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Swedish nurses are prone to chronic shoulder and back pain because of miserable working conditions and poor leadership?

  • Tone Rustøen and Sanna Salanterä
Published/Copyright: July 1, 2010
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 1 Issue 3

Nilsson et al. report in this issue of The Scandinavian Journal of Pain that especially registered nurses working in hospitals have a high risk of musculoskeletal pain—mostly shoulder and low back pain [1]. They followed a group of nurses from 2003 to 2006, focusing on pain, disability, and sick leave. About half of the sample reported pain at baseline, and pain at baseline predicted pain and the odds of being disabled at follow up. They also reported significantly more sick days at follow up compared to baseline. It is also interesting that satisfaction with work leaders decreased during the study period [1].

The number of nurses with pain in Nilsson’s study (50%) is much higher than what is described in a European survey from 2006 were 18% of the general Swedish population reported chronic pain [2]. One reason for the higher prevalence might be that the nurses were mostly women and that women report more chronic pain than men [3]. Nurses might also be an especially vulnerable group regarding work related pain. In fact nursing aides, orderlies and attendants in the USA had the greatest incidence rate (252 cases per 10 000 workers per year) of musculoskeletal disorders according to the U.S. Bureau of Labor Statistics from 2007 [4]. That is much higher than the rate of e.g. truck drivers or labourers and material movers [4].

Edlich et al. [5] describe a crisis in healthcare related to disabling back injuries in US healthcare workers. Back injuries appear to be increasing among healthcare providers, more than 52% complaining of chronic back pain after injuries [6]. The prevalence of back pain is alarming already for the student nurses as reported in a British study where 34% of student nurses had back pain during their clinical placement [7].

The high number nurses with back pain, is thought to be related to repetitive tasks related to patient handling and an increased prevalence of obesity in patients [6]. Furthermore, the aging of the nursing workforce as well as limited workspaces in patient rooms are also mentioned as possible reasons.

In a study evaluating the use of transfer equipment, the nurses had significantly fewer back injuries, less pain/symptoms and less absence from work due to musculoskeletal pain/symptoms compared with nurses at the control hospitals without such equipment [8]. Possible actions that could be performed are regular ergonomic evaluations at work places and evaluations of workers’ patient-lifting and bed-making habits. Peer leaders can be of help. A study conducted in critical care environment used “ergocoaches” who received training and were given responsibility for safe work practices [9]. Also all new equipment should be evaluated from the ergonomics point of view. Wards should be equipped with enough rails for patients and lifting and moving assistance devices. Nurses also need training in proper ergonomics and body posturing.

On the other hand a Cochrane review by van Oostrom et al. [10] about workplace interventions for preventing work disability revealed that there is only moderate-quality evidence to support the use of workplace interventions to reduce sickness absence among workers with musculoskeletal disorders when compared to usual care. Thus, the health outcomes among workers with musculoskeletal disorders did not improve with workplace interventions. Hence we need more research in order to know what actions should be taken to reduce back pain among nurses.

Furthermore, Nilsson et al. [1] stated that personal factors predict pain better than work environment. Two interesting predictors were self-rated health and sleep quality during the past week. They also found that optimists reported less disability than pessimists. Perhaps self-rated health could be measured on regular bases by occupational health authorities and nurse managers could be informed about the results on ward level for further actions. Lack of sleep and low quality of sleep of nurses is as important as that of patients. Power naps during work shifts could be tried out and studied. We do not have enough knowledge about such low cost interventions.

The high level of pain in nurses is not only a problem for the nurses themselves, but for the society, the healthcare system, and the patients. If nurses are on sick leave the burden is greater for the ones left at the work place and it is a big cost for the society. Back injury is also estimated to be the single largest contributor to the nursing shortage [5]. In the US it is estimated that 12% of nurses leave the profession annually because of back injuries [6].

