I come from a family whose careers are concentrated rather heavily in the medical field. I am the daughter of a Registered Nurse with decades of experience in everything from Emergency Medicine to Surgical facilities to Hospice care. My younger sister is a Certified Nursing Assistant with multiple years of experience in several different nursing home and long term care facilities. One cousin of mine is a sleep study technologist. Another works with the EHR system in a clinic. Yet another is also a CNA. An aunt has worked for many years in a medical clinic in an office manager capacity. Another cousin’s fiance is a lab tech. You catch my drift…my family’s career choices are more likely than not to be health care related. I had even briefly entertained the idea of entering the medical field myself, before deciding on my passion for history instead. I suppose it is both fitting and ironic that I am thinking of transitioning into the medical field, albeit on the IT side of things.
Because of this strong experience and connection to the medical field, I listened with interest to an NPR piece last week on OSHA’s issuing of enforcement letters to hospitals warning them that the rate of on-the-job injuries to nurses was too high, and they have intentions of examining hospitals to make sure that they are taking adequate steps to protect staff from those injuries. You can listen to the story or read the companion article here. This is something I have personal experience with. My sister, who is several years younger than me, is in worse physical condition than I am because of the nature of her job. She has suffered numerous musculoskeletal injuries along with various bruises, bites and scratches from lifting and moving patients, some of whom are suffering from dementia and tend to get combative. And she is not the only one.
OSHA is essentially arguing that hospitals and other care facilities are doing too little to prevent these injuries among their staff, and OSHA Chief David Michaels is authorizing his regional offices to begin issuing fines to facilities who do not do enough to protect their workers from on-the-job injuries. In particular Michaels pointed to back injuries incurred when nurses have to move patients, stating that even when nurses use the Proper Mechanics Technique that is taught to them in training, there is a strong probability that the nurse will still be hurt. In an NPR series this year on Injured Nurses, Dr. William Marras, Director of the Spine Research Institute at Ohio State, said flat out “There is no safe way to do it [lift and move patients] with body mechanics.” The only way to move patients safely, the experts concluded, is to use equipment such as ceiling hoists or lift chairs and such.
But will this new enforcement memo have an impact? Does it actually have any teeth to it? The article states that a hospital determined to be at fault for a staff member injury from this type of on-the-job duty could be $7,000, but that the fine may go as high as $70,000 if the investigation determined that hospital administrators were aware of the problem but deliberately ignored it or covered it up. Those fine amounts are nothing to sneeze at, even at bigger facilities. But I share the concerns of Dr. Michael Silverstein, former director of Washington state’s OSHA program, who points out that due to staff and budgetary constraints, OSHA would only be able to investigate “dozens” of hospitals per year. To put that number in perspective, the US has approximately 4000 hospitals alone, and countless more nursing home and long term care facilities.
I do hope that this change will have an impact on this issue. I definitely sympathize with the hospital administrators, being the former director of a non-profit organization myself. I know how tightly the budgets are set, and how easy it is to put off spending on pieces of expensive equipment when staff can do the same task for much cheaper. However, I would encourage administration to take a longer-term view of the problem, as it can be a situation where you are being penny wise and pound foolish. It may be cheaper this quarter or this year to simply pay the staff and their workers comp claims than to invest in chair lifts and ceiling hoists. But take those numbers, combined with lost productivity, high turnover rates among your staff due this issue, re-training new staff and add in a potential OSHA fine; it can very quickly add up to more than the cost of those chair lifts year after year. Smarter up-front investments, even though they are more costly at the start, can be cheaper in the long run. Not to mention the nurses and nursing staff of the world will thank you for saving their careers (and their aching backs).