Running head: Nurse Injury

Nurse Injury at the Workplace

Kassie J. Herp
Ferris State University Big Rapids, MI

NURSE INJURY

Abstract
This issue and analysis paper is centered on injured nurses at the workplace. In this paper,
there will be information on why nurses getting injured at the workplace is an issue. There will
also be information on a nursing theory and a psychology theory that will show a different way
to approach this issue. There will also be a look into the healthcare environment and why some
of these things are happening and what might be changed to combat the issue. Then there will be
a look at recommendations based on American Nurses Association (ANA) standards and Quality
and Safety Education for Nurses competencies. Lastly, there will be insight given on inferences,
implications and consequences of the issue and the recommendations.

NURSE INJURY

Nurse Injury at the Workplace

Workplace injury can be a hard thing for anyone to overcome. It affects you in all aspects of your
life. Not only are you injured and most likely cant work, you are not getting paid, you might be
limited to what you can do at home, it affects more than you tend to realize. In the field of
nursing, there are on average 76 injured workers per 10,000 employees (Howard, 2010). This is
quite an alarming number because of the fact that the average number of injures for all industrial
workers combined is 38 injured workers per 10,000 workers (Howard, 2010). Even more
alarming than that, in nursing homes there is an average of 132 injured workers per 10,000
workers (Howard, 2010). When looking at the numbers you see that nurses, on average, have a
more dangerous job. Making it difficult to perform at their best, if they are hurt. Within the
health care industry, workers in these occupations suffered the most lost time cases of 11960
general musculoskeletal pain and 4700 back pain (Black, Shah, Busch, Metcalfe, & Lim, 2011).
There are many reasons why the nursing profession has more injuries than others. The other
reason that injuries in nursing is an issue is because it affects their home life as well as their work
life. If you get injured on the job, you cant always work, bring in money, you wont be able to
do what you used to at home until you are healed. This issue is country wide. More and more
facilities are trying to improve upon measures to protect nursing personnel and healthcare
personnel, but more still needs to be done.
Some think that this is the facilities fault, others think that it is the employees fault. You
also have those that think that people are just making it up so they can get some time off work.
There is also the argument about what types of solutions work and which ones dont. I think
overall, the workforce needs to stand behind the fact that there is a problem and there is a lack of

NURSE INJURY

safety measures in place for nurses and healthcare workers and we need to try to protect them
from getting injured at work.
Theory Base

In the nursing practice, theories are very vital to how things have evolved overtime.
These theories have shaped out nursing process, how we approach and treat patients, and how we
are nurses. When it comes to nursing injuries on the job, the injured nurses are now in the role of
the patient. The first Theory that applies to injured nurses on the job is Roper Logan Tierney
model of living. This theory is explained as The purpose of the theory is as an assessment used
throughout the patient's care. In the United Kingdom, where the model is prevalent, it has been
reduced to being used simply as a checklist. It is often used to assess how the life of a patient has
changed due to illness, injury, or admission to a hospital rather than as a way of planning for
increasing independence and quality of life. The theory attempts to define what living means. It
categorizes the discoveries into activities of living through complete assessment, which leads to
interventions that support independence in areas that may be difficult for the patient to address
alone. The goal of the assessment and interventions is to promote maximum independence for
the patient. The activities of living listed in the Roper-Logan-Tierney Model of Nursing are:
maintaining a safe environment, communication, breathing, eating and drinking, elimination,
washing and dressing, controlling temperature, mobilization, working and playing, sleeping.
(Roper, 2015). This theory applies to the issue very well because it shows that the problem of
injured nurses affects their ability to live. It also promotes interventions on how to promote
independence for the patient, or in this case, the nurse.

NURSE INJURY

When a nurse becomes the patient, the activities that they can perform become less. They
are unable to maintain a safe environment for themselves and their patients at work, with an
injury. Depending on the injury itself, it could also affect activities such as mobilization and
working. With this theory it mind we see that we need to gather interventions that would not only
help to get the nurses back on their feet but also to prevent injuries from happening again.
The second theory that we are looking at is the Social Learning Theory Albert Bandura.
Bandura's social learning theory proposed that learning can also occur simply by observing the
actions of others (McLeod, 2011). People can learn new information and behaviors by watching
other people. We can take this theory and use it to prevent further injuries in the nursing field. By
observing we can see what the causes of nursing injuries are. After figuring out what is causing
the injuries, there can be interventions can be initiated and changes can be made to prevent the
injuries from happening again. Not only can this theory be utilized by nurses, but it can also be
utilized by other hospital personal such as the educators, administrators, managers and more, that
can learn from observing how the injuries took place and how they can help to prevent them
from happening in the future. This allow for collaboration from different disciplines to come up
with the best solutions to keep the nursing staff safe.

