Workplace Analysis
There are numerous health and safety hazards potentially present throughout a nursing home. Workplace analysis involves you collecting information on these potential hazards. Initially you may need to establish a baseline. It is then a continuous and ongoing process to recognize, evaluate and control Hazards. Employee participation is vital, along with mechanisms for reporting and recording hazards.
How do you know what is causing injuries/illness in your workplace?
  • Look at accident reports, injury and first aid registers.
  • Review causes of previous worker's compensation claims.
  • Review audit reports.
  • Implement a Hazard Report Form.
  • Ask your staff what their health and safety concerns are.
  • Consider using the Map of Potential Hazards below as a guide to identifying potential health and safety hazards.
Once you have identified all potential hazards it is important to assess how these hazards can be eliminated or reduced.
Representatives from all job areas e.g. nursing, kitchen and administration, should be given the opportunity to provide input.

Map of Potential Hazards in a Nursing Home

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Strategies to Reduce Resident Handling Injuries
Common injuries
The most common injuries, which occur in nursing homes, are:
  • Sprains and strains of the back, neck, shoulders.
  • Sprains and strains of the knees, wrists and ankles and fractures.
What can cause these injuries?
  • Pushing/pulling residents on trolleys and other transfer equipment.
  • Lifting residents.
  • Poor workplace layout and confined spaces.
  • Lack of or inappropriate manual handling equipment.
  • Lack of training in, or failure to comply with, manual handling procedures.
  • Lack of organizational policy on manual handling.
How to prevent manual handling injuries in nursing homes
Organizational Issues
  • Document all requirements for safe manual handling in a policy and program. The program can include responsibilities for different groups of staff, training requirements, equipment usage, risk assessment and standards in accordance with the Manual Handling regulations in your State or Territory.
  • Consider implementing a 'No Lifting' policy which requires the use of manual handling equipment to assist in the movement of residents at all times.
  • Handling techniques and equipment needs for individual residents should be written into care plans and updated routinely.
  • Ensure that there is an appropriate number of staff to residents at all times.
  • Implement the practice for your staff to alert each other at shift handover meetings, of any changed conditions on the previous shift that may have introduced new hazards.
  • Physical fitness of staff is important because it enables them to perform their jobs safely. An exercise program suited to the tasks they perform can be beneficial.
  • Share the workload between staff, so that the same staff is not always given the residents with the greatest manual handling needs.
  • The clothing worn by residents should be easy to remove without staff having to adopt awkward postures (Velcro tabs are good).
  • Staff uniforms should provide freedom of movement. Uniforms should provide enough room to squat with legs widely spread (a semi-squat position).
  • Trial and evaluate all equipment trolleys and handling devices prior to purchase to ensure that they are appropriate for the task and are easy for all staff to use.
  • Provide ongoing training for staff in lifting/handling techniques including appropriate techniques for handling in confined spaces such as showers and bathrooms.
  • Design the work so that manual handling activities are spread over the workday.
  • Allocate confused residents or those most likely to fall out of bed closer to the nurse's station.
  • Beds should be height adjustable.
Resident transfer devices
  • Use transfer belts to assist with handling weight bearing patients (these belts are placed around a resident's waist with carers using the belt to assist the patient in standing or sitting or walking). They should not be used for lifting a non-weight bearing resident. Carers can wear these light belts around their own waists, which ensures that they are easily available at all times.
  • Evacuation sheets on beds assist in the removal of residents in an emergency.
  • Consider sliding sheets for moving residents around in bed. These inexpensive items can be used in a number of situations and can be stored easily without taking up too much space.
  • Sliding boards are useful for transfers from bed to chair/wheelchair and chair/wheelchair to bed.

Lifting equipment
  • There are many types of mechanical lifters on the market. Ensure the ones used are appropriate for the tasks and consider a plan for when the lifter is out of service.



  • Lifters/hoists should be easy to use, comfortable and safe for the resident. They should be routinely maintained and conveniently located and available with suitable lifting attachments and slings.
  • At least one hoist or lifter should be able to lift a resident from the floor.
  • A digital scale attached to a mechanical hoist allows the dependent residents to be weighed during routine transfers.
  • Trapeze or monkey bars positioned above the bed allow residents with upper body strength to reposition themselves.
  • Bed ladder straps attached to the foot of the bed assist residents in sitting up in bed.
  • Avoid reclining armchairs that are usually low, heavy and difficult to move.
  • There are lightweight resident’s chairs available which are height adjustable when the chair is empty and can be easily transported on fitted castors when empty.
  • Guidelines should be available to assist staff in determining which equipment/devices are appropriate for particular situations.
  • Consider the infection control implications of using belts, slings etc for different patients. Ensure they are cleaned appropriately.
There are many other types of manual handling equipment and devices available, which have not been discussed. Many are appropriate for specific situations. Equipment is available through suppliers of hospital equipment.
Equipment with wheels
This includes hand-pushed trolleys, commode chairs, mobile lifters/hoists, tea /coffee trolleys, meal trolleys, linen baskets, etc.
For any equipment with wheels consideration should be given to a number of factors to ensure it is appropriate for the tasks required and the environment in which it is used. These factors include:
  • The load that the item is required to bear.
  • Distances over which the item is pushed or pulled (this will determine the type of castors required and the arrangements of the castors).
  • Floor surfaces, i.e. carpet, vinyl etc.
  • Wheel sizes - if going into/out of lifts the diameter of the wheel should be larger than the gap between the lift and the floor.
  • There should be a preventative maintenance program for this equipment.




