Statement of Ann Converso, Vice Chair, United American Nurses Association

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Good afternoon. My name is Ann Converso. I am here representing the American Nurses Association - ANA. I am Vice Chair of the United American Nurses, the labor arm of ANA and the newest affiliate of the AFL-CIO. The nursing community is grateful to the many federal employees, researchers and occupational health professionals who have worked hard for over a decade to make an OSHA Ergonomic Standard a reality for American workers. We urge Secretary Chao to include these experienced specialists in the Department of Labor's efforts to address the greatest occupational health and safety issue facing America's workers today.

Frontline healthcare workers perform some of the most dangerous work in America. Every day, registered nurses, patient care assistants and other personnel, risk their health and future livelihoods in order to restore health, prevent illness and protect the people entrusted to their care. The risk for disabling back, neck or shoulder injuries is great. In the 1999, OSHA calculated that nearly half of all workers in the health services sector will experience at least one work-related musculoskeletal disorder during their working lives.

ANA has long-supported an ergonomics standard and was shocked earlier this year when congress voted to rescind the final OSHA ergonomics rule. Since March, we have waited for Secretary Chao to fulfill her promise to pursue a comprehensive approach to ergonomics so nurses will be protected. We are here today to call for immediate action by the Department of Labor to issue a new ergonomics standard.

Working conditions in our nation's health care facilities are deteriorating. There is an unprecedented shortage of nurses. Earlier this year, ANA conducted a national survey on the issues of staffing and working conditions. Nearly 7300 nurses responded. They told us that the time available for direct patient care has decreased, the quality of care has declined due to inadequate staffing and, most importantly for us today, nurses own health and safety is being compromised in order to care for patients. We need the Department of Labor to take action to assure current and prospective nurses that they don't need to fear a disabling musculoskeletal disorder if they choose to work on the frontlines of health care.

Low back injuries continue to be one of the leading and most costly problems affecting nurses. Studies of back-related workers compensation claims reveal that nursing personnel have one of the highest claim rates of any occupation or industry. Three of the top seven occupations at greatest risk for musculoskeletal disorders, are health care occupations where the workers perform repetitive patient handling tasks. Yet these tasks are the heart and soul of nursing work.

Low back injuries rob health care employers and patients of experienced caregivers. The costs to individual nurses and their families are extremely high - altering lives and ending nursing careers. Unlike some of the physicians speaking on behalf of industry earlier this week, the American Nurses Association will never settle for the definition of wellness being - and I quote - "the ability to able to cope with a musculoskeletal disorder or injury."

The Secretary of Labor has asked 3 specific questions which we are pleased to answer although these questions have already been answered repeatedly. The OSHA docket on ergonomics contains hundreds of thousands of pages of evidence and testimony which led to the conclusion that a standard was necessary. The National Academy of Sciences confirmed OSHA's direction as well as the fact that musculoskeletal disorders are indeed work-related.

First, the Department of Labor wants to establish the definition of a "ergonomics injury." ANA believes that the term "ergonomics injury" is misleading and does not address the true repetitive nature of the problem. Back and other musculoskeletal disorders are finally being recognized as the results of repeated exposure to multiple ergonomic risk factors as well as the results of single events. The term musculoskeletal disorder better describes their nature. In addition, the term has already been fully described and defined by OSHA and the Department of Labor in it's November 2000 final Ergonomics Standard. Subsequently, the National Academy of Sciences supported this same definition.

Since the work of defining these disorders has already been done, ANA believes that efforts should be focused on controlling hazards and assuring that any work-related disorders that do occur are reported and recorded. As our colleagues at the American Public Health Association would remind us if they were here, good case definitions like the one referred to above are the building blocks for investigating and halting disease outbreaks. However, without mandatory reporting and surveillance, we will not have the statistics needed to tell the full story.

ANA understands that the Department of Labor is considering a stay of the MSD reporting provisions contained in OSHA's new Occupational Injury and Illness Reporting Requirements. Relaxing this vigilance on the nation's leading job safety problem, would be irresponsible. You don't need a public health degree to know that if you don't count or track a health problem, for all intents and purposes, it doesn't exist. The Department of Labor must implement the full standard as published in the Federal Register on January 19, 2001, including those requirements pertaining to MSDs.

