Importance of lift teams to nurses

lift_team1_1 lift_team2_2 ethic_in_nursing_the_way_forward_1 lift_team_3_5 lift_team5_4

HOSPITAL
nursing

Weighing in on lift teams
Learn how a large medical center got its lift team off the
ground to benefit both patients and staff.

W
hat nurse wouldn’t want to take the back-
hreak out of moving patients? And what
hospital doesn’t want to improve patient

safety and prevent staff injuries? This article will explain
how instituting a hft team at a large medical center
helped improve patient outcomes and create a safer
work environment for the nurses.

Seeking healthy staff
In 2003, the cardiac intensive care unit and cardiothoracic
surgical intensive care unit council at Miami Valley Hospi-
tal in Dayton, Ohio, sought ways to support the staff and
retain experienced nurses. Concerned about injuries re-
lated to moving patients, the council consulted a clinical
nurse specialist (CNS) about developing a lift team. The
CNS formed an interdisciplinary team to research the
problem and investigate the feasibility of a lift team.

The interdisciplinary team consisted of the medical
director, the nurse-manager of employee health, the manag-
er of patient-transport services, an ergonomics consultant,
and an educator from the Center of Nursing Excellence.
They investigated and found that lift teams reduce lost
time, days when nurses can do only light duty, workers’
compensation claims, and staff injuries.

After the council performed an extensive literature
review and interviewed nurses at facilities that use lift
teams, it sought and received funding to launch a lift team
at the hospital. It also got funds for education and training
measures for the nursing staff

Setting goals
Careful staff selection is critical for recruitment and reten-
tion of a professional lift team. (See Recruiting the team for
details.) Orientation to the program also calls for in-depth
training in the following areas;
• moving patients with and without mechanical assistance
in various environments
• communication
• patient satisfaction
• infection control
• patient confidentiality.

To reduce injury risk, lift team members had to meet

certain criteria before starting training and then do so
yearly to keep their jobs. They had to successfully com-
plete the Firefighter’s Fitness Test and an evaluation by
the medical director of employee health. Physically fit
team members are less likely to be injured, and successful
completion of the fitness test enhances team confidence.

Supervised by the ergonomics expert and nurse-
educator, our lift team members also had to complete
competencies during orientation. Subsequently, they’d
undergo quarterly observation by the ergonomics expert
and mairitain yearly competencies in patient handling.

Getting the team off the ground
Before the lift team was implemented, staff in the six
nursing units with the most patient-handling injuries
were educated on effective use of the lift team. Guide-
lines on accessing team members, scheduling lifts, and
providing feedback were posted in the target units. (See
Setting priorities.)

When the lift team was launched, the nurses contacted
them through central dispatch. But the nurses and lift
team members soon found the process cumbersome, so
the lift team members started carrying wireless phones.
This practice significantly reduced delays and helped the
team members set priorities. (•”

Recruiting the team

Lift team leaders at the facility interviewed 30 people
before hiring the first 4 members. They determined that
the following qualities are crucial to fill the positions:
• physical fitness
• excellent communication skills
• critical thinking skills
• the ability to work under pressure.

A qualified lift team candidate who has limited health
care experience needs support for the emotional aspects
of the job. Exposure to acutely ill patients can be very
upsetting to a novice, so debriefing sessions, education,
and frequent contact go a long way to help. Orientation
to medical/surgical units should be first, followed by ori-
entation to critical care.

48hn8 I Nur$ing2007 I June www.nursing2007.com

art & science ethical decision-making: 7

Ethics in nursing: the way forward
Chaloner C (2007) Ethics in nursing: the way forward. Nursing Standard. 21, 38, 40-41.
Date of acceptance: April 27 2007.

Summary
This series of articles has been developed with the intention of
increasing nurses’ awareness of ethics and ethical decision-making
and clarifying the relationship between ethical thinking and effective
nursing practice. A number of issues have been examined fo show
how efhics affects fhe professional role, buf many ofher clinical and
non-clinical aspects of nursing demand ethical exploration. In the
final article in the series, the relevance of ethics to effective nursing
is emphasised and suggestions for enhancing fhe integration of
ethical decision-making into practice are made.

Author
Chris Chaloner is ethics adviser. Royal College of Nursing, London.
Email: chris.chaloner@rcn.org.uk

Keywords
Ethics; Nursing: philosophy; Nursing: profession

These keywords are based on the subject headings from the British
Nursing Index. This article has been subject to double-blind review.
For author and research article guidelines visit the Nursing Standard
home page at www.nursing-standai-d.co.uk. For related articles
visit our online archive and search using the keywords.

The relevance of ethics

Ethics is as relevant to the ordinary activities of life
as to the extraordinary. Although this series has
focused on topics such as euthanasia and abortion,
it should be emphasised that ethics is not
concerned solely with determining the rights and
wrongs of such sensitive and contentious subjects.
Despite their tendency to generate vociferous
public debate, the critical exploration ofthe ‘big
issues’ is a relatively minor feature of professional
ethics. However, critical expositions ofthe ethical
aspects of health care tend to focus on the more
sensational issues and overlook the less exciting
elements of professional practice. For example, the
motivations of individual nurses, their beliefs and
attitudes towards their work are significant factors
in establishing the ethical characteristics of
nursing. A critical consideration of how and why a
nurse conducts him or herself in carrying out his or
her role is as helpful to evaluating the ethical
validity of professional practice as an investigation
into, for example, the rights and wrongs of
therapeutic human cloning or face transplants.

