1. Injury and Costs Related to Clinical Services and Nursing Occupations
Loss Trend Project: Injury and Costs Related to Clinical Services
& Nursing Occupations
Rene’ Walling and Esther Campos
California State University Sacramento 147-01

2. Injury and Costs Related to Clinical Services and Nursing Occupations 2
Table of Contents
Introduction/Executive Summary 3
Results/Trends
Total Injury Costs per Year/Total Number of Injuries per Year 4
Injury Trends in Clinical Services
Number of Injuries by Manager Unit/ Number of Injuries in Clinical Services 5
Top Three Injuries in Clinical Services/ Total Costs for Clinical Service Injuries 6
Injury Trends related to nursing and strain
Total Injuries from Strain/Injuries due to Strain Compared to all other injuries 7
Total Injuries from Strain in Nurses/Strain due to Moving and Lifting Patients 8
Back related Injuries in Nurses/Nature of Back Related Injuries in Nurses 9
Back Injuries in Nurses Occurring within Clinical Services 10
Conclusion/Recommendations 11

3. Injury and Costs Related to Clinical Services and Nursing Occupations 3
Introduction/Executive Summary
This report was created to present an analysis and evaluation of the losses
preceding 2015, which began in 2012 and concluded in 2014, and are associated with
the key injury trends of the loss data set. Additionally, conclusions and
recommendations for reducing the costs and incidence rates of the most significant
injuries is provided. This research was predominantly carried out by trending various
categories, such as occupations, nature of injury, injured body part and costs for topics
with common frequencies of occurrence, cost, mode of injury, etc.
Exploration into the clinical services manager unit, indicates critical action is
needed within the health care field to improve employee safety. To combat the high
incidence of injuries associated with the lower back, multiple body parts and shoulders
investment in training programs, mechanical devices and policies, is crucial where
clinical services operate. Employee injury related to these three body parts is directly
related to improper patient assistance and lifting by employees. These unnecessary
injuries not only increase employee turnover, but also affect the quality of care a patient
receives. Implementation of training programs teaching how to properly assist patients,
zero lifting policies and new equipment, will increase patient and employee safety,
patient satisfaction, and patient recovery time.
The results of data trending reveal the major cause of injuries for the three years
were due to strain, which represents the majority of injuries, at 51.3%. Further analysis
into which occupations contributed the most injuries caused by strain, establish that
nursing occupations, specifically Certified Nursing Assistants, Licensed Practical Nurses
and Registered Nurses carried the largest fraction of total injuries from strain throughout
the three years, compared to any other individual occupation. This was in large part
due to the physical demands associated with these health care occupations, including
moving and lifting patients, which are very strenuous activities inked closely to back
injuries due to strain in nurses. Additionally, nearly every back injury in nurses due to
the strain of lifting, pushing or pulling, occurred within clinical services.
The prospect for nursing occupations (Certified Nursing Assistants, Licensed
Practical Nurses and Registered Nurses) in regards to strain induced back injuries is
undesirable, as the data confirms a relatively stable rate of these injuries in nurses for
all three years analyzed. Since back related injuries due to strain are typically
developed over time, the urgency with which the issue is addressed is vital to the
prevention of back injuries in unaffected nurses. The back can be injured over time by
lifting large quantities of weight, even with assistance from other employees, it is for this
reason that rather than training in proper lifting technique, it is recommended nurses be
provided portable moving devices for the movement of patients. Provision of this
equipment will eliminate the issues related to moving patients.

4. Injury and Costs Related to Clinical Services and Nursing Occupations 4
Results/Trends
This report presents some of the key injury data trends analyzed from the years
2012 to 2014. Over the past three years there has been decreases to both the total
injury costs and number of injuries per year. Total injury costs exhibited the largest
decreases, with an 8.9% drop in total expenses from 2012 to 2013, followed by a 31%
drop from 2013 to 2014. Figure 1.1 presents the total injury costs per category by year,
and reveals the largest cost decreases occur throughout 2014. A substantial difference
in the indemnity total for 2014 should also be noted as compared to 2012 and 2013.
The indemnity total of $266,129.39 in 2014 is 47.6% smaller than the indemnity costs in
2013, and 50.5% smaller than the total in 2012.
During the span of three years beginning in 2012, and culminating in 2014, a
total of 392 injuries occurred due to all causes. Figure 1.2 compares the percentage of
injuries that occurred for each year. In 2012 the highest number of injuries occurred,
representing 40% of the total injuries for all three years, and contributing to the higher
overall injury costs for this year. In 2014 the least amount of injuries occurred, 29% of
the total, which corresponds to the low total injury costs for 2014. Even though 2013
has merely seven additional injuries than 2014, the injury costs for 2013 are more
closely related to 2012, with average injury costs only 8.3% lower than those which
occurred in 2012.
Figure 1.1 Bar chart show ing the total injury costs per medical expense category from 2012 through 2014.
Figure 1.2 Pie chart illustrating the percentage of total injuries per year.