The Department of Labor has asked how OSHA, employers and employees can determine whether an ergonomics injury was caused by work-related activities or non-work-related activities. In the health care industry, the risk factors faced by nursing personnel who provide direct care to patients are so extreme that personal risk factors pale in comparison. Last year, injured nurse Becky Rice, from the District of Columbia Nurses Association testified at the OSHA Ergonomics Hearings. She described the week of 12 hour shifts leading up to her low back disability. For 4 days that week, she was assigned to a critically ill patient who was extremely heavy - approximately 400 pounds. The patient was unresponsive and on a ventilator. Even with 3 people assisting, the job of moving the patient was very difficult. The unit was short-staffed. Becky found herself having to perform patient handling tasks by herself or with only one other nurse to assist when she was available.

ANA believes that the same criteria should be used for determining the work-relatedness of MSDs as for all work-related injuries and illnesses. The intact January 19th OSHA Recordkeeping Guidelines can guide this action. OSHA should offer targeted outreach and training to employers so that managers as well as employees realize the importance of proper reporting.

In many cases, nurses suffer greatly because their facility lacks a systematic and effective means for reporting the early signs and symptoms of musculoskeletal disorders and obtaining prompt and effective treatment. Often their reports are not taken seriously, revealing the critical education needs that exist among employers and managers alike. Only a comprehensive, prevention-oriented Ergonomic Standard will fully address all these issues.

ANA also recommends that OSHA expand it's liaison work with the Joint Commission for the Accreditation of Health Care Facilities to implement a process for reporting problems related to patient handling procedures. The focus would be on identifying system-fixes for preventing injuries to patients and workers. The Joint Commission carries a big stick in the eyes of health care industry. Some employers who may be willing to risk an OSHA fine would never conceive of taking risks with their JCAHO accreditation which could jeopardize medicare reimbursement.

The final question asks us to describe the most useful and cost-effective types of government involvement to address workplace ergonomics injuries. Nearly 10 years ago, nurses across this country learned that only a mandate from the federal government could get them the immunizations necessary to prevent themselves from contracting deadly hepatitis B infections on-the-job. The mandate was called the OSHA Bloodborne Pathogens Standard. Rates of occupational hepatitis B declined dramatically, but only because employers were forced to immunize their workers.

Last year, nurses mobilized again to urge the federal government to protect them from life-threatening needlestick injuries. The result was a federal mandate - a law passed by both houses of Congress and signed by the President - the Needlestick Safety and Protection Act. Although safe needle devices had been around for a decade, the health care industry was not voluntarily implementing them. Employers had to again be forced to do the right thing.

Without a federal mandate in the form of an OSHA Ergonomics Standard, nurses cannot be assured of protection from ergonomic hazards in the workplace.

Without a federal mandate, health care employers will not provide adequate staffing so nurses can leave their patients and attend training.

Without a federal mandate, there will always be higher priorities than preserving the healthy and safety of workers.

Given the health care industry's track record, I'd have a hard time selling my nurse members on anything less than a strong OSHA standard.

In the Veteran's Administration Hospital System, where I've worked for 25 years, an innovative ergonomics project is underway. I would urge the Department of Labor to investigate this initiative. The goal is to create a safer work environment for nurses who provide direct patient care. The project is called "A Back Injury Prevention Program for Nurses: Safe Patient Handling and Movement." It includes program elements similar to those in the failed OSHA Ergonomics Standard. The elements include a systematic approach to identifying and controlling ergonomic risk factors, training of "Back Injury Resource Nurses" on high risk units, and nurse involvement in the evaluation and selection of lifting techniques and equipment. The program builds on lessons learned in England where a national policy went into effect in 1993 prohibiting nurses from lifting patients. This "no-lift" policy resulted in a significant decrease in job-related injuries.

Right here in Chicago, one of our local bargaining units recently started to work through their labor-management committee to improve health and safety conditions for nurses. The first two issues that nurses presented to management zeroed right in on ergonomic risk factors. They identified 2 control measures that they wanted to see implemented immediately -- Here is their wish list: #1 Replace the worn out velcro strips that keep mattresses securely on stretchers - patients were sliding down and had to be pulled up more frequently -and #2 Institute a regular maintenance program on transport equipment so there is minimal rolling resistance. This wish list is a far cry from assertions by the hospital industry that expensive, overhead hoists would need to be installed in every room, thus making an ergonomics standard cost-prohibitive.

The core of nursing work is caring for patients especially at times when they re unable to care for themselves. The repetitive patient handling tasks required to do this work are the most frequent cause of musculoskeletal disorders. Although effective control measures exist to reduce these risks, few health care employers have voluntarily implemented them. The time is now for the Department of Labor to take the action that we know is essential - the immediate release of an OSHA Ergonomics Standard.

Thank you.