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Back Facts - A training workbook to prevent back injuries in nursing homes

SEIU Education and Support Fund
1313 L Street, N.W. Washington, D.C. 20005 (202) 898-3200

Contents

How This Book Works

Activity 1 - Can nursing home work be hazardous to your health?

  • Summary

Activity 2 - "Back" talk: Why and how you can hurt your back at work

  • Summary

Activity 3 - On the lookout: Does your work make you hurt?

  • Job Task Risk Factors Checklist
  • Body Movement Risk Factors Checklist
  • Summary

Activity 4 - Making your job safe: Solutions that work

  • Lifting Devices Checklist
  • Equipment Checklist
  • Resident Assessment Checklist
  • Lifting Training Program Checklist
  • Summary

Activity 5 - If you are hurt on the job

  • Medical Management Plan Checklist
  • Summary

Activity 6 - Everyone Benefits from an ergonomic program

  • Summary

Activity 7 - A plan for change: Safety and health committees

  • Summary

Appendices

  • Appendix A: Four Basic Exercises for Good Back Care
  • Appendix B: Activity Evaluation
  • Appendix C: Directory of Equipment Manufacturers
  • Appendix D: OSHA Regional Offices
  • Appendix E: SEIU Health and Safety Offices
  • Appendix F: National COSH groups
  • Footnotes

How This Book Works


The SEIU Education and Support Fund (ESF), with funding from the Occupational Safety and Health Administration (OSHA), has put together a training program to educate ourselves and learn how to prevent back injuries on the job.

You know best about the hazards of your job. You face these problems every day on the job. You have ideas about how to solve these problems. SEIU's experience is that workers learn best when they can share experiences and learn from each other. Worker participation is key to a good training program.

This workbook uses a method called the small-group activity method (SGAM). This method allows us to work in groups to solve real-life problems, building upon our skills a nd experiences. It allows us to learn by doing.

The method is based on activities. An activity can take from 30 minutes to an hour. Each activity has a common basic structure: small group tasks, report-back and summary.

Small Group Task

The workshop always operates with people working in groups, preferably at round tables. Each activity has a task, or a set of tasks, for the group to work on. The idea is to work together using each other's experiences to tackle problems and make judgments on key issues. Part of the task involves looking at factsheets to develop and opinion on an issue.

The Report-Back

For each task, the group selects a reporter whose job is to take notes on the small group discussion and report back to the workshop as a whole. The trainer/facilitator records these reports on large pads of paper in front of the workshop so that all may refer to them. After the report-back, the workshop is thrown open for general discussion about the problem/issue at hand.

The Summary

Before the discussion drifts too far and wide, the trainer/facilitator highlights the key points (there are summaries at the end of each activity) and brings up problems and points that may have been overlooked in the report-back. Good summaries are short and to the point.

Activity 1 - Can nursing home work be hazardous to your health?


Purpose: To understand why nursing home work can be hazardous to your health.

Task:

You have just been to a training program on back injury prevention. You go back to your facility and a co-worker asks you what you learned. You tell her that nursing home work causes more injuries than construction or mining. She doesn't believe you. She says that younger workers aren't "tough" enough and that many workers are too careless these days.

Please answer the following questions. Refer to atleast two factsheets in this chapter in your response.

  1. What do you say to her? List three or four responses.

  2. Why has the back injury rate gotten worse over the past 10 years? List three or four responses.
Fact Sheet 1

Good news, bad news and back news

Caring for yourself helps you care better for your residents. You don't have to care until it hurts. Getting hurt is not part of the job. Our jobs can be safer. Unsafe jobs should be fixed before you find yourself out on your back.

The Bad News

Nursing home work can be dangerous work. What you do for a living may lead to more back injuries than working in construction, in a warehouse, or even a coal mine.1

In 1993, nearly 17 out of every 100 nursing home workers lost work time due to an illness or injury on the job. That's a total of 216,400 injuries and illness with untold pain and suffering.2 Only meat processing plants and car manufacturing plants had more injuries.

The number of back injuries mentioned here only count the reported injuries. The true number could be much higher. One study of nursing personnel showed that only one third of those workers who had back pain on the job filed and incident report.3 Most used their own sick time. Many workers are afraid they will lose their jobs if they report an incident. They simply can't afford to be sick.

The Back News

One out of every four injuries in general industry are due to back sprain and strain. Yet back and shoulder injuries are responsible for 54 percent - over half - of all injuries and illnesses among nursing assistants.4 While the number of back injuries is going down in manufacturing, the number has gone up among nursing assistants over the last 10 years.

Fact Sheet 2

Big, getting bigger, and growing fast

Nursing homes are the fastest-growing part of the health-care industry. People are living longer. The Census Bureau says that 40 years from now there will be 70 million over age 65. Nine million of them will be over age 85. That's three times as many people over age 85 as we have today.5 More old people means more nursing homes. That's plenty of new jobs for nursing assistants.

Growing Pains

Sicker residents are entering nursing homes. Many hospitals are shortening the length of a hospital stay because of changes in medical procedures, lack of money, or lack of beds. Medicare also limits the number of hospital days that it will pay for.

Many elderly hospital patients are too sick to go home. But they can't afford to stay in a hospital with the expensive daily price tag. Nursing homes are the solution.

Some nursing home industry studies guess that 10 to 20 percent of acute-care hospital patients can be moved out of hospitals and into nursing homes which provide some of the care found in hospitals, but at a lower cost.6 This is called sub-acute care.

These sub-acute patients are becoming nursing home residents. This changes the kind and amount of work that will be done by nursing assistants in nursing homes.

Nursing home owners are excited. This new group of elderly residents is worth up to $10 billion in new money for the nursing home industry.7 But what does this mean for nursing assistants?

  • Sicker residents
  • More dependant residents
  • More lifting and transferring
  • More risk of getting a sprain or strain injury
Fact Sheet 3

Losing Time

According to the Bureau of Labor Statistics, nearly 80 percent of all back and shoulder injuries are due to handling and transferring residents. In other words, nearly 80 percent of all back injuries are related to overexertion from lifting, pulling, pushing, holding, carrying, and turning motions.8

Altogether, more than 66,500 injuries that resulted in days away from work were reported among nursing assistants in 1992.9 In some cases, many days, weeks, or months were spent away from work. This lost time hurts:

  • the income of the injured worker
  • the families who depend on the hurt worker
  • residents who suffer from lack of care
  • the employer who must pay for replacement help

In addition, the cost of workers' compensation premiums rises.

Remember: Most injuries aren't reported. What we see is the tip of the iceberg. And what we're seeing is high enough.

Fact Sheet 4

Dropping like Flies

Nursing assistants do nearly all of the lifting, transferring, and heavy work in a nursing home. High staff turnover is a big problem in nursing homes. Many nursing assistants quit before their first year is up. A big turnover in nursing home staff means lots of problems for everyone.

When the staff turnover is high, patient care is affected. There are fewer experienced and well-trained staff. If not enough nursing assistants or equipment are available on a shift, workers tend to do the heavy lifting alone.

Why do nursing assistants quit?

  • Low pay
  • Stressful working conditions
  • On-the-job injuries.

Barely Surviving

In one year in Wisconsin, one out of three full-time nursing assistants had been at their present job less than a year.10 Wisconsin is just like other states. High turnover tells us what is really going on.

Fact Sheet 5

The stakes are high

Prevention of back injuries is smart business. Management can save lots of money.

  • Individual back injury claims have cost as much as $90,000. Run-of-the-mill claims can cost $15,000 to $118,000.11 Your employer pays in a couple of ways:
    1. Increased workers compensation costs
    2. Cost of hiring and training replacement workers.
  • Nursing home work is hazardous and expensive. Just ask any insurance company. In Pennsylvania, nursing homes paid almost five times more in workers' compensation premiums than hospitals.12
  • The nursing home industry paid $1 billion in workers' compensation insurance costs in 1994.13 The average size nursing home lays out $50,000 to $100,000 per year for insurance.14 We sure could fix a lot of workplace safety problems with that kind of cash.

And we provide a big chunk of that money-Taxpayers pay into the Medicare system. Medicare pays for most (75 percent) of the inpatient days for residents in nursing homes.15

Fact Sheet 6

Solutions that work: Companies can save money

Nursing home operators who have started back injury programs have found these programs can prevent injuries and save money.

  • A nursing home in Wisconsin was studied to see which job tasks were most stressful to nursing assistants. These stressful tasks changed when nursing assistants were given new equipment and were trained to use it properly. During the 12 months of the study, injuries dropped 43 percent. There was also a big drop in lost or restricted workdays.16
  • The Kennebec Long Term Care facility in Maine lost 573 work days in 1991. By 1994, the number of lost days had dropped to 25. How? A back injury prevention program was put into place. Workers were told never to lift alone. Twelve new lifts were bought after nursing assistants chose the kind they wanted. Kennebec's management said they would make money from the program even if only two injuries were prevented.17
  • Meridian Healthcare Company saved $800,000 in workers' compensation premium costs in 1993 after starting a back injury prevention program.18
Summary

Can nursing home work be hazardous to your health?

  1. The nursing home business is the fastest-growing part of the health-care industry. People are living longer. They are also being transferred out of hospitals more quickly. This means more sick and dependent residents will be entering nursing homes.
  2. Nursing home work can lead to more back injuries than construction or mining. The number of sprain and strain injuries is skyrocketing. Most of these injuries are due to overexertion from lifting and transferring residents.
  3. We only see the tip of the iceberg. The numbers of injuries are really higher than the numbers show since many workers don't report injuries. Instead they use their sick time, suffer quietly, or quit their jobs.
  4. The turnover among nursing assistants is extremely high. Workers quit because of stressful working conditions. High turnover means short staffing, lifting alone and poor resident care.
  5. Back injuries are costing nursing home owners a lot of money. Some injury prevention programs can save a lot of money. Preventing injuries is smart business. Everyone would benefit.

Footnotes
  1. The incidence are for nonfatal injuries and illnesses among nursing home workers was 16.9 (per 100 fulltime workers) in 1993. That same year, the rate in mining and construction was 6.8 and 12.2, respectively. From United Sates Department of Labor, Bureau of Labor Statistics. News, Wednesday, Dec. 21, 1994. USDL-94-600.
  2. Ibid.
  3. Owen, B. The magnitude of low-back problems in nursing. West. J. Nurs. Res 11:234-242. April 1989.
  4. United States Department of Labor. Bureau of Labor Statistics. Unpublished data provided to the Service Employees International Union, February 1995.
  5. United States Census Bureau, based on 1990 statistics.
  6. Fein, Esther B. "As Competition Expands, Nursing Homes Diversify," The New York Times, April 30, 1995, p. 26.
  7. "Existing nursing homes propel strong revenues," Modern Healthcare, April 25. 1994, p. 28.
  8. Unpublished data from the Bureau of Labor Statistics, 1992.
  9. Ibid.
  10. Wisconsin Department of Health and Social Services, Center for Health Statistics, Division of Health. The 1993 Wisconsin Annual Survey of Nursing Homes.
  11. Brook, Steve. "The Back Track," Contemporary Long Term Care, February 1995, pp. 56-64.
  12. Pennsylvania nursing homes paid about $12.08 for each $100 of payroll; in contrast, hospitals pay only $2.49 for each $100 of payroll, or 4.8 times less. From: The High Cost of Short- Staffing, Service Employees International Union, 1992, p. 12.
  13. According to the Bureau of Labor Statistics, the average nursing home worker earned $8.67 per hour at 32.8 hours per week for a total of $14,788 per year. Percent of payroll spent on workers' Compensation premiums varies. In Wisconsin, which is lower than many other sates, the percentage is 4.9 percent of payroll. With 1.651 million nursing home workers in the United Sates, $1 billion in premiums is probably on the low side.
  14. At $725 in premiums per worker (see Note 13), a nursing home with 100 workers pays about $72,500 a year. A range of $50,000 to $100,000 per home is a reasonable range that would cover homes with varying numbers of employees. Actual figures may be higher.
  15. Health Care Investment Analyses. Guide to the Nursing Home Industry, 1993.
  16. Arum Garg and Bernice Owen. "Reducing Back Stress to Nursing Personnel: An Ergonomic Intervention in a Nursing Home," Ergonomics, 1992, Vol. 35, No. 11, pp. 13531375.
  17. G. Pascal Zachary. "Nursing Homes Are Often Hotbeds of Injury for Aides," Wall Street Journal, March 20, 1995, P. BI, B6.
  18. Maria Fern Gold. "The Ergonomic Workplace: Charting a Course For Long Term Care," Provider, February 1994, pp. 21-26.

Activity 2 - "Back" talk: Why and how you can hurt your back at work


Purpose: To help understand how your body works and why nursing home workers get back injuries.

Task 1:

Read the following story.

You are a nursing assistant taking a break. Your co-workers are talking about Marion. Marion hurt her back while transferring a resident who she has worked with daily for three years.

Some workers are saying that Marion is careless sometimes and that her injury didn't come from the job.

Other workers speak up. They say that they too have had pain from lifting and transferring residents. They say that something is wrong with the job because too many people are getting hurt.

  1. What kinds of tasks does Marion have to do on her job that may have hurt her muscles, ligaments or discs? List 6 examples. Look at factsheets #1, #5, #6 and #7 for help answering this question.
  2. What are the first signs that a back injury is starting? List 5 examples. Look at factsheets #3 and #4 to answer this question.