5. Injury and Costs Related to Clinical Services and Nursing Occupations 5
Figure 2.1 Pie chart show ing the percentage of injuries that occurred by manager unit (clinical, ancillary and corporate services/all
other units) for the years 2012 through 2014.
During the years 2012 to 2014, the top three manager units with the most
injuries occurred within corporate, ancillary, and clinical services. The largest portion of
the pie seen in figure 2.1, is clinical services, which accounts for 46% of the injuries in
the three year span. Clinical services encompasses jobs such as medical assistants,
surgical technicians, nursing assistants, nurses, and physicians. The second highest
proportion of 39% belongs to ancillary services, which also includes health care
occupations. Corporate services and all other manger units represent significantly
smaller proportions of the pie, 7% and 8% respectively.
Figure 2.2 indicates no significant change has occurred from 2012 to 2014 in
the total number of injuries per year in clinical services. Since 2012 to 2013, total
injuries were only reduced by two, with the 2012 year having the most at sixty. The
number of injuries remained at 58 for 2013 and 2014.
Figure 2.2 Bar chart of the total number of injuries that occurred in clinical services for each year.

6. Injury and Costs Related to Clinical Services and Nursing Occupations 6
Figure 2.3 Bar chart comparing the top three injuries by body part occurring in clinical services (manger 9) from2012 through 2014.
Figure 2.4 Bar chart detailing the total costs (medical, indemnity and expense) occurring in clinical services by year.
Occupations working within clinical services are often required to lift and
maneuver patients from one bed to another, etc. While healthcare workers should not
lift patients without the proper equipment, it is not surprising that improper carrying of
patients still occurs, eventually leading to injury. The top three injuries within clinical
services involved the shoulders, lower back area and multiple body parts. Figure 2.3
shows the comparison of these three injury sites with the lower back area associated
with the highest number of injuries.
By taking a closer look at the total costs for injuries related to occupations
working within clinical services for three years, figure 2.4 reveals a bell shaped curve.
Medical costs remained stable, with an average cost difference of $86,000 between the
three years. The medical total increased about $50,000 from 2012 to 2013, but came
back down in 2014. The indemnity totals showed the largest variation, with an average
of $122,671 variation. Referring back to the injury totals in figure 2.2, it is interesting
that 2013 had the highest total costs, but a lower amount of injuries than in 2012.

7. Injury and Costs Related to Clinical Services and Nursing Occupations 7
As presented in figure 3.1, over half (51.3%) of the 392 total injuries were
attributed to strain as the cause of injury. Despite the slight downward trend pictured in
figure 3.2 concerning both total injuries and injuries attributed to strain from 2012 to
2014, the total injuries from strain remained above fifty percent of the total injuries from
all causes for both 2012 and 2013; 2014 is not far off with 45.1% of injuries due to
strain.
Figure 3.1 Bar chart show ing the total injuries from 2012 to 2014, compared to total injuries from strain and total injuries from all
other causes.
Figure 3.2 Bar chart comparing the total injuries from all causes to the total injuries due to strain per year.
Nursing occupations (Includes: Certified Nursing Assistants, Licensed Practical
Nurses and Registered Nurses) carried the largest fraction of total injuries from strain
throughout the three years, compared to any other individual occupation. Figure 3.3
(page 8) confirms that from 2012 to 2014, the percentage of total injures due to strain in
nurses, remained above forty percent of the total injures due to strain in all occupations.
Nurses suffer injuries due to strain at a higher rate than any other occupation for all
three years.
Further emphasizing the strong correlation between nurses and occupational
injuries due to strain is the comparison seen in figure 3.4 (page 8) which reveals that

8. Injury and Costs Related to Clinical Services and Nursing Occupations 8
from 2012 to 2014, more than half (52.4%) of all injuries due to strain in nurses were
from causes directly related to moving and lifting patients, according to the incident
descriptions, which describe injuries resulting from moving, lifting and pulling patients.
Figure 3.3 Bar chart of the total injuries from strain in nurses compared total injuries from strain in all other occupations.
Figure 3.4 Bar chart comparing the total injuries from strain in nurses due to moving and lifting patients to strain in nurses from all
other causes.
As previously noted in figure 3.4, 52.4% of all the injuries due to strain in nurses
were due to moving and lifting patients for 2012 to 2014. The majority of those injuries
resulted in back injury (Includes: 21/Vertebrae, 22/Disk (neck), 23/Spinal cord (neck),
38/Shoulders, 41 /Upper back area, 42/Lower back area). As pictured in figure 4.1
(page 9), back related injuries represent the majority of injuries for nurses in all three
years. In 2012 over two-thirds of the injuries related to strain from moving and lifting
patients resulted in back injuries for nurses. In the following two years back injuries still
represent the bulk of injuries in nurses, despite a slight decline from 2012.

