Project A: Integrated Approaches to Improving the Health and Safety of Health Care Workers

Improving and protecting the health and well-being of healthcare workers requires addressing
key risks in the work environment as well as promoting safe and healthy behaviors.
Healthcare workers are at elevated risk for musculoskeletal disorders (MSDs) due to a range
of job factors, including lifting and transferring patients; working long hours (often at
night); and limited control over decisions on the job. Among these, nurses and nurses aides
bear the largest burden of injury. Back injuries in particular constitute the greatest
source of their disability. These risks are likely to increase in coming years due to the
aging nursing workforce, increase in work demands, and labor shortages. Health behaviors,
including physical activity, inadequate sleep, and dietary patterns associated with being
overweight or obese, are also influenced by the work environment and psychosocial factors on
the job, and are also associated with MSD risk. Traditional approaches to redressing these
risks have focused separately on health protection, including efforts to reduce MSD risk,
and health promotion aimed at improving health behaviors. Little research has
systematically examined the dual and potentially synergistic effects of the work environment
on risk of MSDs and worker health behaviors, and there is insufficient evidence to determine
the most efficacious ways to ameliorate the combined effects of these health risks. Our
long-term goal is to improve the overall health and well-being of healthcare workers by
making available evidence-based worksite policies, programs, and practices that foster a
healthy work environment, reduce potential hazardous job exposures, and promote safe and
healthy behaviors. The proposed study is the next logical step in building this evidence
base. Factors in the work environment, including high work demands, low social support, and
long work hours, have been shown to increase risk of MSDs, as well as risk-related
behaviors. Yet little research has systematically explored these cross-cutting pathways and
their implications for improving the effectiveness of worksite interventions to address the
broad spectrum of worker health outcomes.

The proposed research provides a novel approach to worksite interventions that integrate
occupational safety and health and worksite health promotion, taking into account the shared
factors in the work environment shaping both MSDs and health behaviors. Standard approaches
to occupational health and safety and worksite health promotion are based on a parallel
structure of separate silos functioning relatively independently in the worksite, each
drawing from their own disciplines and training experiences within public health. Although
these parallel efforts share the common mission of improving worker health, their strategies
are based on different assumptions about and approaches to improving worker health outcomes.
The proposed research integrates these parallel approaches. Although our prior research has
rigorously tested the efficacy of this integrated intervention model in changing worker
health behaviors, to our knowledge no prior research has examined the impact of this
integrated model on health outcomes associated with work exposures - here, notably, on MSD
symptoms.

Inclusion criteria:

- Adult and pediatric in-patient care units at Massachusetts General Hospital that have
ceiling lifts in place (n=42 units) are eligible for the intervention.

- Patient care workers, including registered nurses (RNs), licensed practical nurses
(LPNs), patient care assistants (PCAs)/nursing assistants (NAs) and Nurse Leaders
working in in-patient units for at least 20 hours per week (n= 9500).

- Of those patient care workers, those working in adult and pediatric in-patient care
units (n=90 units) are eligible to be randomly selected for surveys.

Exclusion criteria:

N/A