The Problem: Safety in the hospital is a concern for patients and providers alike. Nurses face a very specific set of physical challenges that include moving patients, sometimes much heavier than themselves. Injuries resulting from such moves have shortened careers and driven up health care costs.
Background: Lifting and transferring patients from a hospital bed to a wheelchair is no easy task, particularly when performed repeatedly over the course of a nursing shift, a week, a year and a nursing career. But for years, nurses have been expected to do it without mechanical assistance. Predictably, many have been injured as a result, as they strain to lift patients who may weigh dozens or even hundreds of pounds more than they do, over and over.
In the early 1990s, Audrey Nelson, Ph.D., R.N., F.A.A.N., director of the Patient Safety Center of Inquiry and the Research Center of Excellence at the James A. Haley Veteran’s Health Administration (VA) Medical Center in Tampa, Florida, began to focus on the problem. “Ever since nursing began as a profession, nurses have been served up as a sort of human sacrifice,” she says now. “There’s a certain Florence Nightingale effect at work in the profession, where nurses think only of what’s important to patients, and believe it is selfish to take care of themselves. Many get injured as a result. Everyone basically ignored that for years, allowing nurses to get hurt, without really trying to fix the problem.”
The consequence, Nelson observes, is injuries to nurses, causing them to leave the profession early, and costing the industry millions of dollars in workers’ compensation. About 38 percent of nurses report back injuries during their careers, mainly the result of transferring, lifting, moving, turning and bathing patients. Moreover, even nurses who haven’t been hurt can be driven out of the profession by the physical demands of the job.
When she first explored the problem, she explains, “I found thousands of articles on the topic, but they all reached the same conclusion: that this is a really big problem. Not one study I read then offered an evidence-based approach for what to do about it. I was stunned.”
The Solution: Although Nelson’s training was in patient safety, not occupational safety, she and her VA colleagues attacked the problem of nurse injuries, first trying to identify the most common causes of injuries and then seeking approaches to keeping nurses safe while providing care to their patients. “We looked at high risk tasks,” she says, “and particularly at units with the highest injury rates. And then we began carving out a program to make a difference.”
That inquiry led to the focus on lifting and moving patients, and a push for special bedside equipment to help lift patients, sparing the nurses much of the physical burden. In this area, Nelson recognized, U.S. health care trails other nations. For example, the United Kingdom imposed a "no-lift" policy in 1993, pressing nurses to use sling lifts, stand-assist lifts, lateral transfer equipment and other devices. The result, according to a 1996 report in Community Nurse, was a dramatic reduction in lost work hours and absenteeism due to lifting and handling injuries.
Nelson developed a series of approaches to the problem, and began testing them in studies across VA hospitals in Florida, and then across the entire VA system. The solution—ceiling-mounted patient handling equipment—has since become a fixture at VA hospitals across the nation, where it has diminished the frequency and severity of injuries to nurses and patients and decreased workers’ compensation costs. The approach is working its way into non-VA hospitals and nursing colleges, as well.
After devising a solution to the problem, Nelson also recognized the need to market it to multiple groups of stakeholders. “We thought the toughest sell would be the hospital CEOs, who would have to find the money to buy the equipment,” she says. “But to make sure it wasn’t stored in closets, we also had a big marketing challenge with frontline care providers. They needed to see that even though this wasn’t how they learned to do things, it improved patient outcomes and nurse safety.”
One barrier that remains is a perception among some nurses that the equipment takes too much time to use—time that is a valuable commodity for hospital nurses. Nelson points to one study, in the March 2003 American Association of Occupational Health Nurses Journal, which found that devices take about 12 minutes to transfer a patient from a bed to a wheelchair, but notes that “eight of those minutes are spent looking for the device.” So her next objective is to get hospitals to invest in ceiling mounted frames over every bed in every outpatient area of the hospital, coupled with an appropriate number of lifts readily at hand. The frames would also be helpful in other tasks, she observes, including repositioning patients in bed or holding a limb while changing a dressing, catheterization, and more.
She notes, too, that mechanical lifts have demonstrated their economic viability. “We’ve seen three large studies now showing that within two to three years, hospitals get all their investment back,” she says. “The equipment lasts about 10 years, so the hospitals get about seven years of cost savings. It’s a real value added.”
RWJF Perspective: In 2008, Nelson was named an Edge Runner by the American Academy of Nursing (AAN). The Edge Runner program is a part of Raise the Voice, an initiative funded by the Robert Wood Johnson Foundation and directed by AAN to recognize practical innovators leading the way in bringing new thinking and new methods to a wide range of health care challenges. Edge Runners have developed care models and interventions that demonstrate significant clinical and financial outcomes.
The AAN’s Advisory Council for Raise the Voice is chaired by Donna E. Shalala, Ph.D., President of the University of Miami and formerly the U.S. Secretary of Health and Human Services. Joining her on the Board are some of the nation’s foremost health care champions—including foundation executives and former federal lawmakers and administrators.