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Healthcare Assignment: Case Analysis of Ergonomic Health Issues at Workplaces


Case Study: I’m a registered nurse; now, a back-injured registered nurse with a cumulative trauma spinal injury from ten years of lifting and moving patients. I worked at an acute care hospital on medical/surgical, telemetry, and intermediate care units. The patients were generally elderly and acutely ill with a variety of cardiac, medical, and surgical conditions. Many were unable to move themselves up or turn side- to-side in bed, to sit up, stand up, or transfer to the chair or bedside commode without being physically pulled, lifted, or occasionally, even picked up and carried. Confused patients sometimes resisted, increasing the strain. Much heavy lifting was required.

I always had low back pain for years however, it got exaggerated when I tripped over in my ward because of the wiring of the health monitor. I was informing my manager to remove the wires for more than 2 weeks.

“I first experienced severe low back and leg pain when I slipped in my ward while working with the patient while walking through my kitchen during a scheduled day off. I could not walk, sit, and hardly move. I had to call and report that I could not come to work because of back pain. Other than a brief unsuccessful attempt a few months later, I have been unable to return to floor nursing. I’ve been seen by neurologists, orthopaedic surgeons, neurosurgeons, and a chiropractor. I was diagnosed with degenerative disc disease, lumbar strain, and bulging or herniated discs. I’ve had two MRIs, two discograms, a series of lumbar blocks, and ultimately, an anterior lumbar fusion of L4/L5 and L5/S1, with donor bone grafts to replace the discs, and posterior fixation with four titanium screws. The ACC workers’ compensation battle took years before the decision came in my favour that my injury was work related. I had to fight hard before being permitted for modified light duty.

“Almost everything in my life has been altered by being back-injured. I’ve been unable to do many things that I formerly did with ease. I can no longer flip a mattress or even assist to turn a mattress. I need help changing sheets on the bed. I can’t vacuum as before and either let it go, get help, or wait until my analgesic kicks in and then do as much as I can. Sitting for any length of time is painful. Driving is painful because of the vibration and seated position—I drove over 5000 miles with the injury for multiple appointments. I’m not able to pick up small children—the first thing that upset me greatly was realizing that I may not be able to pick up a potential grandchild someday. “I hope you recognize the healthcare worker’s vulnerability and are inspired to work toward zero-lift policies, lift teams, and permanent modified light duty for injured clinicians. Caring for patients and receiving their trust touches us deeply. I loved being a hospital floor nurse. Still, my experience as a back-injured nurse has provided the incentive to learn and the motivation to speak out. I’m grateful for the opportunity to be part of the larger effort for reduction of back injuries to healthcare workers.”

Charney W & Hudson a (Eds). Back Injury among Healthcare Workers: Causes, Solutions, and Impacts. Boca raton: CrC Press. 2004.

Read the above Case Study, ‘When My Job Breaks my Back’ and take notes to prepare a healthcare assignment answering the following questions.

  • What were the issues leading to the registered nurses’ injuries?
  • Could the incident related injuries have been managed differently by the workplace?
  • Did the workplace follow correct incident management procedure?
  • What are the issues relating to workers compensation?
  • What is the role of ACC in workers compensation and return to work programmes?
  • How did the workplace breach the Health and Safety at Work Act?
  • From the perspective of the organisation, what are the strategic elements of a Return to Work Plan? e.g. individualised communication with health professionals working with the employee; return to work goals.


Executive Summary
The report on healthcare assignment discusses a workplace health and safety issue and repercussions it caused for a floor nurse through a case study- When My Job Breaks my Back. The case study puts focus on ergonomic health issues that happen at work places.

Based on the case study, the issues that may have led to the injury to the nurse is identified and discussed. Similarly, workplace health and safety issues were also identified and analysed. Certain strategies related to workers compensation, get back to work after incident and injury and incident management were discussed. Certain recommendations were also provided after deducing the primary reasons of the incidents and how the management could avoid them or act during the course of incident.

