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ANA Handle With Care® Backgrounder

Nursing and Musculoskeletal Disorders

Over the past decade, much attention has been given to the issue of ergonomic hazards as a health and safety concern among health care workers. Professional nursing groups, labor organizations, industry, regulatory agencies, and the scientific community have converged in attempts to arrive at effective solutions to protect health care workers from ergonomic hazards associated with manual patient handling. Despite the recognition that manual patient handling is a high-hazard task, the incidence of musculoskeletal disorders (MSDs) persists at high rates for nurses and other nursing personnel - signaling the need for continued action. Emerging efforts to prevent musculoskeletal injuries have concentrated on reducing exposures through the use of assistive equipment and devices for patient handling.

Patient handling tasks are recognized as the primary cause for MSDs among the nursing workforce. A variety of patient handling tasks exist within the context of nursing care, such as lifting, transferring, and repositioning patients, and, are typically performed manually. Continuous, repeated performance of these activities throughout one's working lifetime results in the development of MSDs. Of primary concern are back injuries and shoulder strains, which can both be severely debilitating for nurses. One study found that 48 percent of nurses experience chronic back pain that they

Compared to other occupations, nursing personnel are among the highest at risk for MSDs. Nursing personnel are consistently ranked among the top occupations with highest rates of MSDs. According to the Bureau of Labor Statistics (2008), nursing aides, orderlies, and attendants reported the highest incidence rate (IR) of MSDs requiring days away from work in 2007.  In 2006, this group also had the highest IR and ranked second in overall musculoskeletal disorders requiring days away from work, with Registered Nurses ranked fifth.

Exacerbating the Growing Nursing Shortage

The extent of MSDs among the U.S. nursing workforce is particularly distressing when considered in the context of the current nursing shortage. Injuries secondary to patient handling tasks compound factors driving the nursing shortage such as aging of the nursing workforce, declining retention and recruitment rates for nurses, and lowering social value of nursing. One study reported that 47% of nurses have considered leaving the profession because of the physical demands of their job, and that number jumped to 59 percent for nurses responds who suffered from job-related chronic pain or injuries (Peter D. Hart Research Associates, Inc., 2006).

Findings of the 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries revealed that 87 percent of respondents stated safety concerns influence their decisions about the type of nursing they do and their continued practice in the field. This result is consistent with ANA’s 2001 Health and Safety Survey and 2007 Study of Injectable Medical Errors, in which responses to this question were 87.9 and 90% respectively.


Research evaluating the cost-effectiveness of lifts and other safe patient handling equipment demonstrates  investment in these devices, as part of a comprehensive safe patient handling programs, saves facilities direct and indirect costs related to MSDs. One study demonstrated that safe resident lifting programs in long term care reduced resident-handling workers’ compensation injury rates by 61%, lost workday injury rates by 66%, restricted workdays by 38%, and the number of workers suffering from repeated injuries (Collins, Wolf, Bell, &, Evanoff, 2004).

In 2007, the Centers for Disease Control and Prevention (CDC) released the results of a six-year field study of a safe patient lifting program which revealed the investment in equipment and training was recouped in less than three years in lower worker compensation claims.

Researchers from the Agency for Healthcare Research and Quality (2007) studied the effectiveness of safe patient lifting programs in 23 units of the Veteran’s Integrated Service Network 8. This 18 month observational study revealed that all of the direct and indirect costs associated with the safe lifting program were recouped in 4.3 years through significant reductions in workers compensation payments and by avoiding the costs associated with caregiver absenteeism.

Federal Legislation/Regulation

In response to persistent outcry from labor organizations and advocates coupled with recognition of mounting scientific evidence, the U.S. Department of Labor - Occupational Safety and Health Administration (OSHA) promulgated a standard intended to protect workers from ergonomic hazards, such as patient handling. In March 2001, Congress repealed the OSHA standard and ordered that the agency cease all work related to the standard.

The U.S. Department of Labor convened a work group called the National Advisory Committee on Ergonomics (NACE) in January 2003. The committee is charged with advising the Secretary of Labor and the Assistant Secretary for OSHA on ergonomic guidelines, research, outreach, and assistance over the next two years.

