 38% of nurses require time away from work during their career because of back injuries, and 12% leave nursing permanently due to back injuries, and that the Bureau of Labor Statistics (BLS) continually ranks nurses in the top 10 for work-related musculoskeletal disorders (MSDs) and reports that in 2007 nursing aides, orderlies, and attendants suffered the highest rate of MSDs, a rate of 252 cases per 10,000 workers, which is more than 7 times the national MSD average for all occupations (BLS, 2008).
I learned about cumulative trauma microfractures from lifting hazardous weights and about spinal injury to nurses from lifting patients. Because there are no pain receptors in the disc nucleus and vertebral endplates where microfractures typically begin, damage can occur over time without pain. Extensive damage may have already resulted in degenerative disc disease before severe pain announces extension of the injury from the center to nerves in the outer ring of the disc. By then, a career-ending or career-changing injury may have already occurred.
Becoming a Voice for Back-Injured Nurses
I discovered that the hospital had a “Back Injury Prevention Task Force” and requested to speak with the group. I presented research on safe lifting limits (35 pounds maximum for patient handling), spinal injury from patient lifting, preventing injuries with lift equipment, and how hospitals can save money through injury prevention techniques (Waters, 2007). I didn’t receive an enthusiastic response. The group indicated that they were aware of what could be done to prevent injuries but had not tried to introduce workplace policies in the organization to prevent nurses from being injured.
My speaking out about preventing back injury began during a chance encounter with a patient lift equipment vendor who introduced me to William Charney, pioneer of “lift teams” and “no lift” policies. In 2001, Mr. Charney asked me to speak at a workshop in Portland, Oregon, on preventing back injuries with safe patient handling. I was glad to have the opportunity to discuss how nurses can be disabled by preventable injuries, issues related to loss of health insurance, and problems with employability.
Next, I spoke at the 3rd annual “Safe Patient Handling and Movement” Conference in Clearwater, Florida. By networking with new contacts, I went on to speak around the country at health and safety conferences, meetings of nursing organizations, hospitals, schools of nursing, workers’ compensation training programs, and others. In 2005, I keynoted a conference for the Australian Nursing Federation (ANF) Victorian Branch “No Lifting Expo,” the ANF Industrial Relations Organizers, and for the Injured Nurses Support Group (INSG).
In 2002, I published my first article about back injury issues in nursing. It was titled “Oh! My Aching Back!” In 2003, William Charney and I collaborated to co-edit a book titled Back Injury Among Healthcare Workers: Causes, Solutions, and Impacts, which was about the epidemic of back injuries caused by dangerous manual patient-lifting practices. We addressed preventive technology and made a case for eliminating manual patient lifting. We included personal stories of back-injured nurses, revealing the lasting, devastating impacts of severe injury caused by physically lifting patients. Mr. Charney and I were the first voices in America since 2001 calling for state and national “safe patient handling-no manual lift” legislation. I contacted my local television station to increase public awareness of injuries caused by patient lifting. As a guest on a television news program, I had the opportunity to raise awareness about the problem. I continued to write about the problem, collaborated on peer-reviewed articles, and was invited to serve on the editorial board of the Journal of Long-Term Effects of Medical Implants. In 2007, my local newspaper published a full-page feature article about my efforts to address nurse injury from lifting patients. Despite all of these efforts to educate and raise awareness, action was still needed to address the problem.
Establishing the Work Injured Nurses Group USA (Wing USA)
I discovered that “no lifting” policies had been in place for years in the United Kingdom, Australia, and other countries, and that some nursing organizations provided support services for injured and ill nurses. There appeared to be no such assistance, information, or support in place for back-injured nurses in the United States. I contacted nurses who were involved in back injury protection efforts in other countries. My first international contacts were Maria Bryson, Royal College of Nursing Work Injured Nurses Group (RCN WING) Steward and Safety Representative in the UK, and Elizabeth Langford, Australian Nursing Federation (ANF) Victorian Branch, and Coordinator of Injured Nurses Support Group (INSG) in Melbourne. Inspired by my new friends who taught me about the services provided to injured nurses by RCN WING, and by ANF and INSG, I set out to work to develop similar services for U.S. nurses.
With the help of friends Teri Jennings and Marian Edmonds, we launched a website called “B.I.N. There—Back Injured Nurses,” thus putting the phrase “back-injured nurses” into online search engines. In 2002, the name was changed to Work Injured Nurses’ Group USA (WING USA), and the website became www.wingusa.org. WING USA provides information about back injury in health care from manual patient lifting and serves as a meeting place for injured nurses from around the country. It is facilitated by a new effort for leaders in each state to provide injured nurses with a contact in their area for mutual support and encouragement, and for sharing experiences and information. Fifteen state leaders are currently active, and our goal is to identify one in each state. State leaders may also be involved in a variety of activities including group meetings, writing for publication, media outreach, speaking events, and political involvement for safe patient handling/no manual lift legislation. We hope that national nurse organizations will initiate broad programs to help injured nurses, particularly advocacy programs to help work-injured nurses remain employed.
Over 600 people receive WING USA’s e-mail updates on legislation for safe patient handling. Recent legislative news posted at WING USA’s website concerns the Coalition for Healthcare Worker and Patient Safety (CHAPS) visit to Capitol Hill to meet with U.S. Representatives and their staff in support of H.R. 2381, the Nurse and Health Care Worker Protection Act of 2009.
Legislative Efforts to Advance Safe Patient Handling
Since 2001, I have worked to advance legislation for “safe patient handling–no manual lift.” This included working with labor unions, meeting with other back-injured nurses, meeting with legislators, and speaking out about the need for legislative efforts. I met with my U.S. Representative, Peter DeFazio (D-OR) (Figure 57-1) and his staff both in the district and in Washington. Congressman DeFazio became co-sponsor of H.R. 2381, the Nurse and Health Care Worker Protection Act of 2009. The legislation would mandate use of mechanical lift equipment for patients and residents nationally. A companion bill, S.B. 1788, was introduced in the Senate. At the time of this writing, both bills are in their respective committees.
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