Nursing can be a real pain in the back.
"You can feel it in your back after a 12-hour shift, there's so much moving and lifting" of patients, says Marjorie Simpson, a registered nurse at Johns Hopkins Hospital's intermediate care unit. She hurt her back a year ago, trying to move a heavy patient on her own.
The lesson: "You practice good body mechanics, and you learn to rely on other nurses to help you with a 'boost.' "
Despite the perils of working among deadly germs, disabling chemicals and dangerous equipment, the No. 1 cause of disability for hospital and health care workers remains the injured back.
After truck drivers and warehouse workers, patient-handlers in the health care industry have the highest number of back injuries, points out Gerard Scannell, head of the U.S. Occupational Safety and Health Administration.
More than half of the injuries and illness claims for worker compensation hospitals are related to back injuries, a federal Bureau of Labor Statistics survey shows.
"Lifting patients is the most stressful kind of lifting. It's awkward, and there is often no choice about having to lift the patient," said William Borwegen, health and safety expert for Service Employees International Union, which represents nearly 400,000 health care workers.
"That's why nursing home workers suffer more back injuries than workers in coal mines or steel mills."
At the Johns Hopkins medical institutions, more than 90 percent of the worker compensation claims are for trauma injuries.
Back injuries are the most common, noted Edward J. Bernacki, the system's occupational health and safety director.
"Back injuries lead to the most disability claims [for employees]," he said, "and nurses have the highest rate of back disorders of any occupation."
Unusual movements that cause back injury can be engineered out of most assembly-line jobs, he observed.
"But in hospitals, there is a free-flowing system of movements" in lifting patients in and out of beds that is more difficult to regulate.
Dr. Bernacki believes that one answer lies in designing new hospital equipment, such as easily raised beds and patient-lifting devices thatare worker-friendly as well as patient-friendly.
"Most hospital equipment has been developed without looking at the ergonomic point of view," he said.
A University of Wisconsin study showed a 30 to 50 percent decreasein back injuries among nursing home workers who consistently used equipment to help lift patients.
The National Institute of Occupational Safety and Health is studying these devices, which include portable mechanical hoists, belts with handles worn by patients to help attendants and special chairs for shower and toilet that reduce the number of times an immobile patient must be lifted.
NIOSH also is revising its 1983 work-practices guide for industries to set limits on how and how much a person can safely lift in various jobs.
Another approach was adopted at San Francisco General Hospital, which created a specialized two-person lifting team for all patient transfers.
Back injuries on the day shift have dropped from 16 to zero in the two years since the team began, with cost savings of more than $75,000 a year, said the hospital's occupational health chief, William Charney.
"Lifting is a skill, not a random task," he said.
"It's so simple and so obvious, but people won't recognize it."
Repeated training programs for nursing staff have failed to reduce back injuries, because lifting requires specialized, concentrated attention to the task, he said.
All too often, accidents happen when hospital workers try to move patients without proper help or concern for their own well-being, noted Jordan Barab, safety and health director of the American Federation of State County and Municipal Employees, which represents about 350,000 health-care workers.
"They see a patient has fallen or needs prompt attention, and they tryto move that patient without waiting for help," he said.
Proper lifting techniques -- bending the knees, keeping the back straight -- are often prescribed as a simple remedy to the widespread problem. But training is often a one-shot item that is not reinforced, he said.
"The fact is, it's not always how, but how often and how much you lift that causes problems . . . it's often a cumulative strain, not one heavy lift, that causes the back to go."
Fatigue can impair judgment and physical abilities of the best-trained personnel, leading to back injuries, noted Addie Eckardt, of the Maryland Nurses Association.
"With double shifts and weeks without a day off becoming more common [because of nurse shortages], there's more chance of it happening these days," she said.
In nursing homes, the higher ratio of patients to employees makes the danger of injury from lifting even greater, she added.
Federal surveys show nursing home workers have a 50 percent higher rate of injury than hospital counterparts.