This is a big challenge for the persons administrating the hospitals and leaders at all levels. If patients shall receive good care the nurses must be there and be capable of taking care of them. Nurse leaders should take some responsibility of the working conditions of the nurses and oversee the ergonomics. The problem of musculoskeletal disorders among nurses must be taken seriously and there is a need to pave the way for nurses to do their job in satisfactory environments. Enough motivated and optimistic nursing staff is needed to take care of the patients, to help them with caring tasks, and to prevent complications of hospitalisation for the patients and to enhance their quality of life.

DOI of refers to article: 10.1016/j.sjpain.2010.05.029.

References

[1] Nilsson A, Lindberg P, Denison E. Predicting of pain, disability, and sick leave regarding a non-clinical sample among Swedish nurses. Scand J Pain 2010;1:160–6.Search in Google Scholar

[2] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287–333.Search in Google Scholar

[3] Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Gender differences in chronic pain—findings from a population-based study of Norwegian adults. Pain Manag Nurs 2004;5:105–17.Search in Google Scholar

[4] US Bureu of Labor Statistics. Musculoskeletal disorders and days away from work in 2007; 2008. http://www.bls.gov/opub/ted/2008/dec/wk1/art02.htm, retrieved May 24, 2010.Search in Google Scholar

[5] Edlich RF, Hudson MA, Buschbacher RM, Winters KL, Britt LD, Cox MJ, Becker DG, McLaughlin JK, Gubler KD, Zomerschoe TS, Latimer MF, Zura RD, Paulsen NS, Long 3rd WB, Brodie BM, Berenson S, Langenburg SE, Borel L, Jenson DB, Chang DE, Chitwood Jr WR, Roberts TH, Martin MJ, Miller A, Werner CL, Taylor Jr PT, Lancaster J, Kurian MS, Falwell Jr JL, Falwell RJ. Devastating injuries in healthcare workers: description of the crisis and legislative solution to the epidemic of back injury from patient lifting. J Long Term Eff Med Implants 2005;15:225–41.Search in Google Scholar

[6] Hunter B, Branson M, Davenport D. Saving costs, saving health care providers’ backs, and creating a safe patient environment. Nurs Econ 2010;28:130–4.Search in Google Scholar

[7] Barnes AF. Reducing the incidence of back pain: student nurses’ recommendations. Br J Nurs 2009;18:1334–8.Search in Google Scholar

[8] Engkvist IL. Evaluation of an intervention comprising a no lifting policy in Australian hospitals. Appl Ergon 2006;37:141–8.Search in Google Scholar

[9] Knibbe HJ, Knibbe NE, Klaassen AJ. Safe patient handling program in critical care using peer leaders: lessons learned in the Netherlands. Crit Care Nurs Clin North Am 2007;19:205–11.Search in Google Scholar

[10] van Oostrom SH, Driessen MT, de Vet HC, Franche RL, Schonstein E, Loisel P, van Mechelen W, Anema JR. Workplace interventions for preventing work disability. Cochrane Database Syst Rev 2009;2. CD006955.Search in Google Scholar
Published Online: 2010-07-01
Published in Print: 2010-07-01

© 2010 Scandinavian Association for the Study of Pain

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  1. Editorial comment
  2. Functional brain imaging of acute postoperative pain
  3. Clinical pain research
  4. Brain activation due to postoperative pain from the right hand measured with regional cerebral blood flow using positron emission tomography
  5. Editorial comment
  6. Long-term low-dose transdermal buprenorphine therapy for chronic noncancer pain
  7. Original experimental
  8. A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naïve to potent opioids
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  19. Observational studies
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  24. What’s wrong with animal models of pain?
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  38. Hyperexcitable C-nociceptors in human paroxysmal pain
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  47. Abstracts
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  52. Epidemiology of persistent postoperative pain: Association of persistent pain and sensory abnormalities
  53. Abstracts
  54. Cost–benefit of a 13-week multidiciplinary rehabilitation course for chronic non-malignant pain patients
  55. Abstracts
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  57. Abstracts
  58. Somatocognitive therapy in the management of chronic gynaecological pain. A review of current approach and historical background
  59. Abstract
  60. The Manual Intervention Trial (MINT)—The effect of various combinations of naprapathic manual therapy. The study protocol of a randomized controlled trial
  61. Abstracts
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  64. Effect of buprenorphine and fentanyl in experimental induced superficial, deep and hyperalgesic pain
  65. Abstract
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  69. Abstracts
  70. A human experimental bone pain model
https://doi.org/10.1016/j.sjpain.2010.05.037

