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About me
 Started as housekeeper in a nursing home
 Progressed from CNA, LPN, RN, BSN, MSN, CNE
 Restorative Nurse, Staff Development, ADON
 Graduate work in nursing education with focused
projects and thesis on back injuries in healthcare
workers
 Currently direct a Nurse Aide Program, teach in a BSN
program, staff education consultant, small business
owner
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My Interest
 Specifically interested in back injuries because of
family history
 Responsible for staff and student training in body
mechanics
 Professional curiosity about nurse aide back injuries
as an understudied population sparked graduate
school research
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Purpose
 Discuss current research into occupational
injuries in nursing and graduate research
 Strategies for injury prevention including staff
and student education
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Statistics
 Nurse aides, orderlies and attendants are the 2nd highest occupation
for MSD’s and RN’s are 5th (Dept of Labor 2006)
 Rising rates of overweight and obese pts. are compounding problem.
In 2007–2008, about one-third of adults were obese and about
two-thirds were overweight or obese (CDC 2010)
 CNAs may be at greater risk for injury than RNs (Li, Wolf, & Evanoff,
2004)
 Nature of their work
 Lack of empowerment
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American Nurse Association Statistics
 ANA estimates 12% of nurses leave annually r/t back
injuries
 Nurses use 30% more sick leave annually due to back
pain when compared to the general workforce
 Over 52% of nurses complain of chronic back pain and
38% of the nursing workforce has been affected by
back injuries
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My Research
 Survey sent out to nurse aides in Colorado
 Gathered information on
-Demographics
-Employment
-Dichotomous and Likert style questions about
injuries, training, equipment and facilities
-Open ended question asking what CNA
perceived as the hardest part of their job
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Findings
 46% reported having hurt selves while lifting, moving, or
helping a patient
 40% reported having hurt back while lifting, moving, or
helping a patient
 78% of those reporting back injuries were working in nursing
home at time of injury
 CNA workplace training: M=3.23
 CNA school training: M=3.69
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Findings (cont.)
 Training on back injury prevention received at work and
school but not applied
 Meaningful proportion (43%) noted that hardest aspect of
their jobs were….
 Having too many patients and/or not enough help
 Poor communication
 Being “looked down on” by nurses, having poor relationships
with nurses with whom they worked
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Implications
 Work-related injury, especially back injury, is an important
issue in work life of CNAs
 Culture change needed; easier to “put up”
than get help or complete necessary paper work
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Implications (cont.)
 Staffing implications
 Owning own role in less than ideal CNA-Nurse working
relationships
 On-going prevention education needed
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Contributing factors to MSD
 Quick movements, repetitive movements
 Combative patients
 Long work hours and overtime
 Work schedules
 Staffing shortages
 Heavy lifting, bending and twisting
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Evidence-Based Interventions and
Challenges
 Patient handling equipment
 No-lift Policies
 Training on proper use of equipment and
devices
 Lift teams
 Ongoing education
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Patient Handling Equipment
 Hi/Low beds, mobile lifts, ceiling mounted lifts, lateral
transfer aides
 Challenges
 Cost
 Staff training
 Time
 Equipment selection for each patient
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No-Lift Policies
 Use of equipment to move patients to reduce manual
lifting
 Challenges
 Putting equipment in place before policy is implemented
 Time
 Staff buy in (Nonpunitive approach)
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Training with Equipment
 Ongoing training in the use of equipment and devices
 Challenges
 Training staff across shifts, staff turnover
 Reinforce training
 Training on equipment only used sporadically
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Lift Teams
 “Two physically fit people, competent in safe lifting
techniques, working together to accomplish high-risk
patient transfers.”
