I am a nurse. how much patient weight am I allowed to lift without hurting my back? My job description states 50 POUNDS. What is the real limit?

In 1994, the National Institute for Occupational Safety and Health (NIOSH) released a lifting equation designed to assist organizations and healthcare workers in determining safe lifting limits during lifting/handling tasks. Unfortunately, it didn't specifically address patient-handling limits. In 2007, Tom Waters of NIOSH wrote an article in the American Journal of Nursing titled "When Is it Safe to Manually Lift a Patient?" He stated that, in general, the revised equation yields a recommended 35-pound maximum weight limit for patient-handling tasks. When weight to be lifted exceeds this limit, assistive devices should be used (Page 53). However, 35 pounds is a guideline for patients who are cooperative and when the outcome of the lift is totally predictable, which is difficult when patients are unwell. It may be best to work on the assumption that there is no safe way to manually lift a patient and use the lifting equipment available to you.

By the way, 51 pounds is the recommended lifting weight for handling materials, not patients.

Reference: Waters, T. (2007, August). "When Is it Safe to Manually Lift a Patient?" American Journal of Nursing; 107(8):53-8.

AS a wound care nurse, I am often asked to review patients' dressings on their heels and apply a wound vac to them. Do you have something that can hold the patient's leg while I treat it instead of askING one of the nurses to hold it?

The best tool for this is a limb holding sling. It can be attached to a ceiling or floor lift to lift the extremity and hold it while you complete wound care. If the process will take more than a few minutes, please make sure to lower the leg and rest it during the procedure to maximize blood flow to the area and to prevent patient discomfort.

I am a physical therapist and hurt my back a few years ago when an obese patient fell and I was trying to use proper body mechanics and a gait belt to help her to the FLOOR. I came off light duty, and I'm afraid of getting hurt again, this time permanently. Is there another way to get my patients walking without getting hurt again?

There is a variety of equipment that can be used to ambulate a patient that does not prevent them from regaining their confidence and gait when recovering from illness or surgery. Some facilities install a single ceiling track in the corridors of the unit or rehabilitation center. The patient can then ambulate wearing a special sling. Some floor lifts can also be used for this purpose. Both options provide support for the patient during ambulation, and should a patient become weak, need to rest or become unsteady during the therapy session, the lift — not the therapist — catches them. This provides a more secure therapy session and may reduce patient falls and staff injuries. Another benefit of these options is that you will be able to ensure that prescribed weight bearing is actually weight bearing, eliminating the need to estimate the patient's actual weight bearing during ambulation.

I have to turn patients every TWO hours, and we are short staffed, so I usually turn the patients by myself and go home sore. I don't have time to wait for another nurse to help me, and even when someone can help, I still go home sore. Do you have something I can use to turn patients without waiting for help?

A variety of types of equipment work well for turning patients, but human strength is not one of them. A ceiling lift or floor-based lift can assist with this activity. With both of these, you still need to get the patient onto the sling, and that in itself can place you at risk of injury if you're unsure of the correct technique for applying a sling with bariatric patients. VanderClips are a great tool that can assist with turning patients every two hours. VanderClips hook to your existing ceiling or floor lift. They clip to the patient's sheet so there's no need to get a sling in place. When you elevate the lift, the clips lift the sheet, which turns the patient. With VanderClips, you can do this yourself and don't need to wait for your colleagues to help you. Just make sure that the bedrails are raised on the side of the bed the patient will be facing.

I take care of my dad at home. He has some upper body strength but is not able to move without assistance, so my husband, son and I have to move and lift him. My husband and I are hurting our backs. We can't afford TO HAVE lifts INSTALLED in the ceiling. are there ways to do the moving and lifting without spending a lot of money?

There are many tools available to assist loved ones with repositioning in a home environment. Floor lifts provide a wide range of assistance to caregivers without the cost of installation. Floor lifts also offer the flexibility of providing care in any room of the house. Repositioning slings are a nice accessory to meet the needs you have described. They are placed under the loved one and then attached to the lift, so the lift handles the weight. You might also consider purchasing a slide sheet to be used when repositioning your father in bed.

I take care of my husband in our double-wide mobile home. The hospital gave us a hospital bed, a floor lift and a couple of the slings, but it's really hard to push the lift on my carpeted floors. Is there a floor lift that's easier to push on the carpet, or is there a better way to get my husband in and out of the bed and chair?

This is a common problem with carpet. Generally speaking, the smaller the wheels on the floor lift, the more difficult it is to push the lift over the carpeting. It's usually recommended to remove carpeting altogether, but if that's not possible, don't be afraid to ask the equipment vendor to switch the wheel casters on the lift to meet the needs of your home. Keep in mind that you'll need the wheels to glide easily under the bed, so you'll need to provide the vendor with the height you need to get the lift under.

You might also consider purchasing some plastic covering for your carpets to protect them from wear and tear. The wheels of the floor lift will move more easily, and you'll still be able to see the carpet design.

