A team of paraprofessionals told their AFT colleagues at an ergonomics conference last year that they’ve practiced partial emergency evacuations of their residential facility, but never a full drill and never with a plan, training or the right equipment.

“No two women can carry a 360-pound person down stairs,” one paraprofessional observed. “No two men can!” another exclaimed, speculating about how much help airplane-style slides might be in getting their patients to safety.

It doesn’t take a crisis, however, to see plainly that healthcare workers and their charges are sitting ducks for serious injury.

“It’s mind-boggling,” said Barbara Egger, a nurse at Runnells Specialized Hospital of Union County, N.J., and president of AFT Local 5112. Her operation has five lift machines for 60 patients. Each nurse is assigned 10 patients, and they’re supposed to have two staffers per lift—but the staff can’t stagger their lifting tasks throughout the morning because every patient needs to be up and dressed by a certain time. “So, you end up lifting them yourself,” Egger said between sessions, adding that lifting people is not like lifting boxes. They move.

Despite having electric wheelchairs and other technical gear, aides still are left “horsing things around,” the paraprofessionals noted. “They tell you to get help. What help?” asked Andre Eugene, a member of the United Federation of Teachers (UFT). “They’re all tied up. They’re busy. So for years, I did it myself.”

It’s not just your problem
According to the National Institute for Occupational Safety and Health (NIOSH), the maximum safe lifting weight is 51 pounds, with all other lifting conditions perfect—minimal forward reach, steady load close to the body, straight back, load between knees and shoulders, and good grips. Very few patient transfers occur under perfect conditions. And despite extensive scientific backing, these are only guidelines. Unfortunately, there is no OSHA legal standard for lifting limits. In reality, many healthcare workers lift 200 pounds or more several times a day, says a survey conducted for AFT Healthcare last year. As a result, more than half of 900 nurses and X-ray technicians surveyed suffered from lifting-related injuries, chronic pain, or both.

Many healthcare workers tend to think of an on-the-job injury as their problem: “Oh, that’s just my bad shoulder.” But it’s not true—it’s everybody’s problem. AFT Healthcare’s task force on safe patient handling urges members to report injuries, express outrage about career-ending injuries and make the case to stop manual lifting (see related story, page 5).

NIOSH-sponsored research backs that up. A 1999 University of Wisconsin study of seven nursing homes and one hospital found that replacing manual lifting with portable electric hoists and other devices reduced injuries 32 percent, workers’ compensation costs 55 percent and lost workdays 62 percent.

In short, the only safe lifting is zero manual lifting.

Even when two to four sturdy nurses or paraprofessionals are available to do manual lifting together, they still risk herniated discs, serious sprains and heart attacks, said Nick Warren, ergonomics coordinator at the Ergonomic Technology Center of Connecticut, one of two trainers who led the conference sponsored by AFT’s health and safety department.

What’s more, patients are getting older, weaker, more debilitated and more obese, added Tim Morse, training coordinator at the center, noting that the University of Connecticut Health Center cares for patients over 500 pounds.

In long-term care facilities, keeping residents within reasonable weight limits is a problem. Healthcare workers have tried to steer patients away from fatty foods, but salt, steroids and other drugs can increase patients’ weight as well. And physical therapy might amount to little more than “a walk around the corner,” added Eugene, a senior residential program specialist with United Cerebral Palsy of New York City, a private, nonprofit residential program for special education students. “They come in big and they get bigger.”

The main risk factors in lifting are repetition, force, awkward or static postures under load, bad grips, and velocity of lifting or twisting, Warren said. But the most dangerous risk factor is the attitude that “We’ve always done it this way,” he told conference attendees, lamenting that sometimes injured healthcare workers actually seem to be proud of their pain.

A better approach
It doesn’t have to be that way. “There really are ways to correct these problems,” Warren said. “It’s a matter of thinking about them and then taking the steps necessary to fix them.” For instance, hospital beds now exist that can lower to 18 inches off the ground so that patients won’t hurt themselves if they fall out. The beds also can be raised so that nurses can work without bending.

But much work remains in bringing healthcare facilities up to speed. After President Bush and Congress squashed the new OSHA ergonomics standard early in the Bush administration, a few states began taking on that responsibility themselves. For example, Texas and Washington state just passed new laws on patient handling, and initiatives have begun in other states as well (see sidebar).

At the federal level, U.S. Rep. John Conyers (D-Mich.) last fall introduced H.R. 6182, a bill that would amend OSHA to establish safer patient handling programs. For now, “Our work is to make changes in the workplace, in the absence of a standard,” said Warren.

Local unions also have spearheaded safety measures at their facilities. For example, members of Health Professionals and Allied Employees (HPAE) Local 5118 at the Cooper University Health System in Camden, N.J., activated a joint labor-management committee on safe patient handling, visited out-of-state health facilities to examine lifting practices, and spearheaded a model program that involved the union in all aspects of safe patient handling, including equipment selection and policy development.

The AFT’s healthcare federation in New Jersey, HPAE, also has secured state funding for joint labor-management training in safe patient handling that’s starting this spring, says HPAE public policy staffer Harriet Rubenstein. Employers will pay for participants’ time, and the state labor department will pay for trainers.

Improving patient handling conditions is key to getting older nurses back to the bedside, says Candice Owley, president of the Wisconsin Federation of Nurses and Health Professionals. The AFT vice president urges fellow members to follow the example of nurses in Australia who became fed up with their situation.

“They organized and won,” says Owley, who together with AFT vice president Ann Twomey visited hospitals in Victoria, Australia, several years ago. “Now, the nurses no longer have to do any manual lifting,” Owley says. “Hospitals in Australia are required to have lifting equipment built into the patients’ rooms, usually right behind the beds. These are the happiest nurses I have ever met.”

Besides bargaining for general contract language on health and safety, other strategies laid out by the AFT’s health and safety director Darryl Alexander include conducting campaigns that focus on working conditions, and forming coalitions with community groups. Union members also can act as catalysts for health and safety committees—and secure a place on them—ensuring that our union voice will be heard.

So, stand up and be counted before your back doesn’t let you. What contract language does your local have that might help you start or improve a safe patient handling program in your workplace?