No Lift Policy
This paper uses data from different studies made on the negative effects of manual patient handling and the benefits of no lift policy at the same time statistics were collected from various government agencies concerned on the healthcare industry. The research wants to explore the evidences as to why no lift policy should be implemented in healthcare facilities and why manual patient handling is such a high risk. Findings point out that many nurses suffer back and shoulder injuries while performing manual lifting. These nurses left the profession or seek other employment, contributing to the shortage of nurses in America. Strong evidences indicate that no lift policy is beneficial to the safety of both patients and nurses as well as financially due to the decrease in workers’ compensation brought about by claims in injuries.
The profession of nursing is an essential part of our society. Nurses perform various tasks that promote the quality of our life. They assist in restoring and maintaining the health of individuals, families, and communities. However, these healthcare workers are at risk every time they perform their duties because of the physical demand of their work. They are second after industrial with the most physical workload intensity. Most nurses are exposed to the hazards of manual patient handling, causing them injuries that cost the healthcare industry billions of dollars a year in workers’ compensation. Manual handling refers to any activity that involves human force to lift, lower, push, pull, carry, restrain or hold a load. Incidents or injuries arising from any of these activities may be described as manual handling problems. In health and aged-care facilities, nearly 30 per cent of all compensable injuries are due to manual handling.  (Lusted, 1998, p. 7, par. 1). This injury is known as the Musculoskeletal Disorder (MSD). The term musculoskeletal disorder describes a collection of conditions affecting, but not limited to, muscles, nerves, tendons, ligaments, joints, cartilage, or spinal discs. Common manifestations of musculoskeletal disorders include low back pain, sciatica, rotator cuff injury, and carpal tunnel syndrome.2 Job tasks, such as patient handling, can lead to the development of these conditions or exacerbate existing ones.  (American Nurses Association, 2003, par. 2). Back and shoulder injuries are the most common type of MSD that nurses suffer due to patient handling.
The lifting capacity for men is only 51 lbs. and 46 lbs. for women. However, nurses perform cumulative lifting tasks of 1.8 tons in an eight-hour shift a day  (Nelson, et. al, 2004, Statement of the Problem, par. 2, line 6) making them vulnerable to injuries. Many of them still work despite back injuries while others are no longer able to work. A lot of nurses suffer work-related injuries during their career. Half of the nursing workforce in the United States complains of chronic back pains and even left the profession due to these pains. Most nurses who currently deal with chronic pain say that it is a long-term struggle. More than one in five (21 percent) nurses say that they have experienced pain for more than three years, and three in ten (31 percent) say that they have experienced chronic pain for two years or more.  (Hart, 2006, p. 5, par. 3). Many registered nurses requested or have been transferred to other units or seek other employment. This scenario hampered nursing recruitment because applicants fear the threat of work-related injuries. The Department of Health and Human Services recorded a shortage of nurses in 2002 and projected that the percentage of shortage will be higher by 2015 and 2020.
Nurses perform patient handling in diverse settings based on their own judgment with no fixed solutions. It becomes high risk when done in unfavorable environment or conditions, which in that case will be a primary cause of injuries. Doing this errand, a nurse has to assess the patient’s size and weight, the transfer distance, unpredictable behavior of the patient, awkward positions, methods in repositioning the patient in bed or in chairs, and toiletry tasks. Patient safety is an essential and vital component of quality care. Yet health care providers face many challenges in today’s health care environment in trying to keep patients safe.  (Ballard, 2003, Patient Safety, par. 1).
Manual lifting, which was deemed unsafe since 1981, increases risk among health workers and poses discomfort to patients. Some of the manual techniques like hook and toss (drag lift), arm and leg lift, and shoulder lift have been ineffective in reducing injuries according to findings. Nurses perceive that patient handling technology is the most effective solution for MSD. In the US, numerous nurses are still practicing the traditional manual lifting and are slow in adopting the “no lift” policy. However, today the healthcare industry realizes that manual lifting and transferring of patients are high risk activities.  (Veterans, 2001, p.5, par. 2). It noted that injuries sustained from these activities are very costly brought about by hiring temporary replacements, overtime, legal fees, decreased output, training of replacements, and various claims.
The No Lift Policy
The Royal College of Nursing in England was accredited for the proposal of this policy, which was enacted in 1992 in the United Kingdom. The policy asserts that manual lifting of patients must to be abolished in all forms except in life threatening situations. To better understand, other factors were added: patients should be encouraged to assist in their own transfers and handling aids must be used whenever possible to help reduce risk if this is not contrary to a patient’s needs, manual lifting may only be continued if it does not involve lifting most or all of a patient’s weight, a no-lift policy does not mean health care providers will never transfer or reposition any resident manually, but rather needs to be based on patients’ physical and cognitive status as well as medical conditions, and proper infrastructure must be in place before a no lift policy is enforced.  (Nelson, et. al, 2004, No Lift Policy, par. 2, line 9-16). Similar has been adopted throughout Europe, Australia, and Canada. The acceptance in the US was rather slow. In the health care sector, one of the most effective ways to eliminate or minimize many of the risks associated with patient handling is to make a no lift policy an integral part of the overall patient handling strategy.  (Workers’, p. 18, No lift policy).