Assessment of Healthcare Environment

As of right now, there is no national policies in place to help prevent nurses from getting
hurt on the job. However, every facility as their own policies on how to protect the nurses. I
could not get specific policies from Spectrum Health, due to privacy issues. However, I do know
that they require lift equipment on every floor that is accessible to the staff. There is also a

NURSE INJURY

nursing manager on the spinal and neuro unit at Blodgett Hospital that requires all of her new
hires to orient and observe with physical therapy so that her staff learns the proper body
mechanics to keep themselves safe when transferring patients. They also learn how to properly
move and transfer the patients to keep them safe with their spinal and neuro injuries. They also
have an initiative going to get ceiling lifts in all of the ICU rooms to make transferring patients
safer for the staff and the patients.
Another hospital in Alaska, is trying to get legislature passed to require all of the hospital
facilities in Alaska to put transferring equipment in every room in the hospital (OConnell,
2013). The one hospital made the initiative to make all of the rooms transfer friendly with
transfer equipment in every room (OConnell, 2013). After the initiative was put in place and
they were able to look at the results, they found that the amount of money they had to spend to
put the equipment in all the rooms was offset by the amount of money they saved from less
injuries to their staff members (OConnell, 2013).
Some challenges that are faced when trying to change policy is the administrative aspect.
From my two years experience with working at Spectrum Health, I found that it takes forever to
get anything changed. This could be a problem because the amount of time that it takes to get
things changed would affect the workers and still put them in harm to get injured. There is also
the challenge of money and resources. A lot of big corporations could most likely afford the cost
for supplying transfer equipment in every room, but the smaller more rural hospitals dont have
nearly as big of a budget so they might not be able to afford it.
When it comes to creating new policies and asking for more resources there are many
different departments involved such as the nurse managers, contractors, financial advisors,
supervisors and more. This is why the process takes so long because you have to write up a

NURSE INJURY

proposal, submit it, and allow for the time to get it approved then make sure you can find the
money for it in our budget. And then figure out it is going to be implemented and how it is going
to affect the patient care on the floors if you were to install transferring equipment in every room.

Recommendations For Quality and Safety Improvements

The first ANA standard that has to be addressed is coordination of care (American Nurses
Association, 2010). There is already a nursing shortage that is happening, and it is not even at the
peak. The suggested time where the shortage will be at its peak is 2025. So because of the fact
that there is already a lack of nurses, this puts more strain on the staff that are working. When one
of them gets injured it becomes even more straining, because they are down another staff member.
This causes for a lack of coordination of care due to the fact that the nurse to patient ratios are
higher. This could cause an issue with making sure that the patients are being taken care of and
getting the proper quality of care. Because the nurse to patient ratio is higher it causes for a lack of
one on one time with the nurse and the patient which is just as vital as the medication that they are
receiving.
The bottom line on how there is a lack of coordination of care and that can be combatted
in multiple ways, which also help to combat some issues with other ANA standards as well.
The second ANA standard that will be addressed is the Education (American Nurses
Association, 2010). This applies to nurses who get injured because there is a lack of education.
Not all the nurses or healthcare workers are up to date proper body mechanics and how to safely
transfer patients. This opens the door for education for all nurses and healthcare workers. Based
on a similar approach from another department and expanding on that, comes the idea of annual

NURSE INJURY

training. The annual training or education day, consists of walking the staff through proper body
mechanics to keep themselves safe and also how to properly transfer the patients while keeping
them safe. There can be collaboration with physical therapy to properly teach safe body
mechanics. This education day could be more expanded to required education day or teaching
upon orientation and in the event of an injury education after recovery. This will allow for proper
teaching to hopefully prevent such injuries from happening again or at all. After talking to the
Patient Transport Educator who has implemented a similar program in the Patient Transport
Department, he said that there has been a decrease in the number of injuries and the severity of
them (VanderZouwen, 2015).
The next ANA standard we will look at is Quality of Practice (American Nurses
Association, 2010). Quality of practice can be greatly improved by the above suggested
intervention, as well as making transfer equipment more accessible. As touched on earlier, the
hospital in Alaska has made the initiative to get transfer equipment available in all of the patient
rooms. This initiative has decreased the amount of nurse and other staff injuries at that hospital
and is saving money. They have now taken this initiative to congress in hopes of getting this law
passed and get it implemented in all hospitals in Alaska. I think that if this was implemented in all
hospitals across the United States, then every hospital will have less nurse injuries and it will
decrease the amount of cost hospitals would have to pay for staff getting injured on the job.
The last ANA standard to look at is evaluation (American Nurses Association, 2010). If
the recommendations are implemented than the facilities can evaluate to see if the
recommendations and interventions are making a difference in the amount of staff injuries have
experienced and the amount of money that had to be spent for the injuries. They can also use
evaluation to see how their policies that have put in place are working. They can also use it to

