Health care workers consistently have one of the highest rates of musculoskeletal injuries on the job, and nurses are no exception.1,2Nurses regularly have to complete physically demanding tasks in order to fulfill their job responsibilities and care for their patients. Movements related to patient handling such as bending and lifting contribute heavily towards overexertion injuries and days away from work among nurses. In today’s post the current research and recommendations for manual lifting tasks will be outlined.
NIOSH Lifting Equation
The National Institute for Occupational Safety and Health (NIOSH) first published the Work Practices Guide for Manual Liftingin 1981. The manual addressed how to lessen musculoskeletal injuries and disorders caused by manual lifting tasks among health care workers. In the manual a lifting equation was presented that could be utilized for calculating recommended weight limits during manual lifting tasks.2
A revised NIOSH Lifting Equation has since been published involving the multiplication of 6 additional factors that influence the calculated recommended weight limit (RML) for lifting. The recommended weight limit for lifting is now calculated using the following equation:3
RWL = LC x HM x VM x DM x AM x FM x CM
- LC = load constant: the maximum weight anyone should lift under ideal conditions (51 lbs.)
- HM = horizontal multiplier: the distance of the object from the person performing the lift
- VM = vertical multiplier: vertical height of the lift
- DM = distance multiplier: distance the object is lifted/lowered vertically
- AM = asymmetric multiplier: distance the object is displaced in degrees from the front of the body
- FM = frequency multiplier: how often the lift is made within a 15 minute period
- CM = coupling multiplier: quality of hand-to-object connection
As you can see from this equation, lifting is a complex task. Although this equation can be useful for assessing basic lifting tasks that are used frequently, it is too complex and time-consuming to be used in day-to-day practice for each individual lifting task. When time does not allow for this equation to be implemented the NIOSH manuals recommend a maximum lifting weight limit of 35 lbs.2This weight-limit decreases when the task is performed under non-optimal conditions, including: lifting from a sitting or kneeling position, lifting with arms extended, or lifting when the load is off to the side of the body.2
Lifting Objects vs. Patients
Close to half of “days away from work” injuries can be attributed to overexertion, and nearly one-third of these injuries result from patient interactions.4Lifting a patient can be unpredictable and should not be viewed as the same as lifting an object of the same weight. Patient-handling lifting tasks such as transfers are generally excluded from the NIOSH Lifting Equation unless certain conditions are met, since these tasks typically pose too many variables not considered in the equation.3,5Patients can have sudden muscle spasms, be combative, and resist the lift. Each of these reactions can create greater loads in the lifter’s spine compared to when the lift is performed slow and smooth with the person who is being lifted remaining still.3
Assistive Equipment and Safe Patient-Handling Programs
NIOSH currently does not have any mandated regulations or standards related to reducing patient-handling injuries.1Even though 35 lbs. has often been designated as the recommended maximum protective weight limit for patient handling, this value does not take into account the many circumstances during which patient lifts take place under non-ideal conditions.2,5This weight limit also deems practically all patients not seen in pediatrics as too heavy to lift manually.
NIOSH and The American Nurses Association have publicly announced that they are collectively in agreement with patient handling professionals who believe that the goal of safe patient handling programs should be to eliminate all manual lifting whenever possible.5 The American Nurses Association is advocating for hospitals to adopt protocols and install equipment that will assist with patient lifting tasks. The ultimate goal of both the NIOSH and ANA is for nurses do not have to move a patient without an assistive device.5
There is some controversy among health care professionals regarding whether or not assistive equipment is always necessary for lifting patients. However, if the worker does not perform lifts properly or the patient moves unexpectedly during a lift, the risk of injury to the nurse or the patient raises significantly.1In circumstances where assistive equipment is not available due to cost or other reasons (as in not enough of lifts on the unit), safe patient-handling programs should be commissioned.
Both safe-patient handling programs and assistive devices for lifting have been shown to be cost-effective methods for reducing musculoskeletal injuries among nurses.6 Nurses will be able to enjoy longer careers and reduced injuries if evidence-based patient-handling techniques are implemented.
References:
- The Patient Safety and Quality Healthcare. Lifting patients puts nurses at risk: have you tried these alternatives? Healthleadersmedia.com. https://www.healthleadersmedia.com/nursing/lifting-patients-puts-nurses-risk-have-you-tried-these-alternatives. Published September 11, 2018. Accessed May 29, 2019.
- Waters TR. When is it safe to manually lift a patient? Am J Nurs. 2007;107(8):53-58. doi:10.1097/01.NAJ.0000282296.18688.b1
- Middlesworth M. A step-by-step guide to using the NIOSH lifting equation for single tasks. Ergo-plus.com. https://ergo-plus.com/niosh-lifting-equation-single-task/. Published December 5. Accessed May 30, 2019.
- The Occupational Safety and Health Administration. Caring for our caregivers: Facts about hospital worker safety. Osha.org. https://www.osha.gov/dsg/hospitals/documents/1.2_Factbook_508.pdf. Published September 23, 2013. Accessed May 29, 2019.
- Centers for Disease Control. Safe patient handling and mobility (SPHM). Cdc.gov. https://www.cdc.gov/niosh/topics/safepatient/default.html#Patient%20Handling%20Ergonomics. Updated August 2, 2013. Accessed May 30, 2019.
- Strengthening your evidence base: Focus on safe patient handling. Americannursetoday.com. https://www.americannursetoday.com/strengthening-your-evidence-base-focus-on-safe-patient-handling/. Published July 2010. Accessed May 30, 2019.