 Challenges
 Logistics of providing a team 24/7
 Cost
 Managing workload
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Ongoing Education
 Annual body mechanics reviews
 Challenges
 Education alone has proven ineffective for MSD safety
 Qualified instruction and return demonstration is key (ideal
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to spot check workers on the job)
Consistent training for new employees and f/u within first
90 days
Training to specific patient needs is difficult
Modeling behavior by peers
Cost
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Emerging Interventions and
Challenges
After-action reviews
Clinical tools
Peer leaders
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After-Action Reviews
 Ways for health care providers to learn from their
own mistakes as well as mistakes of others
 Challenges
 Support and timely response by management
 Time constraints
 Staff fear and embarrassment
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Clinical Tools
 Patient assessment tools to standardize ways to assess
patients and decide on appropriate lifting and care
techniques
 Challenges
 Staff training (turnover, reinforced over time)
 Integration into routine processes (admissions, COC)
 Communication between staff
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Peer Leaders
 Specially trained staff who works on-site with staff to
make practice changes and improve safety
 Challenges
 Incentives
 Support and timely response by management
 Choosing appropriate peer leaders
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Helpful Work Practices
 Assess patient and yourself
 Eliminate or reduce manual lifting when possible
 Get help and ask patients to help
 Mentally plan
 Good working height
 Check equipment
 Proper body mechanics
 Use your legs, keep patient close
 Do not twist when turning (pick up or pivot feet)
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Make Education Count!
 Modeling behaviors
 Ongoing training and assessment
 Return demonstrations (with real
patients)
 Positive reinforcement system
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Help!
 Facebook- Injured Nurses Network of America
 Nurse and Health Care Worker Protection Act of 2009
(S.1788)
 Full text
http://www.govtrack.us/congress/billtext.xpd?bill=s1111788
 ANA- http://www.anasafepatienthandling.org/
 Work Injured Nurses Group (WING)
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S. 1788 Summary

Nurse and Health Care Worker Protection Act of 2009 - Requires the Secretary of Labor to propose a
standard on safe patient handling and injury prevention to prevent musculoskeletal disorders for directcare registered nurses and all other health care workers that requires the use of engineering controls to lift
patients and the elimination of manual lifting of patients through the use of mechanical devices, except
where patient care may be compromised. Requires health care employers to: (1) develop and implement a
safe patient handling and injury prevention plan; (2) provide their workers with training on safe patient
handling and injury prevention; and (3) post a uniform notice that explains the standard and the
procedures to report patient handling-related injuries. Requires the Secretary to conduct unscheduled
inspections to ensure compliance with safety standards. Allows health care workers to: (1) refuse to accept
an assignment in a health care facility that violates safety standards or for which such worker has not
received required training; and (2) file complaints against employers who violate this Act. Prohibits
employers from taking adverse actions against any health care worker who in good faith reports a violation,
participates in an investigation or proceeding, or discusses violations. Authorizes health care workers who
have been discharged, discriminated, or retaliated against in violation of this Act to bring legal action for
reinstatement, reimbursement of lost compensation, attorneys' fees, court costs, and other damages.
Requires the Secretary of Health and Human Services (HHS) to establish a grant program for purchasing
safe patient handling and injury prevention equipment for health care facilities.
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Success Stories
 San Francisco General Hospital- Lift teams and equip
 Camden Nursing Home (Maine)- Lifts
 Kennebec LTC (Maine)- Lifts, assessment tools, gaitbelts,
comprehensive training, safety rewards
 Six LTC facility cohort study
 6 facilities, 1728 participants, 6 year pre-post intervention
 Equipment, zero lift, training (45 minutes-2 staff, return demo on
residents)
 73% reduction in workers’ comp claims
 Equipment and training expenses recovered in less than 3 years
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Personal and Professional
Interventions
 Presentation of research findings at nursing conferences,
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webinars
Discussion of findings with students, peers, colleagues, friends
and family
Student training, modeling, and reinforcing behaviors
Assist with local facilities -annual training, return demos
Formation of Occupational Training Solutions (OTS) to produce
a product that could be used to prepare and retrain safe and
competent caregivers
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Basic Nursing Training
Supplements
Product Development
 Basic Care Skills for Nurses and Nursing Assistants
 More than 50 skills are covered on 5 DVD’s in this OTS Basic Nursing video series.
Demonstrating basic nursing care from real nurses on real people
 Videos are divided into easy to follow modules. Additional learning resources and assessment
tools are included in our package.
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Each skills video includes:
Clear and concise skills demonstrations
Modeling of compassionate interactions between caregivers and patients
Bonus instructional features with tips on “Things to Remember” and “Things to Report” when
caring for patients
 Safe and competent care tips throughout each video
 Proper lifting and back safety techniques modeled throughout. Module of 8
different transfer techniques included
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Thank you!
Questions? Email me!
Patricia Graham
patricia@otsinfo.com
Product Information at
www.basicnursetraining.com
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