Coping period and 12 hours per day.

CopingStrategiesCaldwell and Caldwell suggest using behavioral and administrativestrategies fully before considering pharmacologic aids since these stimulantsand sedatives can be addictive and questions remain about the safety andeffectiveness of long-term use. Taking naps during work is another interventionthat has been associated with improvements in alertness and is an acceptedpractice in some Asian countries. Techniques have begun and will be useful forsome workers, Another type of strategy is work hour limits such as the recentInstitute of Medicine recommendation that work hours for nurses be limited to60 hours per 7-day period and 12 hours per day.

 Musculoskeletal InjuriesFew industries in the United States have undergone more sweeping changesover the past decade than the health care industry. Changes in health care,including restructuring and redesigning, have led to increasingly heavy demandson nurses and other health care workers. Extended schedules and increased workpace, along with increased physical and psychological demands, have beenrelated to musculoskeletal injuries and disorders (MSD).

These demands havebeen found in laboratory and worker studies to increase the risk ofmusculoskeletal pain/disorders. Definitions for MSD vary, though most includepain in the affected body region (e.g., back or neck) for a specified durationor frequency, along with other related symptoms such as numbness andtingling. Health care workers are atextremely high risk of MSD, especially for back injuries. Health care workersare also overrepresented for upper extremity MSDs among workers’ compensation(WC) claims. In 2001, U.

S. registered nurses (RNs) had 108,000 work-relatedMSDs involving lost work time, a rate similar to construction workers. In2003, the incidence rate for nonfatal occupational injuries, many of which wereMSDs, was 7.9 per 100 full time equivalents (FTEs) for hospital workers. MSDs lead to sick days, disability, and turnover. In a survey of morethan 43,000 nursing personnel in five countries, 17–39 percent planned to leavetheir job in the next year due to physical and psychological demands. Inprevious research, the percentage of nurses reporting job change due to MSDranged from 6 percent to 11 percent, depending on the body part injured (neck,shoulder, or back). Staffing has also been related to MSD, with lowerstaffing complements related to increased injuries.

Between 1990 and 1994, the MinnesotaNurses Association collected injury and illness data from 12 hospitals in theMinneapolis-St. Paul area. The researchers found that when RN positions in thehospitals decreased by 9.2 percent, the number of work-related injuries orillnesses among RNs increased by 65.2 percent. Lower staffing ratios for nursesand higher patient loads have both been shown to result in increased exposureto hazardous conditions and insufficient recovery time. In a review ofevidence, the Institute of Medicine indicated that there was strongrelationship between nursing home staffing and back injuries.

Physical/postural risk factors and MusculoskeletalDisorders (MSD)Health care work is highly physically/posturally demanding, andtasks requiring heavy lifting, bending and twisting, and other manual handlinghave been implicated in health care worker back injuries.  nurses werefound to be at particular risk of back injury during patient transfers, whichrequire sudden movements in nonneutral postures. Patient transfers also requireflexion and rotation, increasing the injury risk due to a combination ofcompression, rotation, and shear forces. Highly demanding physical workwas associated with 9–12 times the odds of having a neck, shoulder, or back MSDamong nurses. Hoogendoorn and colleagues, using video observationsand questionnaires in a 3-year study of health care workers, found that extremeflexion and frequent heavy lifting had a strong impact on worker low-back pain.Other analyses found that physical/postural risk factors were related toimpaired sleep, pain medication use, and absenteeism. Neck and shoulder paininclude body placement in awkward postures that need to be maintained for longperiods of time.

Using direct observation, Kant and colleagues found that surgeons had extensive staticpostures, along with operating room nurses who were required to maintaintension on instruments, leading to substantial musculoskeletal stress of thehead, neck, and back. Lifting and stooping were significantly associated with healthcare worker arm and neck complaints, whereas shoulder complaints wereassociated with pushing and pulling motions. Heavy lifting and actionswith arms above shoulder height were associated with shoulder pain or injury inhealth care workers and in other occupational groups. The evidenceindicates that preventive interventions for MSD need to addressphysical/postural risk factors.