Maryland Association of Nursing Students

It’s 0700 and you are writing down your assignment for the shift; everyone is bustling around from room to room, call lights are lit up like Christmas trees, and the occasional bed or chair alarm sounds for the patients who forget to call for assistance before they get up to go to the bathroom. Somehow, during the short ‘lull’ in activity on the floor, the night nurse has time to give you report on the full assignment she is passing off to you. After you go from room to room with the night nurse to do your bedside shift report, you realize that you not only have a full assignment, but most of your patients are heavy assist to turn in bed or get from bed to chair. The day continues to be extremely busy, and you have a bariatric patient that is on Lasix that has saturated the bed. You have called the nurses on either side of the hall several times and each time they have told you they’re ‘too busy’ to help you get this patient cleaned up and perform an occupied bed change. You are running behind schedule and figure that you’re young and healthy, so getting this patient cleaned up can’t be too hard of an individual task, right? As you’re half way in, you give one hard tug on the shear sheet to get them repositioned better so you can slide the old linens underneath them and start to put the new linens on the other half of the bed. Mid-heave you hear a “POP” in your lower back, and quickly let the patient down. You step back and double over, clutching your injury. You take a deep breath and try to return to your task, but that nagging pain in your lower back is just too intense to allow you to generate enough strength to turn this patient again. You finally get the charge nurse to help you finish up, and then you move on to the next task. Hours later it is finally 1900 and the nightshift starts to file in; as you give your handoff to the night nurse, that same back pain is in full force. She notices your discomfort, asks you if you’re okay and proceeds to tell you to follow up with employee health as soon as possible. You downplay your injury and tell her it’s no big deal because you have a few days off and figure that your back will heal and you’ll be good as new for your next shift.

Unfortunately, the above scenario is all too common. The problem with this response to back injury is that it often does not heal itself; each time you injure your back it needs adequate time to heal properly. The recommended time of recess from activities that aggravate the injury and the follow up treatment is something that, unfortunately, is not conducive to the average nurse’s work schedule. This is when we enter that dreadful cycle of re-injuring our back, aggravating that injury repeatedly, and giving rise to a back problem that becomes chronic and negatively affects your quality of life. According to the ANA, nursing personnel are among the highest at risk for musculoskeletal disorders compared to other occupations (ANA, 2000). Among these general musculoskeletal disorders, lower back pain actually tops the list. But the consequences that result from back injuries don’t just stop at acute or chronic pain it causes the injured individual. The incidence of hospital workers missing time from work due back pain result in 90.1 days per 10,000 full time workers (ANA, 2000). Chronic musculoskeletal injuries also cause nurses’ early retirement, change in career, change in unit/position, and accidents at work due to chronic injury flare-ups that limit or impair the level of patient care given. Fifty-two percent of currently employed nurses complain of chronic back pain, 12% nurses permanently leave their place of employment due to back pain as a contributing factor, 20% of nurses have transferred to a different unit, a different position, or completely leave the profession due to back pain. Relatedly, 38% nurses suffered severe occupational-related back pain that actually required them to leave work and 25% nurses have changed jobs due to other occupational related injuries [6%-neck, 8%-shoulder, 11%-(non-lower) back] (Handle with Care Fact Sheet, 2017).

It is important to understand that although we can work hard to significantly decrease the number of back injuries in the workplace, it is impossible to fully eliminate them. We must take the proper steps to protect our backs and preserve our physical health for many years to come. Here are a few things to keep in mind when providing patient care, transferring, or turning a patient in order to do so safely, that I learned in Anne Arundel Medical Center’s Safe Lifting Class during New Employee Orientation:

• Always use the proper equipment [safely] when transferring or turning a patient; there are mechanical lifts and specialized bed features that are in place to lessen or eliminate the physical stress off of both you and the patient.

• Always recruit another co-worker (tech, CNA, GNA, nurse, PT/OT, PT/OT-Aid) when needed- no matter how easy you may think the task is. Be firm when you ask for help or ask if the individual can meet you at a convenient time to assist with the task, your assertive approach will save your back for many years to come.

• When assessing the amount of assistance needed “underestimate” your strength; don’t try to transfer/ambulate patients alone if you will bear more than 25% of the weight.

• Use correct posture when lifting a patient; bend your knees, don’t twist at the waist, don’t make sudden, jerking movements.

• Set things up prior to the transfer or task so everything is close, within reach, and ready.

• Listen to your body; if you have an existing injury or limitation take that into consideration before performing a task that may exacerbate it.

As mentioned before, sometimes you can do everything correct and somehow still injure your back. If you do sustain injury, never down play it regardless of the circumstances! Go directly to Employee Health, the ER, or an urgent care center. This also must be reported to the Charge Nurse and filed with your place of employment so it is documented. If you sustain your injury during clinical, immediately alert your clinical instructor, follow their directions, and take the necessary follow up steps as written in your school’s clinical handbook. Sometimes injuries worsen throughout the day or night and become debilitating and you need further care or extended time off work or clinical, having this case documented with your facility means you will not be alone in taking care of this injury sustained at the workplace. Make sure the incidence is documented and follow up with your instructor and clinical liaisons to avoid any repercussions for absence or to receive an alternative assignment if needed. Follow the healthcare provider’s instructions after your visit; it’s better to get imaging done (if needed), do therapy, and take a few weeks off to fully recover, than to re-injure yourself if you return too soon. You could end up taking a few months off and gaining a chronic injury that will affect your job forever if you are non-compliant. Finally, think of your patients! Your level of care you provide for them and their comfort is directly affected by your decisions and your health. If you know you have a chronic injury or limitation, don’t wait until you drop someone or cause them harm “because your back gave out” to address the problem; be realistic and make safe decisions. Use assistance whenever necessary to lessen the stress you’ll be putting on them and to make things go smoothly and gentler (such as turning or pulling someone up in bed).

Overall, the best way to combat this situation is to protect your back in order to prevent injury; practice safe lifting and always use help when necessary. As we have been continuously reminded at least once in every nursing class: the best first-line weapon against illness or injury is prevention. Respect your back, you need it!

 

 

 

 

References:

 

Handle with care fact sheet. (2017). American Nurses Association. Retrieved September 9, 2017. Retrieved from American Nurses Association website. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/Factsheets-and- Toolkits/FactSheet.html

Maryland Nurses Association:

http://www.marylandrn.org/

June, K.J., Cho, S.H. (July 28, 2010). Low back pain and work-related factors among nurses in intensive care units. Journal of Clinical Nursing, Volume (20), Pages 479-487. doi: 10.1111/j.1365- 2702.2010.03210.x. Accessed September 9, 2017.

Yassi, A., Lockhart, K. (December 3, 2013). Work-relatedness of low back pain in nursing personnel: A systematic review. International Journal of Occupational and International Health, Volume (19), Pages 233-244. doi: 10.1179/2049396713Y.0000000027. Accessed September 9, 2017.