  • Consider height adjustable trolleys to minimize the need for bending.
  • Consider the need for brakes and steering locks.
Preventing Slips, Trips and Falls
Slips, trips and falls in nursing homes can result in serious injuries including fractures, sprained joints, back injuries, contusions and lacerations. The following control options can assist in reducing this risk of injury.
Develop standards for the selection, modification and maintenance of floor surfaces to include:
  • The manufacturer/designer can provide details of slip-resistance testing conducted on the surface you are considering. Methods to improve slip resistance can include acid etching, application of adhesive strips and slip-resistant paint. The best method will depend on your existing floor surface.
  • The supplier can provide the compatibility of the surface with cleaning materials and hygiene requirements (i.e. health and food regulations).
Other control options
  • Implementing effective housekeeping programs to minimize slippery work surfaces and minimize slips and falls.
  • Eliminate uneven floor surfaces.
  • Create non-slip surfaces in toilet/shower areas.
  • Develop a policy of immediate cleaning up of spills on floors.
  • Use signage to warn staff of slippery surfaces.
  • Footwear for staff should be of a closed shoe design with a sole of nitrate rubber, polyurethane or nitrile PVC.
  • The sole should have a deep tread pattern with channels to the outer rim of the shoe allowing liquid to escape.
  • Leather soled shoes are not suitable for wet areas.
Resident Aggression
Story Board
A female nurse developed work related stress following an incident where a patient displayed violent and threatening behavior towards her during a nightshift. The nurse had come back from four days off and had not been informed that the patient had a history of aggressive behavior.
The above incident indicates where aggression may be a source of occupational stress. People exposed to aggression may be injured both physically and psychologically at the time and suffer health effects.
Traditionally aggressive incidents and injury as result of resident aggression were considered 'part of the job'. However both employees and residents have a right to be protected from aggressive behavior.
Aggression can be defined as the infliction or threat of harm or injury (either physical or psychological) upon another person.
Although this section deals with resident aggression specifically, it is important to recognize that aggression in the workplace has the potential to occur between all parties:
  • Resident to resident;
  • Resident to staff;
  • Resident to visitors;
  • Visitors to resident;
  • Staff to resident;
  • Visitors to staff;
  • Staff to staff;
  • Unwanted intruder to staff/residents/visitors.
You should always consider the bigger picture when implementing preventative strategies.
What are some causes of resident aggression?
  • Failure to inform nursing staff of a resident's past history of aggressive behavior at the time of admission.
  • Failure to assess and regularly review the assessment of all confused or demented residents for potential to become aggressive.
  • Lack of adequate facilities (chairs etc) and space in day and dining rooms for residents to maintain personal space.
  • Insufficient facilities to enable resident's privacy.
  • Strategies for handling individual residents are not documented on nursing care plans.
  • Residents are not given or encouraged to exhibit some choice over their daily living activities.
  • Lack of in service training for staff in understanding handling, and communicating with people with dementia.
  • No written policies and procedures for preventing and handling aggression including defusing potentially aggressive situations.
What can you do about it?
In consultation with your employees and doctors, ensure that a resident aggression program is appropriately resourced, including external expertise for post-incident debriefing and counseling. Staff training needs include:
  • Legal, ethical and moral issues in relation to resident aggression;
  • Rights and responsibilities of all employees;
  • Understanding dementia and communicating with residents with dementia;
  • How to identify potentially violent situations including 'trigger' events and situations;
  • Role of the nursing plan in preventing aggressive behavior;
  • Procedures for preventing aggression;
  • Dealing with difficult residents and defusing potentially aggressive situations;
  • Emergency procedures for threatening situations;
  • Evasive self-defense techniques;
  • Post incident reporting procedures;
  • Post-incident support facilities.

THE INFORMATION PRESENTED IN THIS “SAMPLE” SAFETY PROGRAM HAS BEEN COMPILED FROM VARIOUS SOURCES BELIEVED TO BE RELIABLE. HOWEVER, IT CANNOT BE ASSUMED THAT ALL ACCEPTABLE MEASURES ARE CONTAINED IN THIS PROGRAM WITH REGARDS TO YOUR INDUSTRY STANDARDS AND REQUIREMENTS UNDER PARTICULAR FEDERAL, STATE, PROVINCIAL AND LOCAL LAW.