2009 Paul A. Volcker Career Achievement

Audrey Nelson

Explored ways to help nurses and medical practitioners avoid back injuries, which resulted in a $200 million program across the VA to use mechanical lifts and transfer devices when moving patients.

Nurses are some of the unsung heroes of our society, performing long hours of back-breaking labor to look after the sick. Dr. Audrey Nelson is looking after our nurses, protecting them and other health care providers throughout the nation from disabling workplace injuries related to moving and transferring dependent patients.

A nurse scientist at the James A. Haley Veterans Hospital in Tampa, Fla., Nelson began her quest 20 years ago to solve the problem of musculoskeletal injuries among nurses. She observed how workers at loading docks relied on equipment for lifting, and she never stopped asking why nurses weren’t using mechanical means to move patients.

Nelson’s relentless pursuit of a solution to the high rate of nursing injuries has led to a $200 million nationwide three-year program funded by the Department of Veterans Affairs (VA) that is designed to radically change the way nurses handle patients. The emphasis is on shifting away from manual lifting and pulling to an ergonomics-based approach using mechanical technologies.

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

“Her observations led her to do research that transformed the way we care for patients. She challenged the prevailing assumptions in a way that was grounded in research, and she won people over to her point of view,” said Stephen Lucas, director of the James A. Haley Veterans Hospital.

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

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

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

Nelson identified the common nursing tasks that contributed most to musculoskeletal injuries, tested ways to either redesign the task or to complete it using mechanical lifts and transfer devices, and led a series of studies and clinical tests funded by the VA. Her studies developed an approach that decreased the number and severity of patient handling injuries, lowered worker compensation costs and resulted in increased comfort and dignity for patients.

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

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

Nelson met repeated resistance to moving patients mechanically from selfless nurses and from occupational therapists, rehabilitation specialists and long-term care providers who thought it was undignified. Hospital administrators said the change would cost too much.

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

Nelson said many nurses have what she calls the “Florence Nightingale syndrome — they will sacrifice themselves for the patient.”

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

Too often, nurses and the hardships they must endure are overlooked and underappreciated. Nurses and health care providers for the VA can feel better knowing Audrey Nelson’s got their back.