English

Abstract

Introduction The high-risk, fast-paced healthcare industry presents unique health and safety challenges for healthcare personnel, including exposure to psychological and physical demands resulting in the incidence of musculoskeletal injuries of epidemic proportions. The dynamic healthcare environment demonstrates that workers are prone to injury through a host of factors unique to them being directly involved in patient care. Just as heredity and environment interact to result in disease, no single risk factor is responsible for injury but rather a complex interaction of worker, patient, and hospital characteristics. This critical review reports the risk factors and impact of musculoskeletal injuries, with consideration for how these factors impact the worker, quality of care, and patient outcomes. The intent of this critical review is to summarize current literature, identify gaps in research, and broaden the questions that are asked as the efforts to reduce occupational injury move forward, not to provide definitive risk factors and impacts for occupational injury. Conclusion The risk factors of occupational injury are well documented; less understood is the impact of elevated incidence of occupational injury on patient safety. Nursing injury rates are linked to nursing shortages and less nursing time at the bedside, both of which have been scientifically linked to negative patient outcomes. Further investigation is needed in this area not only due to the pain and suffering experienced by those directly affected, but also because of the organizational impacts that indirectly affect patient care. The benefit of this research is to reveal the integral role the individual worker plays in patient outcomes, despite the quality of care they provide, a finding that could dramatically change strategic priorities to deliver exemplary patient care and ensure the health and safety of workers, patients, and the public. Introduction Driven by an ageing population and longer life expectancy, healthcare is one of fastest growing sectors of the economy, employing over 18 million workers in the United States and over 59 million worldwide1,2. This high-risk, fast-paced industry presents unique health and safety challenges for healthcare personnel, including exposure to psychological and physical demands resulting in the incidence of musculoskeletal injuries of epidemic proportions. Occupational risk factors include heavy manual lifting, repetitive movement, poor posture, and continuous work. Overexertion represents one of the most disabling work-related injuries, representing approximately 50 lost workday injuries per 10,000 fulltime equivalent (FTE) employees and more than $13 billion per year in direct costs, accounting for more than one-quarter of the overall national burden of occupational injury3,4. More than one-third of occupational injuries in healthcare involve interaction with people other than the injured employee, most frequently with a patient (28%), indicating the risk associated with patient handling5. Each day, more than 9,000 of the nation’s healthcare workers sustain a disabling injury while moving a patient6. Many experts believe this figure represents significant underreporting of cases. Unfortunately, nurses accept occupational pain and injury as part of their job, with 52% to 63% of nurses reporting musculoskeletal pain that lasts for more than 14 days7. The dynamic healthcare environment demonstrates that workers are prone to injury through a host of factors unique to them being directly involved in patient care. These risk factors can be identified as characteristics of the worker, the patient, and the hospital (Figure 1). Occupational injury in healthcare workers leads to pain, disability, and lost time—all factors that contribute to decreased work effectiveness. The most obvious impacts of work injury are those that are quantifiable, such as direct and indirect costs to the hospital, high turnover and staff shortage. This critical review will summarize current literature, identify gaps in research and broaden the questions that are asked as efforts to reduce occupational injury move forward. This critical review attempted to identify all articles that examine occupational musculoskeletal injury in healthcare personnel responsible for * Corresponding author Email: 4kristenmiller@gmail.com 1 VA National Centre for Patient Safety, Ann Arbor, MI, USA direct patient care. Exclusion criteria for articles included methodologies utilizing symptoms and frequency of pain as determinants (rather than injury) and review of healthcare personnel that do not have direct patient contact (e.g. maintenance, food service, laboratory). All articles