Nurses are arguably the most critical element in the delivery of primary care within any healthcare organisation, either private or public. Within this environment, despite the availability of various types of lifting equipment and aids, the nurse’s role will frequently involve manually lifting or assisting in movement and lifting of patients as part of routine activities such as toileting or bed to chair transfer, or mobilising
Ironically, as a consequence of these often unergonomically sound activities, nurses do experience a significantly increased incidence of back problems, back pain, or injury, in comparison with other occupational groups.
In terms of high risk groups for occupational low back pain, nurses and related workers are considered to exhibit to the highest incidence of lower back pain and back problems (such as lumbar disc herniation) requiring medical or hospital intervention. Registered nurses rank seventh and nursing aides and orderlies are highest ranked across all occupations for back injuries involving absenteeism from work in private industry 1
In a study carried out into the occurrence of back pain in nurses working in an acute care facility in Hong Kong reported a figure of 80.9% of respondents suffering some sort of back pain in their careers with one third experiencing back pain at least once a month.2 The main two dynamic contributory factors to back pain in nurses were lifting patients and transferring patients, with stooping identified as the most common static factor contributing to back pain. Most incidents of back pain were reported to be on orthopaedic wards, closely followed by elderly or geriatric nursing. Dynamic factors thought to be the cause of back pain being manual lifting or transfer of patients. Back pain as a result of standing during surgery was not considered significant.
Another consideration of the impact of back pain in nurses could be that of low morale. In one of the studies above (2) two thirds of nurse sample population experienced back pain more than twice a year indicating that there could be a serious chronic back pain problem in nurses. Quite often, depression is associated with chronic low back pain which could manifest itself in low morale and lower job performance amongst nurses (Skevington 1983, Tollison 1987).
In addition to the physical and psychological / sociological impacts of the condition, back pain in nurses is a major cost within the organisations as a direct result of compensation costs associated with back injuries. For example in long-term care facilities in the United States, nurses’ back injuries are estimated to cost over US$6 million in indemnity and medical payments. Nurses’ compensation for back injury comprises 56.4% of all indemnity costs and 55.1% of all medical costs.3
Possible causes of lower back pain in nurses
Some of the factors which could lead to an increased incidence of back pain in nurses may include;
- Exposure to high physical loading on the back as a direct result of heavy patient lifting activities.
- Poor posture or twisting of the torso during patient mobilising activity.
- Inadequate lifting techniques
- Psychosocial factors such as personality and the presence of psychosomatic symptoms.
- Insufficient back pain prevention training or education
- Inherent Physiological characteristic of the nurse
The physical size, build, or gender of the nurse will almost certainly be a contributory factor to the incidence of back pain in nurses, especially where lifting assistance either mechanical or by support staff is not sought for whatever reason. The results of one cross sectional study4 into the occurrence of back pain in nursing carried out in indicated that amongst the sample population, the incidence of back pain in nurses was statistically twice as high in female nurses (68%), than in male nurses.
There was also an association with occupational hazard and poor knowledge of back care ergonomics. Again the main conclusion of the study was that poor back care ergonomics was the major predisposing factor of lower back pain
Experience or (inexperience) in the role
Nursing qualifications are important, with nursing assistants at greater risk of back pain than registered nurses. There is evidence that experience or length of service in nursing may also be relevant, with studies concluding that younger nurses are at greatest risk of developing low back pain 5
Although the incidence of lumbar pain in nurses is high, it is not clear at what point or over what period a nurse may develop or experience lower back pain. A study carried out in Western Australia sought to identify the relationship between age and occupational exposure on the prevalence, duration, and severity of low back pain in both nursing students and graduates. 6
The study concluded that the results may have suggested a rise in the occupational exposure from student to working nurse was the primary cause of an increase in low back pain. Increased exposure may have related to physical as well as psychological stressors. As prevalence rates were very high prior to work commencement ,it was suggested that student nurses should be considered as a target group for lower back pain therapy and preventative strategies.
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- Bureau of Labour Statistics. Case and demographic characteristics for work related injuries and illnesses involving days away from work. Resource table 10: detailed occupation by selected parts of body affected. United States Department of Labor, 2002
- The prevalence and cause of occupational back pain in Hong Kong registered nurses (Featured in journal of advanced Nursing Jul 97) Peter French RGN PhD Project Manager, The Institute of Advanced Nursing Studies, Hospital Authority,Hong Kong, Lee Fung Wah Flora RN BN(Hons)Yan Chai Hospital, Liu Sum Ping RN BN(Hons)
Yan Chai Hospital, Luk Kar Bo RN BN(Hons), Pamela Youde Nethersole Eastern Hospital, and Wong Heung Yee Rita RN BN(Hons) Yan Chai Hospital - Nursing staff back injuries; prevalence and costs in long term care facilities Cohen – Mansfield, Culpepper WJ, Carter P AAOHN J 1996 44:9-17
- Prevalence and risk factors of low back pain among nurses in a typical Nigerian hospital L Sikiru, S Hanifa Afr Health Sci March 2010 10(1) 26-30
- Relationship between risk factors and musculoskeletal disorders in the nursing profession: a systematic review. Occupational Ergonomics Sherehiy B, Karwowski W, Marek T. 2004;4:241–79.
- Low back pain characteristics from undergraduate student to working nurse in Australia: a cross-sectional survey. Mitchell T, O’Sullivan PB, Burnett AF, Straker L, Rudd C School of Physiotherapy, Curtin University of Technology, Perth, Western Australia, Australia.