Protecting the RN’s Back

June 19th, 2012


By , BSN, RN

”There was no precipitating event.” That is my new favorite phrase; my physician used it when she described my now, merely, aching, back. And, she was right. Nothing dramatic or traumatic happened the day my back decided to stop working properly and cause me pain. It just had a spasm, made me sit down, and has been hanging on to the pain ever since.

As we discussed my lifestyle and my work my doctors seemed to understand exactly what was happening even if I didn’t. I mean, I expected to throw it out lifting a heavy patient or even one of those freak moments you hear about when someone bends over to pick up a piece of paper and they can’t straighten back up. But no, “there was no precipitating event.”

As she explained it to me, it was routine wear and tear found most often in nurses and nurse’s aides. A little overuse, a little aging, repetitive events and the next thing you know you have back problems. She didn’t even do an x-ray or an MRI. She was so confident of her diagnosis (after a thorough exam) that she said for me to take my anti-inflammatories, go to physical therapy, and try to lose a little weight and I should be fine.

Cumulative Trauma Disorder

What is going on with me — and happens to thousands of other people (nurses just happen to lead the list) — is called cumulative trauma disorders (CTDs). Cumulative trauma disorders are injuries of the musculoskeletal and nervous systems that may be caused by routine tasks and exertions Cumulative trauma disorders are also called regional musculoskeletal disorders, repetitive motion disorders (RMDs), overuse syndromes, repetitive motion injuries, or repetitive strain injuries.

These painful and sometimes crippling disorders develop gradually over periods of weeks, months, or years. Nurses are routinely faced with a wide array of occupational hazards that place us at risk for work-related musculoskeletal injuries. Musculoskeletal disorders represent one of the most frequently occurring and costly occupational issues in nursing.

The duties we take for granted in an average day that can lead to injury include duration, frequency, and magnitude of ergonomic stressors. Examples of ergonomic stressors include:

  • Force – The more force required to perform a particular task, or the longer that force must be applied, the greater the risk of developing a CTD. Common forceful tasks include pushing a stretcher and patient up a ramp.
  • Repetition – Tasks that use the same muscles and tendons over and over, require more muscle effort and allow less recovery time. Often jobs that require high repetition rates can lead to fatigue and injury. Nursing activities such as passing instruments, opening medicines, and typing are example of repetitive motions.
  • Position – When working with the wrists approximately straight, elbows at about 90°, shoulders relaxed and the spine kept in its natural “S” curve, the strain placed on muscles, tendons, discs and ligaments is minimized. Nursing requires many awkward postures, such as holding retractors during a surgical procedure or bending over a bed putting in catheters.
  • Vibration – The use of vibrating or impact tools or equipment for hours at a time can stress the hands and arms, the lower back, and the neck. I couldn’t think of anything here that nurses use but I am sure it exists. In the comment section below let me know.
  • Lifting – Unassisted, frequent or heavy lifting, especially when performed improperly, can stretch the ligaments of the back and cause the vertebrae to become misaligned. Moving or lifting patients, and carrying heavy instruments and equipment are examples that come to mind.

Other factors such as extreme temperatures, poor lighting, general health, age, and gender can also have an effect. Combine those with standing in one position for one period of time (working as a scrub nurse in the operating room) and overexertion (such as dealing with a combative patient) and it is, in fact, impossible to predict exactly who might develop a CTD.

Organizational Interventions

To increase awareness of CTD, organizations must implement injury awareness prevention measures. Whether in employee orientation, or in unit education seminars, employers must focus on teaching caregivers to report signs and symptoms of musculoskeletal disorders to supervisory personnel immediately. This ensures that measures may be taken to reduce a subsequent increase in severity and cost related to such injuries. Of course, this requires educating of supervisory personnel as well.

Another area where organizations can keep injuries in check and thereby protect their employees and their patients is by making sure proper equipment is available to do the necessary caregiver tasks. Making sure gait belts, slings, walkers, commode chairs, and chair lifts are available and the nursing staff knows how to use them will contribute to fewer injuries and a safer environment.

Training needs should be identified and provided for all levels of personnel. This includes the managers of nursing and other caregiving department’s management. The people in charge need to understand the importance of safe lifting practices and equipment and actively encourage their staff to use them. Of course, as mentioned before, nurses and other care providers need to understand the benefits of the policies and be comfortable using the equipment. Finally, maintenance personnel must be on board so they can complete preventative maintenance tasks, keeping the equipment in good repair.

If nothing else makes an impact on management and staff when it comes to working out methods for preventing CTDs it is time to show everyone the money. Administration, management, and staff need to understand what these injuries cost. The cost to the organization in worker’s compensation, medical treatment and rehab; not to mention rising insurance costs, lost labor, substitute labor and time is huge, in the millions of dollars annually. Nationally, the estimated average cost per claim is $24,000. If surgery is involved, the cost for claims increases significantly to $40,000 per injury or higher. One example of a back injury involving surgery totaled $240,000. And all this time, the injured healthcare provider isn’t working. Workers comp is no substitute for a regular paycheck.

In my next installment we will look at what we, as individuals, can do to keep CTDs at bay. Apparently it takes an overall life and work commitment, since all this can happen with “no precipitating event.”

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