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Audrey Nelson: On a Quest to Protect Health-Care Workers

Audrey Nelson
Audrey Nelson (Courtesy of the Department of Veterans Affairs)
From the Partnership for Public Service
Monday, August 10, 2009; 5:29 AM

Audrey Nelson, a medical researcher at the Department of Veterans Affairs, fought the odds to protect thousands of nurses and other health care providers from disabling workplace injuries.

Nelson began her quest 20 years ago to solve the problem of musculoskeletal injuries among nurses. She observed how workers at loading docks relied on equipment for lifting, and she never stopped asking why nurses weren't using mechanical means to move patients.

"Her observations led her to do research that transformed the way we care for patients," Stephen Lucas, director of the James A. Haley Veterans Hospital in Tampa, Fla., said.

Nelson's pursuit of a solution to the high rate of nursing injuries led to a $200 million three-year program funded by the VA, designed to radically change the way nurses handle patients nationwide. The program discourages manual lifting, promoting the use of mechanical technologies instead.

"Because of her tireless dedication to improving care and getting people to work together, we have the best practices for moving patients that will keep them safe, and that will keep nurses safe and in the profession longer," Lucas said.

In coordination with the American Nurses Association and the National Institute for Occupational Safety and Health, Nelson's efforts also have resulted in a safe patient handling curriculum at 26 of the nation's nursing schools.

Nurses represent the largest group of health care providers in the nation, with about 38 percent reporting back injuries during their career due mainly to transferring, lifting, moving, turning and bathing patients.

Back injuries have been a major contributor to the nursing shortage, but for decades the efforts to reduce work-related musculoskeletal injuries in hospitals and nursing homes relied mostly on body mechanics classes or training in lifting techniques that proved to be largely unsuccessful.

Working at the James A. Haley Veterans Hospital in Florida, Nelson identified the common nursing tasks that contributed most to musculoskeletal injuries. She tested ways to redesign the task or to complete it using mechanical lifts and transfer devices, which led to a series of studies and clinical tests funded by the VA.

Her studies developed an approach that decreased the number and severity of patient handling injuries, lowered worker compensation costs and resulted in increased comfort and dignity for patients.

"There's a lot of pressure on government and our health care system with the shortage of nurses. I wish I could find out how many bodies she has saved, how many nursing careers she has saved," Tom Waters, the chief of ergonomics research at the National Institute for Occupational Safety & Health, said.

"Dollar-wise, I'm sure that the savings are in the billions when you think about the worker's compensation claims and injuries prevented, and all of the nurses who can remain on the job because of the changes that she has created in their work environment," Waters said.

Nelson met repeated resistance from nurses, occupational therapists, rehabilitation specialists and long-term care providers to move patients mechanically. Critics considered mechanical devices undignified. Hospital administrators said the change would cost too much.

"Initially, people didn't want to hear about the problem and they just didn't want to see the risk," Nancy Hughes, director for the Center for Occupational and Environmental Health of the American Nurses Association, said. "Audrey persisted and she eventually convinced them that they could work together to create win-win situations for the health care providers and the patients."

Nelson said many nurses have what she calls the "Florence Nightingale syndrome ¿ they will sacrifice themselves for the patient."

"So you have a 125-pound female nurse trying to move a 250-pound male patient using her own body. It's a dangerous situation ¿ for the nurse and the patient," Nelson said. "Now we are hearing that nurses get trained on the equipment in school, and then they expect to have it on the job. They go into their jobs and demand it if it's not available."

This article was jointly prepared by the Partnership for Public Service, a group seeking to enhance the performance of the federal government, and Visit for more about the organization's work.

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