Identify & Analyze the issues leading to nurse’s injuries
The Health and Safety Act 2015 of New Zealand necessitates that employees and others are given the most significant level of assurance in the working environment concerning their well-being and occupational risks, so far as is sensibly practicable (Bolotbaeva, 2018). This encapsulates dangers to both physical and emotional well-being (Neal, 2017, p. 30).

In the case study, the nurse used to attend to patients who were mostly elderly, unable to move. They suffered from conditions that had rendered them acutely ill, such as cardiac conditions, medical and surgical conditions which made them largely immobile and even delusional. The issue of her present day condition of a cumulative trauma spinal injury was a resultant of 10 years of moving and lifting of such patients. This indicates a possible problem in her manual handling skills. Despite her tenure and experience there are chances that she may be doing certain operations incorrectly to cause her lower back pain (Durr et al., 2020, pp. 1- 13).

During the course of her active nurse duty on the floor, she needed to come to office on a scheduled day off. It could also indicate excessive work load or staff shortage. Resource crunches also equally put pressure on existing employees by not allowing them ample rest for their bodies. This is a clear indication of unsafe workplace (Johnson et al., 2018, pp. 20-32). The nurse had even reported the issue of wires but it went neglected. So possible there was also absence of an incident reporting system which could enable to employees to report potential hazards and which would make the organisation to compulsorily look into it.

On top of this, despite her bringing it to the notice of manager of the risk of the tripping from the wiring of the health monitor, no action taken resulted to her getting tripped where she injured her lower back further. The issue could be with floor of the workplace and even floor clutter caused by wires (Cohen, 2017).

Identify & Analyse the Health and Safety Issues at workplace
Ergonomic injuries or MSD (Musculo-skeletal Disorders) at workplace are, throughout the world, one the most serious injuries that occur and often leave the employee suffering either with pain or joblessness. They are heavy burden for the employee and costly affair for the business. Lower back pain is one of the most common type of MSD’s and for the health care industry (Cullen et al., 2018, pp. 1-15). According to a report by Aon in 2019, MSDs accounted for 31.6% in worker’s claims, roughly 40.8% of claim cost.

Some of the health and safety hazards as indicated:

  1. Heavy physical work at workplace, at same place - includes, turning over patient, helping to stand or sit up, shifting to chairs and so on
  2. Lifting and forceful movement of patients to other places on an everyday basis, such as carrying patients, moving patients
  3. Repetition of the same over a long period of time,
  4. Neglect of unkempt wires out of health monitors or possibly other devices which prove as a hazard for tripping over
  5. Neglecting reporting of a potential hazard by an employee to concerned authorities
  6. Allowing employees their day off and not allowing them to office. The nurse got hurt on her day off when she was not even supposed to be there

These hazards, as identified above showcase a workplace where there may be resource crunch because of which the health workers were not provided with ample assistance in terms of machinery or team mates for conducting the tasks which were done by the floor nurse. It could also be that owing to her long tenure, her inputs were neglected or ignored and appropriate action was not taken (Goodyear-Smith & Ashton, 2019, pp. 432-442). It could also be that there is dearth of proper workplace incident management systems which help in appropriate reporting of potential hazards. The nurse got hurt in her ward on her day when she had a scheduled off work. This indicates possible resource crunch owing to which she had to come to office.