Task 2:

Please refer to factsheets #2 and #9 to answer these questions.

  1. What does the word "ergonomics" mean?
  2. How can ergonomics help us to prevent back injuries in nursing homes? List 3 ways.
Fact Sheet 1

Good technique is not enough

Many nursing homes have classes on proper lifting techniques. These classes talk about bending your knees, keeping your back straight, keeping the load close to your body, and using your legs. These are good principles. But lifting people is different.1

The best lifting techniques don't always work when what you are lifting is a person. It is difficult to use good body postures all the time when lifting dependent nursing home residents. Why?

  • Residents can fall, slip or jerk when you least expect it. You can be thrown off balance by the sudden change in weight.
  • Residents can be confused, scared or uncooperative, making it diffcult for them to follow your instructions.
  • A combative resident may be diffcult to hold in the proper position for lifting and transferring.
  • Equipment and furniture get in the way. The weight of the resident can't always be held close to your body.
  • In a confined space like a resident's bathroom or at an awkward angle, you can't always stand with your legs apart.
  • Not everyone has the strength in their legs to lift from their legs.
  • Many lifting techniques require two people. Often you are working alone.
  • Lifting a resident with another nursing assistant who is taller or shorter can be physically stressful. These situations can put a big strain on your muscles, ligaments and joints.2
Fact Sheet 2

All about ergonomics

There is one new word we will be talking about from now on in this workbook. That word is ergonomics (ur-guh-NAWM-ics).

The word "ergonomics" comes from the Greek word for work. Ergonomics is the science of work and the study of how people and jobs fit together.

We will use ergonomics to look at how to design nursing home work to fit nursing home workers.

Ergonomics includes:

  • Designing equipment that is easy to use.

    Example: Transferring a resident with an electric lifting device.

  • Inventing new equipment that will take the strain out of the job.

    Example: A shower chair that also fits over the toilet. The resident can be toileted and showered without being lifted or transferred between these tasks.

  • Organizing work in new ways.

    Example: Storing items that you use daily on the easy-to-reach shelves instead of near the floor or above your shoulders.

  • Changing how tasks are done.

    Example: Transferring a dependent resident with two people.

Ergonomics helps us to stop injuries from happening, such as:

  • Back pain from lifting and transferring residents.
  • Wrist pain from pulling transfer sheets or turning worn or broken bed cranks.
  • Strain injuries from holding the weight of a resident who slips to the floor, or from reaching above the shoulders for linens or equipment.

Ergonomics helps us to understand which job tasks and body movements can hurt us and find safer ways to do these tasks.

  • Lifting a resident who has fallen to the floor.
  • Transferring a resident from the toilet to a wheelchair.
  • Lifting a bag of wet linens.

An ergonomic program is a plan to prevent back sprain and strain injuries from happening in the first place. It should include:

  • Regular inspections of your workplace. It's important to find all the hazards in your facility that could lead to strain and sprain injuries.
  • Training for everyone on how to prevent injuries.
  • A plan to get injured workers the care they need.
  • Safe staffing levels so workers don't get hurt lifting heavy residents alone.
  • The most useful and safe lifting devices to use with residents.

Ergonomics is smart science and common sense. Some job tasks are easy to do and some make you hurt. Your body has natural limits. You are not superwoman/man.

Jobs need to be changed so that workers don't get hurt. Workers come in all sizes, shapes and abilities. One size does not fit all.

Proper lifting skills and back exercises are very important. But they are not enough to prevent injury. Overwork, too much lifting, and lifting in awkward ways can lead to back injuries. That is why many nursing home workers get hurt on the job.

Fact Sheet 3

Listen to your body

Pay attention to those first aches and pains. Your body tells the truth. Learn to listen to it. This is the only way to stop an injury from damaging your back. Pay attention, and don't "turn your back" on:

  • Aching
  • Sharp pain
  • Dull pain
  • Pain that comes and goes
  • Hot, inflamed feeling
  • Tingling
  • Unusual tightness
  • Unusual muscle weakness and fatigue.
Fact Sheet 4

Bit by bit

Many debilitating back injuries result from smaller injuries over long periods of time. Injuries that happen bit by bit are called cumulative trauma injuries, cumulative trauma disorders, or CTDs. With CTDs, the damage gets worse over time. Sometimes you can't feel it happening to you. You don't feel any pain. Or maybe just a little bit-no big deal. All of a sudden, one single movement can trigger serious back pain.

It's up to you to pay attention to the small signs of trouble before they grow. Go get help before your back pain becomes crippling.

Fact Sheet 5

"Back"ground: How your back works

What do you need to know about your back to help you prevent injury?

Your back:

  • Holds you up
  • Supports the weight of your trunk
  • Keeps your head up
  • Lets you move easily

Twenty-four movable back bones, called vertebrae, are stacked, one on top of the other.

  • Shock-absorbing cushions between each vertebra, called discs, provide the padding.
  • Bands of sturdy tissue called ligaments hold the vertebrae in place.
  • At the bottom of your spine, vertebrae are joined together forming a sturdy base. This holds up the rest of your body.
  • Passing through a hole in each bone of the spine is your spinal cord which carries messages from your brain to your muscles and organs.
  • Muscles as attached directly to the vertebrae by tendons. These muscles keep your back stable, hold good posture, and enable you to move around. Stretching these muscles too far can cause back pain.

Your back has a few natural curves forming an "S" shape. These curves are important to balance out the weight of your body and keep your head held up straight.

Fact Sheet 6

What's the cause?

When your lower back hurts, all you know for sure is that your back hurts. Frequent bending over and lifting heavy or awkward loads puts pressure on the spine. This can injure your muscles, ligaments, or tendons. And that hurts.

Back problems are hard to diagnose. That is why it is important to keep track of all pain felt at work and to see your doctor.

Muscles

  • Can be damaged by sudden or unexpected movements.

    Example: Catching a resident who falls while walking.

  • Can be strained by twisting.

    Example: Lifting a resident using just one side of your body.

  • Can be fatigued (get very tired) by overwork.

    Example: Manually transferring many residents in one day.

  • Can be fatigued by awkward postures.

    Example: Bending over to feed a resident.

  • Can be fatigued by holding one position too long.

    Example: Feeding or bathing a resident.

  • Can be weakened by repetitive movements.

    Example: Turning cranks on a bed or hoist.

Recovery: Injured muscles tan take from six to eight weeks to heal.

Ligaments

  • Can be damaged by sudden movements.

    Example: Transferring a combative resident.

  • Can be damaged by exertion in uncomfortable postures.

    Example: Reaching and lifting a resident from a geri chair to the bed.

  • Can be injured by holding awkward positions for a long time.

    Example: Bathing or caring for a resident in a stooped position.

Recovery: Injured ligaments can heal within a few weeks if proper care, rest, and treatment are received.

Both muscles and ligaments can become scarred or weakened through repetitive lifting, pulling, pushing, and straining. These weak links prevent the back from maintaining its natural curves and shape.

Discs

  • Can get injured by the same job tasks and body movements that injure muscles and ligaments.
  • Can slip out of their normal position or rupture. This puts pressure on the spinal nerves.
  • Can wear out and allow the bones of the back to grind together. Nerve damage can result.

These injuries are extremely painful. Some disc problems can improve without surgery.

Strain and sprain injuries that hurt the muscles, ligaments and tendons can also damage the discs.

Fact Sheet 7

Snap, crackle, pop

Not all injuries hurt right away. Many everyday job tasks besides lifting put stress on the body even though no pain is immediately felt Sprain and strain injuries can occur from:

  • Heavy lifting

    Example: Lifting and transferring residents, carrying wet linens and garbage.

  • The application of force

    Example: Pushing and pulling wheelchairs, shower chain, and carts, as well as cranking beds and cleaning dunes.

  • Frequent bending, twisting and stretching

    Example: Showering residents, and removing objects from carts and from heights above your shoulders.

  • Awkward standing posture

    Example: Stooping to feed and bathe residents and to make beck.

  • Sudden load bearing

    Example: Catching falling residents.

  • Repetitive work

    Example: Making beds, doing housekeeping tasks, and lifting.

  • Fatigue

    Example: Overwork due to understaffing, increased patient loads, mandatory overtime and job stress.

Fact Sheet 8

Exercise helps, but...

Keeping your back strong, stretched and healthy is a good thing to do. Good posture and mobile joints can prevent certain injuries. In addition, recovery from an injury can happen more quickly when your muscles are strong and flexible.

Remember: Hazardous working conditions can injure even the most athletic and well-conditioned workers. An exercise program can only reduce back injuries on the job if it is part of a comprehensive back injury prevention program.

Some exercises that will keep your back strong and flexible can be found in Appendix A of this workbook.

Fact Sheet 9

Chain reaction

Most back injuries in nursing homes come as a result of resident handling tasks and associated duties such as:

  • Lifting and transferring residents who are heavy, unpredictable or combative.
  • Lifting and carrying supplies and equipment.

You carry out these tasks often. When you are hurt and can't do your job, many others feel it too.

Who else is affected?

  • Resident care suffers when workers are hurting. The care and attention nursing assistants give residents play an important role in preventing bedsores and falls.
  • Co-workers often must work harder and longer.
  • Families of injured workers suffer financial and emotional strain when caring for an injured family member.
  • Employers must pay out more money for workers' compensation premiums. A typical nursing home with 100 workers pays between $50,000 and $100,000 a year in workers' compensation premiums.3
  • Taxpayers pay for most of the cost of running nursing homes. They pick up the slack when the cost of caring for disabled workers is placed on the larger community.
Fact Sheet 10

Back on track

Both management and workers have a role to preventing back injuries on the job.

It's management's responsibility to:

  • Provide a safe and healthy workplace.
  • Prevent known hazards.
  • Maintain adequate staffing levels.
  • Implement effective injury prevention programs.
  • Purchase and use lifting machines and devices.
  • Conduct effective training and education programs.
  • Provide proper medical care and treatment for injured workers.
  • Make sure workplace injury prevention programs are working.

It's your responsibility to:

  • Work with your health and safety committee to prevent unsafe conditions.
  • Listen to your body and report the first signs of back pain.
  • Take the best care possible of your back and your health.
Summary

"Back" talk: Why and how you can hurt your back at work

  1. Jobs should be designed to fit the worker, not the worker to fit the job. This is called ergonomics.
  2. Your body has natural limits. Some job tasks can lead to injuries when you go beyond these limits. Many strain and sprain injuries of the back are caused by repeated smaller injuries over a period of time. Most back pain is caused by injuries to the muscles, ligaments, and discs.
  3. Your body tells the truth. It is important to pay attention to the very first signs of back pain before a small problem turns into a crippling injury. Report all back pain.
  4. Lifting is not the only activity that leads to sprains and strains. Carrying, bending, twisting, pushing, pulling, and repetitive movements can also lead to strain and sprain injuries.
  5. Using good lifting techniques is not enough to prevent injuries. It is difficult to use proper lifting techniques when transferring residents. Hazardous body movements need to be prevented.
  6. Keeping your back stretched and healthy is a good thing to do. Stretching can prevent some injuries and reduce the time your body needs to heal after an injury. Exercises only help prevent injuries when they are part of a comprehensive back injury prevention program.
  7. Resident care suffers when workers are hurting. Taxpayers, employers and family members must absorb the unnecessary expense. Everyone feels the strain.

Footnotes
  1. Bernice Owen and Arun Garg. "Back Stress Isn't Part of the Job," American Journal of Nursing, February 1993. PP. 48-51; and Jensen, Roger C., "Prevention of Back Injuries Among Nursing Staff," Essentials of Modern Hospital Safety, vol. I (Charney, William and Joseph Schirmer, eds.). Chelsea, Mich.: Lewis Publishers, pp. 237-258.
  2. Owen, B.D. and Garg,A. "Patient handling tasks perceived to be most stressful by nursing assistants." 1989. In A. Mital (ed.), Advances in Industrial Ergonomics and Safety I (Taylor and Francis, London), pp. 775-781.
  3. The average nursing home with 100 employees pays $72,500 per year in workers' Compensation premiums. This is based on figures from Wisconsin which state that premiums are 4.9 percent of payroll. The average nursing home worker makes $14,798 per year. Other states pay a high percentage of payroll for compensation insurance costs. Actual figures may be higher than this.

Activity 3 - On the lookout: Does your work make you hurt?


Purpose: To learn how to identify job tasks and body movements you do every day on your job that might be hurting your back.

Task:

  1. Working alone, fill out the checklists on page 32 and 33.
  2. Working in your small group, make a list of at least five of the hardest job tasks or body movements you do as part of your job. Review factsheets #1-6 to see if you left anything out.
  3. Make a list of three things your group learned from the factsheets that you didn't think about before.
  4. Describe two ways that you will use these checklists in your workplace.
Checklist

Job task risk factors

Use the following checklist to think about the tasks that you do during an average shift that could lead to a sprain or strain injury.

How many times a day do you do this task during an average shift?

