How much can nurses handle? A "no-lift" policy in hospitals and rest-homes promises to reduce nurses' back injuries caused by handling patients and lead to improved patient care.

NURSES' BACKS are one of the most-used pieces of equipment in the health sector, and subject to plenty of wear and tear. The result is back injuries that cost the industry a fortune, not to mention the cost to nurses themselves, who often leave the profession with back problems.

Recognising the danger of injuries caused by handling patients, and after working with the Department of Labour's Occupational Safety and Health Service (OSH) and the industry, ACC put out the New Zealand Patient Handling Guidelines: the Liten Up Approach in 2003, based on a "no-lift" approach. (See www.acc.co.nz for information on how to download or order a copy). Some organisations here and overseas have introduced no-lift policies that mean mechanical equipment and simple aids like slippery sheets, in combination with safe handling techniques, can remove the burden of heavy lifting. Is the move to "no-lift" nursing inevitable? Is it financially viable? And how will nurses themselves react to the change?

Wellington Hospital recently introduced a new patient-handling regime, which has dramatically improved the health of nurses, reducing days off due to injury from 100 days in the year to zero. The programme was a 2004 finalist in the ACC Thinksafe Workplace Safety Award of the Wellington Region Gold Awards.

Capital and Coast District Health Board's (DHB) first move was to employ a patient handling co-ordinator. Occupational health team leader Dave Robbie said: "We needed a person with expertise and mana to develop the programme fully." A clear patient handling policy was put into place, which was understood and supported by management--an important aspect, as management needed to release staff to attend training.

The DHB's policy closely followed the key points of the Patient Handling Guidelines:

* Review and evaluate existing regime

* Policy and planning

* Patient risk assessment

* Training

* Supply of patient handling equipment

* Facility design.

Any patient-handling programme relies on well-trained staff. It was worked out that employees needed at least a half-day of training to learn new techniques, and needed the opportunity to practise those new skills.

"The thing about the training is that it's hands on," Robbie said. "It says: 'here are the situations most encountered, have a go at doing it yourself Instead of focusing on general "back care" messages, the training gives staff first-hand experience in using equipment like ceiling hoists and slings."

As well as investing in training, the DHB spent $400,000 on patient handling equipment. "We made sure the type of equipment we bought was reliable, easy to use and met the needs of each area," Robbie said. "We wanted to avoid a one size-fits-all approach."

Well-trained staff set the tone when it came to using the new equipment. "You might wheel in a hoist and the patient thinks, 'I don't want to be lifted up in this contraption'. But if staff are confident with the equipment, they'll pass this on to patients."

Alongside new skills were new attitudes, he said. "We have to move from 'how do I lift a heavy load safely?' to 'how can this task be done without needing to do heavy lifting?' Society's attitudes need to change too. There has long been an unspoken belief that those in the caring professions should selflessly place the needs of others ahead of their own, encouraging them to 'suffer in silence' about their own injuries," Robbie said.

"No-one wants to undermine the caring, 'patient-first' attitudes that make nurses one of society's most respected groups. But the public needs to acknowledge that nurses can only look after us, if we look after them. We also need to encourage nurses to look after themselves."

Avoiding injuries to nurses has substantial pay-offs. Overseas evidence has shown that spending on patient handling improvements is a smart investment. Estimates range from $2 to $17 saved for every dollar spent. (1) And, Robbie said, patients could benefit too. "If you hurt your back and you drop the patient, the patient's going to get hurt. It's as simple as that."

As nursing shortages make front page news, some OSH staff have suggested that improving patient handling could help retain staff, and bring nurses back into the profession who have left due to back problems.

--This article has been supplied by The Occupational Safety and Health Service of the Department of Labour.

REFERENCE

(1) Head, M. (1998) Manual Handling Project: The Canberra Hospital (1994-1996) Evaluation. Canberra Hospital