Ergonomics: Guidelines for Nursing Homes
These guidelines provide recommendations for nursing home employers to help reduce the number and severity of work-related musculoskeletal disorders (MSDs) in their facilities. MSDs include conditions such as low back pain, sciatica, rotator cuff injuries, epicondylitis, and carpal tunnel syndrome. The recommendations in these guidelines are based on a review of existing practices and programs, State OSHA programs, as well as available scientific information, and reflect comments received from representatives of trade and professional associations, labor organizations, the medical community, individual firms, and other interested parties. OSHA thanks the many organizations and individuals involved for their thoughtful comments, suggestions, and assistance.
More remains to be learned about the relationship between workplace activities and the development of MSDs. However, OSHA believes that the experiences of many nursing homes provide a basis for taking action to better protect workers. As the understanding of these injuries develops and information and technology improve, the recommendations made in this document may be modified.
Although these guidelines are designed specifically for nursing homes, OSHA hopes that employers with similar work environments, such as assisted living centers, homes for the disabled, homes for the aged, and hospitals will also find this information useful.
OSHA also recognizes that small employers, in particular, may not have the need for as comprehensive a program as would result from implementation of every action and strategy described in these guidelines. Additionally, OSHA realizes that many small employers may need assistance in implementing an appropriate ergonomics program. That is why we emphasize the availability of the free OSHA consultation service for smaller employers. The consultation service is independent of OSHA's enforcement activity and will be making special efforts to provide help to the nursing home industry.
These guidelines are advisory in nature and informational in content. They are not a new standard or regulation and do not create any new OSHA duties. Under the OSH Act, the extent of an employer's obligation to address ergonomic hazards is governed by the general duty clause. 29 U.S.C. 654(a)(1). An employer's failure to implement the guidelines is not a violation, or evidence of a violation, and may not be used as evidence of a violation, of the general duty clause. Furthermore, the fact that OSHA has developed this document is not evidence and may not be used as evidence of an employer's obligations under the general duty clause; the fact that a measure is recommended in this document but not adopted by an employer is not evidence, and may not be used as evidence, of a violation of the general duty clause. In addition, the recommendations contained herein should be adapted to the needs and resources of each individual place of employment. Thus, implementation of the guidelines may differ from site to site depending on the circumstances at each particular site.
While specific measures may differ from site to site, OSHA recommends that:
Manual lifting of residents be minimized in all cases and eliminated when feasible.
Employers implement an effective ergonomics process that:
provides management support;
addresses reports of injuries;
provides training; and
evaluates ergonomics efforts.
These guidelines elaborate on these recommendations, and include additional information employers can use to identify problems and train employees. Of particular value are examples of solutions employers can use to help reduce MSDs in their workplace. Recommended solutions for resident lifting and repositioning are found in Section III, while recommended solutions for other ergonomic concerns are in Section IV. The appendix includes a case study describing the process one nursing home used to reduce MSDs.
(1) Documents submitted to OSHA by Wyandot County Nursing Home. (Ex. 3-12)
Occupational Safety & Health Administration (OSHA)
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