Addressing musculoskeletal disorders in the healthcare sector

Healthcare workers provide essential care in hospitals, residential aged care, community clinics, disability services and patients’ homes. Their work can also place sustained demands on the back, shoulders, neck, arms and legs. Moving a person who cannot assist, supporting a patient during rehabilitation, standing for long periods and working in awkward spaces can all contribute to musculoskeletal disorders (MSDs).

These conditions include back pain, sprains, strains, tendon problems, joint injuries and persistent discomfort linked to repetitive or physically demanding work. A single incident may cause harm, but many disorders develop gradually through repeated handling, forceful exertion, awkward postures, vibration, insufficient recovery or a combination of physical and psychosocial pressures.

The Australian healthcare environment has particular features. Large hospitals in Sydney, Melbourne, Brisbane and Perth manage high patient volumes, while rural and remote services often operate with smaller teams and fewer specialist resources. Aged care and home care workers may travel between clients, work in unfamiliar rooms and provide care in homes that were not designed for clinical tasks. NDIS support work can also involve highly individualised routines and complex mobility needs.

Effective prevention requires more than telling workers to lift carefully. Employers need to design tasks, equipment, staffing arrangements and workspaces around the real demands of care. Workers, health and safety representatives, patients and families should contribute to solutions. European research and practical resources from EU-OSHA, including OSHwiki, risk-assessment guidance and the OiRA platform, can support this process alongside Australian legislation and advice from Safe Work Australia and state and territory regulators.

Why healthcare work creates musculoskeletal risk

Patient handling is a major source of physical strain. Workers may reposition people in bed, assist with transfers, support walking, respond to falls or hold limbs during treatment. The person receiving care may be frightened, confused, in pain or unable to predict the movement. These factors make the task dynamic, with force and posture changing from moment to moment.

Repetition also matters. Nurses, personal care workers, cleaners, dental staff, physiotherapists and laboratory employees may perform similar movements throughout a shift. Reaching across beds, pushing equipment, bending over low surfaces, using keyboards or preparing medications can create cumulative loading. A task that appears light can still be harmful when it is performed hundreds of times without adequate variation or recovery.

Work organisation can intensify exposure. Short staffing, unplanned admissions, overtime and missed breaks may encourage workers to rush or work alone. Emotional stress can increase muscle tension and reduce attention to safe movement. Fatigue may affect coordination, decision-making and willingness to wait for assistance. MSD prevention therefore belongs within broader work health and safety planning rather than being treated as an isolated manual-handling issue.

In Australia, workforce shortages and an ageing population add pressure to hospitals, residential aged care and home-based services. High turnover can also mean that inexperienced workers are asked to manage complex mobility needs before they have received practical instruction. A prevention programme should account for these operational realities instead of relying on ideal staffing conditions.

Identify hazards through real work assessment

A useful risk assessment begins where care actually occurs. Observe transfers, showering, toileting, bed-making, meal support, equipment cleaning and emergency responses. Speak with workers about the tasks that leave them sore, the equipment that is difficult to access and the occasions when they improvise. Incident reports are valuable, but early discomfort, near misses and informal workarounds often reveal problems sooner.

Assess the whole task rather than focusing only on lifting weight. Consider the person’s mobility, size, cognition and behaviour; the height and layout of the bed; floor space; lighting; footwear; equipment condition; staffing; time pressure and communication. A worker may be exposed while pushing a loaded trolley, holding a patient steady or reaching around a bed, even when no conventional lift takes place.

Common exposure points to review

Risk assessment should be repeated when a patient’s condition changes, a ward is redesigned, new equipment is introduced or staffing arrangements shift. Consultation is essential. A hoist that is technically suitable may not be used if it is stored too far away, difficult to charge, incompatible with slings or impossible to position in a small room.

Digital tools can make assessments more consistent. OiRA provides a structured approach to identifying hazards and selecting controls, while OSHwiki offers accessible explanations of occupational safety and health topics. Australian organisations should adapt any tool to applicable duties under the model Work Health and Safety laws, state or territory requirements, clinical governance systems and local procedures.

Design controls that reduce physical load

The strongest controls change the way work is designed. Adjustable beds, height-appropriate treatment surfaces, ceiling or mobile hoists, transfer boards, slide sheets and suitable shower equipment can reduce force and awkward posture. Equipment must be selected for the people and environments involved, then maintained, cleaned and stored so it is available when needed.

A safe system for patient handling should specify when a worker needs assistance, which device is appropriate and how the person receiving care will participate. Care plans should record mobility requirements in clear, practical language. They should also account for sudden changes, such as delirium, injury, sedation or a fall. Staff need a reliable method for obtaining help during high-risk tasks, including overnight and weekend shifts.