THE NATURE of the nurse-patient relationship,
in which respect, confidence and privacy have
important roles, demands that nurses consider
the ethical nature of their actions. A fundamental
feature of effective professional practice is the
ability to reflect on the ethical issues nurses
encounter on a daily basis. The articles in this
series have provided an overview of ethics and
ethical decision-making by exploring a number of
topics in the context of ethical analysis. The belief
that ethics, critical ethical thinking and decision-
making are relevant to all aspects of professional
– and personal – life has been emphasised.

As noted in the first article, some nurses may
regard ethics as a remote concept that is of little
practical value and associate it with theories and
guidelines that have no immediate relevance to
their role (Chaloner 2007). The series aimed to
address these misconceptions and show how
ethical analysis and decision-making contribute
to everyday practice.

Other important ethical issues __ __

The inherent limitations of a short ethics series ha ve
meant that only a few issues have been addressed.
As has been emphasised throughout, critical ethical
thinking can, and should, be applied to all aspects of
the professional role and, consequently, the scope
for ethical analysis is limitless. For example, issues
such as genetics, mental health, care of older people
and public health generate a broad range of specific
ethical questions. Individually, each of these topics
provides a basis for extensive ethical debate.

In addition to addressing everyday practice-
based ethical decisions, nurses are increasingly
being called on to contribute to wider ethical
debates on issues affecting health care, nationally
and globally. The ethical basis of strategic planning
and health policy development must be informed
by contributions from the nursing profession.

The future

4 0 may 30 ;: vol 21 no 38 :: 2007

As this series has demonstrated, the impact of
ethics and ethical decision-making on professional

NURSING STANDARD

practice is being increasingly recognised. Raised
ethical awareness and seemingly unceasing
technological and social developments mean that
the range and complexity of ethical issues that
nurses and their colleagues should respond to will
increase, emphasising the need for enhanced
ethical sensitivity and reasoning skills. In recent
years ethics has become an established element of
professional education programmes and this will
hopefully produce increasingly analytical and
ethically inquisitive health professionals.

Final thoughts

To promote the successful integration of ethical
decision-making into nursing, it is essential that
ethics is perceived as an accessible and practical
concept. A number of preconceptions and
misconceptions persist about how and why
ethics relates to professional practice. Applying
ethics does not require a degree in philosophy or
access to a lexicon of obscure terminology, but it
does require thought and rationality. It is perhaps
understandable, given the complexity of some of
the ethics-related literature, that some
individuals find ethics off-putting or irrelevant.

Ethics should be an ongoing feature of
professional life rather than something that is only
discussed when a problem arises. Ongoing ethical
reflection can help to make ethics more relevant
and interesting. One means of achieving this is for
educationalists and managers to take advantage
of individuals’ shared understanding of ethics:
most people hold a view on the rights and wrongs
of certain topics – even if that view is ‘I don’t know’
– and these views should be used to promote
ethical discussion and to demonstrate the process
of critical ethical analysis.

It is insufficient, in terms of applying ethics,
to mechanically adhere to the ‘rules’ of good
practice. Therefore, key ethical concepts such as
autonomy, consent and confidentiality should
be regularly examined to produce an informed
appreciation of why the generally accepted
ethical tenets of professional practice, for
example, maintaining confidentiality, are ‘right’.

Engaging in ethical deliberation can be
challenging but it is also an enjoyable and
rewarding experience. There are no ‘right
answers’ in ethical debate, and exploring the
issues in a considered and critically informed
manner is a valuable and productive activity.

Conclusion ^ _ _

This series has examined some key ethical issues
and established that ethics and critical ethical
thinking are fundamental aspects of nursing. The
primary objectives ofthe series have been to
encourage nurses to apply ethics to their work

and to contribute to the de-mystification
of a subject that many consider confusing,
off-putting or irrelevant.

By examining the ethical features of some of
the ‘big issues’, it has been possible to explore the
nature of ethics and the ways in which ethics and
professional practice may be aligned. The series
has demonstrated that clinical competence
demands effective ethical decision-making and
that ethics is not a remote concept but is essential
to good nursing practice.

A range of issues that relate directly to the
day-to-day realities ofa nurse’s clinical role, and
indirectly via the processes of professional
education, management and broader strategic
developments, demand further critical ethical
input from the nursing profession. It is hoped that
this series has contributed to that undertaking NS

Reference
Chaloner C (2007) An introduction to ethics in nursing.
Nursing Standard. 21, 32, 42-46.

USEFUL RESOURCES
Books:
Ashcroft R, Lucassen A, Parker M, Verkerk M, Widdershoven G (2005)
Case Analysis in Clinical Ethics. Cambridge University Peess, Cambridge.

Brazier M (2003) Medicine, Patients and the Law. Third edition. Penguin
Books, London.

British Medical Association (2004) Medical Ethics Today: The BMA’s
Handbook of Ethics and Law. BMJ Books, London.

Garwood-Gowers A, Tingle J, Wheat K (Eds) (2005) Contemporary
Issues in Healthcare Law and Ethics. Elsevier, London.

Glover J (1977) Causing Death and Saving Lives. Penguin Books,
Harmondsworth.

Mason JK, Laurie GT (2005) Mason and McCall-Smith’s Law and
Medical Ethics. Seventh edition. Oxford University Press, Oxford.

