Safe Patient Handling Addressed by Unions in Contracts & Collective Bargaining Tuesday, Oct. 28/APHA Ann Converso Introduction Thank you for the chance to speak to you today about a problem that is facing more and more nurses: unsafe patient lifting and movement and the injuries it causes. This is a growing problem that is still largely below the radar screen for those who don t directly experience it, but as nurses at the bedside face injury from unsafe lifting they leave or find work elsewhere contributing to a nurse staffing crisis that will impact every patient and every nurse. Unions are making headway in tackling this problem through our contracts and bargaining. More needs to be done, but this start has given us the momentum to pursue legislation in the states and at the federal level. Defining the problem In 2003, noted author and researcher Audrey Nelson wrote that 52% of nurses complain of chronic back pain. In 2005, RNs 1
ranked 8 th among occupations at risk for strains and sprains ahead of construction and maintenance workers (Bureau of Labor Statistics). If you know a staff nurse, these statistics are probably not surprising. In total, nurses lift an estimated 1.8 tons per shift, causing gradual wear and tear on their spines. RNs routinely lift, pull and move patients and equipment well beyond the limits recommended by NIOSH (the safe maximum lifting limit for women is 46 lbs and 51 lbs for men) because the lift equipment and extra staff necessary to safely execute these moves are not readily available in their facilities. Patients moved or lifted manually without proper equipment suffer stress and indignity, skin tears and abrasions, broken bones and even head injuries. Unsafe lifting practices have a chilling effect on an RN staffing crisis that is not improving. As we look at different strategies to make bedside nursing a more appealing option for RNs, the dangers of unsafe patient lifting are another reason for RNs to leave the bedside. A 2006 survey by Peter Hart found that 47 percent of hospital nurses report that they have considered 2
leaving patient care because of their jobs physical demands; among those nurses already injured, 59% have considered quitting. While unsafe patient handling is made worse by an aging nursing workforce and the increasing number of bariatric patients, this widespread problem affects every group of RNs nurses in their 30s, male nurses and patients who are not obese. Providing safe lifting equipment and the training to use it is a cost-effective, readily available option for hospitals and is safer for patients. Our national union, the United American Nurses, believes that every hospital in America must be required to provide equipment necessary to move and lift patients safely. UAN is working to pass safe patient handling legislation at the national level, and an increasing number of states, such as Minnesota and Washington State, have passed similar laws. The foundation for the legislative activity that has begun on this issue is the work that has been done in local RN bargaining 3
units to require hospitals to provide the tools for safe patient handling. Safe Patient Handling Addressed in Contracts We are beginning to make real progress in addressing the problem through contract provisions and other union activity. We are making headway in reaching agreements with hospitals on the nature of the problem and solutions to address it. Some examples: In the VA Health System, union nurses at the James A. Haley VA Hospital in Tampa, where UAN represents RNs, are taking the lead in establishing and implementing a safe patient handling program. While the union contract in the VA does not include provisions specifically on safe patient handling, union leaders are playing a critical role in partnering with the VA to develop and implement a safe patient handling program. o The union leadership in Tampa has worked closely with the VA to become the alpha site for a new safe patient handling initiative founded on the work done by Audrey Nelson and the Tampa Patient Safety Center of Inquiry. 4
The goals of the program are to build healthy communities, become an employer of choice and increase RN retention through safe patient handling as well as saving the human and monetary expenses caused by patient transfer injuries. o UAN union leaders sat with managers on the VA committee tasked by Congress with developing the safe patient handling program that was just launched at the Tampa VA last month. [PLEASE ADD YOUR OWN EXPERIENCES/COMMENTS ABOUT SAFE HANDLING POLICY IN THE VA] In Michigan, MNA/UAN nurses and management at Sparrow Hospital have made a no single lift policy an integral part of their comprehensive safe patient handling and movement program. o Parties agree that proper equipment and staff assistance will be available to health care providers to reduce the risks associated with single lift patient handling. 5
o Employees will not lift a weight that is unsafe for them individually without an appropriate lifting device and/or assistance. o Employer must provide employees with training on transfer techniques, and the union s health management subcommittee may recommend an appropriate number of lifting devices. In our union, Minnesota has made some of the most progress of any state on the issue of safe patient handling through the growing incorporation of model contract language they have developed on the issue. In addition to enactment of the state s groundbreaking safe patient handling legislation last year, the Minnesota Nurses Association/UAN and Fairview Hospitals (Twin Cities) have agreed to: o A repetitive lifting standard limiting lifting by a nurse to 35 pounds no more than 12 times per shift. Also, a nurse will not be required to lift without assistance more than one-half of his or her ideal body weight based upon a standard agreed upon by the Nursing Health and Safety Committee. 6
o The hospital agrees to make a reasonable effort to provide nurses with safe and adequate equipment the bargaining unit may designate one of its members to serve on CQI or product evaluation committees whose decisions affect systems or products to be used by RNs in delivering patient care. Also in Minnesota, a Letter of Understanding between Methodist Hospital and MNA/UAN nurses states the parties shared interest in safe patient handling, which results in minimum lift requirements and zero injuries to patients and staff members. The LOU goes on to call for the formation of a committee, composed of equal numbers of management and union representatives, dedicated to assuring safe patient handling and the pursuit of a zero injury goal, through research and recommendations for changes to equipment, technology and facility design as well as building support and compliance with the use of new equipment and technology. The committee is allocated a budget to be spent during the life of the contract, and has the authority and resources to act on its recommendations. 7
Conclusion Continuing to work at the bargaining unit level to address the dangers of unsafe patient handling is a critical component of educating hospitals and nurses alike about this issue. This serves to build momentum for additional state staffing laws and to increase support for federal legislation. For too long, nurses were trained to do what we have to in order to get by and take care of our patients even if it meant injury to ourselves. We have a real opportunity to address this issue with a new generation of nurses, who are learning not to accept previously common unsafe lifting practices or lifting without the proper equipment. The expansion of contract language on the issue and increased union activism in places like the Tampa VA are key tools in pursuing this goal before more nurses and their patients are injured. 8