The effectiveness of this policy has been well documented in many research studies that show the long-term benefits due to the decrease in compensation payments, common law actions, fatigue, sick leave, improve morale, increase productivity, assistance with recruitment and retention of nurses. The use of mechanical lifts greatly reduces injuries from 95% to 60%. It saw the reduction of compensation costs by 95%, insurance premium by 50%, medical and indemnity costs by 92%, lost work days by 84%, and absenteeism by 98%.  (Veterans, 2001, p. 9, par. 2). These devices like ceiling lift, sit-to-stand lift, hydraulic lift, and ambulatory lift eliminated all risks of manual lifting. Most of these technologies are designed for repositioning patients in bed, pulling patients in bed, bathing, stretcher transport, and car transfers.
Nurses experienced reduction in discomfort when using mechanical lifts and said that their jobs became much easier. This resulted in better retention of nurses, patient satisfaction, and financial benefits for healthcare facilities. The program produced many intangible benefits including improvements in patient comfort and safety during transfers and patient care. The nursing personnel perceived their backs were less sore and they were less tired at the end of their shifts. More pregnant and older workers were able to perform their regular duties and stay on the job longer.  (Garg, 1999, Abstract, par. 3). In addition, the system afforded a patient’s safer recovery, comfort, and protection of his or her dignity. Jessica Palmer, clinical operations director of Duke University Hospital in Durham said that patients usually feel safer with the use of lift equipment and understood the system for their own and the nurse’s safety. The US Department of Labor and the Occupational Safety and Health Administration (OSHA) released in 2003 guidelines for nursing homes that manual lifting of residents be minimized in all cases and eliminated when feasible. OSHA further recommends that employers develop a process for systematically addressing ergonomics issues in their facilities, and incorporate this process into an overall program to recognize and prevent occupational safety and health hazards.  (Occupational Safety and Health Administration, p. 6, par. 1, line 4) As a result state legislations were introduced in Washington, Ohio, Texas, New York, California, Massachusetts, and New Jersey. A growing number of healthcare facilities adopted the policy and reported positive results and cost savings. The no lift policy is an evidence-based solution for high risk patient handling tasks.
Perhaps, the best way to measure the effectiveness of the no lift policy is to cite the experiences of some healthcare facilities that already practice the strategy. As said earlier many case studies indicated the efficiency of such policy. In Wyandot County Nursing Home in Ohio, almost $140,000 annually was paid to worker’s compensation for injuries from 1995 to 1997 with a turnover rate of 55% among its nursing assistants. When it implemented the policy in 2000, worker’s compensation claim averaged only $6,750 and a turnover rate of 3%. Its record of injuries fell from nine in 1995 to five in 2001. The nursing home spent $155,000 worth of equipment in 2003. It saved some $55,000 annually in payroll due to overtime and absenteeism and more than $125,000 in turnover costs. Worker’s compensation dropped from $140,000 (1995-1997) to below $4,000 (2000-2002). The Countryside Care Center in Illinois also faced the same experience after applying the policy. It spent $24,000 for mechanical lifts in 2002 and saw a drop in worker’s compensation claim from $67,500 to $1,215. Its injuries decreased from 74 to 27. In addition, the center encounter better resident care and employee morale as well as reduced penalties.  (US Department of Labor, 2006, par. 5).
This table is the result of other case studies of successful policy implementation.
 (Veterans, 2001, p. 14)
Assessing these case studies is important to the choice hospitals and nursing homes make in implementing no lift policy. This strategy requires commitment and the cooperation of all personnel from the industry. It has been noted that nurses are vulnerable to injuries in performing their lifesaving tasks. It is ironic that these health workers are trying to save others while endangering themselves in the process. The health industry must take prevention measures in protecting nurses and put integrity to the profession. There is enough evidence that manual patient handling is a high risk job for nurses.
It is very likely that unsafe work environments will place the very future of nursing at risk. Unsafe environments will have adverse effects on both recruitment and retention of nurses. Nurses do not complain about working hard. In fact, they expect to work hard, and enjoy a great deal of satisfaction when that work makes a difference. However, when that work places nurses at risk, nurses experience dissatisfaction.  (Foley, 2004, Future Trends and Implications, par. 1). Experts on this topic suggest that systematic change must be drafted to meet the complexity of the problem that cannot be done by a single intervention. The gap between traditional and scientific evidence is wide when addressing risks in patient handling. A major shift is needed in order to meet the requirements of safe patient handling. This is not just about saving money but for the worker and resident safety. There are new approaches and technology available and researches are on-going to perfect the system. A major change is also needed in training nurses, using evidence-based strategies that will enhance their knowledge and skills at the same time use new technologies to avoid injuries in the workplace.