Tingle J, Cribb A (Eds) (2002) Nursing Law and Ethics. Second edition.
Blackwell Science, Oxford.

Websites:

Bioethics Today: www.bioethics-today.org

BioethicsWeb: www.intute.ac.ul

International Philosophy of Nursing Society:

www.ipons.dundee.ac.uk/index.html

Nuffield Council on Bioethics: www.nuffieldbioethics.org

Royal College of General Practitioners Medical Ethics Portal:
www.rcgp.org.uk/collegejnformation/collegejnformation/committees/

medicaLethics_committee.aspx

The Ethox Centre: www.ethox.org.uk

The International Centre for Nursing Ethics: www.nursing-ethics.org/

UK Clinical Ethics Network: www.ethics-network.org.uk/index.htm

Wellcome Trust Biomedical Ethics: www.wellcome.ac.uk/nodel016.html

World Medical Association Ethics Unit:
www.wma.net/e/ethicsunit/index.htm

(Last accessed: May 8 2007)

NURSING STANDARD may 30 :: vol 21 no 38 :: 2007 41

Bruce Cunha, RN, MS, COHN-S, manager of
employee health and safety. “I don’t see a differ-
ence. I see a world in which everybody is testing.
With the federal Drug-Free Workplace [Act],
there are few employers who have federal con-
tracts who are not testing. You have to wonder –
the places that are not testing, are they magnets
for people who can’t get a job elsewhere?”

Strong Memorial Hospital in Rochester does
not use random drug-testing. But Auerbach, who
is an MRO and moderates an MRO listserv, says
that random testing can be effective as a deterrent.
It should be used with other programs to detect
performance problems that could be drug- or
alcohol-related and programs to enable employ-
ees to come forward and receive treatment and
support.

“You do [random testing] in a way that
respects the dignity of the individual being
tested, most of whom are not going to be drug
users,” says Auerbach. “You give everyone an
equal opportunity to be tested.”

Random testing is just one part of a broader
program that includes treatment, he says. “I fully
agree with the need for treating drug use in a med-
ical way, in a compassionate way, and offering vol-
untary routes to take care of the issue,” Auerbach
says. “That is in no way mutually exclusive to the
fact that many people don’t come forward. I think
it’s very important that you have both [elements].”

Dose tracking catches diverters

At Vanderbilt University, Mary Yarbrough,
MD, MPH, director of occupational health and
wellness, sees a number of conditions that
could affect employee performance, from the
declining vision of older workers with presby-
opia to depression. She wonders how much
attention should be focused on random drug-
testing in an atmosphere of limited resources.

“I think the way you identify drug users is by
watching their behavior,” she says. “If we have
a limited resource, why not put that money into
supporting supervisors in their role [of monitor-
ing performance].”

Yarbrough also favors treating drug abuse as
a medical problem and encouraging physicians,
nurses, and others to come forward for counseling
and treatment. “If you voluntarily come in and
seek help, we will be an advocate for you,” she
says. “If you go to treatment and get help, we will
treat this, as long as there’s not been any indication
that there’s been a problem in the workplace.”

Bill Buchta, MD, MPH, medical director of the
Employee Occupational Health Service at the
Mayo Clinic in Rochester, MN, also questions the
use of resources for random drug-testing. “It fos-
ters an environment of distrust and that’s not
what we want here at Mayo Clinic,” he says. “I’m
sure that not what most people what.”

Tampa (FL) General Hospital uses the AccuDose-
Rx medication delivery system (www.mckesson.
com) to monitor narcotic use. For example, the
tracking database can produce monthly reports
indicating how many doses of meperidine 50 mg
for injection are given by each nurse compared to
other nurses on their unit or in the entire hospital
and can track the dosage by the date and time it
was removed, explains JoAnn Shea, MSN, ARNP,
director of employee health and wellness. The
Employee Health Director and the pharmacy nurse
liaison review the AccuDose reports via a computer
database monthly and identify and investigate
discrepancies.

In one case, a nurse in the recovery room was
drawing twice as much morphine as other staff —
although his charts didn’t show a difference in
patient conditions. In another case, an emergency
department nurse was taking 100 merpidine a
month while co-workers were taking two or three.
Those employees were placed in treatment for sub-
stance abuse.

Shea estimates that it would cost $20,000 to
$30,000 a year to conduct random testing. “Is it
really worth it? I’d rather spend that money on
promoting health for employees, and spending
time identifying the diverters,” she says. ■

Linen lift teams
lighten the load
Fewer injuries with carts, tugs

Lift teams aren’t just for patient handling. Asthe UC Davis Health System in Sacramento
discovered, the same concept can reduce injuries
for other workers who must transfer heavy loads.

At UC Davis, environmental services workers
were at high risk of musculoskeletal injury. Workers
change about 10 tons of soiled linen each day.

Custodians would lift linen bags from patient
rooms to carts. Laborers would lift bags from the
carts to larger transfer carts and then into another
cart, for transport to an outside laundry.

68 HOSPITAL EMPLOYEE HEALTH ® / June 2007

A single custodian might lift 40 or 50 heavy
bags of linen in a day. A bag of wet linen could
weigh 30 or more pounds. “Every single lift they
made was a chance to get injured,” says Janet
Ford, PT, MS, a physical therapist and workers
compensation biomechanics specialist.

