Adding insult to injury

Nursing is a physical job but nurses are vulnerable to psychological as well as musculo-skeletal injury.

When a nurse is injured at work it usually results in much more than physical pain and loss. It usually goes hand-in-hand with psychological injury and a sense of anxiety about the future.

Dr Maya Guest, of the School of Health Sciences at the University of Newcastle, has conducted comprehensive research with 674 injured nurses, looking at their rehabilitation. The study involved nurses with a significant injury that had resulted in an absence of more than five days away from their usual work.

She said the research was driven by two key questions: why are so many nurses unable to return to pre-injury jobs? And why is it so difficult to find them suitable duties?

“Research shows that it is best to get workers back to the workplace as soon as possible but in suitable duties that don’t exacerbate the injury. If you do that it is more likely to get them back to pre-injury duties. This wasn’t happening in an ideal manner,” she says.

Musculo-skeletal injuries are by far the most common injuries for nurses but the big, poorly acknowledged sleeper is the psychological injuries that can come with the injury, and from the difficulties and trauma found on the road to recovery.

“People were saying in the research ‘I have a musculo-skeletal injury but I also have a psychological injury’. They told us that the process was so difficult that they ended up with a psychological injury as well,’ says Dr Guest. “Psychological becomes important because 32% said that when they reported the injury they got a negative response from their supervisor or from HR.

“If you report a psychological injury the chances of getting a negative response are high, which exacerbates the problem.”

Failure to find suitable duties

Maya Guest says the key impediment to rehabilitation is the failure to find suitable duties for nurses to allow them to return to work.

“Nursing is a physical job, especially for AiNs and ENs, but it is difficult to give them suitable duties, compared to specialist nurses who are easier to return to work.

“If you’re injured, the employer should be able to provide you with duties that avoid tasks that would worsen that injury.

Dr Guest says 87% of those nurses with musculo-skeletal injuries who participated in the research were provided with suitable duties. The 13% who weren’t, went on to develop a psychological impact.

Just more than half (51%) of participants had not been able to return to their pre-injury duties. This often left them worried about their long-term ability to work and earn a living. Lack of understanding from colleagues compounded the problem.

“If you are a nurse, employed on a ward, and another nurse can’t do manual handling but can do other tasks, and if she is not supernumerary, you have to cover for her. This is where some resentment comes from.

“This explains why nurses continue to work when they have an underlying injury, because they don’t want to be a burden on their team.

“They know they have a problem. They try to cope, they use up their leave and then, when they report the injury, it is going to be tough. She says older nurses especially are likely to do this.

“Ageing of the nurse workforce is a huge factor and will continue to be one. Older nurses struggle on through the injury and tend not to report it.”

Rural nurses trying to return to work also face particular obstacles to their rehabilitation.

“There is a bigger distance to work and also to treatment. The travel often undoes the good physio that is done. People can travel 50 kilometers on dirt roads to get to work. The car trip is a killer.”

Dr Guest quotes one particular nurse who she says captures the frustration of the process of rehabilitation: “For 30 years I gave my patients the best available care but when I was a patient I didn’t get it. I had to wait for approval from the insurer.”

Other sectors try harder

In contrast to health, employers in heavy industries will do anything to get their employees back to work because their premiums are based on the company’s claims history says Maya Guest.

“They will do anything to keep the premiums down. If the organisation is big enough they will always find a role because of the premium. In big multinationals it is often a KPI for the CEO. Unfortunately this doesn’t translate into the health sector.”

Dr Guest says the state government may well be right that the workers’ compensation scheme has high costs. But, she argues, there are other ways to fix the problem.

“With what we have seen in our research, rehabilitation in some areas is not working well. So I am not surprised that the costs are high. There are structural issues with the process.

“We know nurses, with their health expertise, have a good knowledge of what is needed to get better. One problem for nurses is the process is not working for them or it is holding them up from getting the treatment they need.

“Get the process working better initially and you won’t have these long drawn out claims. The claims shouldn’t be taking this long.”

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Injury suffered by nurses

Dr Guest’s research found that of the injuries suffered by nurses:

  • 86% were physical: the most common being musculo-skeletal.
  • 62% resulted from the heavy nature of the work: — pushing/pulling injuries.
  • 22.5% were from aggression: — bullying or mental stress.

The difficulties nurses face in returning to work

  • 63% took more than two weeks to return to work.
  • 76% needed suitable duties.
  • 64% needed to see a specialist and needed approval from an insurance company to do this.