Injuries among nursing staff have dramatically declined since incorporating patient handling equipment and devices along with an institutional commitment to the safest available methods. In a work environment that values an ergonomic approach and applies a formal program, nurses are provided a safe workplace in which to practice without the threat of injury.  (de Castro, 2004, Benefits, par. 1). Many health organizations and private sectors have embraced this policy, which is vital in addressing the shortage of nurses. However, there are challenges ahead such as changes in behavior. Many still do manual lifting because it has been the tradition or habit practice for many years. Implementing will need considerable resources and efforts. It will cost but the long-term benefits are irreplaceable. The danger manual handling can be reduced through continuous risk assessment and control, management commitment and staff involvement, and on going patient handling training. Government support is also needed through state legislation and funding.
(1) Lusted, Marcia. (1998). Manual Handling Guide for Nurses. Edited by Butrej, Trish., West, David., & Kirshenbaum, Gerry. the NSW Nurses’ Association. Retrieve May 10, 2006, from http://www.workcover.nsw.gov.au/NR/rdonlyres/91C47652-5530-4487-BB67-14C8489171ED/0/guide_manualh_nurses_4216.pdf#search=’case%20studies%20on%20manual%20patient%20handling’
(2) American Nurses Association (2003). Elimination of Manual Patient Handling to Prevent Work-related Musculoskeletal Disorders. Position Statement. Retrieved July 31, 2004, from http://nursingworld.org/readroom/position/workplac/pathand.pdf
(3) Nelson, A. PhD, RN, Faan & Baptiste, Andrea S. MA, CIE. (2004). Evidence-Based Practices For Safe Patient Handling And Movement. Online Journal of Issues in Nursing. Vol. #9 No. #3, Manuscript 3. Retrieve May 10, 2006, from www.nursingworld.org/ojin/topic25/tpc25_3.htm
(4) Veterans Health Administration and Department of Defense. (2001). Patient Safety Center of Inquiry. Ergonomics Technical Advisory Group.Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement. Retrieve May 10, 2006, from http://www.visn8.med.va.gov/patientsafetycenter/resguide/ErgoGuidePtOne.pdf
(5) Occupational Safety and Health Administration. Guidelines for Nursing Homes: Ergonomics for thePrevention Musculoskeletal Disorders. Retrieve May 10, 2006, from http://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.pdf
(6) US Department of Labor. (2006). Safety and Health Case Study: Countryside Care Nursing Home. Retrieve May 10, 2006, from http://www.osha.gov/dcsp/success_stories/alliances/abbott/nursing_homes.html
(7) Hart, Peter D. Research Associates, Inc.(March 2006). Safe Patient Handling: A Report Based On Quantitative Research Among Nurses and Radiology Technicians. Conducted on Behalf of AFT Healthcare. Retrieve May 10, 2006, from http://www.aft.org/topics/no-lift/download/PeterHartSurvey-final-03-16-06.pdf
(8) Garg, A. (1999).Long-Term Effectiveness of “Zero-Lift Program in Seven Nursing Homes and One Hospital. University of Wisconsin-Milwaukee. Sponsored By: National Institute for Occupational Safety and Health. Retrieve May 10, 2006, from http://www.aft.org/topics/no-lift/Zero_Lift_Report.pdf
(9) Workers’ Compensation Board of British Columbia. Handle With Care. Patient Handling and the Application of Ergonomics (MSI) Requirements. Retrieve May 19, 2006, from http://www2.worksafebc.com/pdfs/healthcare/HWC/HWC_L.pdf
(10) Foley, M., (September 30, 2004) “Caring for Those Who Care: A Tribute to Nurses and Their Safety”Online Journal of Issues in Nursing. Vol. #9 No. #3, Manuscript 1. Retrieve May 20, 2006, from www.nursingworld.org/ojin/topic25/tpc25_1.htm
(11) de Castro, A.B. (September 30, 2004) “Handle With Care: The American Nurses Association’s Campaign to Address Work-Related Musculoskeletal Disorders”Online Journal of Issues in Nursing. Vol. #9 No. #3, Manuscript 2. Retrieve May 20, 2006, from www.nursingworld.org/ojin/topic25/tpc25_2.htm
(12) Ballard, K. (September 30, 2003) “Patient Safety: A Shared Responsibility” Online Journal of Issues in Nursing. Vol. #8 No. #3, Manuscript 4. Retrieve May 20, 2006, from www.nursingworld.org/ojin/topic22/tpc22_4.htm