THERE HAS been extensive literature on medical errors over the last decade, which has prompted the development of many safety initiatives and guidelines for practice. Most of these are intended to improve patient safety as they should, but it has become increasingly clear that we also need initiatives and guidelines to improve worker safety in the health care setting. Health care organizations striving for high reliability need to be concerned with the safety of both patients and their workers; patient safety initiatives are not enough.1 Recommendations for integrating patient and worker safety initiatives include building worker safety as a core value of the organization, identifying opportunities to link patient and worker safety activities across departments and programs, understanding and measuring performance on safety-related issues, and maintaining successful patient and worker safety improvement initiatives.1,2

One area that needs improvement is preventing injury and illness among nurses and other health care providers from lifting and moving patients. The US Bureau of Labor Statistics3 reported that registered nurses ranked fifth in injuries and illnesses related to musculoskeletal disorders occurring at work. These injuries often result from the manual handling of patients-from lifting, transferring, and repositioning patients; making a bed with a patient in it; and working in awkward positions. Not only do these injuries in nurses result in chronic pain and disability, but they also lead to lost work days and increased costs associated with medical expenses and disability compensation. The Occupational Safety & Health Administration reported that 20% of nurses leave their direct patient care positions because of work-related injuries and risks.4

Safe patient handling and mobility programs can reduce these types of injuries. These programs involve assessing high-risk patient care activities, deciding what type of assistance to provide with lifting and moving patients, and using the appropriate equipment to move patients.5 A systematic review by Tullar et al6 found a moderate level of evidence for exercise interventions and multicomponent safe patient handling interventions. These included a change in organizational policy, use of lift or transfer equipment, and training on equipment. Having equipment and other technology available, though, does not ensure that nurses and others will use it. Look around your unit and facility, and you are likely to find nurses rounding up colleagues to help them lift or move a patient.

In a study by Stevens et al,5 a multicomponent safe patient handling program reduced the number of injuries to nurses and other health care providers by 36%, and there was a 71% reduction in the number of lost work days, among other outcomes. Program components included state-of-the-art equipment for safe patient handling; education on risk and patient assessment and on equipment; a unit-based ergonomic assessment that guided decisions on the type and amount of equipment needed on the unit; assessment criteria and guidelines for safe patient handling; visible support from leadership in the organization; a unit-based champion for the program; and an evaluation plan to determine program effectiveness.5

The American Nurses Association has released national standards for safe patient handling and mobility with the aim of promoting a stronger culture of safety in the work environment, protecting not only patients but also health care workers from injury.7 These standards eliminate the manual handling of patients. There are 8 standards, developed by an interprofessional group that included nurses, and they are applicable across health care settings (Table). The standards will provide a framework for developing policies and, most importantly, multicomponent programs for safe patient handling.

Table. New American Nurses Association Interprofessional Standards of SPHM

More attention needs to be given to the instruction that nursing students receive on safe patient handling, in the laboratory, simulation, and clinical setting. What are students learning in the skills laboratory about lifting and moving patients? Are they gaining adequate practice in the laboratory and through simulation in using equipment and technology for safe patient handling? Do they know how to assess high-risk patient care activities and decide on the type of assistance to use with lifting and moving patients? Are clinical educators up to date with the current evidence, and what types of practices do they demonstrate when working with students in the clinical setting? In a study with undergraduate nursing and physiotherapy students, almost half of the sample admitted using unsafe moving and handling activities in the clinical setting, and 29% reported that they have experienced pain since becoming a student.8 If students are using poor practices, it is unlikely these will change when they graduate and enter the workforce. More needs to be done in nursing programs to better prepare students with practices that will prevent injuries in the work setting. The American Nurses Association national standards for safe patient handling and mobility will provide guidance for nurse educators in ensuring we are teaching current practices in our nursing programs.

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