iStock | Susan Chiang
First, do no harm. It’s the overriding principle of healthcare. While it applies, of course, to the patients you treat, you should also apply it to yourself.
As a nurse, if you don’t stay healthy and safe, it’s going to be difficult to give your patients the care they need.
Here are some of our top tips for staying well and out of harm’s way in the workplace. Use it to reinforce what you learned in nursing school and remind yourself of how your patients’ health and safety is dependent on yours.
BACK OFF! AVOID MUSCLE ACHES AND PAINS
The patient is 250 pounds; you’re 125. When you encounter him, he’s struggling to get from his wheelchair into bed. Do you: a) lift him back into bed, b) give him a shoulder to lean on or c) go get the lift down the hall? Logically, you know c is the right answer. However, in the heat of the moment, are you going to be more likely to choose a or b?
“Nurses have little computers in their heads and they know how long it takes to do something. If that something adds 10 seconds, they’re not going to do it,” says Nancy Menzel, PhD, RN, an associate professor of community health nursing at University of Nevada, Las Vegas. All the more reason to keep assistive devices—such as mechanical lifts—convenient to the bedside, says Menzel, whose research focuses on prevention of work-related musculoskeletal disorders in nurses.
Not surprisingly, nurses and other healthcare workers are second only to firefighters in work-related injuries. And nurses in some units are at greater risk (particularly for back injury) than others. One 2012 study, by researchers at Boston University School of Public Health, found that operating rooms, float pools and step-down units had the highest rates of nurse injuries (pediatric/neonatal and non-inpatient units had the lowest).
Contrary to what’s often thought, musculoskeletal injuries don’t generally happen because you make one wrong move. “It’s usually cumulative trauma, caused by many small microtears,” says Menzel. “If those tears aren’t allowed to heal, they can cause permanent damage and eventually put you out of work.” So don’t wait for the straw that breaks your back. Put our preventive measures into place now.
No Heavy Lifting
Safe patient handling isn’t about body mechanics—even with your knees properly bent, transferring a 200-pound patient with a draw sheet puts you and your patient at risk—it’s about taking an ergonomically appropriate approach to moving, positioning and assisting patients. Research from the National Institute for Occupational Safety and Health puts the limit on safe lifting at 35 pounds; above that, forgo manual labor for mechanical equipment and assistive devices such as powered lifts and lateral transfer devices. Other guidelines to keep in mind:
- Avoid awkward positions—if it feels strange, it’s not safe.
- When attending to a patient, be sure the bed is adjusted to a comfortable height for you to work.
- Request proper equipment for obese patients, but also be careful about ordering a bed that’s too big. If it’s too large, you could strain your back reaching across to assist the patient.
- If turning a patient, reduce damage on your own body by flexing the patient’s knees and hips and using his thigh as a lever.
- Take breaks throughout the day to recover from lifting and other taxing maneuvers.
Can Exercise Help?
There are always many great reasons to exercise, but being fit doesn’t provide a free pass on muscle injuries—or license to disregard safe patient handling guidelines. However, core-strengthening exercise in particular can help ward off muscle fatigue. Then there’s this: Some research indicates that stretching can help relieve the pain of injuries that have already occurred. In a 2012 study, Taiwanese researchers compared nurses with lower back pain who stretched to a group that did no stretching. After six months, they found that the stretchers were in much better shape than the non-stretchers—81 percent reported moderate to high levels of relief.
Advocate for Safer Conditions
What’s most critical to your muscular health is that you have the right tools for the job. If your workplace doesn’t have proper lifting equipment and a safe patient handling program in place, exercise your right to speak up.
- Check in with the employee safety committee to make your concerns known.
- Contact your local union if you’re not getting any traction at work.
- If you’re interviewing for a new job, ask about their safe-handling programs. If they don’t have one, seriously consider passing.
FOOTLOOSE AND PAIN-FREE
Nurses are frequently dogged by foot problems, and it’s no wonder. Standing on hard floors, bending, lifting and working up a (foot) sweat can lead to a number of painful conditions, including plantar fasciitis, cramping, corns and bunions. Foot pain prevention begins with good shoes, says Suzanne Levine, DPM, a New York City podiatrist, but there are a few other precautionary measures you can take to keep your feet healthy.
- Stretch. On break or after work, take a few minutes to stretch the muscles in your feet. Point your toes and use those tootsies to “write” the alphabet. Cock your feet, then pretend that you’re pressing on a gas pedal. Wave your feet as if they were windshield wipers. You’ll feel the difference when you’re done.
- Change your socks during the day. Moisture accumulates during a 12-hour shift and can contribute to the development of calluses as well as provide a nice little environment for fungus to grow. Bring a change of socks to work (and don’t forget to put them on!).
- Consider orthotics. If you have plantar fasciitis (a strain in the ligament that supports your arch) or other problems that make your feet ache, off-the-rack shoe inserts and orthotics (which are custom-made, molded to your specific feet) may help. To try: Dr. Comfort inserts and Spenco orthotic arch supports, both given a seal of support from the American Podiatric Medical Association.