Evaluate Strategies

  1. Worker Compensation – A system to send notification to the employer about the workplace injury and getting immediate treatment by getting treated by the doctor, are both necessary to be able to lodge a claim for compensation by the injured employee.
    Getting a medical certificate is the way to get these claims. Hence, after showing the doctor and getting the medical certificate, the employee must lodge a claim to the authorities presenting all the necessary documents. With the expectation of acclaim, the worker will not leave any stone unturned and stay invested in his or her treatment to get complete medical attention to get well soon to get back to work (Christopherson et al., 2020, pp. 1-8). However, there should be sufficient evidence at work to get the compensation and this is supposed to be logged by the workplace. Without ample evidence, the claim could be rejected.
  2. Injury and incident management- Employees must have an appropriate incident reporting system at place which could act as a strategy to reduce workplace related injuries claims. The manager or supervisor at work is supposed to monitor the workplace on an everyday basis to identify and classify hazards to put necessary access to the potential hazard place. For safety at workplace, regular monitoring is imminent. There needs to be appropriate training to arrest injuries and provide first aid to minimise the impact. For determining the root cause of the issue, taking account of the injured as well listening to the representative at workplace is both important. This needs to be documented following a designated format to aptly find the reason of the incident (Goode et al., 2018). Companies are equally liable to log the incident and make sure it reaches WorkSafe NZ to enable them to conduct an impartial investigation and suggest appropriate health and safety systems as part of improvisation. After the recommendations, it is important for the workplace to work on the suggestions and put in place a system on those lines to avoid another future incident. This shall ensure not only lesser claim costs but also aid in building assurance in the mind of workers that their workplace is safer.
  3. Return to work programmes from an organisational perspective – At present, to return to work, the employee needs to get a fitness certificate from the doctor and notify the same to ACC and the workplace to initiate the process of coming back to work. The employee filing this also needs to get ready for a multi-dimensional reviews and checks to assure that his reinstatement statement and plea is not out of place. The injured worker at home undergoes a lot of psychological and finance related stress while they cannot get back to work or return to the life that was there prior to them becoming injured. It is important that after getting notified of intent to return back to work, the company prepares a plan to get back to work.
    As of now, there is provision from ACC that provides cushion to employees who just joined work from an injury for shorter duration of shifts and other related benefits which allows their simplified and relaxed re-blending to the work culture. There are certain ‘return to work’ programmes which aid employees in New Zealand for the same (Collie et al., 2019, pp. 1-12). It addresses the resilience employee’s face physically and which also causes mental hesitance and other side effects where they realise and get discouraged for not being able to give their work 100% as before. So, planning a return needs to include employee’s welfare more and give them the required cushion to get at ease at work after the injury.

Recommendations to improve incident management issues and systems
Planning and implementing good incident management systems to address issues arising at workplace is an ever growing challenge. This is especially true even for healthcare settings. With presence of so many life-saving machines, drugs, rush of doctors and nurses during emergencies, patients all around, it is easy to give operations preference over hazard identification (Kussmaul et al., 2019, p. 6). Certain steps have been recommended below which may be helpful

  1. Implementing an early reporting system. Studies have pointed out that early reporting of potential hazards and risks at workplace have been successful in avoiding incidents in most cases. There needs to be appropriate classification of potential incidents such as risks, probabilities, dependencies, vulnerabilities, impacts and so on (Hillier et al., 2020, pp. 595-598). Each of these should have detailed action attached to them department and authority wise. For example a water leakage issue reported need to be reported to which department, they should in turn inform which government department and log the incident with information about the incident when it was spotted. Information carries key to determining the seriousness of the issue. Following a proper format insures time is saved and speedy action (Baxter et al., 2018, pp. 1-13)
  2. Good training practices put in place – in a healthcare setting, having good and proper machinery in place can reduce the load of lifting and carrying patients completely. Such machines need to be procured and employees should be trained to their use. Till then, lift teams should be put in place and ergonomic safe training must be compulsorily provided to the employees and lift teams to avoid activities involving moving, carrying or any heavy lifting actions (Wallis & Middleton, 2019, pp. 49-54)
  3. A good communication platform – A good communication culture promotes inter department operability. When implementing incident management systems, they should be trained to explain their rationale behind actions. In a healthcare setting, with changes in communication protocols, better communication can be established where supremacy of a personnel or a department is not given priority rather the incident management is given weightage and all cooperate to mitigate the incident at hand (Gabbe et al., 2020, p. 100322)
  4. Improving upon shared situational awareness during an incident – Incase the incident that is in progress and it has been longer than expected that it is continuing, it is important to address the mental anxiety as well as analyse accurately the vulnerability of systems near and potential that could be affected by it (Smeh & Bonokoski, 2020, pp. 519-540). Certain incidents may also have a cascading effect and hence, it is important to have a proper protocol in place during the preparation phase itself which makes everyone aware of their shared responsibilities, how to share information, communicate and so on for enabling coordination at its best.

In this report, the case study ‘When My Job Breaks my Back’ was referred to and certain identifications and analysis of situation were conducted. The case study is about how a floor nurse faced a workplace injury that further pushed her MSD condition into a severe state.

