Factors associated with changes in ergonomic exposures among nursing assistants after the introduction of a no-lift program in nursing homes

Musculoskeletal disorders are well documented in the nursing profession and are particularly prevalent among nursing assistants in nursing homes. In 2004, a corporation with 217 nursing homes began implementing a No-Lift Program (NLP), introducing resident lifting equipment, procedures, and policies. We investigated the effect on observed ergonomic exposures of nursing assistants using PATH (Postures, Activities, Tools, and Handling) in four nursing homes. We also collected survey and focus group data on health, work history and working conditions in this population to assess factors associated with lift equipment use. Ergonomic observations and surveys were collected at baseline, three-month, 12-month and 24-month periods following NLP implementation.

After one year, the proportion of time that nursing assistants were handling residents dropped from 13.8% to 9.3%. While resident handling, nursing assistants used lifting equipment 14.6% of the time vs 5.7% before the NLP, and neutral trunk postures were observed 8.2% more frequently. Survey responses indicate that previous low back pain is predictive of lift use. One year after NLP implementation roughly 2/3 respondents reported using the lift equipment always or often. Common barriers to lift use included accessibility problems, resident objections, and perceptions that the equipment was not necessary.

Changes in observed ergonomic exposures support the idea that the NLP is effective for reducing the amount of time nurses spend in resident handling and improving trunk postures. However, incomplete uptake of the intervention, coupled with barriers identified, point to the need for greater coordination and education throughout intervention sites to assure a sustainable program.