Oregon OSHA Health and Safety


August 2015

Going the Distance

Company: HumanFit, LLC

Ergonomist/Human Factors Consultant: Lynda Enos, RN, MS, COHN-S, CPE

Lynda Enos, RN, MS, COHN-S, CPE

Common hazards: Musculoskeletal injuries (sprains, strains) primarily from manual patient lifting and moving and slips, trips and falls; workplace violence (including violence from patients, visitors, and co-workers); bloodborne pathogens; exposure to infectious diseases and chemical hazards; and psychosocial hazards (shift work, long hours, and overtime)

What is your background and how did it bring you into the work you do today?

I started my career as a registered nurse and then a nurse midwife in the United Kingdom. After immigrating to the U.S. with my husband in the 1980s, I worked as an occupational health nurse at an aerospace manufacturing company in Texas. It was in that work environment that I became interested in prevention of worker injuries and, specifically, how to design work processes and products to reduce acute and cumulative work-related musculoskeletal disorders.

I completed my undergraduate degree in nursing and certified as an occupational health nurse but decided that completing a graduate degree in ergonomics and certifying as a professional ergonomist would give me the additional knowledge I needed.

During the past 23 years, I have provided comprehensive ergonomics consulting services to more than 250 companies, including health care, manufacturing, semiconductor, wood products, and service sector facilities nationwide.

In 2001, while working with Auburn Engineers, I was asked to research and co-author the federal OSHA "Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders." As I worked on this project, I realized that ergonomics and prevention of worker injuries, specifically musculoskeletal disorders in health care, was not being addressed as well as it was in manufacturing and other industries at that time.

As a nurse who had suffered a serious back injury from manually lifting and moving patients early in my career, I returned to work in the health care environment with the goal of designing work systems to prevent similar injuries occurring to nurses and other health care workers.

The past 14 years I have worked with many health care organizations, including acting as a consultant and ergonomist for Oregon Nurses Association. I had the unique opportunity to provide safe patient handling, ergonomics, and safety consulting services to 25 hospitals in Oregon for up to five years per facility.

Currently, I am working with several health care facilities in the Northwest, including Oregon Health & Science University (OHSU), where I am assisting to implement a housewide comprehensive safe patient handling (SPH) program.

I have been actively involved as a volunteer in several professional organizations, including the American Nurses Association (ANA) as a contributor for the ANA Safe Patient Handling and Mobility Standards that were released in June 2013 and as co-chair of the Oregon Coalition for Health Care Ergonomics (OCHE) since 2003. In 2014, I had the honor of receiving the Ergonomics Professional of the Year Award from the Puget Sound Human Factors and Ergonomics society.

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What do you see as some of the challenges in health care given that there is no OSHA standard for ergonomics?

Successful ergonomics and safe patient handling programs are multifaceted; thus, health care organizations have to be committed to providing ongoing financial and personnel resources for the purchase of patient lift equipment and education of staff. I believe ongoing support has to be provided that facilitates the necessary change in culture or behavior from a manual handling to safe patient handling work environment.

Without ergonomics regulation to help direct and prioritize implementation of worker safety initiatives, programs such as safe patient handling have to demonstrate a direct contribution to the achievement of the health care organizations' business objectives, mission, and patient and staff satisfaction, if they are to compete for budget and staffing resources.

Hospital and health care settings have a variety of overlapping government regulations. How do you keep an employer focused on worker safety?

Repeatedly demonstrating to employers that prevention of worker injuries benefits their organizations' business goals and mission is critical, so that worker safety programs are consistently treated as a priority, as much as patient safety initiatives.

The education of health care executives and senior management about the true cost of worker injuries such as workers' compensation, staff replacement costs, and negative impact on patient care and safety, is essential.

Executive rounding and manager and staff "huddles" are increasingly being used as a tool to improve patient safety efforts in health care organizations. Incorporating discussion about worker safety issues, such as patient lifting and mobility, into these activities can help to engage employers and workers in safety efforts and enhance a culture of safety.

Similarly, incorporating key questions related to worker safety as part of "Environment of Care" rounds, which are conducted as part of a health care organization's accreditation requirement, can help an organization focus on a proactive approach to patient and worker safety. It is estimated that at least 50 percent of worker-related injuries and incidents go unreported in health care. Therefore, educating health care workers about the importance of early reporting of occupational injuries and how to bring safety concerns to their supervisor and organization's safety and health committee is critical. This allows employers to be more accurately informed about the scope of safety issues at their facility.

How do you stay motivated to continue this type of work?

There many things that keep me motivated, including the positive feedback I receive or hear from health care workers related to the impact of safe patient handling and ergonomics programs. When a nurse, aide, or tech says to me that they don't feel as tired at the end of their shift because they used the lift equipment to move patients, I know that their risk of disabling injury and likelihood of making a mistake during patient care due to fatigue is reduced.

I am also encouraged by the recent focus by regulatory bodies (Centers for Medicare and Medicaid Services and the Joint Commission) to explore and communicate the relationship and importance of health care worker safety to the delivery of safe patient care.

In addition, increasing media have helped communicate the seriousness of injuries related to manual patient handling and movement to a broader audience. This has influenced federal OSHA to increase its enforcement efforts of worker safety programs in hospitals, with a focus on safe patient handling efforts.

What advice do you have for others in health care hoping to make a difference?

Don't reinvent the wheel. Safety and health challenges are similar across health care environments and there are many resources and tools already developed that can be freely shared such as those on the Oregon Coalition for Health Care Ergonomics website.

I encourage people to network and share information with other likeminded professionals. Organizations, such as the American Society for Safety Professionals (ASSE), have an active and dynamic Healthcare Practice Specialty group, as do the Northwest chapter of the Association of Occupational Professional in Health Care (AOHP). Contact me directly if you are interested in joining the OCHE network in Oregon.

Know your numbers. Make sure that administrators, managers, and staff understand the full cost of worker injuries (beyond workers' compensation costs) and all the evidence-based benefits of safe patient handling, ergonomics, and other safety programs.

Be persistent and patient in your efforts. Developing a true culture of safety in health care that integrates worker and patient safety with equal importance and changing everyday work practices takes a team effort and time. ◼︎

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