NURSE INJURY

learn from and see if they need to change anything about it so that they make the necessary
improvements.
When looking at the ANA standards and the recommendations made with them, we also
have to keep the quality and safety competencies in mind. The following takes a look at each of
the competencies and makes sure that they are thought about when recommending interventions
to prevent nurse injuries. One competency is patient centered care (Quality and Safety Education
for Nurses, 2015). This becomes affected when nurses are injured because it decreases the
amount of time patients can have with their nurse because the floor is short staffed because of an
injured nurse. The hope with the recommendations is that patient centered car will no longer be
jeopardized by short staffing because of injuries. The second competency is team work and
collaboration is also affected by nurse injury (Quality and Safety Education for Nurses, 2015).
With this, the rest of the floor depends on their peers to help them with the work load and with an
injured staff member the amount of work load for all the peers increases, making it difficult for
them to perform their jobs adequately. Again, the goal is that with the recommendations, there
will be less injuries and the team doesnt have to try to handle the heavier work load. With the
recommendations made you will see that there is a collaboration such as partnerships with
physical therapy, the administration, and more. The third competency is evidenced based practice
(Quality and Safety Education for Nurses, 2015). We see that the evidence shows that there is a
lack of knowledge and resources to keep the staff members safe. With that, quality improvement
comes into play. You can improve by hiring more nurses and staff. The hospital can make a
policy requiring a standard for all rooms to have available transferring equipment in each room.
Another competency is safety, which is a big part of this scenario (Quality and Safety Education
for Nurses, 2015). The point of this research and recommendation is to ensure that the nurses are

NURSE INJURY

10

working in a safe work environment which also ensures that the patients are being taken care of
in a safe environment.

Inferences, Implications, and Complications

When looking at the numbers of employees that are being injured in the healthcare field,
you can see that it is an issue. Based on that, there needs to be something done so that these
injuries dont occur. Logically speaking, it would make more sense for people to see that it is a
huge waste of time and money to not put some interventions in place. It is also imperative that
we keep in mind the health of our staff. If you dont value their safety as much as you value the
patients then you will end up losing staff, not only from injuries, but also because of
dissatisfaction.
As for the most likely outcome, if the recommendations were to be implemented then
there would be a significant decrease in the number of injuries that are happening to nurses. It
would also end up saving the hospitals a lot of money in the long run and they could put the
money they will be saving into other improvements to make the hospital better. However, if the
hospital does not implement these recommendations or implement their own, then there will
continue to be staff injuries and money and time lost. But the hospitals could also argue the fact
that there is a lack of funding to implement new recommendations.
Some implications that have to be looked at in this scenario are how work injuries effect
the staff. Not only are they injured and in some sort of pain, but they are most likely off from
work. This could be a huge challenge for them financially if they are the bread winners. Not only
are they worried about getting better and back to work, they also have to figure out where the

NURSE INJURY

11

money is going to come from to pay for their bills, workers compensation only pays so much.
There is also the issue of how much money it will cost the hospital or facility. Not only does the
facility have to pay for the injured worker, they then have to try to pay someone to cover that
shift until the injured worker can work again. There is also the matter of medical bills that the
facility incurs because of a work related injury.

Conclusion

Overall, there is a problem when it comes to the nursing profession and that is injuries on
the job. The basis of this job is taking care of other people and treating them, it is a part of our
character. But, so often we fail to take care of ourselves. This is where this issue needs to be
corrected. We need to take care of ourselves and make sure we are performing at our best so we
can take care of our patients to the best of our ability. That means that something needs to change
so there are not so many injuries occurring, and hopefully that means that there will be some
consideration of recommendations and new initiatives will be implemented.

NURSE INJURY

12

References
American Nurses Association. (2010). Nursing: Scopes and Standards of Practice. (2nd ed., pp.
41-45). Silver Spring, Maryland: American Nurses Association.
Black, T., Shah, S., Busch, A., Metcalfe, J., & Lim, H. (2011). Effect of Transfer, Lifting, and
Repositioning (TLR) Injury Prevention Program on Musculoskeletal Injury Among
Direct Care Workers. Journal of Occupational and Environmental Hygiene, 8(4), 226235. doi:10.1080/15459624.2011.564110.
Hopcia, K., Dennerlein, J., Hashimoto, D., Orechia, T., & Sorensen, G. (2012). Occupational
Injuries for Consecutive and Cumulative Shifts Among Hospital Registered Nurses and
Patient Care Associates: A Case-Control Study. Workplace Health Safe Workplace
Health & Safety, 60(10), 437-444. doi:10.1177/216507991206001005
Howard, J. (2010). Occupational Hazards in Home Healthcare. Retrieved October 23, 2015, from
CINAHL.
Lee, S., Lee, J., & Gershon, R. (2015). Musculoskeletal Symptoms in Nurses in the Early
Implementation Phase of California's Safe Patient Handling Legislation. Research in
Nursing & Health, 38(3), 183-193. doi:10.1002/nur.21657
O'Connell, D. (2013). Focus on Safe Lifting Protects Nurses, Patients. Alaska Nurse, 63(1), 1-6
6p.
Quality & Safety Education for Nurses (QSEN). (2015). Retrieved October 23, 2015, from
http://www.aacn.nche.edu/qsen/home
McLeod, S. (2011). Albert Bandura | Social Learning Theory | Simply Psychology. Retrieved
October 25, 2015, from http://www.simplypsychology.org/bandura.html

NURSE INJURY

Nancy Roper - Nursing Theorist. (2015). Retrieved October 25, 2015, from
http://www.nursing-theory.org/nursing-theorists/Nancy-Roper.php

VanderZouwen, W. (2015, October 25). [Personal interview].

13