You don’t have to look far to find evidence that healthcare is one of the most dangerous professions. US News and World Report states that 654,000 healthcare workers are harmed each year. This is alarming since healthcare is also one of the fastest growing sector of the US economy according to the National Institute of Occupational Safety and Health (NIOSH). Chief among these occupational hazards are patient transfers which often lead to overexertion and injury in nurses and can indirectly impact patient outcomes such as patient falls and pressure ulcers. Nurses and aides conducting patient-transfers face verbal and physical aggression from patients. Consistent use of equipment not only makes the job safer for nurses but is also associated with less patient initiated physical and verbal violence.
Patient-assist injuries typically cost $15,860 in worker’s compensation claims and $15,825 in turnover replacement a year. Safe patient handling & mobility programs (SPHM) are effective in reducing injury and compensation costs. Yet curiously, evidence-based guidelines and research find that simply providing training, changing policy and providing equipment is often insufficient.
So how can we care for healthcare providers?
Effective safe patient handling often requires two or more nurses and subsequent communication of logistics such as staff availability, equipment availability (its storage location and sanitation status) as well as the ergonomic assessment of a patient’s status.
Our past research has indicated that nurses who have more peers in the workplace they can consult for safe patient handling advice and support were more likely to use equipment while nurses who have fewer peers to consult were more likely to quit. Based on these findings, our lab developed an evidence-based solution to reduce nurse’s musculoskeletal injuries by improving workers’ safety behaviors and was implemented at a 25-bed community hospital in Oregon. Our tactic was the identification, recruitment, training and deployment of peer leaders who champion safety practices like equipment use among their unit co-workers.
Preliminary results after just one year include reduced patient-transfer injuries.
- 50% decrease in patient-assist injuries
- 151% increase in safety incidents reporting
- Tripling frequency of patient-transfer equipment use
- 12% increase in safety climate
- 19% increase in team effectiveness
How did we do it? We are still analyzing our data but we suspect that champions were instrumental in producing these positive changes. Our program utilized social network analysis to identify nurses co-workers nominate as sources of safe patient handling advice. We then invited them to become safety champions who can address challenges related to safe patient handling. We equipped champions with effective communication and leadership skills to model equipment use to other nurses as needed during shifts. Champions also attended quarterly meetings where they discussed program challenges with hospital leadership, shared successes, generated action plans and reviewed progress.
What is novel about our approach is we leverage the informal relationships between employees to address workplace safety and health challenges, rather than training a supervisor to formally mandate behavior, which may not be effective if a supervisor does not consistently monitor and work alongside employees. Healthcare workers are more likely to report incidents and safety concerns to each other than a superior.
We’re excited at the prospect that this model of identifying and equipping champions can have for addressing health and safety behaviors across multiple industries. We hope to replicate this cost-effective program across rural hospitals in Oregon and expand the scope of the program by integrating patient-outcomes such as falls and pressure ulcers.
Submitted by Sam Greenspan, Research Assistant, MPH and David Hurtado, ScD, Hurtado Lab