Articles in the same Issue

  1. Editorial comment
  2. Functional brain imaging of acute postoperative pain
  3. Clinical pain research
  4. Brain activation due to postoperative pain from the right hand measured with regional cerebral blood flow using positron emission tomography
  5. Editorial comment
  6. Long-term low-dose transdermal buprenorphine therapy for chronic noncancer pain
  7. Original experimental
  8. A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naïve to potent opioids
  9. Editorial comment
  10. Repeated nociceptive stimulation for detecting drug effects
  11. Original experimental
  12. The effects of gabapentin in human experimental pain models
  13. Editorial comment
  14. Whether the weather influences pain: High prevalence of chronic pain in Iceland and Norway: Common genes? Or lack of sunshine and vitamin D?
  15. Observational studies
  16. A population based study of the prevalence of pain in Iceland
  17. Editorial comment
  18. Swedish nurses are prone to chronic shoulder and back pain because of miserable working conditions and poor leadership?
  19. Observational studies
  20. Predicting of pain, disability, and sick leave regarding a non-clinical sample among Swedish nurses
  21. Abstracts
  22. Trigeminal neuralgia or odontogenic pain
  23. Abstracts
  24. What’s wrong with animal models of pain?
  25. Abstracts
  26. Immunotherapy for neuroblastoma elicits a complement dependent whole body allodynia
  27. Abstracts
  28. Pain mechanisms in animal models of rheumatoid arthritis
  29. Abstracts
  30. Translating basic research to pharmacological treatment of neuropathic pain
  31. Abstracts
  32. Free Poster Presentations: Forearm heat pain does not inhibit electrically induced tibialis anterior muscle pain
  33. Abstracts
  34. Offset analgesia evoked by non-contact thermal stimulator
  35. Abstracts
  36. Inhibition of FAAH reverses spinal LTP
  37. Abstracts
  38. Hyperexcitable C-nociceptors in human paroxysmal pain
  39. Abstracts
  40. Pain sensitivity and experimentally induced sensitization in red haired women
  41. Abstracts
  42. How are opioids used in Norway? Persistent use, utilization of depot formulation and age profile in non-palliation patients
  43. Abstracts
  44. To which extent does incident and persistent use of weak opioids predict problematic opioid use?
  45. Abstracts
  46. Is transdermal buprenorphine for chronic non-malignant pain used long term without co-medication with other potentially addictive drugs?
  47. Abstracts
  48. Prostaglandin E2 production in synovial tissue and acute postoperative pain after knee arthroscopy
  49. Abstracts
  50. Girl presenting with oesophageal spasm pain after fundoplication
  51. Abstracts
  52. Epidemiology of persistent postoperative pain: Association of persistent pain and sensory abnormalities
  53. Abstracts
  54. Cost–benefit of a 13-week multidiciplinary rehabilitation course for chronic non-malignant pain patients
  55. Abstracts
  56. A novel and effective treatment modality for medically unexplained pain
  57. Abstracts
  58. Somatocognitive therapy in the management of chronic gynaecological pain. A review of current approach and historical background
  59. Abstract
  60. The Manual Intervention Trial (MINT)—The effect of various combinations of naprapathic manual therapy. The study protocol of a randomized controlled trial
  61. Abstracts
  62. The experience of chronic pain, loss and grief
  63. Abstracts
  64. Effect of buprenorphine and fentanyl in experimental induced superficial, deep and hyperalgesic pain
  65. Abstract
  66. Pretreatment with opioids enhances afferent induced long-term potentiation in the rat dorsal horn
  67. Abstracts
  68. Pigs in pain—Porcine behavioural responses towards mechanical nociceptive stimulation directed at the hind legs
  69. Abstracts
  70. A human experimental bone pain model
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