1. Transferring a resident from toilet to chair

__________

2. Transferring a resident from chair to toilet

__________

3. Transferring a resident from chair to bed

__________

4. Transferring a resident from bed to chair

__________

5. Transferring a resident from bathtub to chair

__________

6. Transferring a resident from bathtub chairlift to chair

__________

7. Weighing a resident

__________

8. Lifting a resident up in bed

__________

9. Moving resident from side-to-side in bed

__________

10. Repositioning a resident in a geri chair, wheelchair or regular chair

__________

11. Changing "Attends" on a resident

__________

12. Making the bed with a resident in it

__________

13. Undressing a resident

__________

14. Feeding a bedridden resident in an awkward sitting position

__________

15. Making a bed when the resident is not in the bed

__________

16. Lifting a resident to or from a Clinitron bed

__________

17. Lifting wet linens or laundry

__________

18. Lifting heavy trash bags

__________

19. Pushing and pulling heavy food carts

__________

Total number of stressful tasks per day:

__________

Body movement risk factors

Use this checklist to help you understand what kinds of body movements and positions can lead to back injuries. Read each type of stressful body movement listed below. Think about how many rimes each day you have to do this activity.

Body Movement

Seldom

(One to three times per day)

Often

(Four to ten times per day)

Very often

(eleven times or more per day)

1. Twist your body while lifting, carrying, or positioning a patient.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

2. Lift more than 50 pounds.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

3. Reach above your shoulders to get something.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

4. Pick up something weighing over 20 pounds from the floor.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

5. Grip tightly with your hands a belt, sheet or article of clothing in order to pull, lift, or reposition a resident.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

6. Sit in an awkward position for more than 15 minutes.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

7. Stand still in an awkward position.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

8. Lift something that is more than one foot away from your body.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

9. Lift something that is more than one foot away from your body with a bent back.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

10. Transfer a combative resident.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

11. Lift something heavy above the height of your chest.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

12. Stoop or bend over to perform a job task.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

13. Lift using just one side of your body.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

14. Transfer a resident who cannot bear weight without the use of equipment or the help of a co-worker.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

15. Transfer a resident who cannot bear weight without the use of equipment but with the help of a co-worker.

__________

Seldom __________

Often __________

Very Often __________

__________

__________

Fact Sheet 1

Bit by bit

Many back injuries happen bit by bit, even if there is no pain.

Stressful job tasks or body movements that can lead to injury are called risk factors.

Knowing how to find the risk factors is the first step toward preventing back injuries in nursing homes.

Here are some things you can do:

  • Watch your co-workers to see if they are doing physically stressful job tasks and movements. Think about how these stressful tasks and movements can be prevented.
  • Listen to co-workers talk about where they hurt and what tasks are hard to do.
  • Talk to your co-workers about how to prevent back injuries. Ask injured workers how they got hurt. Tell the health and safety committee about the hazards you see and how they can be prevented.
  • Use the checklists found in this activity to find out where the problems are on your job.
Fact Sheet 2

Twist and shout

Carrying or lifting weight while your back is twisted is very risky business. Your back was built to do its best work when in a straight, upright position. If your feet and shoulders are not pointed in the same direction, then you are twisting your back. Even if you are twisted a little bit, your back is at risk of getting injured.

Twisting puts an extra strain on muscles, ligaments, and discs. When you add the weight of lifting or the force of pushing or pulling, the shouting begins. For example:

  • Transferring a resident from a wheelchair to a toilet in cramped bathrooms.
  • Transferring a resident who suddenly moves, throwing you off balance.
  • Lifting a resident using only one arm and one side of your body (as when you and your co-worker bend toward the resident and lift the resident to a standing position).
Fact Sheet 3

Stressful body movements are common to nursing home work

Stooping Down Low to lift stresses every part of the body: back, neck, shoulder, and legs. For example:

  • Lifting residents who have fallen to the door.
  • Leaning and stooping to turn a stiff or broken bed crank.

Somewhere, Over The Shoulder

Lifting loads above the shoulder puts an extra level of force on your shoulders, arms, neck, and back. For example:

  • Lifting linens down from a high shelf.
  • Reaching above shoulder level for items you need.

So Far Away

It's much harder to lift residents or objects that are far away from your body. Your back has to work much harder when you lift with your arms stretched out. Lifting while stretching puts much more strain on the discs in your lower back. For example:

  • Transferring residents from a geri chair to bed, or from bed to a geri chair.
  • Making a bed with or without a resident in it.
  • Lifting a resident to and from a Clinitron bed.
Fact Sheet 4

The back stops here

Even with the best body posture, you can still get hurt. Close to half of all workers' compensation claims for back injuries are from lifting.1 Frequent lifting causes muscle fatigue, which also increases your chances of getting hurt.

Lifting heavy weights can hurt your back. For example:

  • Working alone to transfer a resident who cannot bear any weight.
  • Transferring a resident from the toilet to a wheelchair.

What a Drag

Pulling and dragging is very stressful on your shoulders and back. For example:

  • Lifting, pushing or pulling a gel mattress.
  • Pushing or pulling a medication cart.

Staying Put

Sitting and standing in awkward positions puts lots of strain on your muscles. This strain can cause fatigue and weakness, especially in your lower back. For example:

  • Feeding a bedridden resident.
  • Bathing a resident while in a bent position.
Fact Sheet 5

In a pinch

When you grip a sheet, belt, or piece of clothing very tightly in order to lift or pull a resident, a strain injury can occur. For example:

  • Repositioning a resident in a bed by pulling on the drawsheet.
  • Transferring a resident who is lying down by using a sheet as a sling.
  • Supporting an unsteady patient by grasping a gait belt without handles.

Studies have shown that comfortable handles reduce the amount of force needed to do the task. Less force means fewer injuries.

The Bulky and The Awkward

Strain and sprains can be caused by lifting objects that are too big, bulky or have uneven weight. For example:

  • Kitchen workers who have to lift large plexiglass table tops in order to clean the tables.
  • Carrying big bulky bags of trash to the dumpster.
  • Moving wheelchairs, chairs, and other equipment out of the way.
Fact Sheet 6

It's the law

OSHA (Occupational Safety and Health Administration) requires all nursing homes to keep a yearly log of every work related injury or illness among workers. If you have an injury that causes you to stay out of work, get medical care, or go on light duty, then you must be listed on this log. This is called the OSHA 200 log.

The information on the log must include:

  • Date, worker's name, job title and department.
  • A description of the injury.
  • Exact body part or parts that got hurt.
  • Number of lost work days.
  • Number of "light" or restricted duty days

You have the right to ask for and get a copy of the OSHA 200 log for your facility. It is best to make your request in writing. Ask to see the whole log and not just a summary. According to the law, your employer is required to annually post the OSHA log summary in a place where workers can see it. This summary must be posted no later than February 1 of each year.

The OSHA 200 log shows what kinds of injuries are most common in your nursing home. You will be able to see how much work time was lost and how many workers went on light duty last year.

Some joint safety and health committees keep a separate record of injuries at a facility in addition to the OSHA 200 log. See Activity 7 for more information about how your committee can find out who got hurt last year. You can also find out what kinds of injuries happen most often to your facility. Knowing this information will help you prevent injuries in the future.

Summary

On the lookout: Does your work make you hurt?

  1. Risk factors are job tasks and body movements that can lead to injury. Finding the risk factors in your job is the first step toward preventing back injuries.
  2. Back sprain and strain injuries happen bit by bit Many injuries do not happen all at once. The following job tasks have the biggest risks:
    • Twisting while lifting or carrying
    • Stooping down low to lift
    • Lifting or reaching above your shoulder
    • Lifting residents or objects far from your body
    • Lifting residents even with perfect posture
    • Frequent lifting without adequate rest between lifts
    • Pulling and dragging
    • Sitting or standing in one position for a long time
    • Lifting bulky or awkward objects
    • Lifting heavy residents or objects
  3. Checklists are tools to help you identify the risk factors to your lob. Find out what the risk factors are and educate your co-workers.
  4. The OSHA 200 log gives you information about the kinds of injuries that happen at your facility. Under the law, you have a right to see this information. OSHA 200 logs must be posted by February 1 each year.

Footnotes
  1. Brooks, Steve. "The Back Track: Ergonomics training programs are cutting costs and employee back injury rates." Contemporary Long Term Care, February 1995, p. 56.

Activity 4 - Making your job safe: Solutions that work


Purpose: To learn about the different kinds of equipment, devices and work practices that help protect workers from back injuries.

Task 1:

Review factsheets #1, 2, 3, and 4 to help you answer this question.

  1. Working alone, make a list of the equipment ("engineering controls") that you use NOW in your nursing home.
  2. Working in your small group, talk about what kind of equipment would make your job easier. Make a list of two or three items. Look at factsheet #4 for help.

Task 2:

Review factsheets #5, 6, and 7. Answer these questions based on YOUR JOB.

  1. Which work practice controls (such as resident assessment and training) are used RIGHT NOW on your job?
  2. How do you find out what the transfer needs are for each resident?
  3. In your small group, come up with a better way to get information about resident transfer needs.

Task 3:

Your group is the safety and health committee at your nursing home. You get the document on the next page from your employer- Look at factsheets #1 and #6 to help you answer these questions.

  1. How will you respond to the memo?
  2. Can back belts prevent back injuries?
  3. What do you think is the solution?

Document 1:

Best Rest Nursing Home
1001 Valley Wind Road
Harrisburg, Pennsylvania 17111

September 5, 1995

  • Hr. John Justice
  • President, Local 711
  • 1400 Oak Street
  • Harrisburg, Pa. 16111

Dear Mr. Justice:

The Best Rest nursing home corporation will be implementing a back support program on a nation-wide basis. The back support is a personal protective device which helps nursing assistants to follow correct lifting procedures. This device, called the Pro-Flex back support, is currently being used in major Fortune 1000 companies. After many months of testing and evaluation of various products, our company has chosen this positive approach in the enhancement of our safety program for all nursing home workers.

Policy Guidelines

  1. All nursing assistants, nurses, laundry and dietary personnel will be required to wear the back belt as part of their uniform.
  2. All employees will receive in-service training on the use of the back support.
  3. Failure or refusal to wear the back support may be subject to disciplinary action, up to and including discharge for just cause for failure to follow company safety policies and procedures.

This program demonstrates a major commitment in both time and expense on the part of Best Rest Nursing Homes, Inc., to reduce the rate of workers' compensation costs on a national basis. Please contact me if you have any questions.

Sincerely,

  • Bill Ruinback
  • Human Resources Director
  • Best Rest Nursing Home, Inc.
Fact Sheet 1

In control

A control is any equipment or method that does the lifting for you or makes lifting easier and safer to do. In a nursing home, a control is:

  • Equipment that does the lifting for you.
  • A transfer board or transfer belt that makes lifting easier to do.
  • A work practice that makes sure you always have a nursing assistant to help you when you need one.

Not all Controls are the same.

Controls work better the closer they are to the hazard other than the worker. You will see three kinds of controls in your nursing home:

  1. Controls that remove the hazard at the source.
  2. Controls that remove the hazard along the way.
  3. Controls like personal protective equipment that you wear.

Your Best Bet

The best controls are machines, equipment and devices that do the lifting for you. Why?

Because they remove the lifting hazard at the source. Machines don't get back injuries. A machine can lift and transfer residents for you so you have less chance of getting hurt.

Example: Battery-run lifting devices that can safely transfer a resident from the geri chair to the bed.

Machines and devices that do the lifting and transferring for you are called engineering controls. These are the best bet because they solve many problems and let you do what you do best: care for the residents.

Second Best

The second best type of controls are changes in how the lifting is done in your nursing home. These are only second best because you still have to do all the lifting and transferring. The difference is that you have more help.

Example:

  • Transferring residents with a helper at all times. You shouldn't have to transfer alone.
  • Color-coded labels in every room that tell you the special lifting needs of that resident.
  • Education programs on how to lift and transfer patients safely.

These controls are called work practice controls because they change how you do your job. They're second best because they don't remove the real hazard: lifting. You get help along the way. These controls stop working when communication breaks down or when there aren't enough hands to help out.

The Last Resort

The last kind of control is one that is put on you, the worker. This control is called personal protective equipment (PPE)- often protective clothing such a gowns and gloves. There are problems with this kind of control.

  • Personal protective equipment does not remove the hazard in the workplace.
  • PPE is often uncomfortable and restrictive.
  • PPE often does not fit properly. Remember, one size does not fit all!
  • PPE is often not taken care of-cleaned and maintained.
  • The burden is put on you to prevent injuries. If you get hurt, it becomes your fault.

According to OSHA, it's your employer's responsibility to keep the workplace safe.

Some nursing home operators think the back belts (belts that a worker wears) are personal protective equipment and that they protect you from back injuries. They are wrong. Back belts are medical devices and should only be prescribed by a health-care provider. There is no proof that back belts prevent back injuries.1 They don't stop you from lifting and transferring heavy residents.

Remember: There are three kinds of controls.

  1. The best: Machines and devices that do the lifting for you.
  2. Second best: Changes in work practices that give you more help and more information.
  3. The last resort: Personal protective equipment doesn't fix the real problems in your workplace, and may not even protect you at all.

Often more than one kind of control is needed to make the job as safe as possible. Both the "best" (equipment and devices) and "second best" (work practice) controls are necessary to prevent injuries. The last resort" type of controls are only to be used:

  1. When they are proven to work.
  2. When there is no equipment or solution of any kind that can do the same or better job.
  3. As a short-term solution while the permanent solution is on its way.
Fact Sheet 2

Not all lifting devices are created equal

You are an expert about the job you do. The experience of nursing assistants all over the country tells us what to look for when shopping for new equipment. Since you use the equipment, you should be involved when new lifting equipment is being bought for your facility. If you use lifting devices at your facility, then you've heard these complaints:

  • "It takes much longer to use. I can't take the time."
  • "It won't fit in the bathroom. That's where I need it the most."
  • "I feel like it's going to tip over and hurt a resident."
  • "My shoulder aches all day from turning that broken crank."
  • "I can never find the sling for the lift when I need it. Why bother?"

