Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Steve Browning, PhD

Committee Member

Lorie Chesnut, DrPH

Committee Member

Wayne Sanderson, PhD


Objective: The objectives of this study were to 1) Describe the nature and prevalence of workplace injuries in nursing assistants (NAs) and 2) Assess the impact of physical and psychosocial works factors on the occurrence of back injuries and muscle strains in these nursing assistants.

Methods: Data for this study are from the 2004 National Nursing Assistant Survey (NNAS), which was conducted as a supplement to the National Nursing Home Survey (NNHS). The original dataset contained 3,017 records. The data were analyzed as a case-control for this study’s purpose. Cases were defined as participants who had experienced a back injury or another pulled or strained muscle in the preceding 12 months (n=714). Controls were defined as participants who had not experienced any injury in the preceding 12 months (n=1141). Logistic regression was used to estimate the effect of physical and psychosocial work factors on case status, as well as controlling for possible confounders.

Results: The majority of the NAs reported at least one injury in the last year, with only 40.6% reporting no injuries. The most commonly occurring injuries were wounds (45.1%), followed by bruising (19.3%) and back injuries (17%). NAs were most frequently injured due to resident aggression (59.7%) and from lifting, handling, or bathing a resident (50.0%). NAs who responded that they did not have enough time to complete activities were more likely to have suffered a back or muscle injury (OR=2.19, 95%CI= 1.79-2.69). Job satisfaction was significantly associated with outcome status; cases were more likely to report being somewhat and extremely dissatisfied with their current job (chi-squaredf3=158.73, P=<0.001). Controlling for all variables through 3 logistic regression, not having enough time to complete activities (OR=1.43, 95% CI: 1.13-1.82), mandated overtime (OR=1.47, 95%CI: 1.11-1.94), having the facility provide training on preventing work injuries (OR= 0.65, 95% CI: 0.44-0.97), and being extremely dissatisfied with the job (OR= 5.36, 95% CI: 2.92-9.83) were significantly associated with experiencing a back or muscle injury.

Conclusion: Both physical and psychosocial factors were found to impact the likelihood of a nursing assistant experiencing a back injury or a muscle strain in the preceding 12 months. With 40% of the study population experiencing an injury in the preceding 12 months, this study provides evidence that improvements are needed to reduce injuries in nursing assistants, particularly as the need for long-term care services is increasing.

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