Ergonomics Guidelines for the Nursing Home Industry

March 13, 2003
OSHA Administrator John Henshaw today announced the first in a series of industry-specific guidelines for the prevention of musculoskeletal disorders in the workplace. Not surprisingly, the number one recommendation from the agency was to eliminate manual lifting of residents when possible.

The Guidelines for Nursing Homes focus on practical recommendations for employers to reduce the number and severity of workplace injuries by using methods found to be successful in the nursing home environment.

"Less than a year ago, we announced that we would work with the nursing home industry and workers to develop guidelines to reduce ergonomic-related injuries in their industry," Henshaw said.

The guidelines are divided into five sections: developing a process for protecting workers; identifying problems and implementing solutions for resident lifting and repositioning; identifying problems and implementing solutions for activities other than resident lifting and repositioning; training; and additional sources of information.

In the guidelines, OSHA encouraged employers to implement a basic ergonomic process that provides management support while involving workers, identifying problems and implementing solutions, addressing reports of injuries, providing training and evaluating ergonomics efforts.

Developing a Process for Protecting Workers

OSHA says the process for protecting workers will:

  • Provide Management Support. Employers should develop clear goals, assign responsibilities to designated staff members, provide resources, and ensure responsibilities are fulfilled. A sustained effort is paramount.
  • Involve Employees. Encourage employees to submit suggestions or concerns; discuss workplace and work methods; participate in training and procedural designs; respond to surveys; and participate in task groups with ergonomics responsibilities.
  • Identify Problems. Establish systematic methods for identifying ergonomic concerns in the workplace, e.g., analyze information from OSHA injury and illness logs, workers' compensation claims, insurance company reports, etc.
  • Implement Solutions. Effective solutions usually involve workplace modifications that eliminate hazards. Changes can include the use of equipment, work practices or both. (The guidelines include solution examples in Sections III and IV).
  • Address Reports of Injuries. Manage work-related MSDs in the same manner and under the same process as any other occupational injury or illness. Like many injuries and illnesses, employers and employees can benefit from early reporting of MSDs. These reports can also help the establishment identify problem areas and evaluate ergonomic efforts.
  • Provide Training. Provide ergonomics training to nursing assistants and other workers at risk of injury, charge nurses and supervisors, and designated program managers.
  • Evaluate Ergonomics Efforts. Evaluation and follow-up are central to continuous improvement and long-term success. They help sustain the effort to reduce injuries and illnesses, track whether or not ergonomic solutions are working, identify new problems, and show areas where future improvement is needed.

Identifying Problems and Implementing Solutions

Specific measures or guideline implementations may differ from site to site, but OSHA recommends that all facilities minimize manual lifting of residents in all cases, and eliminate such lifting when feasible. The agency suggests an analysis of resident lifting and repositioning tasks that involves an assessment of the needs and abilities of the resident involved. The resident assessment should include:

  • The level of assistance the resident requires.
  • The size and weight of the resident.
  • The ability and willingness of the resident to understand and cooperate.
  • Any medical conditions that may influence the choice of methods for lifting or repositioning.

The guidelines present 22 descriptive examples (with illustrations) of options that a facility can use to implement Solution for resident lifting and repositioning. Many are simple, common sense modifications to equipment or procedures that do not require a lot of time or resources. The represented categories include: transfer from sitting to standing position; resident lifting; ambulation; lateral transfer; repositioning in a chair; weighing, bathtub and shower activities. Integration of various solutions into the nursing home is a strategic decision that will lead to long-term benefits.

Some reports indicate a number of work-related MSDs occur in activities other than resident lifting. Some activities a nursing home operator may want to review include: bending, lifting food trays above shoulder level or below knee level; waste collection; pushing heavy carts; lifting and carrying while receiving and stocking supplies; and laundry removal from washing machines and dryers. While these tasks do not necessarily present problems in all circumstances, they may present problems in certain cases. The guidelines offer a few examples (again with illustrations) of possible solutions for activities other than resident lifting and repositioning. Examples include storage and transfer of food and supplies, mobile medical equipment, working with liquids in housekeeping and in kitchens, hand tools, linen carts, handling bags, working in deep sinks, and loading and unloading laundry.


The guidelines describe areas of training for nursing home employees, their supervisors, and program managers responsible for planning the home's ergonomics efforts.

Nursing Assistants and Other Workers at Risk of Injury. Train employees before they lift or reposition residents, and ensure workers understand policies and procedures, how to recognize MSDs and their early indications, and the home's procedures for reporting work-related injuries and illnesses.

Charge Nurses and Supervisors. Charge nurses and supervisors should reinforce the safety program of the facility, and should focus on more detailed issues such as methods for ensuring use of proper work practices; how to respond to injury reports; and how to help other workers implement solutions.

Designated Program Managers. Staff members responsible for managing ergonomics efforts should receive information that will help them identify potential problems through observation, use of checklists, injury data analysis, or other analytical tools; address problems by selecting proper equipment and work practices; and evaluate the effectiveness of ergonomics efforts.


The guidelines include additional sources (including accessible websites) for those seeking further information about ergonomics and the prevention of work-related MSDs in nursing homes. OSHA also included "A Nursing Home Case Study," based on information provided by Wyandot County Nursing Home in Upper Sandusky, Ohio. Wyandot used a process that reflects many of the recommendations in these guidelines to address safety and health concerns.

"Nursing home workers are suffering too many ergonomics-related injuries," Henshaw continued. "But, the experiences of many nursing homes provide a basis for taking action now to better protect these workers. These guidelines reflect best practices for tackling ergonomic problems in this industry."

The guidelines are available on OSHA's Web site at www.osha/ergonomics/guidelines/nursinghome/index.html. Print copies will be available shortly. To order a copy, contact OSHA at (800) 321-OSHA.

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