You must receive training on any new equipment before you can be expected to use it.

How does the equipment in your facility rate? Many lifting device companies are making safer and better products. Your facility's joint labor/management safety and health committee can use the equipment checklists found in this activity and other tools to evaluate equipment and get the information you need.

Fact Sheet 3

Out of sight

Even good lifting devices are useless if they aren't around when you need them. Ask yourself these questions:

  • Is the lift available when you need it?
  • Are there enough lifts on your floor?
  • Do you have to go to another floor to get it?
  • Is the lift easy to find? Is it stored in the same place when not in use?
  • Did you get "hands-on" training to use the lift?
  • Is the lift in working order?
  • Are you using broken lifting devices where you work?
  • Is the lift maintained on a regular basis?
  • Are slings available when you need them?

Few studies have been done about these new devices. Do they prevent injuries? Are they easy to use? Do they feel safe and comfortable for the resident? Your opinions are important.

Fact Sheet 4

Tools of the trade

There is a lot of equipment available to help nursing home workers avoid injury on the job. Some of it is good, some is not so good. See Appendix C for the names and addresses of equipment manufacturers.

Chairs With Wheels: The Good, The Bad and The Scary

Shower chairs can help reduce the number of transfers you do every day. How does your shower chair rate? These are the features that matter:

  • High enough to fit over the toilet (saves many stressful transfers such as bed to wheelchair, wheelchair to toilet, toilet to shower chair, and back).
  • Adjustable arm rests (less strain to transfer resident).
  • Steady construction (won't tip over).
  • Brakes on at least two wheels (foot-operated brakes mean less strain).
  • Commode (bucket) for toileting (makes transfer to toilet unnecessary).
  • Comfortable commode seat for the resident (increases amount of time resident can stay on chair).
  • Footrest releases (avoids hazards from tripping, scraping and extra leaning to transfer resident).

Wheelchairs

  • Removable armrests (easier transfer; residents don't have to be lifted over the armrest height).
  • Removable or swing-out footrests (space is needed to help the resident turn [pivot] during transfers).

Walk The Walk

Walking belts can help protect you and the residents you care for.

Posey belts are walking belts with handles. Nursing assistants should receive training on how to use the Posey belt. You will learn a rocking and pulling motion that makes the transfer easier to do. This motion uses the weight of the resident to help with the transfer. You don't have to use as much force to lift. The good points of Posey belts include:

  • Wide, sturdy, with buckles and Velcro for a good and quick fit.
  • Padded handles on each side make it easier to grip.
  • No forceful grasping or gripping is needed. Less pressure from fingers and knuckles against the resident.
  • When used correctly, walking belts reduce the force on the discs in your lower back.2

However, placing this belt on the resident can be somewhat time consuming.

Gait belts are simple canvas walking belts used to support residents who can walk with assistance. They also help the nursing assistant protect him or herself from slipping and falling residents. However, they have several bad points:

  • They can slide up on a resident, causing scrapes and skin tears and pushing onto the rib cage. This is a big problem with pear-shaped residents.
  • They are not safe to use with heavy patients.
  • They can be stressful to the nursing assistant's hands and wrists.
  • They are uncomfortable for residents because the wearer can feel the knuckles of the nursing assistant.

Moving On

Inflatable transfer devices (Air Pal) blow up like pillows and can be very helpful when transferring a resident between beds of different sizes. Some problems include:

  • The resident can slide off the Air Pal if he or she is not placed directly in the center of the device.
  • The resident can slide off the Air Pal if the straps are not used or are used incorrectly.
  • It takes a long time to use it.
  • It is noisy and may be frightening for some residents.
  • An electrical outlet must be nearby in order to operate it.
  • The canister providing the air pressure is bulky and heavy.

Beasy boards are transfer boards set up like a slide. There is less friction and more comfort than wooden transfer boards. Here are some concerns:

  • Chairs of unequal height make the board unstable.
  • The board is very hard and uncomfortable under the resident's head.
  • Very large people may experience skin friction with this device.
  • The board is heavy.

Glider transfer devices are plastic transfer boards. A movable piece goes under the residents' buttocks. This reduces the friction usually caused by transfers. It may be hard to get the device under the resident correctly and then out from under the resident after the transfer.

Pivot discs are devices that residents stand on when getting out of bed. The nursing assistant can turn the resident on the disc to transfer him or her into a chair. The pivot disc is a good idea, but it doesn't work very well for many nursing home residents. Many residents cant remember to stay on the pivot disc or don't have the cognitive skills to follow instructions.

Patient handling slings (Medesign) can help move residents from one location to another. The sling can be quick and handy to use. But a sling can:

  • Dig into the resident.
  • Slip off because it isn't attached to the resident.
  • Only be used with residents who can bear weight.

Pelvic lift devices (Kimbro) inflate like a pillow and lift the pelvis of the resident so they can be toileted without getting out of bed. Good points include:

  • The Kimbro pelvic lift can be used for both urinating and defecating; toilet transferring is eliminated.
  • Comfort level is high for the resident.
  • Bad points include:

  • The foot inflator is hard to use.
  • The residents' upper body has to be raised. Some lifting might be involved.

Crank It Up

Bed cranks are hand cranks located at the bottom of the bed. Most beds are kept in the "low" position. To make the bed higher or lower you have to squat and stoop. Many old bed cranks are broken or hard to turn. Bed cranks need to be in good working order. Using force in a stooped position is bad news for back health.

Bed brakes must be in good working condition. Brakes that are not working can be a strain to use and be dangerous for both nursing assistants and residents.

Nursing assistants must receive training before any lifting and transfer devices are used on residents. Without proper training, this equipment is neither effective nor safe.

Fact Sheet 5

Work practice controls that work

Resident Assessment Matters

Has this ever happened to you?

  • You are transferring a new resident. You didn't know that he is combative and is afraid of the lifting device.
  • You are transferring an unfamiliar resident, who barely speaks, from the bed to a geri chair. You don't know if she can bear any of her weight.

Finding out what the resident needs is called resident assessment (a resident assessment checklist can be found at the end of this chapter). You need to know how each patient should be transferred. Transfer needs don't stay the same. The mental and physical states of residents can change quickly. Resident assessment should be updated on a regular basis - biweekly, for example.

You should be included in the assessment since you provide most of the direct care to residents. You need to see this information before you can work with the resident.

Your workplace should have a system that tells you the lifting needs of the residents. Communication is a vital part of making our workplaces safer.

It's not good enough if your supervisor has this information and you have to ask every time. It's not good enough if the lifting needs are only listed in the "Activities of Daily Living" (ADL) log. It's too time-consuming for you to be looking for folders and answers. Often this information isn't part of the ADL anyway.

A system must be in place that makes it easy to get this information, like color-coded stickers attached to easy-to-see places like the door or bed. Resident privacy is important. These codes are one solution. They can tell you:

  • Which lift to use
  • What the resident can do on his or her own
  • What kind of help the resident needs
  • If the resident is combative.

It Takes Two

Work practice controls include having the help you need in order to perform transfers safely. Some transfers need two people.

Unfortunately, there aren't any state or federal laws that make sure nursing homes have enough staff to match the needs of residents who need more care. That's why there isn't a second person on hand when you need it most.

Lift and Learn

Learning how to lift properly is very important and should be known by everyone. Good lift training classes should talk about bending your knees, keeping your back straight, keeping the load close to your body and using your legs.

We know that lifting people is very different firm lifting boxes. Even with the best equipment on hand, lifting technique is both important and necessary.

Not all lifting training programs are the same. The best programs are hands-on, and are taught by someone who understands the hazards of nursing home work as well as you do.

You can use the checklist found at the end of this activity to tell you how your program rates.

Fact Sheet 6

Beyond the belt way

In some nursing homes, nursing assistants are required to wear back belts. But do back belts work?

What are Back Belts Good For?

Back belts are a medical device, not protective equipment. They are prescribed by doctors for certain medical problems. There is no proof that back belts prevent injuries.3 Belts do not remove the hazard of heavy lifting, pushing, pulling, bending, or twisting. Back belts don't make us stronger. They may even cause other lends of problems:

  • Long-term use of back belts may lead to less muscle strength. Since the belt holds you up, your muscles lose their tone. Weak muscles can mean a higher chance of getting hurt.
  • Back belts may give a false sense of strength and confidence. Workers may lift harder and heavier loads thinking they're safe. They're not.
  • Back belts put the burden of fixing the workplace on the worker. The best protection is removing the hazard at the source. Back belts cant replace good lifting devices and work practice controls. They don't fix the job and they don't make lifting safe.
Fact Sheet 7

Non-solutions: Hidden in the closet

That's where a lot of old and broken lifting devices are - in a corner or closet. Or they're on the second floor and you work on the fourth floor. Some lifting devices are used even though they don't work right. This puts both resident safety and your safety at risk.

Out of The Closet and Into The Trash

That's where unsafe equipment should go. Maintenance and repair are as important as getting the equipment in the first place.

CHECKLISTS
Lifting Devices

Does your lifting device pass the test?

Yes

No

1. Can it be safely operated alone?

__

Yes __

No __

__

2. Is it in working condition?

__

Yes __

No __

__

3. Is it stable (not easily tipped over)?

__

Yes __

No __

__

4. Can it be cranked, maneuvered, or operated without strain?

__

Yes __

No __

__

5. Can the lift pick up a resident who has fallen to the floor?

__

Yes __

No __

__

6. Can you place the resident in the sling without lifting or pulling them?

__

Yes __

No __

__

7. Can you remove the sling without lifting the resident?

__

Yes __

No __

__

8. Is the resident's head erect when he or she is suspended in the sling?

__

Yes __

No __

__

9. Can the device fit through a narrow bathroom doorway?

__

Yes __

No __

__

10. Can the device fit around a bulky wheelchair?

__

Yes __

No __

__

11. Can the resident be toileted directly from the hoist?

__

Yes __

No __

__

12. Does the device reach high enough to lift a resident off a Clinitron (or other high) bed?

__

Yes __

No __

__

13. Is the resident safe from falls caused by slipping through the straps of the sling?

__

Yes __

No __

__

14. Does the sling design avoid pushing the residents legs apart (concern for residents with hip replacements)?

__

Yes __

No __

__

15. Can the battery be replaced without squatting or stooping?

__

Yes __

No __

__

16. Does the lift have an emergency shutoff button?

__

Yes __

No __

__

Equipment

Does your equipment have these features?

Yes

No

Shower Chairs

1. Removable armrests

__

Yes __

No __

__

2. Removable footrests (or that swing to one side)

__

Yes __

No __

__

3. High enough to fit over the toilet

__

Yes __

No __

__

4. Easy-to-repair wheel casters

__

Yes __

No __

__

5. Foot-operated brakes

__

Yes __

No __

__

Wheel Chairs

6. Adjustable armrests

__

Yes __

No __

__

7. Adjustable footrests

__

Yes __

No __

__

Beds

8. Bed cranks that can be reached without squatting

__

Yes __

No __

__

9. Bed cranks kept in good working order

__

Yes __

No __

__

10. Brakes in good working order

__

Yes __

No __

__

Walking Belts

11. Comfortable handles

__

Yes __

No __

__

12. Buckles that are easy and quick to fasten

__

Yes __

No __

__

13. Were you trained to use the rocking/pulling motion to avoid lifting?

__

Yes __

No __

__

Walking Belts

14. Are transfer devices in use at your facility?

__

Yes __

No __

__

15. Were you trained to use transfer devices safely?

__

Yes __

No __

__

Resident Assessment

Assessment

Yes

No

1. How much does the resident weigh?

__

Yes __

No __

__

2. Does the resident understand instructions?

__

Yes __

No __

__

3. Can the resident bear weight?

__

Yes __

No __

__

4. Is the resident able to sit?

__

Yes __

No __

__

5. Can the resident help physically?

__

Yes __

No __

__

6. Can the resident walk with assistance?

__

Yes __

No __

__

7. Do you need more than one person to transfer safely?

__

Yes __

No __

__

8. Does the resident have any special problems, like contracture or amputation?

__

Yes __

No __

__

9. Is the resident combative?

__

Yes __

No __

__

10. Is the resident's behavior predictable?

__

Yes __

No __

__

11. What is the condition of the resident's skin?

 

 

12. What kind of lifting device is needed?

 

 

13. How many nursing assistants are needed to transfer this resident?

 

 

