Our previous post in the series addressed system-level learning points for healthcare from the fast food industry’s recent business model changes. In contrast, this entry specifically focuses on what healthcare can learn from the construction industry to help reduce the frequency and severity of nurse staff injuries.
It is well documented that construction-related roles are physically demanding, requiring workers to lift heavy materials for several hours daily. Although it is less frequently acknowledged, nursing is also a strenuous occupation, given the number of hours and physical tasks nurses perform daily. Examples include lifting and transferring patients, who can weigh several hundred pounds, and standing for several hours at a time, resulting in back strain and sore feet. Therefore, the potential back injuries from their work range from pain inducing to career altering.
According to the Department of Labor’s Bureau of Labor Statistic (BLS) data on musculoskeletal disorders, nursing assistants have a yearly incidence rate of 208 injuries per 10,000 workers among nursing assistants; this sharply contrasts with the yearly incidence rate of 72 injuries per 10,000 construction workers. Furthermore, in terms of sheer number of injuries, the BLS musculoskeletal data indicates that nursing professionals are injured more often than any other profession.
This begs the question, what is contributing to the rate of back injuries in nursing staff?
One potential explanation is the difference in the availability and structure of industry safety guidelines. However, research demonstrates that construction guidelines and nursing guidelines for the use of equipment and heavy lifting are similar in nature. This indicates, at the least, the existence of safety guidelines is not the key driver of the injury rate differential between the industries.
Another potential explanation is that healthcare does not have the appropriate equipment to help nurses with physical tasks, as construction workers do in completing their tasks. However, this is misleading, given that a range of medical devices are available in the market for tasking, such as moving patients. In addition, there are instructions and processes to indicate how a specific instrument should be used in various situations, similar to construction’s best practices for equipment use.
If appropriate guidelines and equipment exist in both industries, what is a potential root cause?
The immediate argument would be that nursing guidelines are not as detailed or that the equipment they have available is not as effective in achieving the desired objectives. While this may be a contributing factor, it is difficult to argue that such a large gap in injury rates can exist due to such minute differences. Instead, the answer lies in the nature of each industry.
In construction roles, heavy lifting generally surrounds a regimented and documented process. Workers know, in advance, when and where they need to lift objects and how heavy the material will be. This allows them to more easily organize groups to assist with lifting or acquiring the right equipment at the needed window of time.
In contrast, nursing is a high-touch field, in which patients’ emotions are often factored into decisions. In addition, the need to move a patient can occur sporadically, given that patients do not feel ill or need to use the bathroom at pre-specified times. Therefore, equipment is not always readily available. Even if it is, nurses can make judgment calls to not use it, because they feel it can be dehumanizing for a patient to be moved like an object. As the Safety and Wellness Director at the American Nurses Association acknowledges, patients are not objects and do not have handles. Thus, nurses can rightfully hesitate to treat them as such.
So, what can nursing learn from construction to mitigate this complex problem?
Three specific solutions are evident:
- Nursing workplaces need to create and adopt systems by which nurses can request aid to move patients. It is unreasonable to expect nurses to suddenly begin using regimented processes, given the nature of their work. However, a system that communicates the need to lift a patient, the patient’s weight, and the current location, can begin to help organize staff efficiently. This will serve to mimic, at a reasonable level, the processes construction has surrounding heavy lifting.
- Enforceable rules, not guidelines, need to be enacted to ensure that the available equipment is used. Training nurses in doing so will help reduce the number of judgments calls, which if incorrect, can often lead to injury. If one needs a rationale for implementing this change, it should be considered that in the construction industry, objects that weigh far less than patients are always moved by using equipment, without question.
- Nurses must set expectations with patients regarding these rules at the beginning of a patient’s stay. It is understandable that nurses consider patients’ emotions. However, it is also vital for nurses to consider their physical capacity as they perform their duties. Taking the time to explain to patients how different situations will be handled, which equipment will be used, or that staff will be called, can help patients understand how their needs are being met. At the same time, it helps them understand that the choices are being made to help protect nurses.
Although these changes require significant time, effort, and monetary investment, enacting them can drastically reduce the injuries nurses face in the long term. Reducing injuries has a number of follow-on benefits including career longevity, reduced insurance and staffing costs for health systems, and better quality care through best practices adherence. Healthcare is an industry where workers encounter events that require situational judgments, in whether or not to apply these best practices. Regimenting this decision making process is a critical step forward in both cost savings and quality of care.