In the 2004-2005 fiscal year, the environmental
services department suffered about 50 shoulder
and back injuries. Linen closets are small, so the
hospital couldn’t just use smaller bags and let
them pile up.

To design a new method of handling laundry,
Ford shadowed custodians and laborers and
investigated options. The result: Linen lift teams
that use small carts connected to each other and
to a motorized tug. The lift teams use a mechani-
cal lift to empty carts into a larger container that
is shipped to a nearby laundry.

The new equipment cost about $20,000, esti-
mates Sures Chandra, assistant manager of envi-
ronmental services and conference services. “The
cost of one injury can easily offset that,” he says.

Repetitive lifting was culprit

Ford began her investigation into laundry han-
dling with a basic question: What is causing the
injuries? Custodians thought the nurses were fill-
ing the laundry bags too full, and nurses wanted
the laundry removed more promptly. But those
issues weren’t the real problem.

The main risk factor was repetitive lifting, she
discovered. Pulling and pushing linen-filled carts
through the hallways also caused problems.

Even injuries that seemed unrelated to linen
may have been connected, Ford suspects. “When
you look at your workers’ compensation injuries,
sometimes it’s misleading,” she says. “When some-
one says they hurt themselves mopping, it may be
because they were tired from lifting linen.”

The hospital previously had considered a sys-
tem of small, rolling bins in patient rooms or hall-
ways, in which nurses would place soiled linens.
That would eliminate multiple lifting of laundry
bags. But fire codes wouldn’t allow for bins in the
hallways.

Ford decided to focus on a well-trained group of
employees for laundry lifting, just as the hospital
does for patient lifts. The hospital hired six new
employees to work as a linen lift team. They work
in two-person teams on the day and evening shifts,
with one additional person in each team to allow
for time off.

“We’ve now taken a large number of employees

out of lifting linen, so we are reducing our expo-
sure to risk,” she says.

The hospital could have identified existing
employees in environmental services to form the
lift team, but the additional staff allowed the cus-
todians to spend more time on the floors, says
Chandra. “We decided to allow our existing
cleaning crew to do additional cleaning on the
floors,” he says.

The linen lift crew starts at the loading dock and
empty caster carts to the units. There they swap out
their carts for one in the soiled linen utility closet
and collect linen from each patient room. They
make a reverse trip with the loaded caster carts
that hook together and maneuvering them with the
tug back to the dock. (Caster carts have two large
wheels and two small wheels in the front, which
make them easy to tip but stable when upright.)

Making a change requires patience and flexibil-
ity, Ford cautions. She sought feedback from
employees and made changes in the new lift pro-
gram when it seemed necessary. For example, the
hospital initially considered a stationary mechan-
ical lift to empty larger collection carts at the
loading dock and decided it wouldn’t work out.
A mobile lift worked better.

It may take time for everyone to see the benefits.
In fact, in the first year, the number of injuries
within the Environmental Services department
actually rose, from 46 to 48 — although the severity
decreased by 42%. In the first half of the next year,
injuries were down by 38% and costs declined an
additional 39%.

Equipment alone won’t solve your problems,
either, says Chandra. It’s also important to train
employees in lifting techniques and body mechan-
ics, he says.

“You have to give them good training and plan
their routes well so they get sufficient rest,” he
says. “That’s the only way you prevent injury.” ■

Taking a LEAP
lowers WC costs
Fewer CNA injuries with lifts

It’s a common disconnect: An employee at home,healing from an injury, feels increasingly distant
from work. As time passes, the chance of that
employee returning to work drops. The result:
high workers’ compensation costs.

June 2007 / HOSPITAL EMPLOYEE HEALTH ® 69

143April 2009, vol. 57, no. 4

research abstract
A lift team was implemented at an urban medical center in the pacific northwest to reduce employee injuries. The lift
team consisted of a lift technician and a nursing assistant both trained in lifting techniques. The trial lasted 1 year. Data
on employee injuries and day versus night injuries before and during lift team implementation are presented. results do
not show the same reduction in employee injuries described by previous authors. possible explanations are related to the
use of the lift team and policy development.

Preventing Employee Injury
implementation of a lift Team

by Pamela J. Springer, PhD, RN, Bonnie K. Lind, PhD, Johanna Kratt, MS, Ed Baker, PhD, and
Joanne T. Clavelle, MS, RN, NE-BC, FACHE

I
n 2006, the Bureau of Labor Statistics (BLS) re-
ported 1,183,500 non-fatal occupational injuries re-
sulting in lost time from work. Non-licensed health

care workers experienced the third highest number of
lost workdays due to injuries, with 526 workers injured
per 10,000 (BLS, 2008a). In this same year, employee
lifting injuries represented a significant number of the
total claims for health care workers. Tasks such as lift-
ing, turning, and ambulating patients are associated with
musculoskeletal strains and back injuries, accounting
for more than 30% of all lost-time cases (Caska, Pat-
node, & Clickner, 1998; Haiduven, 2003). Nurse aides,
orderlies, and attendants suffered 27,590 musculosk-
eletal disorders, being surpassed only by occupations
requiring heavy physical labor (e.g., miscellaneous
laborers and freight, stock, and material movers). In
the same year, registered nurses (RNs) reported 9,200
musculoskeletal disorders, the fifth highest occupation
(BLS, 2008b). Nursing personnel are thus one of the oc-

cupational groups at highest risk for sustaining muscu-
loskeletal injuries.

