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No one expects the situation to improve in the coming years. For one thing, the progressively direr shortage of nurses ensures that they will be rushed in their duties. And then there is the national patient profile. "Given the weight of Americans going up, these problems are not going to go away quickly," said Alan Hedge, Ph.D., professor of ergonomics at Cornell University.

And yet measures can be taken to prevent back injuries. Studies show that regular exercise and pre-work stretching go a long way in preventing chronic back pain as well as the corollary, that obese nurses are significantly more likely to suffer from musculoskeletal disorders. Even mood can have some bearing, according to one longitudinal study conducted in England.

Nurses also must be sure to use proper lift techniques whenever possible. Common suggestions include:

• Begin your lift with the object or patient between the level of the knuckles (with arm hanging at side) and the shoulder.
• Plan before the lift and be realistic about your abilities.
• Get a firm grip on the object/patient.
• Bring the object/patient as close to your body as possible.
• Point your feet in the direction of movement and separate them at shoulders' width.
• Move the object/patient in a straight line; avoid twisting or sideways bending of the back.

Of course, in this profession, lifting with ideal body mechanics is easier said than done. The bulk of on-the-job back injuries comes while moving or turning patients, which is a little different than hauling boxes or 2-by-4s.

"Human beings don't have handles," Byrne said. "When they're in bed, you can't get close to them. Anyway, the average person in industry isn't expected to lift 200 pounds."

And certainly not 200 pounds with a tendency toward instability, uncertainty or even combativeness. "You might have a 300-pound person who's helping you lift him, then suddenly he's not helping," said Carolyn Blue, MSN, RN, an associate professor at Purdue University School of Nursing. "Do you let him hit the floor? The usual reaction is to help him. So some things are just unavoidable."

On the other hand, many factors can be controlled. One important element of a back-friendly work environment is ergonomics. Tight, cluttered spaces tend to hamper a nurse's movements. Low beds or drug trolleys require too much stooping and long periods of standing are no good, either. OSHA has created a set of ergonomic guidelines for nursing homes, going so far as to fine facilities that repeatedly register a high percentage of employee back injuries. Many would like to see the agency next turn its attention to acute care hospitals.

Ergonomics is not the complete answer, though. A study at Ohio State University showed that in most situations, even a two-person lift places undue strain on the vertebrae. Fortunately, the technology is available to assist nurses, including slide sheets, roller boards, transfer discs, bridgers, gait belts, overhead lifters and slings, and standing and raising aids. Yes, these devices require an initial burst of capital, but the money saved on downtime and workers' compensation claims can more than balance out the costs.

"There's usually a return on investment within two years," said Greg Gale, vice president of marketing for Arjo, the nation's largest supplier of patient-handling equipment. "And we guarantee a 30 percent reduction in claims within six months."

According to Gale, acute care hospitals make up about 30 percent of the company's business. That's half as much as nursing homes, but hospitals showed greater growth this year. Arjo's contract with Columbia/HCA, for example, covers about 25 of the hospital group's locations.

Need a lift?

In the long run, the best way for nurses to protect their backs might be to lobby for lift teams. Pioneered by William Charney of San Francisco General Hospital, it's a concept with a developing track record of success.