Men in Nursing:

When it is not Cool to be Tough

Implications for Safe Patient Handling, Men’s Health Promotion, and Retention of Men in Nursing

Nancy M. Daraiseh, PhD

William T. Lecher, RN, MS, MBA, NE-BC

Cincinnati Children’s Hospital Medical Center

2010 AAMN Conference

Men in nursing tough guys?

More nursing tough guys?

More men in nursing have been tough guys for centuries

Men in Nursing & Florence Nightingale

• The presence of men in nursing diminished

• For a period of time men in nursing were almost non-existent

• Well … 25% were men in this graduating class

Men in Nursing; Retention & Men’s Health

• Men re-entered the health care team as hospital orderlies with one of the purposes to perform lifting and movement of patients.

• Men now make up

6-8% of nurses

Men in Nursing; Retention & Men’s Health• Anecdotally men in nursing report that they are sought

more often than their women counterparts to perform heavy lifting and movement of patients.

• As such, men may be more at risk and as nurses may experience disparities in health and occupational injury rates compared to their female counterparts.

AAMN Objectives

1. Encourage men of all ages to become nurses and join together with all nurses in strengthening and humanizing health care

2. Support men who are nurses to grow professionally and demonstrate to each other and to society the increasing contributions made by men within the nursing profession

3. Advocate for continued research, education and dissemination of information about men’s health issues, men in nursing, and nursing knowledge at the local and national levels

4. Support members’ full participation in the nursing profession and its organizations, and use the Assembly for the limited objectives stated above

AAMN strong focus on• The national organization for men in nursing

• Recruitment & retention for men in nursing

• Men’s health

Our Presentation Objectives

1. Explore strategies associated with successful recruitment and retention of men in the nursing profession (association with work safety, employee injury)

2. Create goals for improving men's health and minimizing health care disparities, while understanding how the AAMN contributes to those goals

3. Critique research findings focusing on men in nursing, and men's health issues, to predict future directions

Men in Nursing; Retention & Men’s Health• Healthcare workers and occupational hazards

• Nursing vulnerability

• Nurses cite occupational health care risks as a primary factor for leaving the profession

• Is there a difference between men and women in nursing and injury and leaving profession?

Men in Nursing; Men’s Health

• Men’s health broadly defined …

“A holistic and comprehensive approach that addresses the physical, mental, emotional, social, and spiritual life experiences and needs of men throughout their life span”

Demetrius Porche,

President, AAMN, 2007-2010

Gender; Men in Nursing Implications

• Physical aspect of nursing

• Not just lifting; injuries, illnesses, exposure

• It isn’t just lifting – psychosocial , environmental (noise, lighting, envt of care), organizational (scheduling, policies, interaction with MD’s, colleagues)

• Psychosocial issues; acceptance/societal norms

The Literature

• Occupational hazards faced by nurses have been, and continue to be studied

• Men in nursing have not been a focus and at times excluded from these investigations.

• Therefore, very little is known about what risk factors are specific to the men in nursing population and what are the most prevalent health outcomes men in nursing experience.

The review of the research

• Provide a baseline understanding of the state of the science regarding occupational exposure and risk among men in nursing.

• We hypothesized that the literature would show significant differences in types and prevalence of health outcomes (e.g. musculoskeletal, injuries due to patient handling and subjective health complaints) between men in nursing and women

Overview

• 83 research studies reviewed from 1974-2010 (English, no other languages)

– Excluded systematic review/reviews, editorials, non-study articles

– 18 did not mention gender– 30 excluded males from subject pool– 35 included males but only 4 reported gender

specific outcomes

Citation Gender % Male Body region Results Comments

Lee et al 2010 Yes 7.2/US LB/Neck/Shoulders/Any No gender specific reportingNgan et al 2010 Yes 13/BC All time-loss injuries –

including musculoskeletal

- Males had a lower RR for all injuries (0.72) and lower for MS (.69).- however 75% of all injuries were MS in nature.

Patient care & non-patient care subjects

Daraiseh et al 2010 Yes 8.8/US All No gender specific reportingKarahan et al 2009 Yes 31.2/Turkey LB Gender is a significant factor Not only nursesWarming et al 2009 Yes 8/Denmark L B/neck/shoulder/knee No gender specific reporting

Stone et al 2007 Yes 7.4/US MS/Body fluids ORs reported for female only but sig for MS (0.67)

Alamgir et al 2007 Yes None (record review)/Canada

All injuries - Male RNs: Higher rate of injuries per 100 FTE 23.3 vs 21.8. - Male LPNs: Lower 23 vs 31.3- Male Aides: Lower 29.4 vs 30.9

Vieira et al 2006 Yes 4%, 13% (2 cohorts)/Canada

LB No gender specific reporting

Fochsen et al 2006 Yes 4-10 (3 cohorts)/Sweden

MS Males over twice as likely to leave nursing

Aim of study was to examine factors leading to leaving nursing

Lipsomb et al 2004 Yes 4.6/US Neck/shoulder/back No gender specific reportingFeyer et al 2000 Yes 15/Australia LB - No gender specific reporting.