Caska et al. (1998) described three primary reasons
for work-related injuries among health care workers: or-
ganizational factors, environmental factors, and personal
factors. Organizational factors may include lack of time,
insufficient lifting equipment, unavailability of additional
personnel to assist with lifting or moving tasks, and pres-
sure to complete assigned work. These organizational
factors are heightened by the current nursing shortage.
According to the Health Resources and Services Admin-
istration (HRSA), health care facilities throughout the
United States are operating with vacancy rates around
8.5% and these are predicted to increase significantly
(HRSA, 2006). Environmental factors include confined
space and inaccessible or inoperable lifting equipment.
The most common personal factor associated with back
injury is previous back strain or injury (Caska et al.).
However, heavier patients and an aging nursing work
force should also be considered (Allen, 2008; Collins,
Wolf, Bell, & Evanoff, 2004; O’Malley et al., 2006). Two
of every three adults are overweight, and it is estimated
that one fourth of the overweight population is actually
obese (Humphreys, 2007). In 2004, the average age of
nurses was 46.8 years, with 41% being 50 or older (up

About thE Authors
Dr. Springer is Associate Dean, College of Health Sciences/Chair, Depart-
ment of Nursing; Dr. Lind is Associate Research Professor; Ms. Kratt is a
student; and Dr. Baker is Director, Center for Health Policy, Boise State
University, Boise, ID. Ms. Clavelle is Vice President, Patient Care Services/
CNO, St. Lukes Regional Medical Center, Boise, ID.

144 AAoHn JournAl

from 33% in 2000). As nurses age, many are not physical-
ly able to engage safely in patient-handling tasks (Harper
& Pena, 1994).

PhIlosoPhy of A lIft tEAm
Some authors view patient lifting as a specialized

skill that should not be considered “routine” and per-
formed by all nursing personnel. Charney (1997) states,
“. . . lifting patients is considered a specialized skill per-
formed by expert professional patient movers who have
been thoroughly trained in the latest techniques, rather
than a hazardous random task required by busy nurses”
(p. 300). This philosophy has led some health care or-
ganizations to implement specially trained “lift teams”
to move patients. Several authors have reported substan-
tial reduction in employee injuries as a result of lift team
implementation (Caska et al., 1998; Caska, Patnode, &
Clickner, 2000; Charney, 1997; Charney & Gasterlum,
2001; Charney, Zimerman, & Walara, 1991; Davis, 2001;
Guthrie et al., 2004; Hefti et al., 2003; O’Malley et al.,
2006).

rEvIEw of thE lItErAturE rEgArdIng
lIft tEAms

The lift team trials reported in the literature ranged
from 8 months to 6 years. Charney (1997) described a
multi-institution study of lift team implementation show-
ing a 69% reduction in employee lifting injuries. Hefti
et al. (2003) also showed a decrease in lost workdays
and restricted workdays ranging from 57% to 95% after
the introduction of a lift team. Several authors examined
cost savings realized with a lift team, including reduc-
tions in employee injuries and workers’ compensation
claims. With a lift team, Charney et al. (1991) reported
1-year savings of $65,000 and a 72% reduction in work-
ers’ compensation dollars. Hefti et al. reported $45,815
in overall savings. In another 1-year study, Charney and
Gasterlum (2001) reported workers’ compensation costs
decreased from $224,000 before a lift team to $14,000
after lift team implementation. These facilities, like most
that reported significant injury reduction, implemented
policies forbidding nurses from lifting patients (“no lift
policies”) and employed lift teams that were available by
pagers and answered calls from nursing staff for lifting
assistance.

study PurPosE
An urban medical center in the Pacific Northwest

decided to implement a lift team to reduce employee
injuries and increase support to the nursing staff. The
medical center partnered with the nursing department at
a local university for program evaluation. The purpose of
this study was to determine the effect on employee injury
rates when a lift team was introduced without implemen-
tation of a no lift policy.

mEthods
This study was undertaken at a 350+ bed medical cen-

ter in the Pacific Northwest. The study received approval
from the human subjects review boards of the medical
center and the university that evaluated the project.

Description of the Lift Team
Two lift teams were formed. Each team included a

nurse aide (CAP) and a second lift team member. The
facility’s philosophy was one of ensuring patient needs
were always met first. This philosophy was the basis for
the decision to have one of the lift team members be a
certified nurse aide; the certified nurse aide could meet
basic patient needs (e.g., toileting, fluid intake, or vital
signs). All lift team members received training in ergo-
nomics from the medical center physical therapy depart-
ment and were hired and supervised by the internal trans-
port office.

Four medical and surgical units were selected to
use the lift teams. Each team served two units by mak-
ing rounds and moving patients hourly on each unit. The
lift teams began each hour by checking with the charge
nurse on the unit to identify patients needing the most
assistance with moving. The charge nurse categorized the
immobility of patients using an in-house scale ranging
from 0 to 3 (0 = totally independent in moving; 1 = as-
sistance needed to get out of bed; 2 = assistance needed
from one person to turn and ambulate the patient; and
3 = 2-person lift required). Those patients with a score of
3 were automatically visited by the lift team and helped
to move in bed, to a chair, or to the bathroom every 2
hours. If time allowed, other patients were also assisted
to a chair and the bathroom or moved in bed. In addition,
nurses could access the lift team for assistance by call-
ing the main transport dispatch center and having the lift
team paged. Each unit had its own lifting equipment read-
ily available on the floor. The lift team was introduced to
the staff on the units via staff meetings. Nurses were told
the lift team would move patients who were categorized
as being the most immobile. Also, nurses were asked to
call the lift team for turning and ambulation activities for
all patients.