Communication

14. Are all residents evaluated for transfer needs?

__

Yes __

No __

__

15. Are the recommendations of the nursing assistants included in this assessment?

__

Yes __

No __

__

16. Is this information made available to all caregivers in a way that everyone can understand?

__

Yes __

No __

__

17. How is this information made available?

__

Yes __

No __

__

Lifting Training Program

Yes

No

1. Did every worker from all shifts attend the training?

__

Yes __

No __

__

2. Was the trainer familiar with nursing home work?

__

Yes __

No __

__

3. Did the trainer have experience lifting and transferring residents?

__

Yes __

No __

__

4. Was the training hands-on?

__

Yes __

No __

__

5. Did some part of the training take place at the bedside?

__

Yes __

No __

__

6. Did everyone have a chance to practice in front of the trainer?

__

Yes __

No __

__

7. Were you encouraged to ask questions?

__

Yes __

No __

__

8. Did you practice on people of different shapes and sizes?

__

Yes __

No __

__

9. Did you learn how to handle combative residents?

__

Yes __

No __

__

10. Did you practice on people who cannot bear weight?

__

Yes __

No __

__

11. Did you learn how to handle residents with special needs such as contractures or amputations?

__

Yes __

No __

__

12. Did you practice lifting people up from the floor?

__

Yes __

No __

__

13. Did you get answers to your question?

__

Yes __

No __

__

14. Do you get a refresher training program every year?

__

Yes __

No __

__

15. Do you feel comfortable doing resident transfers as a result of the training program?

__

Yes __

No __

__

Summary

Making your job safe: Solutions that work

  1. Controls make jobs safer by preventing injuries. The best kind of controls are those that remove the hazard at the source. These are also called engineering controls. The second best kind of controls are work practice controls which control how your work is organized and how you get the information you need. The last resort is protective equipment which puts the burden of safely on you, the worker.
  2. Good equipment is an important part of back injury prevention.
    • Well-designed lifting devices.
    • Shower chairs that fit over toilets.
    • Wheelchairs with moveable armrests and footrests.
    • Walking belts with padded handles.
    • Devices that work and are regularly maintained.
    • Training for proper use.
  3. Not all lifting devices, belts, chairs or transfer devices are created equal. Get involved in choosing equipment in your facility. You need to be trained on how to use the new equipment before you can be expected to use it.
  4. Resident assessment can help you select the correct lifting devices and to work safely. This information must be updated regularly. The health status of a resident can change quickly. Communication is the key. Make sure resident needs are communicated to all workers who provide direct care.
  5. Some transfers can only be done safely with two workers. There are no state or federal laws that require staffing levels to match the needs of residence who require more care.
  6. Get the right stuff in your training. Training programs should be hands on, answer all of your questions, and be taught by someone who is very familiar with the hazards of nursing home work.
  7. Back belts are medical devices that should be worn only for certain medical problems. There's no proof that back belts prevent back injuries. They don't make lifting safe and they don't fix unsafe jobs.

Footnotes
  1. National Institute for Occupational Safety and Health (NIOSH). Back Belts: Do They Prevent Injury? USDHHS (NIOSH) publication No. 94-127, Centers for Disease Control and Prevention, 1994.
  2. A. Garg and B. Owen. "Reducing Back Stress to Nursing Personnel: An Ergonomic Intervention in a Nursing Home," Ergonomics, 1992, Vol. 35, No. 11, pp. 133-135.
  3. Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services. "Workplace Use of Back Belts: Review and Recommendations." July 1994, DHOWS (NIOSH) No. 94-122.

Activity 5 - If you are hurt on the job


Purpose: To understand how a written plan can help injured workers get better and get back to work.

Task:

Pat is a nursing assistant. She hurt her back last week when she transferred a resident from the geri chair to the bed. She filed an incident report and rested for a few days. When she returned to her night shift job, she was put on "light duty". Pat's doctor told her not to do any heavy lifting.

There were 46 residents on her floor and just two other nursing assistants. Pat didn't want to burden her coworkers. When Mr. Brown asked for help to get to the bathroom, she said okay because Mr. Brown can walk with assurance. Mr. Brown slipped. Pat caught him. Pat is now flat on her back.

  1. Why did Pat help Mr. Brown when she knew she was on light duty?
  2. What could Pat's employer do to make sure that this doesn't happen again? Look at factsheets #3, 4, and 5 to help you answer this question.
  3. You are on the labor management safety and health committee. The committee is reviewing a program that will help injured workers get better and get back to work. Make a list of six things that should be in this plan. Look at factsheets #6, 7, and 8 and the checklist on p. 73 to help you answer this question.
Fact Sheet 1

You bring home more than a paycheck

Back injuries often happen bit by bit, ether than all at once. If you have any signs of a strain or sprain injury,

  • Report it!
  • Get medical help!
  • Fix the unsafe job!

We all know how it goes.

You don't report the first signs of injury. You don't want to dump extra work on your co-workers and friends. Maybe you're afraid of losing your job. Then you get put onto light duty. But there is always so much heavy work to do. You feel pressured to do your regular job. You're back to lifting and transferring residents. You get hurt again, this time worse. You're out again, and money is tight. Now you're really afraid you'll lose your job.

Let's break this cycle!

Fact Sheet 2

Ouch!

Don't turn your back on these body sensations that may be a sign of a back sprain or strain injury. If you feel any of these symptoms, pay close attention:

  • Aching
  • Sharp pain
  • Dull pain
  • Pain that comes and goes
  • Hot, inflamed feeling
  • Tingling
  • Unusual tightness
  • Unusual muscle weakness or fatigue

Listen to your body. Your body tells the truth.

Fact Sheet 3

Document everything

If you have any signs of an injury, file a report with your employer. Make sure your injury is documented. Keep a copy for yourself. Make sure your health and safety committee knows about your injury.

Record and report every incident that results in back pain. This is very important information for two reasons:

  • For investigating hazards in your workplace.
  • In case you need to file for workers' compensation or disability.

Your injury is not just your problem. You are not alone. Other workers are probably hurting too.

Keeping track gives us important information that we need to make changes on the job.

Speaking out helps all of us make nursing homes safer to work in.

Fix the unsafe job. Good medical care won't make you better unless changes are made in your workplace. Your doctor can't fix your job. You, your co-workers, your union, and your management, together, can fix your job.

Don't Wait: Get Help

If you have signs of any injury, get medical help immediately!

Three good reasons why you should get help right away:

  • To get proof that your job may have contributed to your injury.
  • To get better and learn how to stay better.
  • To find out what conditions may have led to your injury.

Report the symptoms to your employer as soon as you feel them. Early reporting may:

  • Prevent you from getting seriously hurt.
  • Prevent you from ruining your back and ruining your life.
  • Prevent you from needing workers' compensation.
  • Prevent other workers from getting hurt.
Fact Sheet 4

Trip to the doctor

The doctor can help you find out which part of your body was strained, sprained, damaged or injured.

Educate Your Doctor

The medical treatment you will get depends on what's wrong and what's causing the pain.

Tell your doctor all about your job. Explain the tasks that you must do on your job. Make sure the doctor knows:

  • How long you have been working as a nursing assistant.
  • The kind of lifting, bending and twisting you do every day.
  • How much weight you are lifting every day.
  • Which job tasks cause pain and discomfort.
  • What kinds of body movement cause pain.

Some states require that you see the company doctor first. If so, go see your own doctor as well.

Fact Sheet 5

Light and Lively?

When a doctor at your facility puts you on "light duty," you may have the following restrictions:

  • No heavy lifting (above 25 pounds)
  • No lifting while twisting
  • No lifting while bending forward
  • No lifting while reaching
  • No sitting for long periods of time.

Light duty means that you are not expected to do your regular tasks. Light duty tasks can include: doing closet checks, passing ice, manicuring nails, doing simple office casks, and sometimes feeding residents.

The average nursing home resident weighs 136 pounds. Light duty restrictions often mean extras staff will be needed to do the heavy work.

Returning to work soon is a good thing. A long recovery process can be lonely, isolating, and put extra burdens on your family members. Returning to work benefice everyone. But it has to be safe.

Make sure your light-duty restrictions aren't violated. Your recovery matters too much. Preventing a permanent disability is the most important thing you can do. Be clear about the tasks you are not able to do. If you are already injured, you can't take those kinds of chances. If no one is there to replace you, contact your supervisor or your union right away.

Disabled people have the right to work. The Americans with Disabilities Act (ADA) says that your employer has to provide disabled workers with a "reasonable accommodation." This means your employer has a responsibility to make changes in your job to help you perform it adequately. This could mean providing lifting equipment or more staff to assist with a resident transfer. You will need to find out if your injury counts as a "disability." If you are disabled but can still do certain job tasks, you may be able to get an accommodation from your employer. To find out more information about the ADA, contact the Equal Employment Opportunity Commission (EEOC) or your union representative.

Fact Sheet 6

Make a new plan, Stan

Every nursing home operator should have a plan for handling injuries after they happen. This is called a medical management plan. A medical management plan helps you get better as fast as possible. It also helps you return to work safely while continuing to earn your full paycheck. Everyone benefits: you, residents, and your employer. Everyone saves money. It makes sense!

The Pieces Of The Plan

Medical management is a program for getting care, medical treatment, and follow-up to any worker who is injured. It's a way to help you get better, stay better and get back to work sooner. Medical management starts with the "responsible person."

A responsible person is someone from management who is in charge of staying on top of the whole program. Management should pick someone who knows how to prevent back injuries in nursing homes.

Your employer should:

  • Encourage every worker to report the first signs of back pain.
  • Make sure injured workers are seen by an experienced health-care provider.
  • File an injury report right away and keep track of all injuries at your facility.
  • Make sure workers' compensation forms are filled out right.
  • Stay in touch with every injured worker while they're getting better, at home or on the job.
  • Make sure light-duty restrictions aren't violated.
  • Make sure unsafe job tasks are fixed.

Trained health-care providers should be available to work with you. They should understand how to prevent injuries caused by your job.

Everyone Benefits

Everyone benefits firm a medical management plan. Your employer's workers' compensation insurance costs are lower. Management benefits from less staff turnover. Residents get better quality care. Everything runs better with more experienced staff on board.

Fact Sheet 7

Don't wait for workers' comp: It could be too late

Workers' compensation may provide benefits to you if you become permanently or temporarily disabled from your job. Workers' compensation is "no-fault" insurance. This means that you can't sue your employer if you receive money and benefits from workers' compensation.

Workers' compensation laws are different in each state. Some states have strict guidelines. There is a lot of paperwork, but the effort is worth it. You need to educate yourself about your rights and the benefits that might be available to you. Ask your employer or your union for help filling out the forms.

Workers' compensation benefits may include:

  • Part of your salary
  • All medical expenses paid
  • Money back for the cost of traveling to the doctor or hospital
  • Sick leave time back (if that time was used because of a job-related injury).

It's against the law to be fired or discriminated against because you got hurt on the job and filed for workers' compensation. Under the law, you cannot be harassed for using your rights. Don't grin and bear it. Don't avoid getting treatment. The longer you wait, the worse off you could be.

Start The Ball Rolling

Before you file a workers' compensation claim:

  • See your doctor. In some states, you have to see your employer's doctor first. Go see your own doctor, too. Make sure your doctor understands what kind of work you do.
  • Let your employer know in writing that you have a work-related injury.
Fact Sheet 8

Getting better all the time: Healing your back injury

Your doctor will need to take a medical history and give you a physical exam. Be sure to explain your back symptoms, including when they began and which activities make the pain better or worse. Again, tell your doctor about the job tasks and body movements that are part of your job.

What your doctor prescribes depends on what's wrong. Here is the most updated opinion on sprains and strains from the medical world:

  • Don't do any job task or body movement that causes discomfort or pain. If you continue doing them, your body won't be able to heal and your symptoms might get worse.
  • Some injuries require cold packs, others need heat. Sometimes both heat and cold are recommended.
  • Sometimes doctors prescribe medications that reduce the amount of pain and inflammation (the hot, swollen feeling). These drugs don't cure the problem. They just reduce the pain and discomfort.
  • Bed rest is rarely prescribed. For most injuries it is better to move around in ways that don't make the pain worse. Walking and riding a stationary bike are good exercises. Ask your doctor about exercises that will improve strength and muscle tone in your back.
  • Some people benefit from chiropractic and other care. Ask your doctor.
  • Surgery is tricky business. If your doctor recommends surgery right away, get a second opinion. Surgery is a last resort. It often fails to provide lasting relief and can cause other serious problems.
  • Some workers can return to work quickly with light-duty restrictions. A good medical management policy will make sure light-duty restrictions are safe and not violated.
CHECKLIST
Medical management plan

Does your medical management plan include the following?

Yes

No

1. The name of the management person responsible for the policy.

__

Yes __

No __

__

2. A system for recording all injuries that occur in your family.

__

Yes __

No __

__

3. Training that encourages you to report the first signs of back pain, sprain or strain.

__

Yes __

No __

__

4. The name of the person to whom you report an injury or any symptoms of back pain.

__

Yes __

No __

__

5. A system to provide every worker with a written copy of the medical management plan.

__

Yes __

No __

__

6. A written light-duty policy in your facility.

__

Yes __

No __

__

7. A responsible person appointed by management who checks in with you to make sure your light-duty restrictions are not violated

__

Yes __

No __

__

8. A responsible person appointed by management who follows up with you to make sure you are getting better.

__

Yes __

No __

__

Summary

If you are hurt on the job

  1. Keep track of everything. Report all incidents of pain, numbness, tingling, and aching to your employer. These records are very important.
  2. See a doctor right away at the first signs of back injury, strains, or sprains. The longer you wait, the more damage can occur. Tell your doctor about your job. Explain the tasks and activities you must do on a regular basis.
  3. Light-duty means no heavy lifting, or lifting while twisting, bending, or reaching. Be clear about the tasks you are unable to do. Make sure your doctor provides clear instructions about the tasks that you are unable to do.
  4. If you are hurt on the job, you have a right to workers' compensation. It is against the law to discriminate against you because you got hurt on the job. Find out the laws and deadlines in your state and make sure you file on time.
  5. With a medical management plan, workers get help as soon as the first signs of back injury begin. Workers stay healthier and productive. Residents get better care. Management saves money. Everyone benefits.
  6. Find out how to care for your injury. In most cases, some movement is better than bed rest. Surgery is a last resort. Your best bet is a medical management program that helps you return to work safely.