In the first section, issues related to nurses injuries were identified and analysed referring to the case study. Certain issues which were identified are potential manual handling competency based issue, possibility of incorrect floor material not suited for the job and thereafter absence of an appropriate incident management system were discussed.

In the next section, issues related to health and safety at workplace was discussed. Certain issues were identified and few were analysed. It could be deduced that the organisation may be facing resource crunch to hire sufficient employees or machinery and hence could not ensure safety and wellbeing of employees.

In the next segment, certain evaluations related to worker compensation strategy, injury and incident management and return to work programs were discussed. In the next segment, four recommendations were provided which may be helpful in good handling of workplace health and safety incidents at the nurse’s workplace.

Baxter, S., Johnson, M., Chambers, D., Sutton, A., Goyder, E., & Booth, A. (2018). The effects of integrated care: a systematic review of UK and international evidence. BMC health services research, 18(1), 1-13

Bolotbaeva, J. (2018). Occupational health and safety reforms in New Zealand: Tripartite views on the Health and Safety at Work Act 2015 (Doctoral dissertation, Auckland University of Technology).

Christopherson, R. M., Fadyl, J. K., & Lewis, G. N. (2020). Return-to-work expectations and workplace supports in New Zealand: injured workers’ perspectives. Disability and Rehabilitation, 1-8.

Collie, A., Sheehan, L., Lane, T. J., Gray, S., & Grant, G. (2019). Injured worker experiences of insurance claim processes and return to work: a national, cross-sectional study. BMC Public Health, 19(1), 1-12.

Cullen, K. L., Irvin, E., Collie, A., Clay, F., Gensby, U., Jennings, P. A., ... & Amick, B. C. (2018). Effectiveness of workplace interventions in return-to-work for musculoskeletal, pain-related and mental health conditions: an update of the evidence and messages for practitioners. Journal of occupational rehabilitation, 28(1), 1-15.

Dürr, M., Gröschel, C., Pfeil, U., & Reiterer, H. (2020, April). NurseCare: Design and'In-The-Wild'Evaluation of a Mobile System to Promote the Ergonomic Transfer of Patients. In Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems (pp. 1-13).

Gabbe, B. J., Veitch, W., Curtis, K., Martin, K., Gomez, D., Civil, I., ... & Joseph, A. (2020). Survey of major trauma centre preparedness for mass casualty incidents in Australia, Canada, England and New Zealand. EClinicalMedicine, 21, 100322.

Goode, N., Salmon, P. M., Lenne, M., & Finch, C. (2018). Translating systems thinking into practice: a guide to developing incident reporting systems. CRC Press.

Goodyear-Smith, F., & Ashton, T. (2019). New Zealand health system: universalism struggles with persisting inequities. The Lancet, 394(10196), 432-442.

Hillier, J. K., Matthews, T., Wilby, R. L., & Murphy, C. (2020). Multi-hazard dependencies can increase or decrease risk. Nature Climate Change, 10(7), 595-598.

Johnson, J., Hall, L. H., Berzins, K., Baker, J., Melling, K., & Thompson, C. (2018). Mental healthcare staff well?being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. International journal of mental health nursing, 27(1), 20-32.

Kussmaul, J., Peri, K., & Boyd, M. (2019). Workplace environment for nurses and healthcare assistants in residential aged care facilities in New Zealand. Australian Journal of Advanced Nursing, The, 36(4), 6.

Neal, B. (2017). Health and Safety at Work Act 2015: Intention, implementation and outcomes in the hill country livestock farming industry. Victoria University of Wellington Legal Research Paper, Student/Alumni Paper, (30).

Smeh, D., & Bonokoski, N. (2020). New Zealand Injury Prevention Strategy. In Casebook of Traumatic Injury Prevention (pp. 519-540). Springer, Cham.

Wallis, K. A., & Middleton, S. (2019). Doctors, drugs of dependence and discipline: a retrospective review of disciplinary decisions in New Zealand, 1997–2016. The New Zealand medical journal, 132(1488), 49-54.


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