Data Collected
The lift teams operated from February 19 to Decem-

ber 31, 2007. To allow for a pre-post comparison, pre-data
were initially collected from February through December
2006. This was later expanded to include 3 full years of
pre-data to minimize seasonal personnel fluctuations.

Acuity, census, and length of stay data were collect-

Employee lifting injuries are costly to institu-
tions. A variety of strategies have been used
to reduce or prevent injuries, including no lift
policies, lifting equipment, and lift teams. This
research demonstrates the importance of re-
viewing injury data over time to ensure a more
accurate representation of the effectiveness of
programs.

Applying research to Practice

145April 2009, vol. 57, no. 4

ed. Acuity level was collected from all patients twice a
day with a tool developed for use by the facility. Acuity
was measured on a scale of 1 to 3 (the higher the number,
the higher the acuity). Census was defined as the number
of patients present at midnight. Census was calculated per
unit or floor. Length of stay was the number of days (in-
cluding partial days) from admission to discharge. Data
regarding acuity level and census were collected before
lift team implementation and during the year of lift team
implementation.

Nursing time saved was collected. This was assumed
to be the amount of time the lift team registered work-
ing directly with patients. It was time the nurses would
have spent making these moves. Lift team members used
handwritten diaries to collect this information, which was
entered into a spreadsheet each evening. The data were
collected by the lift team supervisor, and files were sent
to the researchers monthly for analysis.

Lifting injuries and restricted workdays for RNs and
CAPs were also collected. A lifting injury was defined as
any injury that an RN or CAP reported to have occurred
at the time of moving a patient as captured on an Occupa-
tional Safety and Health Administration 300 Log (www.
osha.gov/recordkeeping/new-osha300form1-1-04 ).
Data related to employee injuries were collected by the
institution, de-identified, and sent to the researchers. RN
and CAP lifting injuries were tallied during three time pe-
riods: prior to lift team implementation, during lift team
implementation for hours the lift team worked, and dur-
ing lift team implementation for hours the lift team was
not on duty. Restricted workdays were defined as time
spent on either the home unit with restricted work duties
(i.e., no lifting) or a different unit performing non-direct
patient care duties.

Analysis
Stata software (version 10) was used for all analy-

ses. Mean patient acuity, census, and length of stay for
each month were compared for February to December
2006, prior to lift team implementation, and February to
December 2007, when the lift team was in place. Means
were compared using independent samples t tests. Due to
the small sample size, tests were repeated using the non-
parametric Mann-Whitney U test, which uses ranks rather
than actual data values. Results did not differ between the
two tests.

Employee lifting injuries were analyzed using inde-
pendent sample t tests for average monthly injuries dur-
ing the months prior to implementing the lift team and
during the months the lift team was in place. RN injuries
were analyzed separately from CAP injuries. A Poisson
regression model was fit for the number of RN injuries
per month. Poisson models are designed to model out-
come data based on discrete counts. Independent vari-
ables in the model were patient acuity and census, and
an indicator for whether the lift teams were implemented.
“Month” was the unit of analysis. Total RN hours worked
was included in the model as the exposure variable (i.e.,
the amount of exposure reflected in each observation). A
goodness-of-fit statistic was calculated after fitting the
model to assess whether the Poisson model was appropri-
ate for these data. The average number of days employees
were on restricted duty or transferred out of their home
units was analyzed using independent samples t tests.

All analyses included data from March through De-
cember of each year. Data for January and February were
excluded from the pre-lift team period because the lift
team was implemented in late February and, as a result,
no lift team data were available from January or February
for comparison.

rEsults
Acuity, Census, and Length of Stay

Acuity, census, and, to a lesser extent, length of stay
can affect staffing levels and the likelihood of employee
injuries. The analysis began by examining whether these
factors changed between before implementation and dur-
ing implementation. The average acuity was significantly
higher for 2007 than 2006, and the average census per
floor was lower in 2007 than in 2006 by an average of
1.5 patients each month. Average length of stay did not
differ between 2007 and 2006 (Table 1). The period in
2006 before implementation is not comparable to the lift
team period in 2007 in terms of acuity and census, and
the analyses that are adjusted for these factors should be
given the most consideration.

The lift teams worked an average of 8 to 10 hours
per day. It was assumed when the project was proposed
this might be credited as nursing time saved. However, a
review of staffing patterns revealed the presence of the
lift team had no impact on unit staffing. Nonetheless, one
could argue that the patients received higher quality care

Table 1

Comparison of mean monthly Patient Acuity, Census, and length of stay before
and during the lift team

Before Lift Team (2006) During Lift Team (2007)

n m sd n m sd p

Acuity 10 2.75 0.147 10 3.01 0.038 < .001

Census 10 24.61 0.798 10 22.97 0.821 < .001

length of stay (days) 10 4.79 0.491 10 4.73 0.235 .74

146 AAoHn JournAl

due to frequent moves and nurses having more time to
devote to other aspects of patient care.

Lifting Injuries
The number and rate of RN injuries varied greatly

between 2004 and 2007, increasing from a low of 10 in
2004 to a high of 20 in 2006 and then falling to 12 in
2007 during lift team implementation (Table 2 and Fig.
1). CAP injuries also showed significant variability, with
a minimum of 2 in 2006 and 2007 and a maximum of 6 in
2005 (Table 3 and Fig. 2).

