By Gary Evans
Lynda Enos, RN, MS, COHN-S, CPE, is a Jill of all trades and a master of many. She is a Certified Professional Ergonomist for HumanFit, LLC, near Bend, OR. She also is an occupational health expert on safe patient lifting equipment; preventing violence in healthcare settings; musculoskeletal injuries; preventing slips, trips, and falls; OSHA regulations; and once worked for a nursing union. Given that incomplete list, it sounds almost innocuous to say she began as a nurse midwife. Hospital Employee Heath spoke with Enos between her many speaking engagements and consulting work. This interview has been lightly edited for length and clarity.
HEH: Can you tell us a little bit about your background and how you became interested in occupational health in healthcare?
Enos: I was trained as a nurse midwife in England, but when my husband and I moved to Texas, I couldn’t practice in that job. I got hired where my husband worked, which was an aerospace manufacturing company. I got into occupational health nursing and really developed that passion for worker safety and health. The company put me through a lot of professional training with some of the professional associations, American Association of Occupational Health Nurses — I was really lucky to have that support.
I started to get interested in musculoskeletal disorders and in industrial engineering to redesign work so we don’t injure workers, and also improve productivity and quality. Ultimately for business, that’s the bottom line. After about six years in the field, I had a chance to move to a plastic packaging corporation in North Texas. I got to start the occupational health program there from scratch, which was wonderful. After about four years, I met a female engineer at that company, and we started HumanFit. There was so much manufacturing and semiconductor work in Texas, and the South generally. It was a wonderful proving ground, as ergonomics was gaining some traction federally, and we were starting to become aware of what caused carpal tunnel and how to prevent back injuries. We worked with many companies, providing ergonomic services, redesign, and training programs.
I went back to graduate school to get my master’s in human factors and ergonomics because I really was so interested in this field. That makes me kind of unusual — there may be half a dozen nurses who have done that. My husband changed jobs again, and we moved to Oregon. I discovered quickly that was a very different environment — not so much manufacturing, but a lot of small mom-and-pop businesses.
Ergonomics Standard Quashed
HEH: Unfortunately, we know where this is heading. OSHA passed an ergonomics standard in November 2000, but the Bush administration and Congress said it was unduly burdensome and annulled it about four months later.
Enos: We could talk at length about that, but it is the only worker health and safety standard in the United States to my knowledge that has ever been repealed by a sitting president. Ergonomics was a pretty controversial topic, and I was involved in trying to finalize that federal regulation. Then it was repealed, but we had this huge issue of musculoskeletal injuries in all industries, but especially in healthcare. I had taken the lead in healthcare because of my background as a nurse. I did a huge amount of research with a couple of colleagues. That [raised the question]: “What is going on in healthcare for worker safety in general in this country?” It was then I realized we were about 20 years behind general industry. I kept my [HumanFit] company going but also joined a nurses union as a professional practice nurse consulting in health and safety in ergonomics for most of the hospitals in Oregon that had union members. That allowed me to work with most of the hospitals across the state, developing worker and safety programs. I worked with hospitals for some six years to develop these programs. Primarily, we worked with safe patient handling, but we also dealt with all sorts of issues. It was a really good experience.
About 12 years ago, I decided to go back and work full time in healthcare. There was so much to be done in healthcare. I was asked by healthcare associations and unions in Oregon to address the two leading causes of injuries in healthcare, which were patient handling and violence.
HEH: Healthcare violence certainly is a hot topic. We have talked about OSHA possibly issuing a draft healthcare violence prevention standard this year, and there are some laws under consideration in Congress. Realistically, do you think there are actions that can be taken to alleviate this long-standing problem?
Enos: Yes, absolutely. I have heard that OSHA is moving forward. They are convening with small business groups right now to get feedback. I’m going to be involved in this, having developed the Oregon Violence Prevention Toolkit.1 But this still is a new field for healthcare. We can’t wait 15 to 20 years for research to ask, “If you do X, Y, and Z, does the program prevent violence?” We can use what we’ve got, but we’ve got a lot to learn.
I think with OSHA, The Joint Commission has standards, and there are several states with varying laws. I think having a federal standard will set the foundation. I don’t think an OSHA standard should be overly prescriptive because every healthcare environment is a little bit different. The OSHA standard approach with the management commitment, employee engagement in work culture, training, education, proactive return to work programs, and safe patient handling — that’s the foundation. I think we can do that.
But in addition to the key elements, we need to have patient assessment tools. We need to assess and quickly screen the risk for violence in patients and visitors. Then, we have measures to appropriately intervene. That doesn’t mean security addresses all violence — it means we address the root cause of violence, whether it is behavioral health, drugs and alcohol, brain injury, or post-anesthesia aggression. One size does not fit all.
Hospitals have got to set the ground rules for patients and visitors. You probably know that Louisiana passed a law after a nurse was killed in 2019.2 Part of that law — which I think is interesting — is that hospitals can file charges against patients and visitors if they aggressively disrupt their services. There are a lot of caveats to that, but they can actually take action under criminal laws. We need to send a clear message, and this is one of the first I’ve seen like that in the nation. Other countries have done this. We often say nurses and others should be able to file charges against the patient who assaults them. If you are an individual nurse or a doctor who has been assaulted, it takes a lot of courage to file a charge against a patient, especially in small communities where everybody knows everybody. We see that in Oregon in our rural areas. But if a hospital can do this, you now have a large entity filing felony charges. That, to me, makes perfect sense, rather than relying on an individual who is already traumatized. Something has to be done. If we want to retain staff and attract people into healthcare, we have got to address the elephant in the room, which is violence.
Spotlight on Patient Lifting
HEH: You are a strong advocate of safe patient lifting equipment. Why is it so hard to get this equipment to the bedside and in widespread use?
Enos: There was a lot of research by nursing groups, but in the last 10 years, it has really fallen off. That is worrying, because [patient handling] is still a leading cause of health worker injuries. There is no federal legislation for safe patient handling — it’s not for the lack of trying, but it is probably not going to happen in my lifetime. There is a lack of knowledge by leaders in hospitals — [failing] to link [safe lifting] to patient safety, earlier mobility, and better outcomes. COVID put the spotlight on this: If we take care of workers, we are going to have better patient outcomes. This is a prime example of how you can do that. You don’t have to buy lots of fancy equipment, but you have to invest in a program.
The other piece of this complex puzzle is nursing because we want to do for our patients first. We think it is quicker to manually lift, so we put their health ahead of ours. We have to change that culture.
I’ve seen what can be done. Is it perfect? Heck no. But I’ve seen this in a lot of hospitals that have put the resources in and followed the ANA [American Nurses Association] and OSHA standards around it. It is hard work, but the payoff is huge, especially to patients. I’m at the bedside every week, and I’ve seen terminal patients going home — which they couldn’t have if we didn’t have the right equipment to get them standing and walking. I’ve seen terminally ill teenagers whom you can get mobile enough to go home and attend some important high school event. We could not have done this with manual equipment. Include preventing all the healthcare worker injuries, and to me it’s astounding we can’t get traction on this topic in this country. There is certainly enough research.
REFERENCES
- Enos L. Workplace Violence in Hospitals: A Toolkit for Prevention and Management. Oregon Association of Hospitals Research & Education Foundation. 2nd edition, 2020.
- Evans G. OSHA violence prevention draft reg gathers momentum. Hospital Employee Health. Nov. 1, 2022.
Lynda Enos is a Certified Professional Ergonomist and an occupational health expert. Hospital Employee Heath spoke with Enos between her many speaking engagements and consulting work.
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