With American patients getting heavier, nurses already in short supply and the number of musculoskeletal injuries rising among its health care workers, St. Joseph's Health System knew it faced a crossroads. Business as usual - the manual lifting of patients - was no longer safe for patients or hospital workers.

"We decided that we would aim toward a systemwide 'no-lift' policy, as advocated by the American Nursing Association's 'Handle
With Care,' ergonomics campaign," said Christine Jacob, RN, MSN, occupational health coordinator for employee health at St. Joseph's.

Since launching Handle With Care in 2003, the ANA has been lobbying Congress and working through the regulatory process to establish stronger ergonomic protections for nurses. U.S. Bureau of Labor statistics consistently show that nurses have the highest back-injury claims of any industry because of moving and lifting patients, yet technology is available to move patients safely. Several states, including Texas and California, have passed legislation to eliminate manual patient-handling.

"We knew it would be a challenge to make such a big cultural change - not unlike the mandating of gloves for nurses 20 years ago -
and for the program to work, every hospital unit had to participate and everyone comply," Jacob said.

St. Joseph's performance improvement committee launched its Smooth Moves initiative by attending the Safe Patient Handling Conference in 2004.

"They met with vendors of all the various types of equipment on the market and began making on-site visits around the country to choose a provider. It took 18 months," Jacob said.

While equipment and training would cost $500,000, St. Joseph's considered it a good investment.

"The average cost of a nonsurgical musculoskeletal injury is $25,000, and when you're seeing about six of those a month, we knew it wouldn't take long to recoup our investment and, at the same time, keep everyone safer," Jacob said. "It just didn't seem right that
the people taking care of patients should get hurt themselves."

To implement Smooth Moves, the committee identified "super users," clinical partners throughout the hospital who would take a six-week training course on the new equipment and introduce it in their units.

"We declared July 5, 2005, Injury Independence Day and introduced the equipment on every floor with balloons and fanfare," Jacob said.

Nurses, aides and transporters are trained to use parachute-like Maxislide sheeting or hover mats when moving patients from stretchers to beds or moving them up in beds.

"The tugging and pulling involved in lateral movement is when many back injuries occur, and, since back injuries are cumulative, a nurse can hurt herself moving an 80-pound patient as easily as [when moving] a 300-pound one," Jacob said.

Special lifts allow caregivers to move patients from beds to chairs and from chairs to a standing position with ease. Previously, when a patient fell, it would take a group effort to lift him or her. Now one nurse, with the aid of an Opera (a machine that lifts up to 720 pounds), can do it alone with less risk to the patient.

"In 11 months, we have seen wonderful results. There has been a 70 percent decrease in injuries," Jacob said.

St. Joseph's is the first hospital in Georgia to implement a minimal patient-transfer policy throughout its entire system. It took strong organizational support and dedication on everyone's part to give this gift to nurses, Jacob said. The hospital was willing to make the initial capital outlay, knowing that it was protecting its assets, but it was the passion of individual trainers that encouraged acceptance
and use of the equipment.

"The initial reaction of nurses is that they don't have time to enlist equipment, but they were told to think about the time they'd lose if they hurt themselves," Jacob said.

Training is ongoing, and a recent survey showed that nurses are more satisfied on the job. A safer workplace is a strong recruiting tool, especially in attracting new nurses trained on lifting equipment in nursing school.

"I've been in nursing 22 years and these workers are near and dear to my heart," Jacob added. "I'm excited about this program. I like
going home at night with the feeling that we've done something good."