Adult obesity rates have risen to a staggering 35% in the United States. While this epidemic causes many health risks for those afflicted by excess weight, it can also pose surprising health risks for another group — nurses. Read on to learn how obese patients might be putting the safety of workers on the front line of patient care, at risk.Nursing has always been a tough job, and now it’s getting tougher. Working floors populated by more and more overweight patients means nurses have to be more vigilant about the health needs of larger people, and more careful to protect their own physical health too.
Larger patients’ physical size adds a slew of complications to the care that hospital and nursing-home nurses are responsible for administering. When taking care of obese patients, basic medical interventions become more of a challenge. In addition to the mechanical difficulties associated with rolling over patients or transporting them from beds to gurneys, nurses must be aware of other obesity-related issues such as skin care, respiratory problems, difficulties in assessing due to the size of machines, or layers of fat surrounding organs. On top of that, there are barriers to administering lifesaving measures, along with altered drug absorption due to excess body fat, and limited intravenous access with devices such as IV lines and catheters.
A Nurse’s Perspective
Tammy Munro, pictured, is a Portland-born registered nurse who worries about the upward-trending weight of patients. Munro has worked as a nurse for 12 years, and currently practices at UCLA in California. She notes that patients’ sizes vary by hospital and city, but patients everywhere seem to be getting bigger.
“Obesity in patients can be dangerous for nurses,” Munro explains. “It affects every aspect of care. With smaller patients, I’m physically able to roll them from side to side to clean them or get them onto a bedpan. An obese patient can require two to four nurses or aides for the same job.” In a perfect world, there would always be the help needed to safely care for everyone. While there are plans and protocols in place, the reality of a hospital doesn’t always allow nurses to slow down and adhere to them.
“If someone is shouting for a bedpan, and I need three more nurses to help me, I have to take the time to find them or wait until they finish something. This is when things get dangerous. Nurses end up knowingly taking on more than they should… but you can’t tell a screaming guy to hold his bowels while you assemble your team.” At 5’2’’ with a slim frame, Munro is a relatively small person, which increases her likelihood of getting hurt. “I am grateful I haven’t had any serious injuries, but I have seen many co-workers with back and shoulder injuries which take them off the job for months at a time.”
Munro says that moving patients from seated to standing positions is a major issue. Protocols often require hydraulic lifts, and while this may seem like a good solution, using the lifts can actually add challenges.
“We are required to have lifts on every floor, which raises the issue of trying to create space where there was none. But the most important thing I want to say about the lifts is that they take a long time. Sometimes patients want to jump out of bed — almost always when they need to use the bathroom. A lift could safely get them and us there, but maybe not in time.”
She explains that a caring disposition and an “autopilot” drive to protect puts nurses in harm’s way. “If someone jumps out of bed and I’m the only one in the room, I go into nurse mode and do anything to keep them safe. More than once, I’ve caught a patient who was falling and broken their fall with… me. I’ve pulled them so they would land safely on top of me on the ground. Luckily I have only done this with smaller people so far, but if an obese person is falling, it’s our instinct to protect them. It’s not unusual for me to have patients well over twice my size. Obviously this is a safety risk.”
In a 2015 article in The Journal of Nursing, Dr. Mary Rowan, a clinical professor at the University of Minnesota School of Nursing, says that “manual transfers, where nurses use their own body strength, results in 35,000 nurses being injured each year.” The article cites lifts as a tool to help prevent the most common injuries reported by healthcare workers, shoulder and lower-back injuries, but again, this solution doesn’t seem to work well in practice.
What We Can Do
Short of solving the nation’s obesity problem, is there a solution to the extra stress that larger patients put on today’s nurses? A combination of educating nurses about body mechanics and the physics of lifting, mechanical devices, and more on-the-floor staff can help, but Munro hopes the issue continues to be explored for the sake of her fellow healthcare professionals and her patients.
“On top of the risk for us,” Munro elaborates, “nurses also want the best for our patients, and it’s hard to watch this obesity epidemic hurting the people we care for.”
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