Administrative measures support engineering controls. Rostering can reduce excessive consecutive shifts and provide overlap for transfers. Breaks should be planned rather than treated as optional. Team leaders can monitor workloads, rotate highly repetitive tasks where appropriate and ensure new workers receive supervised practice. In home care, scheduling should allow travel time, equipment setup and communication with families or other providers.

Training works best when it is task-specific and reinforced at the point of work. Generic instruction about keeping the back straight is insufficient for a complex transfer or a cramped bathroom. Workers should practise using local equipment, communicating with patients and colleagues, checking the environment and stopping when conditions are unsafe. Training should never be used as a substitute for providing suitable equipment, enough workers or adequate time.

Build participation, recovery and early support

Workers often notice emerging hazards before managers do. A respectful reporting system should make it easy to raise concerns about pain, faulty equipment, understaffing or unsafe layouts without fear of blame. Health and safety representatives, union delegates, clinical educators and frontline supervisors can help turn individual experiences into system improvements.

Patients and families also have a role. Explaining each movement, allowing time for participation and agreeing on a transfer method can improve cooperation and dignity. In home care, discussions may need to address furniture, pets, floor coverings, bathroom access and family expectations. A practical plan should respect the person’s preferences while making clear what workers can safely provide.

Early reporting of discomfort allows employers to respond before a minor problem becomes a disabling condition. Suitable responses may include temporary task modification, clinical assessment, physiotherapy referral, equipment review, altered duties or additional assistance. Workers returning after injury may need a staged plan with defined duties and regular review. Privacy must be protected, and health information should be managed appropriately.

Actions that strengthen day-to-day prevention

Psychosocial safety deserves equal attention. Bullying, low control, conflict, violence and constant time pressure can affect muscle tension, fatigue and recovery. A safer workplace combines physical controls with supportive supervision, realistic workloads and access to assistance after distressing events. This is particularly important in emergency departments, mental health services, aged care and community work involving unpredictable behaviour.

Measure progress and sustain improvement

Prevention should be evaluated using several types of information. Track reported MSDs, first-aid cases, workers’ compensation claims, restricted duties, lost time and equipment-related incidents. Balance these figures with leading indicators such as completed risk reviews, equipment availability, training participation, response times for assistance and worker feedback.

A fall in reports does not automatically prove that risk has declined. Workers may stop reporting when they believe nothing will change, or when reporting is associated with blame. Regular conversations, anonymous surveys and observations can reveal whether controls are being used and whether they work under normal operating conditions. The ESENER survey and the OSH Barometer provide useful European context on how organisations manage occupational risks, while Australian employers should compare findings with local data and regulator guidance.

Healthcare organisations should set clear responsibilities. Managers need authority and resources to fix hazards; supervisors need time to coach and monitor; procurement teams should consider manual-handling risks before buying equipment; and workers need a genuine voice in decisions. Contractors, agency staff and volunteers must receive relevant information and access to the same basic protections.

Results should feed into continuous improvement. If a ward reports repeated shoulder injuries during repositioning, examine the bed design, staffing, patient mix, sling availability and care plan rather than simply reminding staff to use better posture. If home-care workers report back pain after travel, review vehicle setup, visit scheduling and equipment transport. A targeted response is more likely to succeed than a generic campaign.

Apply a practical Australian prevention framework

A healthcare MSD programme can begin with a focused review of the highest-risk tasks across the organisation. Prioritise activities that are frequent, forceful, unpredictable or associated with previous harm. Include hospitals, aged-care facilities, rehabilitation services, ambulance operations, dental practices, pathology areas and community care rather than limiting the review to inpatient wards.

Australian employers should align their approach with the hierarchy of controls and relevant duties under work health and safety legislation. State and territory regulators may provide specific guidance, while Safe Work Australia offers national model codes and information. Organisations should also consider accreditation requirements, infection prevention, disability access, privacy and patient-centred care when designing controls.

Local conditions can change the solution. A large Melbourne hospital may need a central equipment service and rapid-response team, while a remote Queensland clinic may require durable, easily maintained equipment and remote clinical support. A home-care provider in outer Sydney may need realistic travel schedules and portable aids. A residential facility in Adelaide or Hobart may need to balance older building layouts with modern lifting systems.

A written plan should identify priority tasks, responsible people, required resources, completion dates and review measures. It should be visible to staff and updated after incidents, consultation or changes in service delivery. The aim is to make safe care the normal way care is organised, not an extra step that depends on an individual worker’s strength or vigilance.

Healthcare workers deserve systems that protect their bodies while preserving safe, respectful care for patients. Employers can begin by reviewing one high-risk task, speaking with the workers who perform it, checking whether suitable equipment is available and making one measurable improvement. Record the result, learn from feedback and expand the approach across the service.