Activity 6 - Everyone Benefits from an ergonomic program


Purpose: To identify the parts of a good back injury prevention program for your nursing home.

Task 1:

You are on the joint labor/management safety and health committee. You are reviewing your facility's current back injury prevention program.

You get these two policies to review:

  1. Page 77: An outline of the lifting training program which occurs once a year.
  2. Page 78: A memo that explains how to use gait belts.

In your small group, read these two policies carefully and answer the following question.

  1. Will these two policies protect you from getting a back injury? If no, why not? Look at factsheets #2 through 6 to help you answer this question. Ask each worker in your small group to look at one or two of these factsheets. Make sure that each factsheet is read by someone in your group.

Task 2:

Your safety and health committee has just attended a training program about back injuries in nursing homes. You learned that there are five (5) important parts of a good back injury prevention plan. Look at factsheet #1 to help you answer this question.

  1. Make a list of these 5 parts.
  2. Explain why each part is important.

Document 1:

LIFT SAFE:
A Back Injury Prevention Program

All nursing home workers who are assigned patient-handling tasks must attend the LIFT SAFE training program once a year. The program lasts approximately one hour. The following topics are included:

  1. Introduction
    • Who's at risk
    • Cost of back injuries to the nursing home industry
  2. Why and how back injuries happen
    • Correct body mechanics
    • How to reduce the force on your back-posture and conditioning
  3. Basic lifting skills: On and off the job
    • How to size up your load
    • Tips for performing lifts and carrying residents
    • Tips for pushing and pulling heavy carts and equipment
  4. Transfer skills for nursing home workers
    • The challenge of handling human loads-variable size and weight
    • How to communicate with residents
    • Team lifting concepts
  5. Conclusion: Taking responsibility for your own back
    • Human limitations that can lead to back injury
    • Human traits that can lead to back injury
    • Your role in preventing back injuries

Document 2 :

Valley View Nursing Home

Gait Belt Safety

Policy:

It is the policy of Valley View Nursing Home, for physical therapy, restorative nursing personnel, and all nursing assistants to utilize gait belts with patients during transfers, ambulation and gait training.

Procedure:

  • Restorative Nursing Program personnel will utilize gait belts on patients during all ambulation and transfers.
  • Physical Therapy Department personnel will utilize gait belts during all gait and transfer training except in instances where patient is wearing a belt with everyday clothing.
  • Nursing assistants will utilize gait belts during all ambulation and transfers.

The Gait Belt

It is recommended that a gait belt be worn by the patient when you are transferring or ambulating a person. The gait belt provides a firm grasping surface or the staff person and protects the resident from accidental trauma to the skin. The gait belt gives the patient a sense of security as it is tightened. The belt also allows the staff person to gradually lower a patient to the floor (if necessary) without injuring self or patient.

Contraindications for Use of Gait Belt

  1. Recent colostomy/ileostomy surgery
  2. Severe cardiac condition
  3. Severe respiratory problems
  4. Recent abdominal, chest, or back surgery
  5. Abdominal aneurysm
  6. Phobia regarding belts

Ambulation with Gait Belt

Policy:

To be used in transferring and ambulation activities of patients who need the security of this assistive device.

Objective:

To promote ambulation activity by providing increased security for patient and staff.

Equipment:

Gait belt

Procedure:

  1. Gait belt is applied snugly to the patient's waist.
  2. To bring patient to standing position, keep your back relatively straight and pull on the gait belt.
  3. After the patient is standing, use gait belt to assist in stabilizing and turning patient.
  4. If patient begins to fall, draw patient close to your body using gait belt, and slowly lower patient to the floor.
Fact Sheet 1

Five parts make a complete program

To have a complete ergonomic program you and your employer should take the following five steps:

  1. Learn about the risk factors and conditions that can cause back injury. Then inspect the workplace to look for hazards. Why?

    Knowing the conditions, job tasks and hazards in your nursing home is a key part of a prevention plan.

  2. Use equipment and devices. Get training on how to use these devices. Why?

    Lifting and transferring equipment makes a big difference. You should receive training on all new equipment that is used on the job.

  3. Organize job tasks and work practices in ways that reduce injury. Why?

    Resident assessment: you need to know how each resident should be transferred. Transfer needs don't stay the same. The mental and physical state of the resident can change quickly.

    It takes two: Some lifting and transferring should only be done by two people. Part of organizing a safe workplace is making sure that enough workers are on hand to transfer residents who need more care.

  4. Have a plan to provide care and support for any worker who is hurt. Why?

    If you get hurt on the job, you need and deserve support and follow-up to make sure you get better as fast as possible and can return safely to work.

  5. Conduct ongoing training and education of workers, supervisors, and managers. Why?

    Everyone needs training-workers, supervisors and managers. Training and education help us to understand how we get hurt on the job. Training and education help us to understand how to fix unsafe jobs.

Get It In Writing!

Get the ergonomic program in writing. The plan should:

  • Describe the complete ergonomic program.
  • Be made available to all workers.
  • Be easy to read and available in the language you speak.
  • Be endorsed by the highest level of management..
  • Include a timetable that says when certain activities or changes will be made.
  • Updated annually or whenever job tasks change.

Ask to see the plan for your facility. See if all the pieces are in place. Let the joint labor management safety committee or management representative know what is missing.

Fact Sheet 2

A closer look at each piece

The first step is to do some good detective work. Learn how to identify all existing hazards and conditions that may lead to back injuries on your job. This is called a worksite analysis.

The best way to do this detective work is with the joint labor/management safety and health committee or ergonomic committee. The whole facility should be inspected. Every visible problem should be discussed, with a solution proposed and a timeline set to fix the problem. Improvements that are made should be followed up to make sure they are working. These inspections make a difference when they cake place on a routine basis, with a firm schedule set in advance. Leave no stone unturned.

Get plenty of input from workers. They can provide you with information about which tasks are stressful. Workers can provide good ideas about how to fix an unsafe job.

Other sources of information about hazards include:

  • Incident reports and worker complaints
  • OSHA 200 logs
  • Medical and insurance records
  • Results of surveys and checklists in this workbook
Fact Sheet 3

Equip yourself with the best

Using equipment and devices can help. Machines don't get back injuries. Lifting devices reduce the number of times you have to lift and transfer a resident.

Examples:

  • A lifting device (hoist) that is well-made, well-maintained, and available when you need it.
  • A shower chair on wheels that is designed to roll right over a toilet. This smart and simple piece of equipment prevents the need for several stressful transfers.
  • A transfer belt with handles to use when transferring residents who need some help getting to a standing position.
Fact Sheet 4

Communicate, coordinate, educate

The way your job is organized can make work safer. Knowing the transfer needs of each resident can make work safer.

Examples:

  • Ongoing training and education programs.
  • Make sure two nursing assistants are available to perform certain transfer tasks.
  • Provide enough staff to cover for workers who are out sick, on vacation, or working with light-duty restrictions.
  • Assessing residents regularly to find out their transfer needs.
  • Making sure all nursing assistants are told the results of these resident assessments.
Fact Sheet 5

A medical management plan

A medical management plan = support far injured workers. Medical management is a plan to support and follow up with any worker who gets hurt, and to:

  • Encourage all workers to report symptoms immediately.
  • Make sure injured workers are seen by a qualified health-care provider.
  • File injury reports right away and keep track of all injuries.
  • Make sure workers' compensation forms are filled out right.
  • Make sure light-duty restrictions aren't violated.
  • Get your facility, supervisor, doctor, and union talking to each ocher.
  • Make sure unsafe job tasks are fixed.
Fact Sheet 6

Lift and learn

Ongoing training and education programs. You should get information about the hazards on your job and how to prevent injuries. Training should:

  • Draw on your wealth of experience.
  • Encourage active participation.
  • Be evaluated by you and other workers.
  • Be changed to meet your needs after each evaluation.
  • Take place on a regular basis. Every time a new job task or piece of equipment is introduced, training should follow.

The trainer should be very familiar with the hazards of nursing home work. Trainers should be able to demonstrate transferring techniques and the correct use of transfer devices. Supervisors and managers should receive this training as well.

The training program should include the topics in this workbook:

  • Why nursing home work may lead to sprain and strain injuries.
  • How to identify risk factors in nursing home work.
  • Why early reporting of the first signs and symptoms of back pain is important.
  • How to fix the job before you, your co-workers, or residents get hurt.
  • What should be in your facility's ergonomic program.
  • How to work with a joint labor/management safety and health committee to make a safer workplace.
Fact Sheet 7

Who's in charge?

An ergonomic program can't run by itself. A well-run program requires a serious commitment from everyone concerned.

A responsible person, selected by management, should be in charge of making sure each piece of the program is working. This person should be experienced in preventing back injuries in nursing homes and must know about ergonomics. Every nursing home employee should know the name of the responsible person and how to get in touch with him or her.

A Team Effort

The responsible person can't do it alone. A team is needed to make it work, including:

  • Top management staff who have the power to make decisions to buy new equipment and maintain the equipment already in use.
  • Physical therapy staff who can help with their expertise.
  • Trainers who provide ongoing programs to workers and supervisors.
  • Worker involvement and input from all job titles

    Get the word out about how to prevent back injuries.

  • Articles in newsletters
  • Notices on bulletin boards
  • Educational programs
  • Communication between facilities.
Summary

Everyone benefits from an ergonomic program

  1. Only a comprehensive ergonomic program can successfully prevent disabling back injuries and strain of sprain injuries. This program should:
    • Identify the hazards in your facility.
    • Use equipment and devices that make transfers safer and train everyone to be able to use this equipment correctly.
    • Specify work practices like resident assessment and enough staff to help you perform a lift safely.
    • Include a plan to support any worker who gets hurt.
    • Have ongoing training and education of workers, supervisors and managers.
  2. A team effort will make an ergonomic program work. Commitment from everyone is important.
  3. Request a copy of your facility's ergonomic program in writing. Check to see if any of the important pieces are missing. An ergonomic program will work best if it is comprehensive and every player does their part.

Activity 7 - A plan for change: Safety and health committees


Purpose: To understand how to make joint labor/management safety and health committees better at solving and preventing back injury problems.

Task 1:

  1. How can you make sure that your joint labor-management safety and health committee is working well? Use Factsheets #1, 2, and 3 and your own experience to answer this question.
  2. In general, what are the common problems faced by safety and health committees? Look at factsheet #4 to answer this question.

Task 2:

You have been chosen to be a member of your workplace safety and health committee. You are very concerned about the number of back injuries in your facility.

  1. What would be the top two problems you would tackle first to prevent back injuries?  Please refer to factsheets #5, 6, and 7 to answer this question.
  2. Why did you choose these two problems?
Fact Sheet 1

What does a safety and health committee do?

Safety and health committees are the backbone of a solid plan to prevent back injuries.

Look High And Low

Joint committees can:

  • Identify the hazardous conditions in your workplace.
  • Walk through and inspect your facility every month.
  • Investigate and keep track of all injuries and accidents.
  • Look at past injury records to understand risk factors.

Make It Happen

Joint committees can:

  • Look at existing injury prevention policies and see if they are working.
  • Plan training and education programs for managers and workers in all job titles.
  • Help workers get the information they need to work safely.
  • Review and approve new equipment before it is bought.
  • Keep an open line of communication between managers and workers.
  • Help to settle conflicts.
  • Get a comprehensive ergonomic program going in your facility.
Fact Sheet 2

Who should serve on a safety and health committee?

A well-run safety and health committee should have equal numbers of labor and management representatives.

Labor representatives should be chosen by the union. The labor reps should represent and be in touch with workers in a wide variety of job titles.

Management members are usually picked by the company. The committee will work best if management representatives have real decision-making power.

Committee Roles And Responsibilities

The committee chairperson should switch off between labor and management. Switching the chair between labor and management helps both parties feel a shared sense of responsibility for the success of the committee.

In some workplaces, the committee secretary switches off between labor and management. In other workplaces, management writes up the minutes. Both sides should read and review the minutes before they become official.

Fact Sheet 3

Making it work

Make it regular. The committee should meet on a regular basis, at least once a month. The committee should have a plan to meet in case an emergency meeting is needed.

A solid agenda. Work from an agenda developed by both labor and management.

Write it down. Keep minutes and check them carefully. Minutes should be reviewed and approved by both sides. The minutes are your written record of every complaint discussed at the meeting. The minutes also record the solutions offered to the problems. Make sure that every important decision is in the minutes.

Know who's responsible. List every action to be taken in the minutes. The person responsible for the action should be clearly identified and given a timeline.

Report back. Management representatives should communicate with all management personnel to keep them up to date about all problems, proposed solutions, timelines, and other concerns.

Stay in touch. Union representatives should talk to all local officers, chapter chairpersons, shop stewards, and all workers about the ongoing work of the committee. Show them the minutes to keep them informed about what the committee is doing and to show them the committee is listening to what they have to say.

No free lunch. Work time should be provided for all committee activities. This includes times for committee meetings, regular workplace inspections, attending and conducting safety and health training programs, and other activities.

Make it happen. Include language about joint management safety and health committees in your collective bargaining agreements. This can also help start committees in workplaces where they have not yet formed and can give structure to weak committees.

