Protecting nurses from back injury

Although research points to a need for better policies to protect nurses from back injury, the onus is often on RNs to watch their everyday movements and motions that may lead to long-term pain.

Janet Klok’s experience with back injury is probably more extreme than most nurses will ever face. She’s experienced bullying, fights with the Workplace Safety and Insurance Board (WSIB), two lay-off notices, and arbitration through her union. Her story may not reflect the norm, but it’s one that illustrates just how much your life can change when you twist awkwardly to help a patient. It was a Sunday at 4 a.m. on the neurosurgical floor of the  hospital where Klok was filling in as a member of the float team. As the veteran RN (with 20 years of experience) finished up her rounds, she heard an unusual sound down the hall. She entered a room where she found a woman, groggy from her meds, grasping her walker and heading for the bathroom. As Klok stood at the foot of the bed, she noticed the woman attempting to squat to relieve herself. She grabbed her by the arm to pull her back up.

“I’ve turned a 500-pound patient by myself, so I know how to move,” Klok says, adding the woman began pulling in the opposite direction. “She just caught me off guard.” Klok twisted to reach the call bell, a motion that strained her neck and injured her lower back in one fell swoop. She struggled to hold the woman up for at least five minutes, waiting for colleagues to arrive. The now 51-year-old mother of four knows that’s what did her in. Four years after that injury, WSIB has now deemed Klok’s neck a permanent impairment. She’s still fighting to have her lower back injury recognized as equally problematic.

“I was not going to go to emerg,” she recalls of that night in 2009. Her colleagues convinced her to have the injury checked out, and she says “it’s been a nightmare ever since.” That’s primarily because she feels she’s had very little support from her employer, and suffered severe stress as a result of bullying by a manager at work. Klok was on sick leave immediately following the injury, then stress leave a few months later. She was laid off during her stress leave, and only this September resumed her role thanks to help from her union. “I didn’t do anything wrong,” she says. “I did my job and got hurt…and I didn’t deserve to be treated the way I was treated.”

Klok admits she knew nothing about her rights when she injured her back. And she’s not alone. “I’ve actually become a bit of an advocate and resource for other nurses who are injured and have no idea what to do,” she says. Klok is currently doing her master’s degree, and suggests the lack of knowledge among nurses could stem from the lack of research on the subject.

One comprehensive study that looked at the issue is the now eight-year-old National Survey of the Work and Health of Nurses. Conducted by Statistics Canada in 2005-2006, it found one in 10 nurses reported occasional or frequent injury on the job in the year before the survey. And about 37 per cent reported they had experienced pain serious enough to prevent them from carrying out their normal daily activities.

A more recent systematic review of 89 existing studies on the correlation between nursing and lower back pain, conducted by nursing researchers at the University of British Columbia and published in the International Journal of Occupational and Environmental Health (September 2013), found a clear link between nursing duties and lower back pain. That link is sufficient scientific justification for reversing the burden of proof placed on injured nurses, researchers wrote, suggesting “…sufficient evidence exists … to warrant new policies.”

Although these are important research findings, they don’t quite get to the heart of what Klok and others suggest is a bigger issue: an acceptance of back injury as commonplace in the profession. Klok considered simply working through her pain, and says many of her colleagues would do the same. She wonders if that attitude can be linked back to nurses’ training days, and the implied message she remembers from nursing school: if you’re injured, “suck it up.”

That message to students may not be as prevalent today, thanks in part to educators like Anne Marie Lozinski, a clinical tutor at McMaster University in Hamilton who teaches good body mechanics (proper body movement that helps to prevent injury). Lozinski, who sustained a back injury in 2004, admits that injury is sometimes not preventable, because it’s an unexpected movement on the part of the patient. But, more often, it’s about understanding patients’ limitations. “You can underestimate how much assistance they need,” she explains. If colleagues are busy, “…You think ‘I can do it myself,’ and then…you’re stuck, holding someone who’s not able to bear their weight.” Lozinski admits that when she injured her back, she had just come off an evening shift, and returned to work for a day shift less than eight hours later. She says the muscles that should have engaged to protect her back were fatigued from overuse and lack of rest.

York region public health RN Patricia Ono was a new grad working in acute care when she first hurt her back in the 60s. Young and naïve, she entered a patient’s room and decided not to turn on the light and wake the gentleman in bed. She went to pull a lever to adjust his position, and yanked the wrong one, pulling her back out instead. She continued to work, and when a large gentleman later grabbed her arm to pull himself up, she collapsed on the floor and couldn’t stand up. Ono believes the onus is on the nurse “…to think all the time.” The first question she asks herself in any situation is ‘how am I going to do this with the least amount of stress on my back?’ “I used to have a head nurse who would say, ‘if you think with your head, you’ll save your feet,’” Ono recalls. She’s altered that motto: “If you think with your head, you will save your back.”