9. Injury and Costs Related to Clinical Services and Nursing Occupations 9
Figure 4.1 Bar chart comparing the back related injuries in nurses to injuries involving all other body parts in nurses.
Figure 4.2 Bar chart comparing the total back related injury causes (strain from lifting/strain from pushing or pulling) to all other
back related injury causes.
The high rate of back related injuries (Includes: 21/Vertebrae, 22/Disk (neck),
23/Spinal cord (neck), 38/Shoulders, 41 /Upper back area, 42/Lower back area) due to
the strain of moving and lifting patients for nurses is further magnified by the data in
figure 4.2. This bar chart represents the fraction of back injuries among nurses that
were specifically caused by either the strain of lifting or the strain from pushing or
pulling. Both 2012 and 2014 had more back injuries in nurses related to the strain of
lifting or the strain from pushing or pulling, than back injuries in nurses occurring from all
other causes. In 2013, more back injuries in nurses occurred from causes other than
the strain of lifting or the strain from pushing or pulling.
Nearly every back injury in nurses due to the strain of lifting or the strain from
pushing or pulling (56 & 57), occurred under manager 9 (clinical services). As seen in
figure 5.1 (page 10), the rate for 2014 is especially high, with 100% of those injuries
(56 & 57) occurring under clinical services, followed by 2013 at 86%. In 2012 79% of
the injuries were associated with clinical services, however this still represents over two-
thirds of the incidences.

10. Injury and Costs Related to Clinical Services and Nursing Occupations 10
Figure 5.1 Bar chart show ing the number of back injuries in nurses that occurred from either the strain of lifting or the strain from
pushing or pulling, and the number of that occurred under Manager 9 (clinical services).

11. Injury and Costs Related to Clinical Services and Nursing Occupations 11
Conclusions/Recommendations
Occupations within the healthcare field, are among those at greatest risk of
suffering work-related injuries. The largest proportion of injuries from 2012 to 2014,
concerning each manger unit occurred within clinical services, (46%) followed by
ancillary services (39%) in close second. Both of these manager units are heavily
comprised with healthcare workers. Clinical and ancillary services encompass
occupations such as medical assistants, surgical technicians, nursing assistants,
nurses, and physicians. The top three injuries by body part for clinical services are the
lower back, multiple body parts and shoulders. These positions are known for their long
work hours and physical demands, chiefly lifting and moving patients. The strain put on
the muscles of the back, shoulders and other areas of the body when lifting more than
one should and more often than one should, suggests that injury to these top three body
parts is directly related to heavy lifting.
It is possible to reduce the quantity of injuries that occur within clinical services,
however, workers must demand alternative ways to complete difficult tasks that will not
result in long term injury. Chiefly, hospitals need to develop policies which mandate
minimal lifting of patients for specific situations, (assistance walking, dressing, and
bathing) and training programs that demonstrate how to properly assist patients in low
impact ways. An investment should be made in mechanical lifting devices to assist
employees when a patient needs complete assistance (patient cannot walk, transfer
from bed to bed, etc.). The ultimate goal should be to eventually implement zero lifting
policies. Ultimately, the benefits of investing in training programs and new equipment
will outweigh the yearly costs (figure 2.4, page 6) associated with clinical services
injuries.
Based on the trends considered in this report, injuries due to strain represent
over fifty percent of all injuries from 2012 through 2014, with the majority (over 40%)
occurring among nurses (Certified Nursing Assistants, Licensed Practical Nurses and
Registered Nurses) for all three years. This suggests that employees in nursing
occupations are particularly susceptible to suffering injuries due to strain. The majority
of strain related injuries in nurses are related to moving and lifting patients, indicating
that these nurses may not have access to the proper equipment required to move
patients (especially larger patients) to and from bed. Additionally, of those injuries
suffered by nurses due to the strain of lifting or the strain from pushing or pulling,
(nature of injury 56 & 57) generally resulted in back injury (21/Vertebrae, 22/Disk (neck),
23/Spinal cord (neck), 38/Shoulders, 41 /Upper back area, 42/Lower back area).
Further analysis of the back injuries referenced above, indicates that virtually every
back injury in nurses due to the strain of lifting or the strain from pushing or pulling (56 &
57), occurred under manager 9 (clinical services).
Nurses working in clinical services are subjected to a myriad of stressors while
working within clinical services that will predictably influence work performance and the
quality of choices made during work situations, such as the action taken when a patient

12. Injury and Costs Related to Clinical Services and Nursing Occupations 12
unexpectedly falls or needs assistance moving their entire body weight to and from bed,
etc. While nurses should be responsible for their actions during work hours, they
nonetheless should be provided the equipment or training necessary to avoid injury.
Since it is generally not advisable to lift large amounts of weight with or without the
assistance of other employees, implementing proper lifting technique workshops would
be of little use in preventing long term back injuries due to strain, especially in the
occupation of nursing, where moving and lifting patients is a daily occurrence. For this
reason, portable lifting devices are the ideal implementation for avoidance of long term
back injuries. Portable lifting devices should be made available to nurses for use, which
will directly decrease the hazard associated with strain from lifting and moving patients.
Provision of adequate numbers of portable moving devices, that every nurse may have
one available when necessary, is the key to arresting the incidence of strain related
back injuries due to lifting, pushing or pulling patients.