Take a walk. Inspect the workplace on a regular basis. Since working conditions change all the time, a walk-through should take place once a month.

Learn as much as possible about the hazards and risk factors in your facility. Committee members can attend training programs together about sprain and strain injuries. Experienced safety and health specialists can be invited to give presentations to the committee. Use checklists in this workbook to help you decide where problems are:

  • What are the risk factors?
  • Do you do these tasks alone?
  • How good are your lifting devices?
  • How does your equipment rate?
  • What are the resident lifting needs?
  • How good is your lifting training program?
  • What makes a good medical management policy?
Fact Sheet 4

Why joint labor/management committees fail

Sometimes joint labor/management safety and health committees don't work well for a variety of reasons. Here are some of the most common:

Too much planning but not enough action. There is a lot of talking but not much walking.

The list-making committee. If the committee spends a lot of time in its meetings talking about repairs that may or may not have been completed, or about specific workers breaking safety rules, then the committee is probably not getting much done. While it is important that repairs be completed and that workers follow established injury prevention rules, these are activities that should be done in a routine way while leaving most of the committee time for the bigger concerns:

  • Employer ergonomic policies
  • Recent injuries and near misses
  • Discussing inspection reports
  • Launching mining programs for workers and managers

These activities can have a big impact in preventing injuries and should be the focus of the joint committee's work.

The buck stops here. The committee may not have a budget. Without any money, the committee is unable to pay for safety equipment, safety and health training programs, or expert consultants who can make suggestions for a safer workplace.

No commitment. The joint committee may not have the full backing of top management. The employer representatives on the joint committee may be well-intentioned and sympathetic, but they may lack power to make decisions. To be effective, the management reps on the joint committee must include people who have the power to make decisions.

Fact Sheet 5

Road map for health and safety committees

An effective health and safety committee's main goal is to improve working conditions and prevent injuries and illnesses. Since there are many problems to solve, the committee will need to see its work as an ongoing process. There are several parts of this process.

Reach out to your co-workers. Find out what they think. Take the time to listen to their concerns. Asking workers to fill out checklists in this workbook is a good way to interest them in the work of the committee. Ask them what they think the committee should be working on.

Develop a list of health and safety problems. Write down what you find out from talking to other workers in your facility. This will help you choose which concerns the committee should address and in what order. It also keeps other workers informed and lets them know that the committee is listening to what they have to say.

Pick a few problems to tackle at first. The committee can't solve every problem at once. You will have to choose carefully which ones to try to solve and when. This may be one of the hardest tasks facing your committee. Concerns raised by some workers may not be the same problems you would tackle first. Make a plan of action.

Evaluate the activity to see if it is working. A health and safety committee will only learn by doing and then discussing what worked, what didn't work, and why.

Start small and build toward bigger changes. A health and safety committee should try to solve small or easy problems before they try to make major changes. Take a look at the list of problems given to the committee by the workers. First try to fix the ones you feel can be solved easily. Build your committee on small successful changes. Tougher problems can be solved based on the experience gained from small beginnings. Taking an issue on early that is too big can squash the life out of a committee before it gets started.

Everyone has a role. In order to solve problems on the job, you will need all the help you can get from your co-workers. Not everyone will have the same level of energy and commitment. Yet many people may be willing to help out with small tasks if not big ones. The job of a health and safety committee is to find the tasks and activities that will help change the present situation. Add new levels of activity as the committee's experience, knowledge and commitment grow.

Fact Sheet 6

Information is power

Joint labor/management safety and health committees need to be informed in order to function. Knowledge of ergonomic principles, laws and regulations, and prevention and treatment of injuries will help build the reputation of the committee.

Your committee will need to find and review information about the prevention of sprain and strain injuries. Luckily, there are many good resources and centers that can help you get the information you need.

Where To Get Information

Your union's health and safety department can help in many ways. They can get you additional information and provide training programs on health and safety. See Appendix E for the office near you.

OSHA has a resource library with pamphlets, booklets, and other information about a wide variety of safety and health topics. For more information, see Appendix D for the OSHA regional office nearest you.

COSH groups are community-based "Coalitions on Occupational Safety and Health." They are resource centers on safety and health problems, and can help in many ways. See Appendix F for an office near you.

Universities sometimes have programs that provide training on injury prevention. Ask your regional SEIU office to see if there is a program near you.

NIOSH is the National Institute for Occupational Safety and Health. They research workplace health and safety problems. They have a toll-free number where you can ask for information on many hazards. Call: 1-800-356-4674.

Other government agencies may have helpful information. State OSHA, health departments, environmental protection agencies, and state and local fire departments may be able to get you information on certain health and safety hazards. Look in the blue pages of your phone book under U.S. Government, State Government, and City Government for the offices near you.

Other community organizations, such a research institutes, environmental groups, and charitable groups can also be good sources of information. You can get the names of organization from your local SEW health and safety representative, COSH group, or university program.

Your employers written policies on health and safety can be a good source of information. Most employers will have written plans for safety and health issues such a safe lifting procedures, chemicals you work with, accident reporting, and many others.

Fact Sheet 7

Health and safety committee activities

There is no set list of activities for a good joint labor/management health and safety committee. A really effective committee will be limited only by its imagination and energy.

Here are some activities that joint committees can do:

Use the checklists and surveys in this workbook to collect information.

Educate co-workers and management personnel. Some ways to do this include:

  • Reports at staff, union, and management meetings
  • Posters on bulletin boards
  • Health and safety newsletters
  • Sponsor training programs, talks and presentations
  • On-the-job meetings on health and safety issues

Form product evaluation committees. These committees review new lifting equipment and devices. Nursing home workers at many SEIU local unions have been part of these committees. They have worked with management to buy safer equipment.

Keep records. An important job of the committee is to keep track of all injuries in the facility. Sometimes this is the only proof that there are hazards in the nursing home. Facts are needed to make changes.

Start a library and resource center. See Fact Sheet 6 in this chapter for a list of groups that may have materials free or for sale.

Do monthly inspections. Make sure that both labor and management reps are present at every inspection. Workers in every area being inspected should be asked questions about safety and health hazards.

Investigate all accidents and near misses. A thorough investigation after the fact can uncover the cause of an accident and steps can be taken to prevent it from happening again. Obviously, safety improvements should be made before an accident or near miss happens.

Summary

A plan for change: Safety and health committees

  1. Joint labor/management safety and health committees are one of the best ways to tackle ergonomic problems. There should be equal numbers of representatives from labor and management. The labor reps should be chosen by the union. The management reps should have power to make real decisions.
  2. The committee should set an agenda in advance, meet regularly, and always keep a written record of decisions made and problems discussed. The person responsible for completing a task and the timeline to solve problems should be clearly stated in the minutes. Minutes should be read and agreed upon before they ate put into the permanent record.
  3. Work time should be provided for all committee activities. This includes committee meetings, committee activities, inspections, surveys, and training programs.
  4. The committee can use the surveys and checklists in this manual to gather information from workers about hazards and concerns in the facility. Other important activities include: investigating accidents, training labor and management, keeping records, and getting a comprehensive ergonomic program started.
  5. Joint committees fail when they lack the ability to make real decisions and changes. Without resources, the ability to make changes, and full support from top management, joint committees may be limited in their efforts to make the workplace safer.
  6. The committee should pick problems that can be solved and are important to the worker. Make a plan of action, then evaluate how things went. Build your committee on small successful changes.
  7. Information is power. Use the sources of information mentioned in this activity to learn as much as possible about how to prevent back injuries and other safety and health hazards.

Appendices


Appendix A

Four Basic Exercises for Good Back Care

The following exercises are helpful for many people. They can be done every day in the order listed below.

Note: Everyone's body is different. Don't do any exercise that causes pain or gets more difficult to do over time. If the exercise relieves pain or gets easier after a few repetitions, keep doing it.

If you are under medical care for a back problem or if you have back pain, be careful. Ask your health-care provider before you try these exercises.

The Pelvic Tilt

The pelvic tilt exercise helps strengthen your stomach, buttocks, and thigh muscles as well as stretching the lower back muscles. This exercise flattens the back and then let the back return to its natural curve.

  1. Lie flat on your back on a hard surface with head resting on a small pillow.
  2. Bend knees and hips so both feet are flat on the hard surface.
  3. Push lower back flat to the floor. Make sure your back is flat by trying to place your hand between your back and the hard surface. When done correctly, your hand shouldn't fit.
  4. Tighten your "stomach" (abdominal) muscles.
  5. Tighten your "buttock" (gluteal) muscles.
  6. Lift your hips from the floor and tilt your whole pelvis forward while keeping your back flat against the hard surface.
  7. Hold for a count of ten.
  8. Slowly relax.
  9. Repeat this exercise ten times. The best way to do this exercise is on the floor. You can also do it against a wall. Once you are familiar with the "feel" of the pelvic tilt, you can do this exercise in any position and you can practice at work or at home. The pelvic tilt can be done standing up against a wall or while you are standing in line, waiting at a red light, or wherever you can focus on your back for a few minutes.

Lumbar Stretches

When lumbar muscles are tight, they become shortened and interfere with bending, twisting, and pelvic rotating. Keeping these muscles stretched also helps keep the natural curves of the spine in shape.

  1. Lie flat on your back on a floor or hard surface with your head on a small pillow.
  2. Bend your knees and slowly bring them toward your chest. Reach your hand behind your thigh to help bend the knees. (Note: pulling from the top of the knee isn't good for the knees.) Don't bounce.
  3. Keep your head on the pillow and elevate your butt as high as possible off the floor. Your knees should be as close as possible to your chest.
  4. Hold this position for a count of 10. Relax, but continue to hold onto your thighs.
  5. Again, pull knees as close to your chest as possible. Do this exercise 10 times.

Hamstring Stretches

When hamstring muscles are shortened or tight they interfere with bending. You can stretch them by doing the following exercise. Begin by lying on a hard surface.

  1. With your knees close to the chest but in a relaxed position, slowly extend one leg toward the ceiling.
  2. Flex your foot and push your heel upward to feel the hamstring muscles stretch. Count to 10 while holding this position.
  3. Now bend this leg and bring the knee back toward your chest, while extending the other leg. Repeat Step 2 with the other leg.
  4. Repeat this exercise 10 times, one leg at a time.
  5. When you are done, bring both knees toward your chest and roll to the side as a safe way of returning to a standing position.

Reverse Situps

Many people have weak abdominal ("stomach") muscles and tend to arch their backs while doing situps. That's why we recommend "reverse" situps to strengthen the three groups of muscles that make the abdomen strong.

  1. Sit on the floor in an upright position with knees bent.
  2. Lock hands together behind your head and hold your arms out to your side.
  3. Tighten your stomach muscles and slowly lean back about 15 degrees, which is like going from 12 noon to 11 o'clock on a timepiece. Hold this position for a count of 5, and 10 if you can.
  4. Slowly lean back to the 10 o'clock position. Hold and count again.
  5. Return slowly to an upright position.
  6. Repeat the whole exercise.
Appendix B

Activity Evaluation

ACTIVITY NUMBER: _______________________

TITLE: _________________________________

  1. How important is this Activity for nursing home workers? Please rank on a scale of 1 to 5. (5 is the most important, 1 is the least important).

Not Important

1

2

3

4

5

Very Important

  1. Which factsheets are the most important to share with your co-workers?

______________________________

______________________________

______________________________

______________________________

______________________________

______________________________

______________________________

______________________________

  1. How could we improve this Activity?
Appendix C

Directory of Equipment Manufacturers

Mechanical Lifts

  • Care Equipment Corp.
  • 1900 A West Stone St., Fairfield, Iowa 52556
  • Tel. (800) 695-4479 Fax: (515) 472-3152 Contact: Kevin Carey
  • ARJO, Inc.
  • SARA and Maxi lifts
  • 8130 Lehigh Avenue, Morton Grove, Ill. 60053
  • Tel. (800) 323-1245 ext. 504 Fax: (708) 967-9691 Contact: Andy Hepburn
  • Medi-Man Rehabilitation Products, Inc.
  • 5630 Tomken Rd., Mississauga, Ontario L4W1P
  • Tel. (905) 238-9199 Fax (905) 625-6980 Contact: David Roy
  • Home Hospital Equipment
  • EZ Lift
  • 3634 Central Avenue N.E., Minneapolis, Minn. 55418
  • Tel. (900) 627-8940 Contact: Fred Downing
  • Parker Bath Corporation
  • Alpine Lifts
  • 805 Teal Drive, Gallatin, Tenn. 37066
  • Tel. (800) 457-8827 Contact: Jack Metz
  • Guardian
  • Hoyer Lifts
  • 4175 Guardian Street, Simi Valley, Calif. 93063
  • Tel. (800) 252-1464 Contact: Jeff Cline
  • Moving Solutions
  • Faaborgliften Lifts
  • 7980 Alabama Ave., Clarendon Heights, Ill. 60514
  • Tel. (800) 228-7980 Voice: (708)789-6995 Fax: (708)789-3399
  • Contact: Mark Niedbalec

Transfer Devices

Ergonomic transfer belt

  • The Posey Company
  • Posey Waking Belt
  • 5635 Peck Road, Arcadia, Calif. 91006
  • Tel. (800) 447-6739 Contact: Emit Posey
  • Central (Ill.): (800) 627-7686 NE (Conn.): (800) 243-0627
  • SE (Tenn.): (800) 251-5731

Pelvic lift for in-bed toileting

  • Health Services Research and Development, Inc.
  • Kimbro Pelvic Lift
  • 10470 Waterfowl Terrace, Colombia, Md. 21044
  • Tel. (410) 964-9678 Fax: (410) 740-2335 Contact: Clara Kimbro, Pres.

