UCSF

BACKGROUND: Work-related musculoskeletal disorders (WRMSDs) are a major occupational health problem among nurses. Existing interventions have not totally eliminated the risk for WRMSDs. Safe work behavior and risk perception may play an important role in modifying this risk.

OBJECTIVES: The aims of the study were to identify factors influencing safe work behaviors related to patient handling and risk perceptions about risk of musculoskeletal injury among critical care nurses; and examine the relationship between safe work behavior and risk perception.

METHODS: A cross-sectional national survey was conducted using a random sample of 1000 members of the American Association of Critical Care Nurses. A total of 412 registered nurses participated in the study, and 361 subjects served as the sample for the data analysis. Nurses reported on the physical, psychosocial, and organizational characteristics of their jobs and on their work behaviors, musculoskeletal symptoms, risk perception, and demographics using a mailed questionnaire.

FINDINGS: Multiple linear regressions revealed that significant predictors for safer work behavior included better safety climate, higher effort-reward imbalance, less overcommitment, greater social support, and day shifts (versus rotating shifts). These five predictors explained 20% of the variance in safe work behavior. Significant predictors for greater risk perception of musculoskeletal injury included greater job strain, higher physical workload index, more frequent patient handling, higher musculoskeletal symptom index, and lack of lifting devices or lifting teams. These five predictors explained 23% of the variance in risk perception of musculoskeletal injury. Nurses' perceived risk of musculoskeletal injury showed a weak inverse association with safe work behavior that was statistically significant in bivariate analysis (r=-.13, p=.01), but not in the multivariate model (=-.02, p=.75).

CONCLUSION: Safe work behaviors and risk perception are best understood as socio-cultural phenomena influenced by organizational, psychosocial, and physical job characteristics. Management efforts to enhance the organizational safety climate and improve stressful job conditions could prove to be crucial in promoting nurses' safe work behavior. Further research is needed to determine the role of safe work behavior and risk perception in nurses' safety and health. The unexpected positive association of effort-reward imbalance with safer behavior should also be further investigated.