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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 2

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 3

Purpose Discuss current research into occupational injuries in nursing and graduate research Strategies for injury prevention including staff and student education 4

Statistics Nurse aides, orderlies and attendants are the 2nd highest occupation for MSD’s and RN’s are 5 th (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 5

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 6

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 7

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 8

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 9

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 10

Implications (cont.) Staffing implications Owning own role in less than ideal CNA-Nurse working relationships On-going prevention education needed 11

Contributing factors to MSD Quick movements, repetitive movements Combative patients Long work hours and overtime Work schedules Staffing shortages Heavy lifting, bending and twisting 12

Evidence-Based Interventions and Challenges Patient handling equipment No-lift Policies Training on proper use of equipment and devices Lift teams Ongoing education 13

Patient Handling Equipment Hi/Low beds, mobile lifts, ceiling mounted lifts, lateral transfer aides Challenges Cost Staff training Time Equipment selection for each patient 14

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) 15

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 16

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 17

Ongoing Education Annual body mechanics reviews Challenges Education alone has proven ineffective for MSD safety Qualified instruction and return demonstration is key (ideal 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 18

Emerging Interventions and Challenges After-action reviews Clinical tools Peer leaders 19

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 20

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 21

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 22

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) 23

Make Education Count! Modeling behaviors Ongoing training and assessment Return demonstrations (with real patients) Positive reinforcement system 24

Help! Facebook- Injured Nurses Network of America Nurse and Health Care Worker Protection Act of 2009 (S.1788) Full text ANA- Work Injured Nurses Group (WING) 25

S Summary Nurse and Health Care Worker Protection Act of Requires the Secretary of Labor to propose a standard on safe patient handling and injury prevention to prevent musculoskeletal disorders for direct- care 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. 26

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 27

Personal and Professional Interventions Presentation of research findings at nursing conferences, 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 28

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. 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 29

Thank you! Questions? me! Patricia Graham Product Information at 30