In March 2003, Federal OSHA released its "Guidelines for Nursing Homes - Ergonomics for the Prevention of Musculoskeletal Disorders." In these "Guidelines," OSHA explicitly recommends that "manual lifting of patients be minimized in all cases and eliminated when feasible." While only a guideline (and not a regulation), this statement still reflects the recognition that manual patient handling is an extremely high-risk job task.

More recently in 2009, a bill and a resolution were introduced in the United States House of Representatives. ANA strongly supports both H.R. 2381 / S. 1788: The Nurse and Health Care Worker Protection Act of 2009 and H.Res. 510: Recognizing the need for safe patient handling and movement and directing the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct care registered nurses, and all other helath care workers by establishing a safe patient handling and injury prevention standard and for other purposes.

State Legislation

Prompted by ANA's Handle With Care Campaign which began in 2003, nine states have enacted "safe patient handling" legislation: Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. Illinois awaits the Governor's signature.

ANA’s State Government Affairs programs monitors trends in Safe Patient Handling and Movement as part of its Nationwide State Legislative Agenda. Reports.

ANA's Advocacy on Ergonomics

On June 22, 2003, the ANA Board of Directors approved a position statement presented by the ANA Congress on Nursing Practice and Economics titled, "The Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders." This position statement was crafted with the intent to deliver a message to the larger nursing and health care communities, be the cornerstone upon which to structure a multi-faceted ANA health and safety campaign focused on the prevention of musculoskeletal disorders, and position ANA as a leading voice to advance current ergonomic prevention efforts.

ANA has also partnered with Audrey Nelson, PhD, RN, FAAN, Director of the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Florida (www.visn8.med.va.gov/patientsafetycenter). Dr. Nelson is a nurse researcher leading the way to developing and incorporating evidence-based interventions that reduce the risk for occupational injury secondary to patient handling through the use of technology and equipment.

ANA partnered with the Association of perioperative Registered Nurses (AORN), the National Institute for Occupational Safety, the Tampa Veterans Affairs Tampa Patient Safety Center of Inquiry to develop a guidance document with ergonomic tools for use in the perioperative setting.

ANA worked on a task force with representative from the National Association of Orthopaedic Nurses (NAON) the National Institute for Occupational Safety and the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center to develop a guidance statement on safe patient handling and movement in the orthopaedic setting.

ANA continues to co-sponsor the Safe Patient Handling Conference with the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center and the University of South Florida and others,  The next conference is scheduled for March 31st to April 1st  2010, in Lake Buena Vista, Florida.

School Curriculum Project

ANA received funding in 2004 from NIOSH to launch the Safe Patient Handling and Movement Nursing School Curriculum pilot project. ANA partnered with the National Institute for Occupational Safety and Health (NIOSH) and the Tampa Veterans Administration Patient Safety Center of Inquiry to develop the curriculum and introduce safe patient handling and movement concepts in to the curriculum of nursing schools. Twenty-six schools of nursing served as test sites and three served as control sites. Invitations were extended to faculty at the participating schools of nursing to attend the 5th Safe Patient Handling and Movement Conference (2005) as part of preparation to implement the curriculum module developed for the project. A focused post- conference session prepared the nursing school faculty to implement the curriculum. The project included partnering with seven safe patient handling equipment manufacturers who loaned equipment to the schools for use during the project. The project was completed in August 2007.  The curriculum modules developed are available in a toolkit.

The American Nurses Association was proud to be one of two recipients selected to receive the 2008 National Occupational Research Agenda (NORA) Partnering Award for the Safe Patient Handling and Movement Training Program for Schools of Nursing project.  The project had received the Award of Excellence for Public Health Training for the Safe Patient Handling and Movement Training Program for Schools of Nursing from the Centers for Disease Control and Prevention in 2007.

Additional ional Information

For more information about ANA's efforts related to ergonomics, work-related musculoskeletal disorders, and safe patient handling, visit the Handle with Care Web site  or contact Nancy Hughes, MS, RN, Director, Center for Occupational & Environmental Health, 301-628-5021, or via email at nancy.hughes@ana.org.