Horizontal transfer aids

  • Incentives Inventive Products
  • SLIPP device
  • PO. Box 51 1450 East North Street, Decatur, Ill. 62521
  • Tel. (800) 356-6911, (217) 423-6911 Contact: Vallery Mullens;

Patient transfer systems

  • Air Pal
  • 805 Harrison Sheet, Allentown, Pa. 18103
  • Tel (800) 633-4725 Contact: Bob or Donna Wheedling
  • Beatrice M. Brantman Inc.
  • Beasy Trans
  • 207 East Westminster, Lake Forest, Ill. 60045
  • Tel. (800) 232-7987 Fax: (708) 615-8894

Repositioning aids

  • Patient Care Corporation
  • EZ Repositioner
  • PO. Box 3716, Carson City, Nev. 89702
  • Tel. (102) 882-0300 Contact: Evan L. Gannon

Adaptive Clothing

  • Caring Concepts
  • 20-21 Wagaraw Rd. Bldg 36 Fair Lawn, NJ 07410
  • Tel: 800-500-0260 Fax: 800-433-1407 Contact: Paul Cohen

Note: This list was assembled in Mach 1995 and is not complete. It will be updated periodically. Devices have not been evaluated for their safety or efficiancy. Please contact your regional health and safety coordinator or the SEIU Health and Safety Department with recommendations for other equipment to help prevent back, shoulder and other strain and sprain injuries.

Appendix D

OSHA Regional Offices

  • Region I
  • (Conn*, Mass., Maine. N.H.,R.I., Vt.*)
  • John Miles, Regional Administrator
  • 133 Portland Street First Floor, Boston, Mass. 02114
  • Telephone: (617) 565-7164
  • Region II
  • (N.J., N.Y*, P.R.* V.I.*)
  • Patrcia K. Clark
  • 201 Virick Street Room 670, New York, NY 10014
  • Telephone: (212) 337-2378
  • Region III
  • (D.C., Del., Md.*, Pa., Va.*, WV)
  • Linda R. Anku, Regional Administrator
  • Gateway Building, Suite 2100, 3535 Market Street
  • Philadelphia, Pa. 19104 Telephone: (215) 596-1201
  • Region IV
  • (Ala., Fla., Ga., Ky.*, Miss., N.C., S.C.*,Tenn.*)
  • R. Davis Layne, Regional Administrator
  • 1375 Peachtree Street, N.E. Suite 587
  • Atlanta, Ga. 30367 Telephone: (404) 347-3573
  • Region V
  • (Ill., Ind.*, Mich.*, Minn.*, Ohio, Wisc.)
  • Michael G. Connors, Regional Administrator
  • 230 South Dearborn Street Room 3244, Chicago, Ill. 60604
  • Telephone: (312) 353-2220
  • Region VI
  • (Ark., La., N.M.*, Okla., Texas)
  • Emzell Blanton, Jr.
  • 525 Griffin Street Room 602, Dallas, Texas 75202
  • Telephone: (214) 767-4731
  • Region VII
  • (Iowa*, Kansas, Mo., Neb.)
  • John T Phillips, Regional Administrator
  • 911 Walnut Street, Room 406, Kansas City, Mo. 64106
  • Telephone: (816) 426-5861
  • Region VIII
  • (Colo., Mont., N.D., S.D., Utah*, Wyo.*)
  • Bryon R. Chadwick, Regional Administrator
  • Federal Building, Room 1576 1961 Stout Street
  • Denver, Colo. 80294 Telephone: (303) 844-3061
  • Region IX
  • (American Samoa, Ariz.*, Calif.*, Guam, Hawaii*, Nev.*,Trust Territories of the Pacific)
  • Frank Strasheim, Regional Administrator
  • 71 Stevenson Street Room 420, San Francisco, Calif. 94105
  • Telephone: (415) 744-6670
  • Region X
  • (Alaska*, Idaho, Ore.*, Wash.*)
  • Richard S. Terrill
  • 1111 Third Avenue Suite 715, Seattle, WA 98101-3212
  • Telephone: (206) 553-5930

*These states and territories operate their own OSHA approved job safety and health programs (Connecticut and New York plans cover public employees only). States with approved programs must have a standard that is identical to, or at least as effective as, the federal standard.

Appendix E

SEIU Health and Safety Offices

  • New York Region
  • Laura Kenny, Susan McQuade
  • 330 West 42nd Street Suite 1905, New York, NY 10036
  • Telephone: (212) 947-1944 Fax: (212) 947-0835
  • New England Region
  • Steve Schrag
  • 14 Quentin Street, Waterbury, Conn. 16706
  • Telephone: (203) 574-7966 (and fax)
  • Northern California Region
  • Maggie Robbins
  • 7901 Oakport Street Suite 4900, Oakland, Calif. 94261
  • Telephone: (510) 568-2500 Fax: (510) 568-3652
  • Pacific Northwest Region
  • c/o Local 6
  • John Mehring
  • 150 Denny Way, PO. Box 19360, Seattle, Wash. 98109
  • Telephone: (206) 448-7348, Extension: 334 Fax: (206) 441-5120
  • Central Region
  • Joe Zanoni
  • 940 West Adams Suite 400, Chicago, IL 60604
  • Telephone: (312) 455-1500 Fax: (312) 455-8184
  • SEIU Michigan State Council
  • Eleanor Holbrook
  • 419 S. Washington Street, Lansing, MI 48933
  • Telephone: (517) 372-0903 Fax: (517)482-5361
  • Canadian Region
  • Ted Mansell
  • 75 The Donway West Suite 1410, Don Mills, Ont. M3C 2E9
  • Canada
  • Telephone: (416) 447-2311 Fax: (416) 447-2428
  • Southern California Region
  • Michael Kushner
  • 3055 Wilshire Blvd. Suite 1050, Los Angeles, Calif. 90010
  • Telephone: (213) 368-7400 Fax: (273) 368-7348
  • MidAtlantic Region
  • Fran Cameo c/o SEW Local 585
  • 237 Sixth St. Pittsburgh, PA 15238
  • Telephone: (412) 828-5100 Fax: (412) 828-2607
  • SEIU Health and Safety Department
  • 1313 L Street, N.W. Washington, D.C. 20005
  • Telephone: (202) 898-3386 Fax: (202) 898-3491
Appendix F

COSH Groups

National COSH Groups

Alaska

  • Alaska Health Project
  • 1818 W Northern Lights Blvd, Anchorage, Alaska 99517
  • Telephone: (907) 276-2864 Fax: (907) 279-3089

California

  • Worksafe/Francis Schreiberg
  • c/o San Francisco Labor Council
  • 660 Howard Street, 3rd Floor San Francisco, Calif. 94105
  • Telephone: (415) 543-2699 Fax: (415) 882-4999
  • LACOSH (Los Angeles COSH)
  • 5855 Venice Blvd. Los Angeles, CA 90019
  • Telephone: (213) 931-9000 Fax: (213) 931-2255
  • SACOSH (Sacramento COSH)
  • c/o Fire Fighters Local 522
  • 3101 Stockton Boulevard Sacramento, Calif. 95820
  • Telephone: (916) 442-4390 Fax: (916) 446-3057
  • SCCOSH (Santa Clan COSH)
  • 760 North First Street, San Jose, Calif. 95112
  • Telephone: (408) 998-4050 Fax: (408) 998-4051

Connecticut

  • ConnectiCOSH (Connecticut COSH)
  • 77 Huyshoup Ave. 2nd Floor, Hartford, Conn. 06106
  • Telephone: (203) 549-1877 Fax: (203) 251-6049

District Of Columbia

  • Alice Hamilton Occupational Health Center
  • 410 Seventh Street, SE, Washington, D.C. 20003
  • Telephone: (202) 543-0005 Fax: (202) 543-1327
  • Telephone: (301) 731-8530 (Md.) Fax: (301) 731-4142 (Md.)

Illinois

  • CACOSH (Chicago COSH)
  • 37 South Ashland, Chicago, Ill. 60607
  • Telephone: (312) 996-3228 Fax: (312) 243-0492

Maine

  • Mane Labor Group on Health
  • Box V, Augusta, Maine 04330
  • Telephone: (207) 622-7823 Fax: (207) 622-3483

Massachusetts

  • MassCOSH (Massachusetts COSH)
  • 555 Amory Street, Boston, Mass. 02130
  • Telephone: (677) 524-6686 Fax: (617) 524-3508
  • Western, MassCOSH
  • 458 Bridge Street, Springfield, Mass. 01103
  • Telephone: (413) 731-0760 Fax: (413) 732-1881

Michigan

  • SEMCOSH (Southeast Michigan COSH)
  • 1550 Howard, Detroit, Mich. 48216
  • Telephone: (313) 961-3345 Fax: (313) 961-3588

Minnesota

  • MN-COSH (Minnesota COSH)
  • c/o Lyle Krych M330
  • FMC Corp. Naval System Division
  • 4800 East River Road, Minneapolis, Minn. 55421
  • Telephone: (612) 572-6997 Fax: (612) 5721956

New Hampshire

  • NHCOSH
  • c/o NH AFL-CIO
  • 110 Sheep Davis Road, Pembroke, N.H. 03275
  • Telephone: (603) 22226-0516 Fax: (603) 225-1956

New York

  • ALCOSH (Allegheny COSH)
  • 100 E. Second Street, Jamestown, NY 14701
  • Telephone: (716) 488-0720 Fax: (716) 487-0968
  • CNYCOSH (Central New York COSH)
  • 615 W Genessee Street, Syracuse, NY 13204
  • Telephone (315) 471-6187 Fax: (518) 393-3040
  • ENYCOSH (Eastern New York COSH)
  • c/o Larry Rafferty
  • 121 Eric Blvd. Schenectady, NY 12305
  • Telephone (518) 372-4308 Fax: (518) 393-3040
  • NYCOSH (NewYork COSH)
  • 275 Seventh Avenue 8th Floor, New York, NY 10001
  • Telephone: (212) 527-3900 Fax: (212) 627-9812
  • (914) 939-5612 (Lower Hudson) (515) 273-1234 (Long Island)
  • ROCOSH (Rochester COSH)
  • 46 Prince Street Rochester, NY 14607
  • Telephone: (716) 244-0420 Fax: (915) 244-0956
  • WNYCOSH (Western New York COSH)
  • 2491 Main Street Suite 438, Buffalo, NY 11214
  • Telephone: (716) 833-1416 Fax: (716) 833-7507

North Carolina

  • NCOSH (North Carolina COSH)
  • PO. Box 2514, Durham, N.C. 27715
  • Telephone: (919) 286-9249 Fast: (919) 286-4857

Oregon

  • c/o Dick Edgington ICWU-Portland
  • 7440 SW 87 Street, Portland, Ore. 07223
  • Telephone: (503) 244-8429

Pennsylvania

  • PhilaPOSH (Philadelphia OSH)
  • 3001 Walnut Street 5th Floor, Philadelphia, PA 19104
  • Telephone: (215) 386-7000 Fax: (215) 386-3529

Rhode Island

  • RICOSH (Rhode Island COSH)
  • 741 Westminster Street, Providence, RI 02903
  • Telephone: (401) 751-2015

Texas

  • TexCOSH (Texas COSH)
  • c/o Karyl Dunson
  • 5735 Regina, Beaumont, TX 77706
  • Telephone: (409) 898-1427

Washington

  • WASHCOSH (Washington COSH)
  • 6770 E. Marginal Way S., Seattle, Wash. 98108
  • Telephone: (205) 757-7426 Fax: (206) 762-5433

Wisconsin

  • WisCOSH (Wisconsin COSH)
  • 734 North 25th Street, Milwaukee, Wisc. 53230
  • Telephone: (414) 933-2338

Canada

  • WOSH (Windsor OSH)
  • 547 Victoria Avenue, Windsor, Ont. N9A 4N1
  • Canada
  • Telephone: (519) 254-5157 Fax: (519) 254-4192
COSH Related Groups

Califorina

  • Labor Occupational Health Program
  • 2515 Channing Way, Berkeley, CA 94720
  • Telephone: (510) 632-1507 Fax: (510) 643-5698

District of Columbia

  • Workers Institute for Occupational Safety and Health
  • 1125 16th Street, NW Room 403, Washington DC 20036
  • Telephone: (202) 887-1980 Fax: (202) 887-0191

Louisiana

  • Labor Studies Program/LA Watch
  • Institute of Human Relations Loyola University
  • Box 12, New Orleans, La. 70118
  • Telephone: (504) 861-5830 Fax: (504) 861-5833

New Jersey

  • New Jersey Work Environment Council
  • 452 East Third Street, Moorestown, NJ 08057
  • Telephone: (609) 866-9405 Fax: (609) 866-9708

Ohio

  • Greater Cincinnati Occupational Health Center
  • 10475 Reading Road Cincinnati, Ohio 45241
  • Telephone (513) 759-0561 Fax: (513) 769-0766

West Virginia

  • Institute of Labor Studies
  • 710 Knapp Hall West Virginia University
  • Morgantown, W.Va. 26506
  • Telephone: (304) 293-3323 Fax: (304) 293-7153
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