- Be careful about pedicures. “If you’re going to have a professional pedicure, skip the foot bath,” says Levine. “Bacteria can linger in the tubs.” (If you must have one, try to be the first customer in the morning.) Choose a place where they use gloves and freshly disinfected tools, and don’t shave your legs right before your pedicure—it increases the risk of infection. Bring your own tools whenever possible.
- Investigate new treatments for feet. Cosmetic techniques once reserved for the face are now being used to staunch foot pain, thwart overactive sweat glands and protect against calluses. Levine, for instance, offers neurotoxin and other injectable treatments as well as lasers, glycolic acid peels and microdermabrasion for the feet. The treatments are pricey, but “we give our local Lenox Hill nurses a discount,” says Levine. “Many other podiatrists give nurses discounts as well.” Be sure to ask.
Does the Shoe Fit?
To avoid foot pain, wear comfortable shoes. What more do you need to know? Turns out that comfort is only one aspect of pain avoidance. Look for these attributes in a shoe:
- Support: “A good shoe will offer support, not just comfort,” says Nichol Salvo, DPM, director of the American Podiatric Medical Association’s Young Physicians’ Program. Support is particularly important under the arch, and shoes should be stiff in the middle, but bend at the ball of the foot.
- Small heel: Flat shoes are fine, but if you want a little lift, then choose a shoe with a 1- to 1½-inch heel. Stay away from pointy high heels in your off hours, too—they can aggravate neuroma, a painful thickening of the nerve between the third and fourth toes.
- Shock absorption: Pick a shoe with a sole that has some give.
- Full closure: Clogs are fine; just opt for the closed ones that hug the foot. Backless shoes are less stable and provide less support.
- Personal perfection: The right shoes will help you sidestep corns and calluses, but there’s no one universally perfect shoe—everybody’s feet are different, says Salvo. Try on a lot of shoes before you buy. That will increase the likelihood that you’ll find the ideal fit.
What a Heel! Make Yours Beautiful Again
Rough heels aren’t just unattractive; they can develop into raw and tender cracks. To remedy, soak your feet in warm water for five minutes, then scrub with a pumice stone. Follow up with a thick moisturizer, preferably one with an exfoliating alpha hydroxy acid like glycolic or salicylic acid. Two we like: O’Keeffe’s for Healthy Feet and Sally Hansen Just Feet Deep Callus Remover. Put on a pair of socks and let the cream do its work.
DEFUSE THE SITUATION
Five years ago, a patient threatened to kill Jessica Leigh Taylor, a young nurse new to the job, then grabbed her hand so hard she thought it would break. As Taylor screamed in pain, the patient looked into her eyes and smiled. It took several staff members to restrain him.
Unfortunately, this was no anomaly. The 2011 Emergency Department Violence Surveillance Survey found that 42 percent of nurses had experienced verbal abuse in the previous seven days, close to 1 percent had experienced physical violence and about 11 percent were subject to both. And workplace attacks, of course, don’t only happen in emergency departments. The American Nurses Association’s 2011 Health and Safety Survey found that 11 percent of RNs were physically assaulted during a 12-month period.
“Nothing I learned in nursing school prepared me for violence,” says Taylor, who works in the emergency department at St. David’s South Austin Medical Center in Texas and is a doctoral student. She believes that nurses need more violence-preventive education. To that end, she has created a workplace violence toolkit for the Emergency Nurses Association, and offers these safety tips:
- Assess the risk. Ask yourself if the situation is safe before you proceed. Who else is in danger, including the patient? Do not go charging into a volatile situation by yourself, no matter how capable you feel about handling it. Make sure you have the resources you need. “Nurses are terrible at doing this because they’re concerned about others,” says Taylor. “Take care of yourself first.”
- Learn to de-escalate. After she was attacked, Taylor pursued training on how to proactively respond to future crises. “A large part of de-escalation is learning better communication skills and how to respond to people based on where they are on a behavior continuum,” says Taylor. “Additionally, treating people with kindness and respect, even when they don’t deserve it, really goes a long way.”
- Report attacks. “There’s the sense that it’s part of the job, but it’s not the part of the job,” says Taylor. “Criminal behavior is criminal behavior, even if someone is ill.”
Prevent Violence Before It Happens
The Centers for Disease Control and Prevention developed these guidelines specifically for healthcare workers.
1. Watch for signals that may be associated with impending violence:
- Verbally expressed anger and frustration
- Body language such as threatening gestures
- Signs of drug or alcohol use
- Presence of a weapon
2. Maintain behavior that helps diffuse anger:
- Present a calm, caring attitude.
- Don’t match the threats.
- Don’t give orders.
- Acknowledge the person’s feelings (for example, “I know you are frustrated”).
- Avoid any behavior that may be interpreted as aggressive (for example, moving rapidly, getting too close, touching or speaking loudly).
3. Be alert:
- Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor.
- Be vigilant throughout the encounter.
- Don’t isolate yourself with a potentially violent person.
- Always keep an open path for exiting—don’t let the potentially violent person stand between you and the door.
4. Take these steps if you can’t defuse the situation quickly:
- Remove yourself from the situation.
- Call security for help.
- Report any violent incidents to your management.