Date of Award

December 2013

Degree Type


Degree Name

Doctor of Philosophy


Health Sciences

First Advisor

Phyllis M. King

Committee Members

Arun Garg, Ann C. Snyder, Susan Cashin, Jennifer L. Johs-Artisensi


Long-term Care, Nursing Assistants, Safe Patient Handling and Mobility, Work-related Musculoskeletal Injuries


Background. Nursing assistants, working in long-term care facilities, have consistently been among the top occupational groups experiencing work-related musculoskeletal injuries. These injuries have been attributed the physical demands of lifting and moving the individuals in their care. Great strides in research have identified successful risk reduction strategies such as the implementation safe patient handling and mobility programs. The benefits of these programs have been advocated over the last two decades, but the rate of injuries among nursing assistants continues to be more than double the national average for all other industries. The purpose of this study was to investigate the influence of safe patient handling and mobility policies and procedures, facility resources, and work practices on the trends in injury rates and the associated costs in long-term care facilities.

Methods. Thirty-eight facilities contributed information to the study. Data were gathered on safe patient handling policies, facility resources, work practices, work-related injuries and workers' compensation costs for 2002 - 2011.

Results. Eighty-four percent of the facilities had patient handling policies or were preparing to implement in the upcoming year. All of the facilities had mechanical lifting devices, employee training and procedures for embedding safe patient handling into daily work practices. Nineteen facilities contributed one to ten years of data, showing injury rates decreased 63% from 2002 - 2011. Eleven facilities provided worker's compensation information showing medical and indemnity costs decreased 54% from 2006 - 2011. The presence of a policy, was not found to independently influence these factors. The number of days away from work due to work-related injuries was significantly lower in facilities with patient handling policies. Conclusion. The presence of the policy was not found to independently influence injury rates or costs, but the prevalence of safe patient handling policies, mechanical lifting devices and safe work practices suggested that a safety culture may finally be present in long-term care. Despite the impressive reductions in injuries and costs, the continued higher than average rate of injuries among this occupational group may indicate that other factors now play a greater role in work-related injuries.