I use lifts at work, and our slings come in different sizes, but they all have the same weight limits. How do I know what size is right for my patient?

Many healthcare workers ask this question. Since slings come in all shapes and sizes, here are a few tips on sizing:

Universal slings, such as VANCARE's Uni-Fit Slings, should be long enough to fit from the bottom of the patient's coccyx to the top of, or a few inches above, the patient's head and wide enough for sling fabric to extend at least 2 inches in front of the patient's anterior shoulder.

Sitting slings, such as the VERA-LIFT, should be long enough to extend from the bottom of the patient's coccyx to 2 to 3 inches below the lower edge of the patient's shoulder blades.

The amputee sling should be long enough to fit from behind the knees (if the amputations are below the knee) or from the bottom of the longest stump (if amputations are above the knee) to the top of the patient's head.

Ambulation slings take into account actual chest and thigh measurements.

Resource Link: UNI-FIT Sling

We were told to create a Safe Patient Handling program, and I am supposed to lead IT. I have never heard of Safe Patient Handling. Do you have programs that help someone like me get a program started?

You might want to consider attending a national or state conference on safe patient handling or attending a workshop to help you get started. You may also want to consider contracting an SPH consultant to assist you with the program planning and initial risk assessment. VANCARE/Visioning HealthCare offers a number of programs and services to help an organization implement and sustain an SPH program every step of the way and provide consulting, American Nurses Credentialing Center-accredited Safe Patient Handling and Mobility workshops and comprehensive risk assessments to their clients.

We bought a bunch of equipment, but staff isn't using it. Now the facility is upset because they spent so much money, but the injury outcomes are the same. What am I doing wrong? How do I make staff use the equipment?

While purchasing SPH equipment is important, it's not the only factor in creating staff buy-in and success for the program. Several factors may be causing this problem:

  • Staff not receiving enough training in the use of the equipment.
  • No written policy to articulate the organization's expectations of them.
  • Not enough equipment or of the wrong kind.

It's important to find the cause of the problem. Sometimes that means going back to the beginning, conducting a full risk assessment of the facility and determining whether the resistance is equipment- or staff-related. One thing is for sure: Telling the staff they have to do it does not work.

My hospital has approved funding for equipment purchases, but How do I know what to buy and how much to buy?

The simple answer is to conduct a comprehensive SPHM risk hazard assessment of the facility, but that can be challenging if you have little experience in this area. A consultant can provide a thorough, unbiased assessment of the facility's equipment and educational needs. Many facilities feel that spending money on a consultant takes away equipment funding. However, a good consultant can save you many thousands of dollars on equipment, so they pay for themselves very quickly. All assessments are not created equal, so don't be afraid to ask for a sample assessment to determine if it will give your facility the information needed to move forward.

I work with a patient population that is dependent and develops pressure ulcers easily. I was told it's OK to leave repositioning slings under the patient, but I'm afraid they will cause sores. What should I do?

Prevention of pressure ulcers is high on most healthcare workers' minds these days as Medicaid and Medicare no longer reimburse costs associated with hospital-acquired ulcers. The first point to prevent pressure ulcers is to turn patients 30 degrees every two hours, unless contraindicated. The primary cause of pressure ulcers is not relieving pressure on the skin in a specific area. Second, as wrinkles can cause pressure ulcers, wrinkles must be removed from under patients, so the patient is lying on a smooth surface. Third, don't be afraid to ask for evidence that supports leaving repositioning slings under patients at your facility. Generally speaking, these types of slings do not cause pressure ulcers; lack of repositioning does. If the sling is in place, it's easier to reposition the patient without having to wait for a co-worker to become available, and it is more likely that you will be willing to reposition the patient more often.

I want to use the ceiling lift with my patients, but they WON'T allow me to. I tell them I have to use it, but they just ask another nurse to do the move without equipment, and the nurse does it. I want to respect a patient's right to refuse, but I should have a right not TO get hurt while caring for the patient. What am I supposed to do?

There is nothing quite as frustrating as wanting to use the equipment but the patient refusing to have it used on them. Add to that the frustration of having a co-worker come behind you and complete the movement without equipment, leading to the patient continuing to request manual handling. A few things to consider: 1) Educate the patient upon admission to expect that staff will utilize the equipment to provide the safest care possible for them. Some facilities show videos or give brochures that show the equipment in use. These allow the patients to see the equipment in action, and it sets the precedence that equipment will be used to protect both the patient and the staff. 2) Determine the patient's reason for refusal. Often it is fear of the unknown, and taking the time to educate the patient and answer questions may resolve the refusal point. 3) Make sure that all staff members are onboard with utilizing equipment. If they are not and you are uncomfortable speaking to them, allow the manager to determine how best to handle the situation. While no one wants to bring this type of situation to the manager, it's important to safeguard the health of co-workers and to prevent patient injuries. Safe Patient Handling and Movement is about process improvement and cultural change, which unfortunately does not happen overnight, so continue to model the appropriate use of the equipment.