- Greatest risk associated with being a case at baseline, history of LBP

Retsas & Pinikahana 2000

Yes 12.3/Australia injuries No gender specific reporting

Hemingway & Smith 1999

Yes 2/Canada All injuries No gender specific reporting

What Does the Research Tell Us??

• Not enough research focusing on gender. • Ignoring/neglecting a distinctive group that by

nature of anatomy and physiology may be confounding results

• When reporting, who do the results apply to? If males are <10% of the participants are they removed from the analysis?

• If investigators continue to neglect this population do we risk alienating future participants?

What Does the Research Tell Us?? • Males may not be at higher risk when

compared to females (still inconclusive) but still at high risk for work related injuries!

• All the negative outcomes from work-related injuries impact the male workforce as well – turnover, dissatisfaction, burnout, disability, etc.

So … our Hypothesis…

The literature will show significant differences in types and prevalence of health outcomes between men and women in nursing:

RESULT: INCONCLUSIVE

Risk Factors to Nurses… Male nurses Included • Organizational factors

– Nurse/physician collaboration

– Scheduling– Decision making– Management– Resources – Salary– Overtime

• Work factors– Growth– Shift work– Fatigue– Teamwork – Direct-care– Violence– Exposures (physical

radiation, BBP, non-ionizing radiation, noise, biological, chemical)

Risk Factors cont’d• Personal factors

– Weight– Height– Age– Gender– Education– Experience– History of injury

• Lifestyle factors– Physical activity– Social activity– Family– Medications– Drug & alcohol use/abuse

• Psychosocial factors– Emotional exhaustion – Stress– Relationships with

colleagues/supervisor– Terminally-ill & very ill

patients– “Minority status”

Outcomes

• Pain – acute/chronic• Disability• Turnover• Leaving the

profession• Burnout• Dissatisfaction

• Illness• Injuries• Infectious diseases• Stress related

disorders• Quality of care

Economic Costs of Nursing Injuries / Illnesses• Medical care and follow-up

• Worker disability

• Staff replacement/Overtime

• Loss of experienced workers

• Cost of importing workers to replace injured US workers

• Reduced productivity

• Poor patient outcomes

Another Look: Safe Patient Handling

• Last week at a conference• Non-scientific, impromptu demonstration• Using 3-D ergonomic 3-D software• Gender, height difference comparison

• Let’s take a look …

Nurse Patient Handling Task Ergonomic Risk Analysis

A comparison of male and female based boost task.

A preliminary review

Sam Bradbury MAOM, ATC, CPE

Ergo-Path System, LLC

Male Nurse Transfer Risk

Female Nurse Transfer Risk

Comparative Analysis

8% increase in Low Back Compression Force may not seem great, however with the increase in frequency of “ask” and “performance” factors, this risk is a significant issue. This combined with increased extremity risk could lead to ergonomic risks among male nurses.

Comparative Analysis – 150#

Comparative Analysis – 250#

10% Increase Low Back Compression force over male counter parts as load increases.

As the patient weight increases the risk increases, shifting to a greater LBCF risk for females.

Asymmetrical Lifting RiskThe consensus of the research literature is that team-lifting capacity is greater than the lifting capacity of an individual, but that the capacity of lifting teams is less than the summed capacity of individual team members.

Further, biomechanical, psychophysical, and physiological stress tends to be reduced compared to the equivalent lifts and transfers performed by individuals.

However, the stress associated with team lifting depends on a broad range of individual team member, load, task and environmental factors, which can interact in unexpected ways.

Caution is therefore recommended against making broad assumptions regarding the use of team lifting.

Hum Factors Man 15: 293–307, 2005.

Male Comparison to Female Nurse Patient Boost Summary

1. Combined ergonomic risk factors increase the total risk of injury significantly - (16x in some cases)

2. Males demonstrate an 8% risk increase of LBCF injury with 150 pound patient.

3. Female LBCF exceeds male risk as the patient weight increases; more than two nurses or lift equipment required

– (10% at 250 pounds without additional lift support)

4. Males are at a moderate risk of injury of extremity injuries as patient weight increases.

5. Asymmetrical lifting is a factor yet to be addressed.

**This is only a brief biomechanical model of potential ergonomic risk of gender based nurse boost task. Further detailed analysis is required.

Next Steps

• Conduct research focused on gender. • Why?

– Risk factors for men and women may be different therefore interventions need to be different.

– Men may suffer from different outcomes than women so ‘one size fits all’ interventions may be not benefit males.

Men in Nursing: The Next Generation

• Implications for Safe Patient • Handling, Men’s Health Promotion, and • Retention of Men in Nursing

Comments & Questions

Thank You!

Nancy M. Daraiseh, PhD

Cincinnati Children’s Hospital Medical Center

(513) 636-7236

Nancy.Daraiseh@cchmc.org

 

William T. Lecher, RN, MS, MBA, NE-BC

Cincinnati Children’s Hospital Medical Center

(513) 407-6425

William.Lecher@cchmc.org