Objectives-To determine the prevalence of musculoskeletal complaints of the back, arms or neck, and legs among nurses, and to investigate the relation between these complaints and various work related and personal variables. Methods-A questionnaire survey was carried out in four nursing homes in The Netherlands. Results-The response was 95% and resulted in 846 completed questionnaires. It was found that a large proportion of the subjects regularly had back complaints (36%) but also had arm or neck (30%) and leg complaints (16%). Almost all respondents (89%) considered nursing work as physically strenuous. Most of them complained of working under time pressure (69%/o), increased work pressure (70%), and having no opportunity to take a break from the work (70%). The physical variables which seem to trouble the subjects most were lifting (65%), working in awkward postures (47%/), and stooping (34%).Moreover, 53% of the subjects responded that the ergonomic lay out of the ward was disagreeable. Most of the work related variables under study seemed to be associated with musculoskeletal complaints. For all types of complaints the strongest associations were found with having to lift heavy loads. Apart from physical stress various aspects of work pressure showed strong associations with the occurrence of musculoskeletal complaints. The variables on the ergonomy of the ward showed less clear associations with musculoskeletal complaints than were found for physical stress and work pressure. Conclusions-From these results it may be concluded that future research of health risks of nursing work should have a wider focus than the relation between physical workload and low back pain. (Occup Environ Med 1996;53:636-641) Keywords: musculoskeletal complaints; physical stress; work pressure; nurses As shown in several studies, nursing work seems to be associated with low back pain' 10 with prevalences found between 42% and 62%.3 67 Depending on the type of work performed and the normally considerable workload in nursing, complaints may also be expected in other regions of the body, for instance in the legs or arm and neck region." However, for musculoskeletal problems at other anatomical sites (arms and neck, legs) it is far less easy to find prevalence rates in the scientific literature. In the study of Stubbs et al5 nurses with back pain were asked to indicate the anatomical site more precisely in a pictogram. The upper back and neck was pointed out as the site of the problem by 4%, and the buttocks and legs by 10% of the subjects with back pain. In a study on nurses in which complaints of the cervical back were examined, apart from thoracic and lumbar spine problems, a prevalence rate of 16% was found.'2 In another study among nursing personnel Lagerstrom et al'3 found prevalences of symptoms of the neck 48%, shoulder 53%, hand 22%, and knee 30%. Severe symptoms established on a nine point scale had lower prevalences on all sites, ranging from 18% for the shoulders to 7% for the knees.Because empirical data are spa...

ealth care workers, especially nurses, have been the subject of many studies to examine how physical stress and other work-related factors may affect their health.1' 11 These studies focused in the first instance on low back pain.7 Most research has been carried out in general hospitals so far, even though large numbers of nurses work in other but comparable settings, such as psy chiatric hospitals or nursing homes. Recent investigation tends to confirm that the physical work load of those working in nursing homes is relatively high.12 Data collected in the health care in the Netherlands support this conclusion. For example, the percent age of sick leave found in nursing homes (10.8%) was higher in 1990 than that in health care as such (9.3%).13 To get a better idea of com plaints and health problems affecting nursing staff in nursing homes, a study was carried out in three Dutch nursing homes to search for underly ing factors for these problems in the daily work situation.14 In this paper a particular part of this study is dis cussed, the one dealing with the asstrenuous aspects o f nursing work. Household and preliminary tasks, ergosessment of physical work load during a nurse's workday. Because Harber et al15,16 showed that it was not only patient-transfer activities that contrib uted to low back pain, we decided to observe all nursing activities and to investigate each task-specific contri bution to physical work load. To get a clearer understanding of task-specific work loads, 36 subjects working in these nursing homes were selected to participate in an observa tional study. In this study we tried to establish which activities took up most of their time, in which of them most of the poor work postures oc curred, which activities were per-

It can be concluded that the course was successful, although it should be carefully investigated as to whether nurses remain capable of working safely in daily practice. The work pressure that nurses experience during their normal duties could prevent them from working safely during everyday work.

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