Coping period and 12 hours per day.


Caldwell and Caldwell suggest using behavioral and administrative
strategies fully before considering pharmacologic aids since these stimulants
and sedatives can be addictive and questions remain about the safety and
effectiveness of long-term use. Taking naps during work is another intervention
that has been associated with improvements in alertness and is an accepted
practice in some Asian countries. Techniques have begun and will be useful for
some workers, Another type of strategy is work hour limits such as the recent
Institute of Medicine recommendation that work hours for nurses be limited to
60 hours per 7-day period and 12 hours per day.


Musculoskeletal Injuries

Few industries in the United States have undergone more sweeping changes
over the past decade than the health care industry. Changes in health care,
including restructuring and redesigning, have led to increasingly heavy demands
on nurses and other health care workers. Extended schedules and increased work
pace, along with increased physical and psychological demands, have been
related to musculoskeletal injuries and disorders (MSD). These demands have
been found in laboratory and worker studies to increase the risk of
musculoskeletal pain/disorders. Definitions for MSD vary, though most include
pain in the affected body region (e.g., back or neck) for a specified duration
or frequency, along with other related symptoms such as numbness and

 Health care workers are at
extremely high risk of MSD, especially for back injuries. Health care workers
are also overrepresented for upper extremity MSDs among workers’ compensation
(WC) claims. In 2001, U.S. registered nurses (RNs) had 108,000 work-related
MSDs involving lost work time, a rate similar to construction workers. In
2003, the incidence rate for nonfatal occupational injuries, many of which were
MSDs, was 7.9 per 100 full time equivalents (FTEs) for hospital workers.

MSDs lead to sick days, disability, and turnover. In a survey of more
than 43,000 nursing personnel in five countries, 17–39 percent planned to leave
their job in the next year due to physical and psychological demands. In
previous research, the percentage of nurses reporting job change due to MSD
ranged from 6 percent to 11 percent, depending on the body part injured (neck,
shoulder, or back). Staffing has also been related to MSD, with lower
staffing complements related to increased injuries. Between 1990 and 1994, the Minnesota
Nurses Association collected injury and illness data from 12 hospitals in the
Minneapolis-St. Paul area. The researchers found that when RN positions in the
hospitals decreased by 9.2 percent, the number of work-related injuries or
illnesses among RNs increased by 65.2 percent. Lower staffing ratios for nurses
and higher patient loads have both been shown to result in increased exposure
to hazardous conditions and insufficient recovery time. In a review of
evidence, the Institute of Medicine indicated that there was strong
relationship between nursing home staffing and back injuries.

Physical/postural risk factors and Musculoskeletal
Disorders (MSD)

Health care work is highly physically/posturally demanding, and
tasks requiring heavy lifting, bending and twisting, and other manual handling
have been implicated in health care worker back injuries.  nurses were
found to be at particular risk of back injury during patient transfers, which
require sudden movements in nonneutral postures. Patient transfers also require
flexion and rotation, increasing the injury risk due to a combination of
compression, rotation, and shear forces. Highly demanding physical work
was associated with 9–12 times the odds of having a neck, shoulder, or back MSD
among nurses. Hoogendoorn and colleagues, using video observations
and questionnaires in a 3-year study of health care workers, found that extreme
flexion and frequent heavy lifting had a strong impact on worker low-back pain.
Other analyses found that physical/postural risk factors were related to
impaired sleep, pain medication use, and absenteeism. Neck and shoulder pain
include body placement in awkward postures that need to be maintained for long
periods of time. Using direct observation,

Kant and colleagues found that surgeons had extensive static
postures, along with operating room nurses who were required to maintain
tension on instruments, leading to substantial musculoskeletal stress of the
head, neck, and back. Lifting and stooping were significantly associated with health
care worker arm and neck complaints, whereas shoulder complaints were
associated with pushing and pulling motions. Heavy lifting and actions
with arms above shoulder height were associated with shoulder pain or injury in
health care workers and in other occupational groups. The evidence
indicates that preventive interventions for MSD need to address
physical/postural risk factors.