The total number of days employees spent on re-
stricted duty was also assessed from March through De-
cember of each year, adjusted for the number of RN and
CAP hours worked. For RNs, the rate was lowest in 2004
at 5.4 days per 1,000 hours worked. There was a slight
increase each year except 2006, when the rate jumped to
21.3. The rate fell to 6.8 during implementation of the lift
team, but this was higher than the 2004 and 2005 rates.
CAPs showed a different pattern, with a rate of 32.1 days
per 1,000 hours worked in 2004, which dropped to 15.2
in 2005. There was a slight increase in restricted days
between 2006 and 2007 during lift team implementation
(Fig. 3).

If the lift teams were having an effect on injury rates,
one would expect to see the greatest impact during the
daytime hours, when the lift teams were working. For
RNs, injuries were more likely to occur during night hours

than daytime hours in most years. The number of daytime
injuries was steady at 7 in 2005, 2006, and 2007. The re-
duction in RN injuries in 2007 is due to fewer nighttime
injuries (Fig. 4). CAPs, on the other hand, had higher
injury rates during the daytime. The number of daytime
injuries was fairly steady at 1 to 2 per year in all years
except 2005, when 5 daytime injuries occurred (Fig. 5).

Poisson regression models were created to assess
whether the presence of the lift teams affected the num-
ber of RN or CAP injuries after adjusting for differences
in acuity and census. The outcome variable was the num-
ber of injuries per month, and the unit of measurement
was 1 month. In the RN injury model, none of the inde-
pendent variables showed a significant relationship to the
number of employee injuries. In the CAP injury model,
patient acuity was strongly related to CAP injury, with a
doubling of risk of injury for each 0.1 increase in acuity
(incidence rate ratio = 2.04, SE = 0.54, p = .006). (The
incidence rate ratio is the ratio of the incidence of CAP
injuries during lift team implementation to the incidence
of CAP injuries prior to lift team implementation.) Lift
team presence showed a trend toward being protective;
the incidence rate ratio was 0.21, indicating an approxi-
mately 80% reduction in risk of injury (p = .06). This

Table 2

registered nurse Injuries

Year
Number of

Injuries Injury Ratea

2004 10 119.4

2005 15 173.2

2006 20 220.2

2007 12 119.5
aCalculated using the Occupational Safety and Health
Administration 300 Log formula: injury rate = number of
injuries 3 200,000/total hours worked.

Table 3

nurse Aide Injuries

Year
Number of
Injuries Injury Ratea

2004 3 67.6

2005 6 205.4

2006 2 63.6

2007 2 55.4
aCalculated using the Occupational Safety and Health
Administration 300 Log formula: injury rate = number of
injuries 3 200,000/total hours worked.

figure 2. nurse aide injuries (CAP) prior to implementation
of lift team (2004 to 2006) and during implementation of lift
team (2007). All years reflect march through december only.

figure 1. registered nurse (rn) injuries prior to implemen-
tation of lift team (2004 to 2006) and during implementation
of lift team (2007). All years reflect march through decem-
ber only.

147April 2009, vol. 57, no. 4

may indicate that although the number of CAP injuries
did not change after implementation of the lift team,
given the higher patient acuity and census, perhaps an
increase in CAP injuries would have been seen had the
lift team not been present.

dIsCussIon
Results do not indicate strong evidence that imple-

mentation of the lift team reduced the number of employ-
ee injuries (RN or assistive personnel) related to patient
handling. Although injuries were lower in 2007 during
lift team implementation than in 2006, injuries in 2004
and 2005 were similar to or lower than those seen during
lift team implementation.

Injury findings from this study are not representative
of the findings of other authors (Charney, 1997; Hefti et
al., 2003). Previous studies have primarily examined the
year of lift team implementation compared to 1 previous
year. In this study, a 1-year pre-post comparison of injuries
would have revealed a similar decline in RN injuries as
well as in restricted duty days. It was after more in-depth
analysis spanning 4 years and controlling for census and
acuity that the researchers discovered no significant dif-
ference in employee injuries related to the use of the lift
team. It is possible that other hospitals implemented lift
teams after a period with high rates of employee injuries,
and perhaps regression to the mean accounts for the lower
employee injury rate after lift team implementation.

Most lift teams in the reviewed literature were avail-
able via paging rather than routine rounds on floors
(Charney, 2004). Additionally, most facilities implement-
ed a no lift policy at the time the lift team was introduced
(Charney, 1997). Anecdotal evidence obtained from RNs
and lift team members indicated the RNs and CAPs did
not wait for the lift team to make rounds or did not want
to “bother” the team. Indeed, some RNs actually wanted
to complete patient care before the lift team made rounds.
Although this is a testament to the desire to deliver high-
quality care and to pride in the care delivered, it may have
contributed to more injuries. The facility did not attempt
to implement no lift policies simultaneously with imple-
mentation of the lift team. The addition of a solid policy

against lifting patients may have increased the odds of the
lift team being called.

Formal evaluation and analysis of the level of satis-
faction with patient care and the work environment was
not part of this project’s scope. However, anecdotal in-
formation indicated the lift team was popular with staff
and patients. Despite the lack of positive outcomes relat-
ed to employee injuries, anecdotal reports from nursing
leader interviews indicated strong support for the model
and continuation of the program. Although the program
continued, changes were made to the lift team staffing
model requiring flexible schedules depending on patient
volumes. Data continue to be collected on musculoskel-
etal injuries and the relationship of injuries to lift team
use.

