Study: Does back pain influence nurses' intention to leave the profession?

Almost one hundred percent of Czech nurses complain of back pain. Despite the shortage of nurses in the Czech Republic, this health issue receives less attention than it does in other European countries.

According to SYRI National Institute researchers, back pain is one explanation for why nurses are leaving the profession in favour of other, less strenuous work. While the overall number of nurses working in the healthcare sector has increased slightly in recent years, there is still a significant deficit of around 1300 nursing posts in acute care and more than 500 posts in non-acute care.

SYRI researchers compared data from the Czech Republic with the situation in the UK, which – unlike Czechia – has a long-term strategy for prevention of back pain and other health issues in healthcare workers. While 84.7% (of 569 respondents) of nurses in the UK experience back pain, the number in the Czech Republic stands at an alarming 93% (of 529 respondents).

“In addition to back pain, Czech nurses reported a lack of compliance with health and safety issues in the workplace which increases the incidence of lower back pain,” said SYRI National Institute expert Andrea Pokorná, who has led the research study focused on this topic.

Although nursing staff make up the largest labour force in the healthcare sector, the Czech Republic lacks detailed datasets on them. Musculoskeletal lower back pain has yet to be recognised in Czechia as a work-related health issue. SYRI researchers seek to provide more detailed data with the aim of improving the situation.

“The study focused on nursing staff but did not include nurses who have changed their jobs because of back pain and other work-related health issues. What we have observed was only the tip of the iceberg,” Pokorná said, adding that one of the next steps is to focus on nurses who have already left the profession due to health problems. 

“Underestimation of the prevalence of lower back pain and its psychosocial impact may explain why non-medical healthcare staff – especially nurses, who spend most of their working time at patients’ bedsides – continue to leave the sector,” the researcher said. Together with her colleagues at the SYRI National Institute Andrea Gilchrist and Denise Porter, Pokorná intends to observe the current situation and suggest appropriate preventive measures. “I believe that it will be possible to include back pain among occupational diseases,” Pokorná said, adding that the Czech Republic is lagging behind in this area, as are other post-communist countries.

The issue of back pain is an important subject of research in the social sciences, occupational medicine and human resources management, especially in Western countries. “Studies there have shown us that the general prevalence of lower back pain is higher among nurses and caregivers than among women of similar age in the general population,” Pokorná said. Compared to other healthcare occupations, the prevalence of lower back pain is demonstrably higher in nurses, a contention supported by experience from St. Anne’s University Hospital in Brno.

The nursing profession places a great deal of stress on the musculoskeletal system. This may be caused by bending at the bedside, rotation of the hips, or repeated static loading of the lower spine when handling patients. “Unfortunately, our hospital is no exception in this,” said Jana Zvěřinová, the University Hospital’s deputy for nursing care. “We are aware of this problem. Together with physiotherapists, we have held ‘Back School’ seminars as an aid to prevention, and we will do so again.” An ergonomic assessment of hospital premises was followed by the purchase of new beds and equipment for easier handling of patients. “However, many situations in patient care require a rapid, immediate response in which the nurse concentrates on assisting the patient, and where concern for the nurse’s back is a secondary consideration,” Zvěřinová added.  

Back pain can impede nurses in their ability to perform their job and other activities in their daily life. Experts in Western countries have long considered the issue a major cause of early retirement from the profession, a fact that in some regions can exacerbate the problem of nurse shortages and lead to increasing workload for other hospital staff. Introduction of policies and regulations to promote the use of hoists and aid the implementation of safer patient handling procedures should form part of the solution.