Implications for practice and research

• Physical, organisational and social aspects of work significantly contribute to musculoskeletal pain in nurses, along with non-occupational contextual and personal factors.

• Measures to prevent neck, shoulder and back pain in nurses should be implemented for nurses from the very beginning of their training programmes, while modifications to overtime work and physical loads should be seriously considered.

• Preventive measures targeting overtime work, physical workload and psychosocial factors need investigating further.

Context

Although back pain is known to be multifactorial, studies from across the globe have documented a higher prevalence among nurses.1 As nurses are in short supply globally, protecting the health of nurses at work is particularly important. It is known that musculoskeletal pain is a key reason for leaving the profession, and that work absence due to pain can threaten the quality and safety of patient care. As little evidence exists about the musculoskeletal pain experiences of new nursing graduates, let alone their pain experiences as they progress in their careers, Lovgren and colleagues explored three domains that have long been linked to these disorders: physical, organisational and social aspects of work; physical and social aspects outside of work; physical and psychological characteristics of the individual.

Findings

Almost half the nursing students reported neck and shoulder or back pain during nursing education and in the period postgraduation. In the six different trajectories of pain (one symptom-free group, two groups with decreasing pain, two with increasing pain and one with chronic pain), the variables associated with pain were consistent. In addition to sociodemographic and lifestyle factors as well as concomitant health characteristics including depression, work organisational factors and physical workload were significant for those with increasing or chronic pain. With respect to physical factors, moving heavy objects, heavy lifting and unexpected physical effort predominated for those with neck and shoulder pain, while uncomfortable work postures were associated with back pain.

Commentary

Hignett concluded, based on a review of over 80 studies published over the previous three decades, that nurses are among the highest-risk occupations for low back problems.2 Other reviews echoed this finding, as did a recent systematic review of back pain in nurses.3 The results of this systematic review found associations were strong, consistent, temporally possible, plausible, coherent and analogous to other exposure-outcomes, with risk estimates ranging from 1.2 to 5.5 depending on definitions, leading to the conclusion that the high rate of back pain in nurses is a causal association. Such a systematic analysis has not yet been conducted for neck and shoulder pain in nurses, but Lovgren and colleagues’ findings add to the evidence suggesting that, despite the multifactorial nature of musculoskeletal pain, work factors are significant.

While Lovgren and colleagues did not investigate the role of work placement activities in the development of musculoskeletal symptoms in nursing students, it is noteworthy that even among those who reported no pain in their graduation year, more than a quarter (27% and 25%, respectively) reported neck/shoulder or back pain 1 year later; by the second year another 16% reported neck and shoulder pain, and 21% back pain, who had not previously done so. The findings from Lovgren and colleagues suggest that mental and physical well-being, at work and outside of work, play important roles in the trajectory of neck/shoulder and back pain, that the problems start early in the nursing career and that preventive measures targeting overtime work, physical workload and psychosocial factors are worthy of attention.