APPlICAtIons And ImPlICAtIons
Thorough analysis of lift team programs is essen-

tial. Previous research into the effectiveness of lift teams
showed a decrease in the number of employee injuries.
The current study revealed no change in employee in-
juries when adjusted for acuity and census and when
compared over a 4-year period. When implemented, the

figure 3. transfer or restricted duty days over 1,000 hours
worked prior to implementation of lift team (2004 to 2006)
and during implementation of lift team (2007). All years in-
clude march through december only. rn = registered nurse;
CAP = nurse aide.

figure 5. nurse aide injuries by day (8:00 a.m. to 6:00 p.m.)
or night (6:01 p.m. to 7:59 a.m.) occurrence prior to imple-
mentation of lift team (2004 to 2006) and during implemen-
tation of lift team (2007). All years include march through
december only.

figure 4. registered nurse injuries by day (8:00 a.m. to
6:00 p.m.) or night (6:01 p.m. to 7:59 a.m.) occurrence prior
to implementation of lift team (2004 to 2006) and during
implementation of lift team (2007). All years reflect march
through december only.

148 AAoHn JournAl

institution did not use a no lift policy, a decision that
could have limited the effectiveness of the lift team. A
process monitor to ensure the lift team was being used
as envisioned could have strengthened the implementa-
tion. For this institution, the partnership with the univer-
sity assisted in a thorough analysis. When evaluating the
effectiveness of programs, health care facilities should
consider partnering with a local university and examin-
ing data collected over longer periods to ensure sound
decision making.

rEfErEnCEs
Allen, L. (2008). The nursing shortage continues as faculty shortage

grows. Nursing Economics, 26(1), 35-40.
Bureau of Labor Statistics. (2008a). Number of nonfatal occupational

injuries and illnesses involving days away from work by selected
worker characteristics and number of days away from work 2006.
Retrieved April 20, 2008, from www.bls.gov/iif/oshwc/osh/case/
ostb1863

Bureau of Labor Statistics. (2008b). Occupational outlook quarterly.
Retrieved April 24, 2008, from www.bls.gov/opub/ooq/2007/
winter/grabbag.htm

Caska, B., Patnode, R., & Clickner, D. (1998). Feasibility of a nurse
staffed lift team. AAOHN Journal, 46(6), 283-288.

Caska, B., Patnode, R., & Clickner, D. (2000). Implementing and us-
ing a nurse staffed lift team: Preliminary findings. AAOHN Journal,
48(2), 42-45.

Charney, W. (1997). The lift team method of reducing back injuries: A
ten hospital study. AAOHN Journal, 45(6), 300-304.

Charney, W. (2004). Prevention of back injury to healthcare workers us-
ing lift teams: 18 hospital data. In W. Charney & A. Hudson (Eds.),
Back injury among healthcare workers. New York: Lewis Publish-
ers.

Charney, W., & Gasterlum, R. (2001). Lift teams: A one-year study. An-
other success story in an acute-care hospital. Journal of Healthcare
Safety, Compliance and Infection Control, 5(2), 65-67.

Charney, W., Zimerman, K., & Walara, E. (1991). The lifting team: A
design method to reduce lost time back injury in nursing. AAOHN
Journal, 39(5), 231-234.

Collins, J. W., Wolf, L., Bell, J., & Evanoff, B. (2004). An evaluation
of a “best practices” musculoskeletal injury prevention program in
nursing homes. Injury Prevention, 10, 206-211.

Davis, A. (2001). Birth of a lift team. Journal of Healthcare Safety,
Compliance and Infection Control, 5(1), 15-18.

Guthrie, P. F., Westphal, L., Dahlman, B., Berg, M., Behnam, K., & Fer-
rell, D. (2004). Patient lifting intervention for preventing the work-
related injuries of nurses. Work, 22(2), 79-88.

Haiduven, D. J. (2003). Lifting teams in health care facilities: A litera-
ture review. AAOHN Journal, 51(5), 210-218.

Harper, P., & Pena, L. (1994). Personal history, training, and worksite
as predictors of back pain in nurses. American Journal of Industrial
Medicine, 25, 519-526.

Health Resources and Services Administration. (2004). National sample
survey of RNs. Retrieved October 23, 2008, from www.bhpr.hrsa.
gov/healthworkforce/rnsurvey04

Health Resources and Services Administration. (2006). What is be-
hind HRSA’s projected supply, demand, and shortage of registered
nurses. Retrieved May 10, 2008, from www.bhpr.hrsa.gov/health
workforce/reports/behindrnprojections/index.htm

Hefti, K. S., Farnham, R. J., Docken, L., Bentaas, R., Bossman, S., &
Schaefer, J. (2003). Back injury prevention: A lift team success sto-
ry. AAOHN Journal, 51(6), 246-251.

Humphreys, S. L. (2007). Obesity in patients and nurses increases the
nurse’s risk of injury lifting patients. Bariatric Nursing and Surgical
Patient Care, 2(1), 3-6.

O’Malley, P., Emsley, H., Davis, D., Roark, S., Ondercin, C., & Don-
aldson, C. (2006). No brawn needed. Nursing Management, 37(4),
26, 28, 30.